South Central Ambulance Service NHS Foundation Trust Annual Report and Accounts 2012/13 Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006.
Other
£3.1m HART
£16.7m
Patient Transport Services
A welcome from our Chairman and Chief Executive
10
How we are organised
TOTAL £144.4m
146
£113.4m Emergency Services
£12.9m Other
£3.1m HART
£15.1m
Patient Transport Services
41
Quality Report 2012/13
TOTAL £138.8m
184
Operational and Financial Review
£107.7m
174
Emergency Services
Business Review
16
Glossary
266
Annual Governance Statement
Annual report 12/13
OVER
TIES
2006
COUN
FORMED IN
COVER
400,000
EMERGENCY INCIDENTS PER YEAR
6 Annual Report and Accounts 2012/13
3,500 SQUARE MILES COVERED BY SCAS
[THE SAME SIZE AS CYPRUS]
VO
01 1,7
ROAD STAFF
STAFF
RS
1,480
EE
NT
LU
2,900
537
CALL CENTRE STAFF
500 COMMERCIAL DIVISION STAFF
7
Operation Ruby Moon. Multi-agency exercise in Southampton
A WELCOME FROM OUR CHAIRMAN AND CHIEF EXECUTIVE 10 Annual Report and Accounts 2012/13
March 2013, saw the 1st anniversary of SCAS becoming a Foundation Trust. A lot has happened in the last year. We have had many successes and we have faced some challenges.
11
Annual report 12/13 As an emergency service at the heart of the health service, we follow our mantra of ‘right care, right place, right time. Through our 999, NHS 111 and associated services we are uniquely placed to understand patient needs and ensure that they receive the most appropriate care, reducing unnecessary presentation to A&E and other services. We will continue to develop our own capabilities and work closely with other health and social care providers, commissioners and the communities we serve, to ensure we continue to deliver excellent patient care 24 hours a day, 365 days of the year. 2012/13 has been a very successful year for the Trust, meeting all of our operational and financial targets, whilst continuing to deliver high quality care to our patients.
This has been achieved in the face of another testing 12 months in the face of increased demand, tight budgets and unpredictable weather. We should be proud of how we have managed to deliver our service. The NHS restructure has also meant that we have had to look at just how we operate. This has required reviews across the service and the results have meant we continue to perform to a high standard and that is credit to the fantastic hard work of staff, volunteers and partners. During the last 12 months we have focussed on our new responsibilities as a Foundation Trust (FT), establishing and working with our newly appointed Council of Governors (CoG) and achieving our target of gaining 12,000 members representing the diverse communities which we serve.
12 Annual Report and Accounts 2012/13
I am delighted to say that we have reached our membership goal for the year and we look forward to continuing to work with the CoG and our members (both staff and public) across SCAS to help shape our services for the future. The transition to FT has encouraged us to look at ourselves as an organisation, to assess how others may see us and really ensure that we learn from the feedback we receive.
Achieving the contracts for NHS 111 in most parts of the SCAS area has been a real triumph. To have control over both the 999 and NHS 111 services will allow us to provide members of the public with the right care dependant on their clinical needs, whether they are in an emergency or non-emergency situation.
We face a lot of challenges over the coming 12 months and we will strive to become an even better service, taking on board the recommendations made by the Francis Report; for example, to ensure that we continue to deliver high quality compassionate care. In this annual report you will read of our increased focus on the quality of our service delivery as we measure, understand and improve the outcomes for our patients.
You will read of areas where we have adapted and improved our services as a result of listening to the feedback of patients, stakeholders and our staff.
I would like to thank all of our staff, volunteers, council of governors, members and partners, for all your support to SCAS during 2012/13.
You will read of our shared vision to deliver a seamless service to patients whether they access services through 999 or NHS 111 and of the importance of the vital patient transport service that so many rely on.
Trevor Jones Chairman
Will Hancock Chief Executive
13
Helimed 24 - Thames Valley and Chilterns Air Ambulance
Business Review
16 Annual Report and Accounts 2012/13
Business Review Our core business is delivering the emergency service, handling and responding to 999 calls. In addition, this year we have successfully added the NHS111 service which has been contracted for delivery alongside 999 in Buckinghamshire, Hampshire and Oxfordshire. Also during the year, the Trust has grown its existing ‘commercial’ business and won new contracts. The Trust continues to provide a significant range of other services, including our Patient Transport Service, Logistics and Commercial Training service. Despite losing our community equipment service last year, additional services won throughout the year have seen increased income across the Trust.
We also provide other services, making use of our specialist skills in clinical telephone assessment, emergency responsiveness, onscene treatment and logistics. These include major incident planning and management, emergency healthcare in hazardous areas, a logistic service to a wide range of NHS customers and first aid training for members of the public and local businesses. In brief we provide 24 hour emergency and urgent care, offering assessment, advice, treatment, management and transport for people who are unwell, injured or concerned about their health. This puts us in a unique position, within South Central, at the very heart of Urgent, Emergency and Trauma care delivery.
Our services for emergencies can be accessed by calling 999, or 111 for any other less urgent health concerns or enquiries. We also manage referrals from GPs and other health professionals needing clinical forms of transport. When we are called then we will assess individual needs and help resolve health issues.
Depending on individual circumstances, we may offer to treat that individual at home or refer to another service. In an emergency, one of our clinicians will be dispatched to assess and help the patient in need. Our business reflects our vision of ‘Enabling you to get the care you need, when you need it’.
Enabling you
to get the care
you need when you need it 17
Annual report 12/13 Background South Central Ambulance Service NHS Foundation Trust has just completed its first full year of operations as a foundation trust having obtained its licence on 1 March 2012. The current registration status is compliant without conditions which indicates that the Trust has received external assurance on its commitment to provide high quality care for patients. The Trust operates across four counties, Hampshire, Berkshire, Buckinghamshire and Oxfordshire. The Trust serves a resident population of around 4 million which can swell during the university academic terms and holiday seasons.
Within the SCAS region we have a number of areas with significant populations such as Southampton, Portsmouth, Reading, Oxford and Milton Keynes. However, our operational area is classified as predominantly rural. The Trust has seen a major boost in its workforce with over 2,500 whole time equivalents (WTEs) most of whom are engaged in the delivery of services to patients. A key element of our growing workforce includes the recruitment of additional clinical staff in both our 999 and NHS111 services. Core to our strategy is to drive a reduction of conveyance of patients to A&E, either through effective telephone clinical triage, or to ensure that they are signposted to the most appropriate service. The Trust’s core business is the provision of an emergency 999 ambulance service.
18 Annual Report and Accounts 2012/13
This is augmented by the following services: »» Provision of NHS 111 service, including access to out of hours services »» Patient Transport Service – non emergency transport for patients with an eligible patient need »» Logistics Services »» Provision of training services to companies and individuals. The Trust has a diverse fleet to assist in its service delivery with 973 registered vehicles including double manned ambulances, rapid response vehicles, a mixture of patient transport vehicles including cars, motorcycles, workshop vans, training vehicles and medical incident control vehicles. The Trust has migrated to two control rooms (from three) located in Bicester and Otterbourne. The Control Room includes a clinical support desk, staffed by Nurses and Paramedics.
This is to support both our call takers in EOC and our frontline staff in the field, with the triage of complex calls and cases, where an enhanced level of clinical skill can help identify the most appropriate care pathway for the patient.
National Performance Targets Challenging national targets are set out by the Department of the Health and they apply to every ambulance service in England. This measures the percentage of calls that the Trust 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 Trusts Computer Aid Dispatch (CAD) systems. From June 2012 category A calls were further subdivided into red 1 calls to cover patients suffering from critical conditions and red 2 calls which are serious but less immediately time critical. The response targets for Red 1 and 2 calls remains at 8 minutes.
Target
Nationally Agreed Target
Actual Performance 2012/13
Actual Performance 2011/12
Category A Red 1
(75%)
77.6 %
n/a
Category A Red 2
(75%)
75.1%
n/a
Category A Red 8 minute
(75%)
75.3%
75.9%
Category A Red 19 minute
(95%)
95.1%
95.3%
In spite of being faced with significant demand pressures, we have again achieved our two key national response time targets for red 8 and red 19 calls.
These targets have been achieved in spite of increased demand levels (5% up on 2011/12 activity).
19
Annual report 12/13 44000
Quarter 3 was a particularly challenging month with high levels of demand and hospital delays impacting on operational performance.
Overall Emergency Demand
42000 40000 38000 36000 34000
2011/12 2012/13
32000 30000
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
2011/12
Hospital Handover delays by Month
Dec
Jan
2012/13
2500 2000
1500 1000
500
0
Apr
May
Jun
Jul
Aug
20 Annual Report and Accounts 2012/13
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Feb
Mar
The Board took the decision to commit extra resources to meet this increased demand. In quarter 4 the Trust received additional funding which assisted it in meeting its year end operational targets.
Regulatory Ratings South Central Ambulance Service NHS Foundation Trust was authorised as an NHS Foundation Trust on 1 March 2012 and achieved the following risk ratings for 2011/12 and 2012/13 based on assessment of its submissions:
Annual 2011/12
Quarter 1 2011/12
Quarter 2 2011/12
Quarter 3 2011/12
Quarter 4 2011/12
Financial Risk Rating
n/a
n/a
n/a
4
Governance Risk Rating
n/a
n/a
n/a
Green
Quarter 1 2012/13
Quarter 2 2012/13
Quarter 3 2012/13
Quarter 4
3
3
3
4
Green
Green
Amber / Green
Green
Annual 2012/13 Financial Risk Rating Governance Risk Rating
The overall financial risk rating of 4 (on a a scale of 1 to 5 with 5 being the best) is reflective of increasing financial strength within the Trust. The generally achieved green ratings for goverance achieved during the year demonstrate that the Trust is achieving its performance objectives with no major governance issues identified.
21
Annual report 12/13 Risks The Trust has developed a risk management culture to empower all staff to make sound judgments. This forms part of the Trust’s risk management strategy. We are committed to continuous improvement of those processes. Each risk is entered in a risk register which is reviewed on a periodic basis by the Audit Committee and Quality and Safety Committee. These form the basis of the Trust Board’s Assurance Framework which is reviewed periodically by the Board as well as the Audit and Quality and Safety Committees.
22 Annual Report and Accounts 2012/13
The Trust’s main potential strategic risks have been identified as follows: »» operational response targets are not consistently met »» hospital handover delays resulting in delays in reaching patients »» poor operational performance in the NHS 111 call handling service »» failure to build adequate stakeholder relationships resulting in poor organisational repuation There are several risks of an external nature that may impact on the Trust, including new commissioning arrangements, ageing population, volatility in fuel prices, changes to NHS competition rules and the challenge of meeting performance targets in a predominantly rural area.
SCAS visit to Priory Rise School near Milton Keynes
Annual report 12/13 Developments 2013/14 2012/13 was a very successful year for the Trust, meeting all of its annual operational and financial targets. We work at the centre of the health system in partnership with commissioners and other providers to provide the right care in the right place at the right time. We strive to do this daily in the most efficient and effective way. The Trust aims to build on these foundations but is mindful of the changing landscape of the NHS and in particular the new commissioning arrangements that place Clinical Commissioning Groups at the heart of the NHS. We will continue to place 999 and 111 as the central point of our focus but in tandem develop services that are closely aligned and complimentary to the existing 999 and 111 services.
We recognise that the shift of engagement from PCT to CCG will require us to place a greater focus on local needs. Our priorities for improvement in 2013/14 can be summarised as below: Assessment and Signposting »» Virtual call taking environment across SCAS »» Improved response to 999 calls with a new dispatch process to inform the most appropriate response to a 999 call »» New PTS contact centre and computer aided dispatch system »» Enhanced clinical assessment processes, to enable the most appropriate response to callers.
24 Annual Report and Accounts 2012/13
Enabling you to get the care you need, when you need it »» Introduction of electronic patient records to improve effectiveness »» Develop further the data and resources at our disposal to improve performance in each area, each week by better matching demand with resource availability.
WHAT WE DO
999 EMERGENCY SERVICE
NHS 111 SERVICE
COMMERCIAL SERVICES
25
Annual report 12/13 999 Our core business is to respond to emergency 999 and urgent GP calls, getting the right treatment to patient with urgent and emergency care needs. At the heart of this service are our Emergency Operations Centres (EOC) which provide 24/7 call handling, communications, dispatch and clinical support capability. We have two centres, based in Bicester and Otterbourne which receive well over 1000 emergency calls every day, which are handled by 537 call centre staff. To meet this demand we have more than 1400 paramedics, technicians and emergency care assistants on the road delivering excellent front line care. We have a fleet of over 300 speciallyequipped emergency vehicles operating from over 30 sites across the region.
To support delivery of our key performance targets (Red 1, Red 2, Red 8, and Red 19) we have established a network of stand-by points, where vehicles wait until dispatched, to ensure the fastest response times for patients. We deploy Rapid response vehicles (RRVs) and ambulances, each with highly-skilled staff trained in the use of the latest medical equipment. We also respond to urgent calls from GPs and other health care professionals. In addition, we utilise a number of other options, provided by our partners and voluntary and charity organisations in order to save time and lives, often freeing our core resources to respond to emergencies elsewhere. We have a number of resources at our disposal which include:
26 Annual Report and Accounts 2012/13
Air Ambulances
Community First Responders
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. Our Air ambulance partners, Thames Valley and Chiltern Air Ambulance, (TVCAA) and Hampshire and Isle of Wight Air Ambulance (HIOWAA) work with us on a daily basis. This year we are proud to have included doctors and for the first time blood for transfusions at scene on board our Air Ambulances, and are grateful for the support from both our charities in funding these important advancements.
We have around 1,300 Community First Responders across the South Central Region. Each is trained to use lifesaving equipment, including defibrillators, and other life saving techniques. Many of our responder schemes, also spend significant time through voluntary activities, to raise funds to provide both vehicles and equipment in their own communities to underpin performance.
BASICS Doctors A network of doctors provides support to ambulance crews at serious road accidents and other trauma incidents. The service is provided on a voluntary basis and all of the specially-trained medics are affiliated to the British Association for Immediate Care (BASICS).
HART (Hazardous Area Response Team) HART units are made up of specially trained paramedics who deal with major incidents. If a chemical site exploded or a terrorist attack took place in the South Central Region, HART on behalf of SCAS would lead the operation. This places our staff at the centre of potentially serious incidents.
NHS 111 NHS 111 is the new nonemergency number that will sit alongside the 999 emergency service. The nature of the service is to provide a “one stop number� for the public so they can access information and local services to support their health needs. The service is free and operates 24/7, 365 days a year. We are currently providing a live service for Oxfordshire, Berkshire and Hampshire. We are one of the first providers to adopt the new national standards. We are currently one of only two providers who have taken over the calls, following the switchoff of the NHS Direct Service. The Department of Health have signed off our NHS 111 service and approved our call handlers, training and operations. 111 staff have received extensive training and performance is regularly monitored with quality reviews undertaken.
The service now receives over 12,000 calls per week which is twice as much as when the service was launched on 24 July 2012. There have been some significant challenges in establishing the service but patient feedback to the service has been very positive. We believe that the introduction of the NHS 111 service within the ambulance service is a critical step for the effective management of demand within the health service and a route to reduce the growing and sometimes inappropriate demand on A&E services.
NHS 111 service
27
Annual report 12/13 Commercial Services The Trust provides a range of other services outside of the core emergency response. These are provided within our commercial services division and include Patient Transport Services, logistic and courier services and commercial training. Each of these areas operate within an open market in competition with other organisations, often private companies. Our patient transport service is provided in partnership with a number of other agencies within the SCAS region, including private sector providers and voluntary agencies. We are particularly indebted to our volunteer car drivers who give their time freely for no remuneration and during 2012/13 undertook 17% of all patient journeys.
SCAS Patient Transport Service ambulance
28 Annual Report and Accounts 2012/13
Patient Transport Service (PTS) Our patient transport service provides support for patients who are eligible to receive transport. Patient movements, which are not confined to the South Central Ambulance Region include patients attending outpatient clinics for pre-planned appointments, admissions and discharges to and from hospital wards and inter hospital transfers. The Trust employs 68 Contact Centre staff based in Bicester and Otterbourne. We hold a number of contracts within the South Central geographical area. In 2012/13 we undertook 616,894 patient transport journeys. This compared with a total of 677,214 patient journeys in 2011/12. The reduction in activity was due to working closely with commissioners to ensure complance with eligibility criteria from the Primary Care Trusts. This will provide greater value for both commissioners and the health system.
The future strategy of the commercial division is to grow our existing successful Patient Transport Services within the SCAS region. Competition for delivery of services is strong, and to ensure SCAS are a cost effective option for Commissioners, we are currently restructuring our business to improve efficiency and customer focus. During 2013/14 we expect to retender for a number of our services. The Trust has commissioned 6 patient surveys across a number of different PTS contracts. A total of 315 patient and relative questionnaires were returned.
Other future developments in this area can be summarised thus: »» we will be equipping our Patient Transport Service ambulances with state of the art GPS technology that will enable us to better control and utilise our fleet »» achieve ISO9002 accrediation for both PTS and Logisitics »» ensure that all of our future vehicle requirements include environmental factors in the procurement decision making process.
The Trust received a satisfied or very satisfied rating for its quality of service, staff appearance, staff conduct and patient care provided.
SCAS Logistics Services
29
Annual report 12/13 Logistics With our pool of experienced drivers and wide variety of fleet, we offer a secure internal courier service that includes movements of parcels, passenger movements, goods and other mail traffic and medical specimens. During 2012/13 our logistic service transported 12,244,912 items mainly for the NHS as shown on the right:
twelve million, two hundred and fourty four thousand, nine hundred and twelve. [items transported]
30 Annual Report and Accounts 2012/13
2012/13
2011/12
Parcel movements
339,472
318,608
Passenger movements
49,178
45,155
Goods and other mail movements
11,583,816
10,922,997
272,446
250,740
12,244,912
11,537,500
Medical Specimen movements
Total
We deliver mainly for the NHS and between departments, hospitals and GP surgeries. Overall logistical activity is up by nearly 6% over last year’s movements due to an increase in business and extended contracts.
Commercial Training As an ambulance service we provide a variety of clinical training to our front line paramedics. This means we are well placed to provide first aid training to the wider public. All of our trainers are healthcare professional clinicians who are experienced in operational and practical situations as well as being trained instructors. We are able to host a number of these courses on a wide variety of premises throughout the South Central area or provide on site training. After a difficult year in 2011/12 we have matched the income earned in 2012/13 and have generated ÂŁ392,000 income. We trained 6,200 individuals in 2012/13.
SCAS Commercial Training
31
Annual report 12/13 Social and Community Issues The Trust is committed to working with the communities it operates in, to ensure that we understand the needs of the people and the issues that they face. We also seek to work collaboratively to put in place local solutions for local needs. We are proud to have as part of our service delivery a range of community based volunteers who work side by side with our frontline staff, to deliver care in medical emergencies. SCAS are able to source a variety of different types of voluntary solo responder. These include Community Responders, Co-responders with with military and coast guard, fire service responder and staff responders. Within the SCAS area they responded to a total of 21,215 red 8 calls which represents 19% of the total red 8 calls responded to by SCAS.
We have seen an increase in the number of automated public access defibrillators (pads) on premises with some 35 already installed in businesses within the South Central Region. A further 44 businesses and organisations have already pledged to install one from April 2013. The Trust can provide training for anybody interested in installing a pad. This is an important adjunct to the very valuable service already provided by our 1,300 volunteer Community First Responders. The Trust also uses a number of voluntary car drivers to transport patients, who have a medical eligibility to transport, from and to their hospital appointments. They transported 104,619 patients in 2012/13 which represented 17% of total patient movements moved on PTS. The Trust has 123 registered volunteer ambulance car drivers.
32 Annual Report and Accounts 2012/13
We already work with a number of partners in proving healthcare across the patch. We have mentioned community first and co–responders elsewhere in this report but we also work closely with Fire and Police Services in emergency preparedness, local charities in the provision of the air ambulance services, Thames Valley and Wessex Trauma Networks for patients suffering major trauma at the pre-hospital stage and the Fire and Police Services for major incident preparedness.
Valuing Staff
Staff Survey
Staff Engagement
The staff survey is an annual survey commissioned by the NHS that provides a mechanism for the Trust to gauge staff wellbeing.
During the year, SCAS has continued to develop the leadership skills of our staff and work towards improving engagement with our workforce. Our priority is to enable and motivate staff to deliver excellence in everything we do One of our formal routes for feedback is through Joint Consultative Committees (JCC) and local staff side meetings. We include, as a matter of course, staff reps on all of our major project boards and committees and work in partnership with them in HR and Operational policy development. We also get feedback directly from staff through the communication’s feedback e-mail address and from the Chief Executive and other board director station visits and staff meetings.
The survey provides valuable data that we use to identify issues that are important to our staff
The table below summarises the key findings highlighting the four highest and four lowest ranking scores from the 2012/13 survey. These are benchmarked against the average score for all English ambulance services.
National NHS Staff Survey Results 2011/12 and 2012/13 2011/12 Trust Response Rate
41%
2012/13 National Average 54%
2011/12 Top 4 Ranking Scores
Trust
Trust Average 32%
National 50%
2012/13 National Average
Trust Average
National
TRUST IMPROVEMENT / DETERIORATION Decrease of 9% and response below national average
TRUST IMPROVEMENT / DETERIORATION
% of staff feeling pressured in the last 3 months to attend work when feeling unwell
30%
34%
27%
38%
Decrease of 3% (improvement) remaining better than the national average
% of staff having well structured appraisals in the last 12 months
20%
20%
28%
20%
Increase of 8% (improvement) and 8% better than the national average
Support from immediate managers
3.40
3.21
3.57
3.21
Increase of 5% (improvement) and 11% better than the national average
Staff motivation at work
3.54
3.59
3.73
3.56
Increase of 5% (improvement) and 5% better than the national average
33
Annual report 12/13 Of the 79 questions asked, we are pleased to report that SCAS improved in 28 areas and performed slightly worse in 8 areas. In relation to other ambulance trusts SCAS performed better in 49 questions and worse in 5 questions. The overall response rate compared to the average response and last year was disappointing and the Trust will attempt to automate this process for 2013/14 thus making the survey easier to complete.
Action plans to address areas of concerns Detailed action plans against these findings have been developed. Area managers and directors will receive a copy of the staff survey report and will be supported in developing an action plan focussing on their areas of responsibility. These action plans will be monitored by the Trust’s Workforce Development Board.
With regard to training, the Trust are proposing the following actions to address the above concerns: »» equality and diversity (E&D) training to continue for all new staff as part of their induction programme »» E&D training to be monitored by the E&D steering group »» E-learning module to be rolled out to all staff
National NHS Staff Survey Results 2011/12 and 2012/13 (continued)
2011/12
2012/13
TRUST IMPROVEMENT / DETERIORATION
Bottom 4 Ranking Scores
Trust
National Average
Trust Average
National
% of staff saying that hand washing materials are always available
32%
47%
30%
44%
Decrease of 2% (deterioration) reduction in line with reduced national average
% of staff having equality and diversity training in the last 12 months
40%
37%
23%
45%
Decrease of 17% (deterioration) with national average increase of 8%
% of staff receiving health and safety training in the last 12 months
57%
54%
41%
49%
Decrease of 16% (deterioration) with national average decrease of 5%
% of staff agreeing that their role makes a difference to patients
88%
89%
87%
87%
Decrease of 1% (deterioration) better than national decrease of 2%
34 Annual Report and Accounts 2012/13
»» further roll out of e-learning modules to include fire and manual handling as a back up to face to face training »» manager access to e learning training data base to monitor team members training »» training and education programme for Team Leaders and Clinical Mentors beginning March 2013. With regard to infection control and health and safety, the Trust is taking the following actions to address the above concerns: »» ongoing focus on infection control with action already in place relating to CQC »» review of Cleaning and Make Ready contracts to ensure hand washing materials are available. Equality & Diversity strategy For further details on the Trust’s approach to E&D visit: www.scas.nhs.uk/about-us/ equalityanddiversity.ashx
Workforce Stats Throughout the year, the Trust has significantly increased its workforce in response to rising demand and the launch of the NHS 111 service. We have recruited a mix of both clinical and non-clinical staff to meet this new demand. The increase is in both its whole time equivalents (WTEs) and staff in post. The following table shows a breakdown of the Trust’s workforce by age, ethnicity and gender, as well as disability information for 2011/12 and 2012/13 respectively. A key objective for 2013/14 will be to recruit and retain staff for the new NHS 111 service as well as a reduction in the use of private providers with the recruitment of our own front line A&E staff. The Trust had a total of 1,298 community first responders (2012: 896) as at the year ended 31 March 2013.
Key: SIP = staff in Post WTE = whole time equivalent
The Trust had a total of 123 volunteer car drivers (2012: 225) as at the year ended 31 March 2013.
Age
2011/12
2012/13
SIP
WTE
SIP
WTE
<20
1
0.88
23
17.39
20 - 29
378
366.94
534
499.44
30 - 39
681
621.22
754
666.45
40 - 49
742
682.02
825
735.70
50-59
462
438.30
515
480.88
60 - 69
157
135.34
141
119.60
70 - 79
15
7.80
13
7.51
SCAS Total
2,436
2,252.50
2,805
2,526.97
Gender
2011/12
2012/13
SIP
WTE
SIP
WTE
Female
1,113
984.23
1,397
1,182.31
Male
1,323
1,268.27
1,408
1,344.66
SCAS Total
2,436
2,252.50
2,805
2,526.97
SIP
WTE
SIP
WTE
No
890
836.97
1,686
1,525.89
Non Disclosure
1,490
1,364.26
993
888.18
Yes
56
51.27
126
112.9
SCAS Total
2,436
2,252.50
2,805
2,526.97
Disability
2011/12
2012/13
35
Annual report 12/13 Ethnicity
2011/12
2012/13
SIP
WTE
SIP
WTE
1,882
1,745.66
2,333
2,100.14
B White - Irish
7
7.00
9
8.41
C White - Any other White background
31
29.65
43
39.63
C2 White Northern Irish
1
1.00
C3 White Unspecified
17
15.84
10
8.92
CA White English
90
84.65
63
60.75
CB White Scottish
7
6.07
3
2.07
CC White Welsh
3
3.00
4
4
CD White Cornish
0
0.00
1
1
CK White Italian
3
2.52
1
1
CP White Polish
1
0.40
1
1
CX White Mixed
1
1.00
CY White Other European
3
3.00
1
1
D Mixed - White & Black Caribbean
2
1.76
3
2.76
E Mixed - White & Black African
1
1.00
2
2
F Mixed - White & Asian
7
7.00
8
8
G Mixed - Any other mixed background
5
5.00
8
6.59
GD Mixed - Chinese & White
1
1.00
1
1
H Asian or Asian British - Indian
5
4.83
7
6.83
J Asian or Asian British - Pakistani
2
2.00
5
3.91
K Asian or Asian British - Bangladeshi
0
0.00
2
0.91
L Asian or Asian British - Any other Asian background
2
1.88
6
4.51
LH Asian British
1
0.93
1
0.93
A White
Key: SIP = staff in Post WTE = whole time equivalent
36 Annual Report and Accounts 2012/13
Ethnicity (contâ&#x20AC;&#x2122;d)
2011/12
2012/13
SIP
WTE
SIP
WTE
LK Asian Unspecified
0
0.00
1
1
M Black or Black British - Caribbean
9
7.63
10
9.24
N Black or Black British - African
3
3.00
11
10.12
P Black or Black British - Any other Black background
1
1.00
2
2
PC Black Nigerian
1
1.00
1
1
PD Black British
1
0.03
1
0.03
R Chinese
0
0.00
1
0.48
S Any other Ethnic Group
1
0.88
3
2.8
SC Filipino
2
2.00
1
0.88
SE Other Specified
0
0.00
1
1
Z Not stated
346
311.77
261
233.09
SCAS Total
2,436
2,252.50
2,805
2,526.97
Key: SIP = staff in Post WTE = whole time equivalent
37
Annual report 12/13 Environmental Reporting The Trust takes its responsibilities towards the environment very seriously. The Trust has in place a detailed Sustainable Development Management Plan (SDMP) which is available on its website. The Trust has a dedicated individual whose responsibilities are to ensure that SCAS is managing its resources in a manner which minimises harm on the wider environment. Our environmental campaign is supported by 71 active green champions who are Trust staff volunteers responsible for supporting this objective. Known within the Trust as the Green Team this band of volunteers have produced a number of very helpful publications. These include successful and pioneering awareness campaigns such as “waste watchers” as well regular publication of helpful environmental information such as the Green Issue.
The Trust is signed up to the overall Department of Health initiative which requires Trusts to reduce their 2008/09 CO2 baseline by 10% by 2015. The table below demonstrates the Trust’s achievement towards this goal and despite increasing activity pressures remains confident that this target will be met.
2008/9
Actual
10,009
tonnes
5,034
tonnes
Function
2008/9 Actual CO2 tonnes
2012/13 Forecast % CO2 Change tonnes
Fleet
10,009
11,192
11.8
Estates related
5,034
2,532
(49.7)
Total
15,043
13,724
(8.8)
38 Annual Report and Accounts 2012/13
Total 15,043
2012/13
Forecast
11,192
tonnes 2,532
tonnes
Total 13,717
The Trust has an established Green Committee chaired by the Director of Finance who is the Board sponsor. This group comprises all of the main functional heads. Its main responsibility is to ensure adherence to the SDMP. This is currently being revised and the new SDMP will be available early summer 2013. The Trust is an active member of the Grean network which is a collaborative hub of other Ambulance Trusts who share environmental related ideas and solutions.
»» CO2 limitation of company allocated vehicles to 120mg CO2 »» Fitting of solar panels on roofs of new vehicles »» Fitting of telemetry in new vehicles »» Approval of video conferencing to reduce requirement of staff travel »» Lower emission ambulances and patient transport vehicles.
The initiatives that have had a direct impact in the reduction of our carbon footprint include;
Rapid response vehicle (RRV) fitted with solar panels on the roof
»» Replacement of outdated estate with new buildings »» Introduction of thermal solar panels on the roof to heat water at Nursling »» Improvements in lighting technology incorporating latest in auto switch off technology
39
Mortimer & Burghfield area Community First Responder (CFR) car
ANNUAL QUALITY REPORT 2012/13 Including Mandatory Annual Quality Accounts
41
Annual report 12/13 PART 1 Introducing South Central Ambulance Service NHS Foundation Trust Quality Accounts and Improvements
South Central Ambulance Service NHS Foundation Trust (SCAS) is an award winning ambulance Foundation Trust which delivers excellent patient care, year on year.
Bicester
We cover an area of approximately 3,554 sq miles with a residential population of over four million people and employ approximately 2,400 staff and approximately 1,300 dedicated volunteer Community First Responders. SCAS has two emergency call centres. Our northern site is based in Bicester, Oxfordshire and our southern site is in Otterbourne nr. Winchester, Hampshire
Milton Keynes
Banbury
Aylesbury Oxford High Wycombe
Slough Newbury
Reading
Basingstoke
Winchester
Southampton
42 Annual Report and Accounts 2012/13
Otterbourne Portsmouth
Access to our service continues to increase with more people calling 999 than ever before; during 2012/13 our emergency operations centres received 459,507 contacts from the public. SCAS maintains high standards of patient experience which is reflected by the fact that our patient liaison service receives over three times more compliments than complaints. On the 1 March 2012, SCAS succeeded in its bid to become an NHS Foundation Trust. We have three main areas of service provision which are: »» Response to 999 calls as an accident and emergency service »» Non emergency patient transport service »» NHS 111 Health Helpline service.
As a Foundation Trust we are accountable to the communities which we serve. We are free from some central government control and work with our Council of Governors who ensure that we engage with and listen to the local population.
We believe strongly in patient and public engagement and regularly undertake promotional activities regarding our Foundation Trust status. We aim to encourage everyone to get involved with what we regard as your ambulance service.
Anyone living in the SCAS area can run for election to our Council of Governors which is made up of three different types of membership:
Our services are vital to our patients and their families and the effective running of the local health economy. We provide an essential service to our population and are committed to assisting those in need. We work hard to effectively manage and respond to the demand on our service. Our Trust Board comprises of 7 Executive Directors and 7 Non-Executive Directors who come from a wide variety of backgrounds, bringing with them a wealth of knowledge regarding business and healthcare.
»» Public Governors - Elected by other public foundation trust members who live in their county »» Staff Governors - Elected by other SCAS foundation trust staff members »» Appointed Governors Elected from organisations that work closely with SCAS such as charities, Clinical Commissioning Groups, and other local authorities.
43
Annual report 12/13
120 RAPID RESPONSE VEHICLES OPERATED BY SCAS
AMBULANCES OPERATED BY SCAS
We continue to review our resource and equipment requirements and have introduced 37 new rapid response cars and 20 new double crew ambulances to our fleet during Winter 2012/13. For non urgent work we have specifically converted 4 long wheel base vans to enhance our patient transport service which are now operational. SCAS acknowledges the changing landscape and architecture of the NHS which has seen the introduction of Clinical Commissioning Groups; and as such operates an ongoing programme of change. Our key challenge is to keep improving our current level of service for all our patients, while reducing costs and protecting and improving frontline services. In line with other NHS provider organisations we need to reduce expenditure to absorb cost pressures which include the rising cost of living, increases in fuel prices and inflation.
44 Annual Report and Accounts 2012/13
These are huge challenges but we are not letting them prevent us from delivering excellent care and improvements for all our patients. We are achieving this by prioritising our resources to the frontline and maintaining the number of clinical hours to deliver the â&#x20AC;&#x2DC;clinically led and patient focused serviceâ&#x20AC;&#x2122; that we have worked hard to develop. SCAS is also engaging with our partner agencies, staff, service users and the wider community to ensure that our patients receive care that is delivered in a timely fashion where it is needed. SCAS plays a key role in improving patient care through clinical networks in Milton Keynes, the Thames Valley and Southern Health Partners. We are working with them to create and maintain initiatives which focus on delivery of a more tailored service.
Examples include our falls referral programme, and the Trauma Unit Bypass Tool which is used to ensure our most seriously injured patients can go straight to a specialist trauma centre. Consequently we are able to treat more patients in their homes or divert them through other appropriate pathways in order to better meet their needs and prevent unnecessary trips to hospital.
rk wo m
a Te
How quality is embedded in our values, behaviours and strategic themes
Inno
vatio
n
VISION
nalism
Professio
STRATEGIC THEMES
g
in
r Ca
OBJECTIVES & RISK ASSESSMENT
REVIEW
SCAS promotes a corporate wide set of behaviours which are comparable with those recommended in the Francis Report. These behaviours are supported by strategic themes and the following chart shows how these underpin our quality position.
TARGETS & DESIRED PATIENT OUTCOMES
> Clinical excellence through public and patient engagement and evidence based best practice > Operational excellence in performance standards without compromising patient outcomes > Effective stakeholder relationships, sound governance, value for money and a strong financial statement
IMPLEMENTATION
FEEDBACK
> Leadership, staff engagement and a learning culture > A network of profitable and high quality non emergency contracts which put patient first
QUALITY 45
Annual report 12/13 Foreword from the Chief Executive Officer, Will Hancock
Welcome to our Quality Accounts 2012/13, our second since becoming a Foundation Trust. South Central Ambulance Service Foundation Trust has, like many other trusts, faced significant challenges during the year. Demand reached unprecedented levels meaning we had to constantly assess our resources and resilience both out on the road and in our call centres during the reporting period. We have undertaken reviews across our organisation, looking to see how we can deliver ever better care. This has resulted in some real improvements in a number of areas including team working across the trust and the speed of our call answering.
SCAS has begun to deliver the new NHS 111, non-emergency telephone service in Oxfordshire and Hampshire and soon for Berkshire. In terms of quality inspection and regulation the Trust maintained its NHS Litigation Authority Level 1 status and you will see later in this report that the CQC made an unannounced two day inspection in 2012. This year we want to build further on our successes and the improvements we have made in services to our patients.
46 Annual Report and Accounts 2012/13
We must continue to transform our service in order to meet the needs of our patientsâ&#x20AC;&#x2122; and the challenges we face whilst ensuring our services are delivered efficiently, effectively and with compassion. Our Board and staff have commenced a comprehensive review of the Francis Enquiry recommendations and we will be ensuring that we learn, implement and action, to assure and reassure you on our quality strategy. This Quality Account has been prepared and written by South Central Ambulance Service NHS Trust under the National Health Service (Quality Accounts regulations) 2010 statutory instrument No 279.
The Trust has reviewed all the data and information available on the quality of care that all the service arms provide on a daily basis. To the best of my knowledge the information in this document is accurate.
Will Hancock Chief Executive
What are Quality Accounts and what do they mean to SCAS and the Public we serve?
Quality Accounts are mandatory annual statements as required in the NHS Act 2009. They are written for the public by all NHS organisations that provide healthcare. Quality reports and accounts are set against the context of three overlapping key themes which can be used to define quality of care:
The Quality Account can be seen as a â&#x20AC;&#x2DC;self assessment toolâ&#x20AC;&#x2122;, the value of which has never been more relevant or vital in the light of publication of the Independent Inquiry Report (2013) by Robert Francis QC, into the serious failings identified in the Mid Staffordshire Hospitals NHS Foundation Trust.
The Francis report found that there were systemic, deep rooted and fundamental deficiencies within the trust, which the Board, managers and staff failed to take appropriate actions to resolve.
Clinical Effectiveness
Safety
Experience
47
Annual report 12/13 In concluding his review Mr Francis stated:
â&#x20AC;&#x153;People must always come before numbers. Individual patients and their treatment are what really matters. Statistics, benchmarks and action plans are tools not ends in themselves. They should not come before patients and their experiences. This is what must be remembered by all those who design and implement policy for the NHSâ&#x20AC;?. 48 Annual Report and Accounts 2012/13
We believe that the SCAS Quality Account is an integral part of patient and public engagement by encouraging ongoing dialogue with our patients, the Board, managers, clinicians and staff about improving quality of care. It allows us as an organisation to assess our quality of care and show our commitment in driving forward improvements and learning from best practice evidence. The Quality Account lets us tell the story of our progress against set priorities and allows us to set further key priorities for ongoing and sustained improvement. This report also meets the requirements set by Monitor in the Quality Governance Framework and Annual Reporting Manual 2012/13.
The purpose of this report for SCAS is outlined below: »» To show how we encourage and respond to feedback and challenges from patients, the public and our external stakeholders »» To explain to our patients and staff where we need to make improvements and how we will improve »» To be held accountable for delivering quality improvements »» To demonstrate SCAS’s commitment to continuous evidence based quality improvement across the whole range of patient services that it delivers Effective Quality Accounts raise the profile of quality improvement across the organisation from the Board to road crews and the staff of the emergency operations centres.
It provides a springboard for discussing how we are improving patient care and outcomes with those who use the services we provide, and our Commissioners and Overview and Scrutiny Committees. External assurance for this account has been provided by our external auditors, KPMG, who will review the content of this report in line with Monitor’s requirements as outlined in the NHS Foundation Trust Reporting Manual 2012/13 and the Compliance Framework 2012/13. They have also reviewed the report for consistency with other sources of data available, provided a limited assurance report, and tested two mandatory performance indicators, including one clinical indicator selected by our Council of Governors.
49
Annual report 12/13 SCAS Current Quality Position As an organisation SCAS fully recognises the seriousness of the findings identified in the Francis Report, and subsequent public inquiry and feels that it is important that this Quality Report includes the relevant recommendations to underpin our quality position. SCAS is identifying and implementing learning points by fully reviewing the recommendations and understanding the implications to SCAS and the service we deliver. Failures at the Mid Staffordshire Foundation Trust were so serious, so protracted and had such a devastating and widespread impact on patient care, that SCAS feels that there must be permanent lessons learnt.
All recommendations will be carefully considered by all SCAS staff, the Trust Board and our commissioners and regulators who will need to work together to create a culture where patients and their voices are truly heard at the heart of the NHS. The Francis Reportâ&#x20AC;&#x2122;s key themes run as a thread throughout our Quality Improvement Programme and Strategy. Part 2 of this Quality Account Report details our main areas of focus drawn from the Francis report as well as other areas of strategic and regulatory importance.
50 Annual Report and Accounts 2012/13
THE FRANCIS REPORT KEY THEMES ARE: STANDARDS AND METHODS OF COMPLIANCE OPENNESS, TRANSPARENCY AND CANDOUR SUPPORT FOR COMPASSIONATE CARE STRONGER PATIENT CENTRED LEADERSHIP ACCURATE RELEVANT USEFUL INFORMATION
SCASâ&#x20AC;&#x2122;s strategic aims and how they fit with the Francis Report are detailed below: Clinical excellence - Providing a positive patient experience while improving clinical outcomes and ensuring patient safety through feedback, accountability and recognised best practice Operational excellence - Achieving response time performance standards, resilience and efficiency whilst still putting the patient first Effective stakeholder relationships, sound governance, value for money and a strong financial standards - Developing whole system solutions and seamless pathways of care Leadership, staff engagement and a learning culture - Developing the workforce, motivating and enabling our people to deliver excellence and compassion in a culture of openness and transparency A network of profitable and high quality non emergency contracts Which operate to the highest standards and always put the patient first.
51
Annual report 12/13 Providing high quality care is at the heart of everything SCAS does, but this can only be achieved if the organisational structure is at its strongest.
To ensure our organisational structure is at its strongest, 2012/13 has seen SCAS undertake an in depth process of restructuring all operational and corporate roles to maximise the efficiency and performance of the Trust.
SCAS is confident in the constant and rigorous analysis of performance data carried out by a series of management review groups and committees. When triangulated with patient safety and experience data, this provides assurance on the delivery of care.
Management tiers have been streamlined in all departments and enhanced emphasis has been placed on clinical leadership. Frontline operations have seen the introduction of a â&#x20AC;&#x2DC;team workingâ&#x20AC;&#x2122; structure which echoes the recommendations of the Francis Report by enabling increased support and monitoring of staff. These changes are helping us to provide a working environment in which clinical excellence and candour can flourish.
There are clear lines of accountability that provide evidence of sound integrated governance and robust arrangements for the assessment and management of risk. Regular leadership and communication days set the scene for forward thinking and innovation where new ideas are shared and discussed, and strategy can be developed for service improvements.
All staff and managers were engaged in the review and implementation of this restructuring process. Staff are regularly invited to feedback their experiences now the changes have been embedded.
52 Annual Report and Accounts 2012/13
SCAS is unshakable in its drive to remain a top performing ambulance service that effectively and efficiently uses its resources to provide high quality care.
To demonstrate this, we have built on our CQUIN areas from last year and have continued with the themes of clinical and operational excellence in our annual plan and contract, aligning our core business to local health needs and our commissioner and stakeholderâ&#x20AC;&#x2122;s priorities.
CQC Regulation and Compliance In November 2012 the Care Quality Commission (CQC) carried out an unannounced inspection at SCAS. The Inspectors spent time in the EOC, CSD and with 111, listening to calls and meeting with staff. They inspected a frontline vehicle and spoke to staff from PTS and a 999 crew. They interviewed a variety of key personnel including Lead Commissioners, a patient voice representative and a Governor. The Inspectors also visited Adderbury and High Wycombe resource centres and reviewed a wide selection of documentation including staff personnel files, training records and minutes of meetings.
The inspectors focussed on seven outcomes. »» Outcome 4 (Regulation 9) – Care and welfare of people who use services »» Outcome 6 (Regulation 24) – Co-operating with other providers »» Outcome 7 (Regulation 11) – Safeguarding vulnerable people who use our services »» Outcome 8 (Regulation 12) – Cleanliness and infection control »» Outcome 11 (Regulation 16) – Safety, availability and suitability of equipment »» Outcome 12 (Regulation 21) – Requirements related to workers »» Outcome 16 (Regulation 10) – Assessing and monitoring the quality of service provision
53
Annual report 12/13 SCAS received some very positive feedback and were deemed compliant with all the essential standards inspected, with the exception of Outcome 8. The inspection found some areas of station cleanliness to be variable and weak evidence of follow up from station infection control audits. It should be noted however that none of the clinical areas or our vehicles were deemed non compliant and the impact was rated as minor. We are pleased that we were assessed as compliant in all but this one area, and while we are disappointed our stations were not deemed compliant with outcome 8, we are determined to make the improvements necessary and SCAS has responded with a full programme of station visits which commenced in December 2012 and will remain ongoing.
An action plan has been put in place and shared with Inspectors who recognised that only two stations were inspected. The full report is available on the CQC website or can be requested from the Company Secretary. Monitor Governance The Trust has re-assessed itself against the Quality Governance Framework for MONITOR and in March 2013 was rated ‘amber green’ with some areas identified for ongoing action. Further assurance will be provided, relating to: »» Ensuring there are clearly defined, well understood processes for escalating and resolving issues and managing quality performance »» Ensuring that the Board can be assured of the robustness of the quality information »» Ensuring that the Board actively engages with patients, staff and other key stakeholders on quality.
54 Annual Report and Accounts 2012/13
Each of these areas has actions in place as well as control measures. Activity ►► SCAS received 459,507 contacts from the public during the 2012/13 reporting period. ►► We received 695 compliments which far outweighed our complaints which numbered 209. We received 554 other feedback contacts. ►► There have been 3 referrals to the Parliamentary Health Service Ombudsman by complainants in the last year, none of which have been investigated; showing that the Trust is resolving complaints effectively ►► The total number of adverse incidents reported internally was 2,685. Of these there were 23 Serious Incidents Requiring Investigation (SIRI’s) which we reported externally to the Department of Health and the Strategic Health Authority.
Department of Health and Monitor Core Quality Indicators In last year’s accounts, SCAS reported for the first time on mandatory core quality indicators set by Monitor and the Department of Health with the approval of the National Quality Board. These indicators are intended to strengthen the reporting process and create a comparable set of targets across all UK ambulance trusts.
SCAS has used the NHS (Quality Accounts) Amendment Regulations 2013, gate way ref: 172401, to ensure inclusion of the relevant core indicators.
The mandatory core quality indicators relevant during 2012/13 are:
The core indicator requirements for the 2012/13 Quality Account includes the following:
Ambulance Response Times Category A (Red 1 & Red 2)
»» The proportion of Category A calls requiring an emergency response that were responded to within eight minutes. »» The proportion of Category A calls requiring an ambulance response at the scene that were responded to within 19 minutes. »» The national average for each of the above proportions.
Responsive ambulance services are critical for emergency and urgent pre hospital care patients and for the NHS as a whole, to improve patient outcomes and prevent people from dying prematurely. The NHS Operating Framework for 2012/13 sets out expectations with regard to this indicator for the reporting period. 1. At least 75% of Category A calls (Red 1 & Red 2) taken by our Emergency Operations Centre (EOC) which require an emergency response, receive a resource on scene within eight minutes. 2. At least 95% of Category A calls (Red 1 & Red 2) requiring a conveying ambulance receive one at scene within 19 minutes.
Ambulance Clinical Outcomes: Acute ST-elevation Myocardial Infarction (STEMI) and Stroke Patients that undergo a prehospital assessment for STEMI (Heart Attack) or Stroke and who are then given specifically tailored care and placed on a treatment pathway that begins en route to hospital and continues after admission, have a higher incidence of improved overall outcome.
This way of working helps people to recover from episodes of ill health or injury and supports the NHS as a whole to reduce the number of patients dying prematurely. The core indicator requirements for the 2012/13 Quality Account includes the following: »» The proportion of patients with STEMI who received an appropriate care bundle. »» The proportion of suspected stroke patients who received an appropriate care bundle. »» The national average for each of the above proportions. An appropriate care bundle is a package of clinical interventions that are known to benefit patients’ health outcomes – for instance, patients with STEMI should be administered pain relief medication to help alleviate discomfort.
55
SCAS Emergency Ambulance
PART 2 How have we prioritised this yearâ&#x20AC;&#x2122;s quality improvement initiatives.
Our focus remains on providing an excellent service to our patients in an organisation where both the users and the staff feel cared for. When areas of poor performance are identified, we are committed to learning lessons, implementing changes and supporting staff in training, learning and supervision where necessary. Our patient and staff surveys, patient feedback, incidents, clinical audits, management review groups and Trust Board all contribute to shaping our priorities, giving us focus and helping to identify areas for improvement. The Trust Board hear real patient stories and concerns from our patients to ensure they are informed and understand where changes can be made. We also take into account areas that can be benchmarked with other ambulance services so that comparisons can be made and targets set as part of a national ambulance programme of improvement in pre-hospital care.
SCAS has used the NHS Quality Account Toolkit 2010/11 from the DH (these guidelines remain unchanged) to inform the process of prioritisation and engagement, which has helped create a quality report which provides an opportunity for us to describe our performance and our improvement goals. We recognise the challenges associated with ensuring accurate and timely clinical data from complex and multifactoral sources. We have engaged with our clinical teams and our senior leadership team internally to establish our key priorities. SCAS has also actively sought views from our staff side/union colleagues. Local Health Overview and Scrutiny Committees have given their views as have our commissioners who are responsible for contracting our services. As a Foundation Trust we engage with our Council of Governors and we have welcomed their input.
Engagement on selecting our priorities needs to be relevant and credible and through these processes we can show that the public view and a clinical view has been listened to and included in planning our priorities. Leadership walkarounds by the executive and non executive directors have also provided intelligence to develop areas for improvement and helped to engage frontline and support staff in discussions and debates about our clinical and patient priorities. Areas often flagged up are the cleaning and stocking of vehicles, availability and use of equipment, and changes to service delivery processes such as meal breaks. Our leadership walk round template has also been revised to provide stronger assurances on elements of the Francis Report.
57
Annual report 12/13 1. Impact - By considering the likely improvement in safety, outcomes and experience 2. Feasibility - The ease of implementation, resources required and likely time to completion or delivery
Pati ent S
Exp
ety f a
3. Measurability – Can the priority we have set be measured accurately in order that we can show improvements 4. Outcomes - Will the initiative improve patient outcomes in the areas of safety, effectiveness and experience.
C li n
es n e ctiv
s
To determine priorities which matter the most to our patients we reviewed feedback contacts, compliments, complaints and committee discussions which covered a range of topics. Following the review we refined our priorities to those which we felt would ‘stretch us’ in delivering the highest possible quality of care.
The initiatives were assessed in terms of:
ce ien er
Meetings and road shows with staff around the Trust have helped engage staff at all levels, sharing with them the Trust’s vision and strategy, but also listening to their views and ideas about changes to make service delivery more effective and patient focused.
ic al E ff e
The patient is at the heart of everything we do 58 Annual Report and Accounts 2012/13
Following a Board consultation and additional consultations with 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 year 2013/14:
Key priorities for SCAS 2013/14
Patient Safety
Clinical Effectiveness
Patient Experience
a. Ensure staff can work in a culture where patient safety is paramount
a. Maintain and improve care bundle advancements for patients with Stroke and Heart Attack
a. Utlilise feedback from other professionals to improve patient experience
b. Ensure patients who contact us following a fall are managed safely and appropriately c. Ensure the regular maintenance of clinical equipment and ensure the cleanliness of vehicles d. To investigate and maximise learning from incidents resulting in severe harm.
b. Reduce the variability of station cleanliness c. Comply with the DH core quality indicators for Red 1 and Red 2 calls d. Improve utilisation of CFRâ&#x20AC;&#x2122;s and other indirect resources.
b. Use feedback from patient satisfaction surveys to improve service delivery c. Improve the experience our patients have at the end of their life.
Each of our priorities and our proposed initiatives for 2013/2014, are described in detail on the following pages. They will be monitored through the Quality Improvement Plan that is presented to the executive and senior management teams and the Quality and Safety Committee. All the quality metrics are included in the Trustâ&#x20AC;&#x2122;s Integrated Performance Report that is published monthly across the organisation and is challenged and scrutinised by the Trust Board and in all our performance meetings. External audit assurance is provided by KPMG and through an internal audit programme.
59
Annual report 12/13 Priority 1 - Patient Safety a. Ensure staff can work in a culture where patient safety is paramount
Aims / Goals »» To ensure that our staff work in an environment where patient safety comes first »» To identify the current attitude and culture within SCAS »» To improve the safety culture where necessary Current Situation and Quality Assurances The Mid Staffordshire NHS Foundation Trust Public Inquiry chaired by Robert Francis QC made 290 recommendations which relate to ensuring high standards of patient care by creating a safe and open culture where failings are identified and addressed, communication is prioritised and there is greater transparency on all levels.
Currently SCAS staff are supported by a strong clinical management structure with a clear point of contact and escalation process. Other initiatives in place are: »» Robust policies available to all staff on dignity in the work place, whistle blowing and discipline and conduct »» An established IR1 incident protocol for reporting adverse incidents with 2,685 recorded in 2012/13 »» A Serious Incident Requiring Investigation (SIRI) Review Group who promptly investigate the most serious of incidents »» A ‘team working’ structure that provides greater support and monitoring of staff
60 Annual Report and Accounts 2012/13
Identified Areas of Improvement A greater understanding of our staff culture is required to identify areas for improvement and to ensure that we recognise any triggers or warning signs that may compromise the safety of our patients. We require improved identification of emerging themes and will achieve this objective by: »» Conducting a recognised staff safety culture audit in 2013/14 using the Manchester patient safety tool »» Creation of action plans based on survey results
Board Sponsor Debbie Marrs Interim Director of Patient Care and Quality
Implementation Leads Mr Rob Kemp Interim Assistant Director of Quality Mr Steve Sugar Clinical Risk Manager
Priority 1 - Patient Safety b. Ensure patients who contact us following a fall are managed safely and appropriately
Aims / Goals »» To improve patient safety and experience by identifying high risk (red rated) fallers »» To enable our partner agencies to organise immediate interventions as required »» To measure crew referral rates throughout 2013/14 and improve by 5% Current Situation and Quality Assurances During 2012/13 patients who had fallen represented up to18% of the entire 999 call volume. This is a significant part of our workload and it has been identified that at present staff are able to see, treat and discharge approximately 51% of fallen patients, with only 49% requiring hospital treatment.
It is our desire to provide the best possible ongoing care for these patients that are non-conveyed, by working in partnership with other services. Progress in this area has already been made with the creation of the falls referral pathway. This is a patient and safety collaborative initiative that was set up between SCAS and NHS Hampshire which is aimed at reducing the number of falls. The falls pathway allows frontline staff to notify a local community falls team by fax and more recently by telephone whenever a patient falls in their area. These teams can then arrange to visit the patient and assess their needs, putting in place measures to prevent a recurrence.
Implementation of this pathway has been successful with crews referring around 60% of all nonconveyed fallers for ongoing care. However, prior to the addition of telephone contact with the falls team, it was identified that the community teams were at times overwhelmed by the triage of our referrals, with some patients waiting as long as 47 days for their first contact. Consequently SCAS undertook a project whose primary aim was to find a way to aid the falls teams in their triage process and to speed up referrals. The result of this project was the creation of the ‘Red, Amber, Green’ or RAG tool.
This simple aid helps ambulance staff to grade patients as to the urgency of their assessment needs. Frontline crews now use this tool in conjunction with a ‘hot referral’ process for the highest risk ‘red rated’ fallers which involves making a brief telephone contact to the Community falls team within 2 hours of the original fall. Falls patients are often vulnerable older patients with complex underlying risk factors. Left unsupported and un-referred, high risk fallers are often admitted to an acute hospital within 3 weeks of their first fall for injuries sustained in a subsequent fall, or an exacerbation of their underlying conditions.
61
Annual report 12/13 The advantages of the RAG tool and hot referral approach are twofold; speedy follow up which greatly improves the safety of this patient group by supporting their physical, medical and care needs. In addition to patient safety, by acting promptly to prevent recurring falls and injury, patient experience is also greatly improved, particularly when this is delivered in the home or community. Enabling the community teams to prioritise their resources also frees up team capacity to address reversible causes in the ‘Amber’ patient group. This again improves patient safety, treatment and experience and lowers ambulance demand.
Rag rating for non-conveyed fallers 65yrs Or Over
Rag rating for non-conveyed fallers
Red / Amber / Green
Red / Amber / Green
Red Patients who:» Are at risk of admission within 24 hours if not seen (crew to call the CCT and make a telephone referral. If out of hours, deliver) ANATMIST handover on tel. message. » Cause serious concerns to the ambulance crew » Have had 2 or more falls in the last week » Have had symptoms of recent syncope/blackout or delirium
Red Patients who:» Are at risk of admission within 24 hours if not s a telephone referral. If out of hours, deliver) AN » Cause serious concerns to the ambulance crew » Have had 2 or more falls in the last week » Have had symptoms of recent syncope/blacko
Amber Patients who:» Have a history of 2 falls or more in past 6 months » Have falls risk factors that are reversible e.g. medication, mobility issues, home environmental problems, postural hypotension, footwear
Amber Patients who:» Have a history of 2 falls or more in past 6 mont » Have falls risk factors that are reversible e.g. m environmental problems, postural hypotension
Green Patients who:» Have had an explained fall e.g. tripped over the cat » This is a first fall and the ambulance crew are not unduly concerned » Referral is for information only » Have declined intervention by the Community Care team » Have non-reversible falls risks e.g. stroke, glaucoma, dementia (unless there is a new problem)
Green Patients who:» Have had an explained fall e.g. tripped over the » This is a first fall and the ambulance crew are n » Referral is for information only » Have declined intervention by the Community C » Have non-reversible falls risks e.g. stroke, glau new problem)
After a successful pilot in the south west of Hampshire, the RAG tool and hot referral process rolled out across the Trust on the 8th of February 2013, supported by online ‘E-learning’ and a DVD provided to staff for self directed study from April 2013.
62 Annual Report and Accounts 2012/13
A = Patients Address N = Patients telephone number (possibly NOK number if required and agreed) A = Age T = Time of Incident / Time of onset of symptoms
M= Mechanism of Injury / Medical complaint I = Injuries/ exam findings S = Vital signs anything that is unusual (Blood pressure, Sp02, Gcs, Pulse, Resp rate) T = Treatment given (if any)
A = Patients Address N = Patients telephone number (possibly NOK number if required and agreed) A = Age T = Time of Incident / Time of onset of symptoms
M=
I= S=
T=
Identified Areas of Improvement
Board Sponsor
Adapt a SCAS wide programme management approach to replicate best practice by:
Debbie Marrs Interim Director of Patient Care and Quality
»» Ensuring education of staff in the use of the RAG tool by way of monitoring E learning uptake and achieving completion rates in excess of 95% by June 2013 »» Reach expected targets of 25% for referral of high risk ‘red rated’ fallers »» Measure crew referrals throughout the year and increase overall referral rates by 5% by year end »» Complete a qualitative audit of referral rates and repeat fallers »» Analyse any complaints or concerns received which relate to the falls referral process and ensure learning is extracted and implemented
Implementation Leads Mr Rob Kemp Interim Assistant Director of Quality Prof. Charles Deakin Dr. Simon Brown Assistant Medical Directors
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Annual report 12/13 Priority 1 - Patient Safety c. Ensure the regular maintenance of clinical equipment and ensure the cleanliness of vehicles
Aims / Goals »» To ensure that all clinical equipment maintenance schedules are completed within expected time frames »» Provide assurance that time scales are being adhered to »» Use regular audit and Adenosine Triophosphate (ATP) testing to assess and ensure the cleanliness of vehicles »» Achieving 97% compliance with the cleaning plan Current Situation and Quality Assurances SCAS operates a six week cycle of scheduled maintenance for the fleet which includes safety inspections, manufacturers servicing schedules and deep cleaning.
Running alongside the vehicle maintenance programme there are also servicing and maintenance requirements for clinical equipment such as stretchers, carry chairs and delicate measuring devices like saturation probes and sphygnometers which may require regular calibration. While these checks are being carried out, SCAS has identified that improvements to planning and record keeping relating to this maintenance could be improved in order to provide greater assurance. Consequently during 2013/14 SCAS will be working to establish a robust clinical equipment maintenance programme with a third party provider.
64 Annual Report and Accounts 2012/13
The intention is to award a contract for a three year period with review after this time. This programme will be reported to the Health, Safety and Risk Committee as part of a continuous audit process to monitor adherence to agreed time scales and to report on percentages that have missed or gone over specific timeframes. SCAS acknowledges that vehicle cleanliness is key to providing a safe clinical environment. To ensure that all vehicles meet high standards of cleanliness SCAS will be aiming for 97% compliance with the cleaning plan and our Clinical Mentors will be providing regular electronic audit for assurance.
Frequent use of Adenosine Triophosphate testing will constantly assess the effectiveness of our cleaning processes.
Identified areas of improvement »» Establish a robust clinical equipment maintenance programme with a third party provider »» Provide assurance that clinical maintenance programmes are being adhered to »» Use regular audit and ATP testing to assess and ensure the cleanliness of vehicles and achieve 97% compliance with the cleaning plan
Board Sponsor Debbie Marrs Interim Director of Quality and Patient Care
Implementation Leads Phil Pimlott Assistant Director Support Services/Special Operations Andy Pope Clinical Equipment Manager Phil Convery Infection Control Lead
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Annual report 12/13 Priority 1 - Patient Safety d. To investigate and maximise learning from incidents resulting in severe harm
Aims / Goals »» To improve patient safety and experience by strengthening the existing investigative processes »» Adhere to the duty of candour as outlined in the Francis Report Current Situation and Quality Assurances SCAS take any incident resulting in harm very seriously and we already have a robust reporting system in place. Adverse incidents are logged through our IR1 protocol and can be reported by any grade of staff.
Early review of the IR1 reports by a dedicated management team means that any incident classified as a serious incident requiring investigation (SIRI) can be rapidly ‘flagged up’ and acted on appropriately. SIRI’s are registered on the Strategic Executive Information System (STEIS) and fully investigated in a timely manner with resolution in no longer than 60 days. All actions relating to SIRI’s are monitored by the SIRI Review Group. SCAS fully expect investigation of incidents that result in severe harm to become a mandatory indicator and wish to ensure our process is as thorough as possible as a result.
66 Annual Report and Accounts 2012/13
Accurate and complete data capture is essential to a successful investigative process and this starts with the patient report form (PRF) filled out by the frontline clinical staff. To limit data loss and speed up data collection the current paper PRF and scanning system will be phased out during 2013/14 and replaced with tablet computers and an electronic PRF (ePRF) which can be downloaded immediately after an incident. SCAS recognise that partnership working on SIRIs could be improved. Some incidents involve multiple agencies and historically investigations have run parallel to each other when they could and should be intertwined.
In 2013/14 SCAS will seek to encourage partnership working whenever possible and participate fully in joint investigations in order to improve and speed up resolutions.
Identified areas of improvement »» To implement use of the ‘DATIX’ system which offers a complete workflow where all improvement actions can be managed together and trends identified »» Introduce and embed the use of the electronic patient report form (ePRF) by April 2014 »» Increase partnership working for serious incidents with other healthcare providers »» Triangulate SIRIs with complaints to maximise learning »» Ensure benchmarking of SIRIs nationally and advise patients of learning
Board Sponsor Debbie Marrs Interim Director of Quality and Patient Care
Implementation Leads Phil Pimlott Divisional Director Steve Sugar Clinical Risk Manager
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Annual report 12/13 Priority 2 - Clinical Effectiveness a. Maintain and improve care bundle advancements for patients with Stroke and Heart Attacks
Aims / Goals »» To benchmark with other ambulance services as per the DH mandatory indicators and be in the top national quartile Current Situation and Quality Assurances SCAS is very proud of its track record of improvement in performance in relation to clinical performance indicators for Heart Attack (STEMI) and Stroke patients. During 2012/13 achieving 90% and 98% compliance with clinical outcome indictors, which benchmark well nationally. However improvements can always be made.
SCAS uses the core indicators as a positive measure in ensuring appropriate care bundles are delivered and that we benchmark with other ambulance services, striving to always be in the top four performing trusts. Current internal initiatives within SCAS to ensure that the indicator targets are met include: »» Regular clinical audits of patient report forms (PRF’s) to analyse the quality of care provided and care pathway compliance »» An annual clinical audit plan to target key areas »» A focused programme of clinical quality metrics for team leaders and their staff
68 Annual Report and Accounts 2012/13
»» Successful rollout of increased analgesia and anti-emetic drug options throughout the Trust »» On going training in the Stoke and Heart Attack pathways through face to face delivery at bi-monthly training sessions and through E learning External initiatives include: »» External review of a quality indicator chosen for our Governors by auditors KPMG »» Increased availability of access to pPCI centres and Hyper Acute Stroke Units from partner agencies through the Clinical Networks
Identified Areas of Improvement »» Include STEMI care in the Continuing Professional Development Course »» Include Stroke care in the Continuing Professional Development Course »» Work with EOC to improve intelligent dispatch methods »» Work with Team Leaders and Clinical Mentors to include Stoke and STEMI care performance indicators in the appraisal process »» Issue a new aid memoire to all frontline staff which names all pPCI centres, their locations, entry routes and drop off points »» Issue a new aid memoire to all frontline staff which names all Stroke Centres, their locations, entry routes and drop off points
Board Sponsor John Black Medical Director
Implementation Leads Dave Sherwood Clinical Excellence Lead Operational Directors North and South Divisions
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Annual report 12/13 Priority 2 - Clinical Effectiveness b. Reduce the variability of station cleanliness
Aims / Goals »» To reduce the variability of station cleanliness and become fully compliant with CQC Outcome 8 – Infection Control Current Situation and Quality Assurances Infection prevention and control across all areas of front line patient contact and care remains a key priority for SCAS and one which we know the public will want to be assured is being monitored and assessed. It is essential to ensure that our vehicles and resource centres have high standards of cleanliness to prevent cross infection.
Our ‘Make Ready’ teams provided by Churchill Support Services have already made a significant difference to the cleanliness of vehicles by providing stocking, equipment and deep cleaning services to all our frontline fleet. We now need to focus on our stations to ensure the highest standards are achieved. During an unannounced inspection in November 2012 by the Care Quality Commission (CQC), SCAS received some very positive feedback and were deemed compliant with all the essential standards inspected, with the exception of Outcome 8. The inspection found some areas of station cleanliness to be variable and inconsistent evidence of follow up from station infection control audits.
70 Annual Report and Accounts 2012/13
Identified Areas of Improvement »» Undertake a programme of station improvement and procurement to purchase and install all necessary equipment to ensure CQC compliance is achievable »» Educate staff in infection control and cleanliness best practice to ensure CQC compliance is achievable »» Continue Leadership walkarounds assessing the cleanliness of stations and vehicles and report findings through the Quality and Safety Committee
»» Action plans to be implemented where we fall below desired and acceptable standards of cleaning, identified through monthly station inspections
Board Sponsor Debbie Marrs Interim Director of Quality and Patient Care
Implementation Leads Phil Convery Infection Control Lead Mike Kerrigan Head of Estates
Priority 2 - Clinical Effectiveness c. Comply with the DH core quality indicators for Red 1 & Red 2 calls
Aims / Goals »» Improve patient experience by increasing the proportion of Red 1 and Red 2 calls responded to without long delays »» To benchmark with other ambulance services as per the DH indicators and be in the top national quartile for Red 1 & Red 2 Calls Current Situation and Quality Assurances We know that patients who call for our help want and often need a rapid response with no delays. Responsive ambulance services are critical for emergency patient outcomes. It remains a key priority for SCAS and one which we know is still very important to the public.
By responding in a timely manner the Trust is able to meet the national performance measures and the DH Core Clinical Indicators that have been developed for ambulance services. Any delay can present itself as a complaint or incident requiring investigation and using an investigative process can help us understand where and how problems may arise. Consequently SCAS is currently monitoring long delays on a daily basis using a ‘Red Misses’ report format which demands that all delays have to be accounted for. This daily monitoring is supported through rigorous root cause analysis at performance management meetings at both area level and director level.
Identified Areas of Improvement »» To reduce waits over 30 minutes for Red 1 & Red 2 calls requiring an 8 minute response to 25 per month (55 in Jan and Feb) »» To reduce waits over 30 minutes for Red 1 & Red 2 calls requiring a 19 minute response to 60 per month (160 in Dec and Jan) »» To reduce waits over 1 hour for Amber calls to 50 per month (100 in Dec and Jan) »» To benchmark nationally with all of the above
Board Sponsor John Black Medical Director
Implementation Lead John Nichols Interim Chief Operating Officer
(a long wait is 30 minutes or more, over and above the planned response time).
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Annual report 12/13 Priority 2 - Clinical Effectiveness d. Improve utilisation of CFR’s and other indirect resources
Aims / Goals »» To increase utilisation of Community First Responders (CFR’s) and other indirect resources across the trust to 10% globally Current Situation and Quality Assurances A study by Pell et al (2001) published in the BMJ investigated the effects that response time had on patient survival after cardiac arrest in the community. This study examined approximately 14,000 incidents in Scotland from 1991 to 1998.
The study concluded that reducing response time from 14 minutes to 8 minutes for 90% of cases increases the predicted survival rate from 6% to 8%, and reducing response time to 5 minutes increases survival to 1011%.
The evidence provided by this and other studies provided the basis for the ‘Chain of Survival which promotes rapid response time in combination with early CPR and early defibrillation in the event of a cardiac arrest.
This is particularly true for those living in rural areas where ambulances have to travel great distances to reach our patients.
The chain of survival
EARLY ACCESS
72 Annual Report and Accounts 2012/13
One of the most effective ways for ambulance services to implement the ‘Chain of Survival’ and reduce response times whilst facilitating early CPR and defibrillation is by the dispatch of Community First Responders (CFR’s) or Co-Responders from other providers such as the Fire service or the RAF.
EARLY CPR
EARLY DEFIBRILLATION
EARLY ADVANCED CARE
SCAS already has a network of around 1,300 dedicated responders who cover hard to reach areas throughout the Trust area. These volunteers receive initial training and are then aided by six monthly refreshers and drop in sessions to ensure they maintain their knowledge and skill level. In 2012/13 a new volunteer scheme handbook was issued by SCAS to support our co-responder and CFR colleagues. SCAS has a vigorous CFR recruitment program which currently runs 2 courses per month and 72 newly recruited CFRs have joined our ranks in the first quarter of 2013 alone. Current SCAS wide CFR indirect performance is variable and we intend to stabilise our performance and increase to a global figure of 10% during the reporting period.
Identified Areas of Improvement »» Enhanced staff training to improve identification of CFR appropriate calls, maximise allocation and ensure rapid dispatch »» Regular audit of dispatch decisions conducted and supported by weekly performance management meetings at area level »» Continued CFR recruitment with a focus on high requirement areas »» Introduction of Public Access Defibrillation (PAD) sites in rural areas. These sites are logged on our dispatch system and those properties or places that are within a 200m radius are instructed by our control room that a shock box is close by in the event of a cardiac arrest »» A program of assessment of the needs of high demand sites such as Nursing and Care Homes
Board Sponsor John Black Medical Director
Implementation Lead Mark Ainsworth Operational Director
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Annual report 12/13 Priority 3 - Patient Experience a. Utilise feedback from other professionals to improve patient experience
Aims / Goals »» Improve patient experience by increasing our learning actions from patient feedback collated by other professionals Current Situation and Quality Assurances SCAS is committed to working with service users and their families to help make their experience as positive as it can be. We seek to continuously improve the quality and experience of care for the public we serve. To do this we need to identify learning points from complaints and other feedback to create actions to improve our service provision.
Within SCAS we have an established Patient Experience Team who offer a comprehensive Patient Advice and Liaison Service (PALS) to our service users. Regular patient surveys are undertaken by this team and other assistance they provide includes:
»» Working with patients and the public to make sure their views are used to improve the service »» If a problem can’t be resolved, we can assist patients in making a formal complaint and respond to it in a timely manner
»» Advice and information on all aspects of the ambulance service and other local health services »» Helping patients to get information from other useful services and support groups »» Listening to patients concerns, and finding answers to their queries
Through partnership working with other Health Care Providers (HCP’s) we have realised that there is much we can learn from the patient experiences recorded by the PAL’s teams in our partner agencies. This year we hope to establish strong links with our partner HCP’s and exchange two way feedback in order to discover more learning points for service improvement.
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Last year’s Quality accounts set targets for reducing complaints and dealing with concerns promptly. Feedback on our progress for these initiatives can be seen in PART 3 of this report.
Identified Areas of Improvement »» Establish a link with primary care patient experience teams including those of the 111 service and the Clinical Commissioning Groups »» Obtain regular feedback relevant to SCAS and ensure accurate logging of records »» Design a systematic process using DATIX to aid learning and triangulate with complaints »» Monitor HCP feedback and actions through the Patient Experience Review Group (PERG)
Board Sponsor Will Hancock Chief Executive
Implementation Lead Liz Rees Head of Patient Experience
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Annual report 12/13 Priority 3 - Patient Experience b. Use feedback from patient satisfaction surveys to improve service delivery
Aims / Goals »» To improve patient experience through analysis and actions plans formed using established patient surveys and the new Friends and Family Test Question Current Situation and Quality Assurances Patient experience is very important to us and our staff, who strive to deliver high quality care for all whether on the front line, providing routine transport or in a supporting role. Whilst the Patient Experience Team is an excellent way to receive and resolve patient concerns and questions, it cannot capture all the various types of patient feedback that could be available to us.
Patient surveys are an additional way to collect feedback that may not be presented via other routes. SCAS already has established patient surveys conducted through our Clinical Support Desk (CSD), Emergency Care Practitioners, Patient Transport Service and by the PALS team. Scrutiny of patient experience data from surveys is included in the performance report at Board level. We have a weekly reporting system for complaints to our frontline team leaders who are best placed to ensure timely responses at a local level.
76 Annual Report and Accounts 2012/13
SCAS welcomes new initiatives that help us engage with our service users by collecting real time patient experience data, and April 2013 sees the launch of the DH’s Friends and Family Test (FFT) question initially for acute providers. This test will ask all patients (with a few exceptions) one simple question: -
Would they recommend the hospital ward, accident and emergency unit or other healthcare provider to a friend or relative based on their treatment? Put simply: each and every patient will be given the opportunity to share their views on their experiences as a patient.
SCAS wants to adopt the test question and others based around it early in 2013 and will be one of the first ambulance services to do so. It is proposed that responses to this “Friends and Family Test” question, will then be published on a locally determined basis. Publishing this data will allow members of the public to compare healthcare services and clearly identify the best performers from a patient perspective. This aligns to the Francis Report and inquiry recommendations.
SCAS FFT questionnaire
Identified Areas of Improvement  Maintain existing patient survey routes with a minimum of 6 surveys in 2013/14. Planned surveys can be seen in the table below:
tions
Ques SCAS FFT Questionnaire questions Are you happy for us to ask today? about what has happened
NO
YES
ed for by our staff today?
How much did you feel car
ated with compassion?
t you were tre How much do you feel tha l your friends Would you feel able to tel had a good service? h How satisfied were you wit received today?
and family whether you
the care and treatment you
on how we comments or suggestions Do you have any further the care we provide? can improve the quality of ge,
, 3 Avera 1 Poor, 2 Below Average Responses are graded as: nt 4 Above Average, 5 Excelle
Type of Experience Survey
Type/medium
Date of implementation
ECP patient experience
Postal questionnaire & phone follow up
May 2013
Patient Experience (Over 65 yrs)
Telephone questionnaire
May 2013
Patient Transport Service (Q2 Oxford Health Hospital sites)
Postal questionnaire
October 2013
Patient Transport Service (Q2 Oxford PCT Patients)
Postal questionnaire
October 2013
Complainant satisfaction
Postal questionnaire
February 2014
Clinical Support Desk Patient Experience
Telephone questionnaire
February 2014
111 patient satisfaction Oxfordshire and Hampshire
(Including Friends and Family Test)
February/March 2014
Foundation Trust Members Survey
(Including Friends and Family Test)
February 2014
Front line patient satisfaction
Face to face questionnaires to include FFT
March 2014
Hear and Treat
Questionnaire
March 2014
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Annual report 12/13 »» Collect real time patient experience data through implementation of the FFT »» Align FFT response data with local patient experience data to drive improvements in the new commissioning and regulatory system »» Utilise survey data to inform our quality priorities »» Put action plans in place at a local level to implement changes required illustrated by survey responses
78 Annual Report and Accounts 2012/13
Board Sponsors Debbie Marrs Interim Director of Quality and Patient Care Duncan Burke Director of Communications and Stakeholder Engagement
Implementation Lead Liz Rees Head of Patient Experience
Priority 3 - Patient Experience c. Improve the experience our patients have at the end of their life
Aims / Goals »» Ensure that all patients that contact SCAS when nearing the end of their life receive care that is specifically tailored to their needs Current Situation and Quality Assurances Dignity and compassion are key themes of the Francis Report both of which are never more relevant than when dealing with patients who are nearing the end of their life. A huge spectrum of emotions and clinical care pathways dictate the needs of patients and their families and SCAS recognises that being able to offer a unified, comprehensive yet flexible approach for these patients is paramount.
During 2012/13 SCAS has engaged with the South of England Strategic Health Authority in order to improve plans associated with compliance of Advance Care Plans (ACPs) and the delivery of the End of Life strategy. Part of this engagement was to review the uDNACPR form and the policy that relates to its implementation. Following this process we have worked to integrate the revised form and the electronic end of life register that supports it on to our Computer Aided Dispatch system (CAD), so that our frontline crews can be better supported by their colleagues in our emergency control centres when dealing with matters relating to End of Life Care (EoLC) in patient facing situations.
All operational staff have received EoLC training as part of their trauma training which was completed in 2012. Furthermore SCAS has provided E learning for CSD Nurses and ECPs on the EoL Oxford Learning Pathway, and face to face training in the form of clinical ‘Winter Workshops’ on death and dying to SCAS Staff Band 5 and over.
Adverse incidents relating to EoLC are rare with only 3 reported in 2012/13. However SCAS recognises the learning opportunity that this small but important group represents and all cases are brought to the EoLC lead for detailed investigation. Findings are fed back to operational managers and cascaded to staff to ensure there are no repeat occurrences.
Two new staff have been employed by SCAS to enter and manage the upload and monitoring of uDNACPR forms and entry of Anticipatory Ambulance Care Plans (AACPs) on to our database.
To maximise patient experience, SCAS intends to direct time and resources to this area again in 2013/14 to further improve our understanding and implementation of practices relating to end of life care.
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Annual report 12/13 Identified Areas of Improvement »» Ensure that the Area Management Team engage with the local EoLC steering groups »» Provide PTS, CSD, 111 and EOC staff with training in EoLC and uDNACPR »» Ensure full compliance with the EoLC strategy »» Fully investigate all adverse incidents relating to EoLC and uDNACPR and extract and disseminate organisational learning »» Produce and circulate a SCAS bereavement leaflet for all staff to hand to relatives to offer support
80 Annual Report and Accounts 2012/13
Board Sponsors John Black Medical Director Debbie Marrs Interim Director of Quality and Patient Care
Implementation Leads Pete Warren Clinical Quality Assurance Lead Ian Teague Head of Education
Patient Transport Service at Oxford Radcliffe Hospital
Annual report 12/13 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 statutory requirements and statements which show SCAS is performing to essential standards, measuring clinical performance, and is working across organisational boundaries to improve quality.
82 Annual Report and Accounts 2012/13
During 2012/13 SCAS provided and/or sub contracted three relevant services: »» Emergency 999 Ambulance Service »» Non Emergency Patient Transport Service »» 111 Urgent Telephone Advice Service SCAS has reviewed all the data available to them on the quality of care in these 3 relevant services. Along with qualitative data the Board has sought assurance from a variety of sources: »» Patient surveys »» Public consultation meetings »» Narrative from complaints and feedback and their resolution »» Root cause analysis of incidents and identified leaning »» Internal audit reports »» External reviews of quality »» Leadership walk arounds »» Bi monthly committee meetings »» Staff meetings.
The income generated by the relevant services reviewed in 2012/13 represents 100% of the total income generated from the provision of relevant services by SCAS for 2012/13.
During 2012/13 11 national clinical audits and nil national confidential enquiries covered relevant health services that SCAS provide. During 2012/13 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.
The national clinical audits and national confidential enquires that SCAS was eligible to participate in during 2012/13 are as follows: »» Acute Myocardial Infarction and other ACS (MINAP) »» National Clinical Performance Indicator Asthma »» National Clinical Performance Indicator Hypoglycaemia »» National Clinical Performance Indicator Febrile Convulsions »» National Clinical Performance Indicator Below Knee Fractures »» National Ambulance NonConveyance Audit »» Ambulance Service Clinical Quality Indicator Stroke Care Bundle »» Ambulance Service Clinical Quality Indicator Cardiac Arrest ROSC Rates (and separate witnessed arrest ROSC rates) »» Ambulance Service Clinical Quality Indicator Cardiac Arrest Survival to Discharge (STD) Rates (and separate witnessed arrest STD rates)
»» Ambulance Service Clinical Quality Indicator ST elevation Myocardial Infarction Care Bundle »» Ambulance Service Clinical Quality Indicator Primary Percutaneous Coronary Intervention (pPCI) call to Balloon within 150 minutes. The national clinical audits and national confidential enquires that SCAS participated in during 2012/13 are as follows: »» Acute Myocardial Infarction and other ACS (MINAP) »» National Clinical Performance Indicator Asthma »» National Clinical Performance Indicator Hypoglycaemia »» National Clinical Performance Indicator Febrile Convulsions »» National Clinical Performance Indicator Below Knee Fractures »» National Ambulance NonConveyance Audit »» Ambulance Service Clinical Quality Indicator Stroke Care Bundle
»» Ambulance Service Clinical Quality Indicator Cardiac Arrest ROSC Rates (and separate witnessed arrest ROSC rates) »» Ambulance Service Clinical Quality Indicator Cardiac Arrest Survival to Discharge (STD) Rates (and separate witnessed arrest STD rates) »» Ambulance Service Clinical Quality Indicator ST elevation Myocardial Infarction Care Bundle »» Ambulance Service Clinical Quality Indicator Primary Percutaneous Coronary Intervention (pPCI) call to Balloon within 150 minutes. The national clinical audits and national confidential enquiries that SCAS participated in, and for which data collection was completed during 2012/13, are listed 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.
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Annual report 12/13 National clinical audit
Number of cases
% submitted
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.
916
100%
National Clinical Performance Indicator Asthma
300
100%
National Clinical Performance Indicator Hypoglycaemia
300
100%
National Clinical Performance Indicator Febrile Convulsions
27
100%
National Clinical Performance Indicator Below Knee Fractures
18
100%
National Ambulance Non-Conveyance Audit
1,442
100%
Ambulance Service Clinical Quality Indicator Stroke Care Bundle
4,848*
100%
Ambulance Service Clinical Quality Indicator Cardiac Arrest ROSC Rates (and separate witnessed arrest ROSC rates)
870*
100%
Ambulance Service Clinical Quality Indicator Cardiac Arrest Survival to Discharge (STD) Rates (and separate witnessed arrest STD rates)
793*
100%
Ambulance Service Clinical Quality Indicator ST elevation Myocardial Infarction Care Bundle
983*
100%
Ambulance Service Clinical Quality Indicator Primary Percutaneous Coronary Intervention (pPCI) call to Balloon within 150 minutes
650*
100%
*These figures are for quarters 1, 2 and 3. Full year data is available from June 2013 on request
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The reports of 11 national clinical audits were reviewed by the provider in 2012/13 and South Central Ambulance Service NHS Foundation Trust intends to take the following actions to improve the quality of health care provided: »» Ensure quality of data in the changeover to electronic Patient Report Forms (ePRF) »» Implement real time data utilising ePRF »» Improve call to depart scene time for Stroke patients »» Continue to reduce the number of delayed responses to patients »» Continue to review the appropriateness of conveyance decisions The local clinical audits are all documented and monitored through the integrated performance report and reported through the Quality and Safety Committee. More details can be found on www.scas.nhs.uk.
The number of patients receiving relevant health services provided or sub contracted by SCAS in 2012/13 that were recruited during that period to participate in research, approved by a research ethics committee, was 406. Participation in clinical research demonstrates SCAS’s commitment to both improving the quality of care we offer, and to making our contribution to wider health improvement. Our clinical staff stay abreast of the latest possible treatment possibilities and active participation in research leads to successful patient outcomes. The following demonstrates our commitment to clinical research and the use of evidence based information for the improvement of care: »» Participation in collaborative research projects »» Supporting paramedic staff undertaking research projects for the degree programme.
There were 535 clinical staff participating in research approved by a research ethics committee at SCAS during 2012/13. These staff participated in research covering one area of pre hospital care – ‘Pre hospital randomised assessment of a mechanical compression device in cardiac arrest (PaRAMeDIC) trial handover’ (http://www.controlledtrials.com/ISRCTN08233942) In the last year, conference presentations and publications demonstrate our commitment to transparency and desire to improve patient outcomes and experience across the NHS: »» Deakin CD. Drowning: guidelines extant, evidencebased risk for rescuers? Editorial. Resuscitation 2013: 84: e33
»» Dickinson P, Freshwater E, Eynon CA, Crouch R, Deakin CD. Critical care impact of an on-site helipad at University Hospital Southampton: the first 100 flights. Intensive Care Society, State of the Art Meeting, UK. London, Dec 2012. »» England E, How do patients with osteoporosis make sense of the local decision making process for the development of osteoporosis management guidelines? Royal Pharmaceutical Society Conference, Birmingham, Sept 2012. »» Farmer AJ, Brockbank KJ, Keech ML, England EJ, Deakin CD. Incidence and costs of severe hypoglycaemia in diabetes requiring attendance by the emergency medical services in the United Kingdom. Diabetic Medicine 2012. 29:1447-50.
»» Freshwater E, Dickinson P, Crouch R, Eynon A, Deakin CD. Extending access to specialist services - the impact of an onsite helipad: analysis of the first 100 flights. Emergency Medicine Journal 2013 In press. »» Shrewsbury V, Deakin CD, Petley GW. Do Clinical Examination Gloves Provide Adequate Electrical Insulation for Safe HandsOn Defibrillation? European Resuscitation Council Annual Meeting, Vienna, October 2012. Resuscitation 2012; 83: e13.
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Annual report 12/13 Our engagement with clinical research also demonstrates SCAS’s commitment to testing and offering the latest medical treatment and techniques. The areas of engagement are outlined below: »» Pre-hospital Randomised Assessment of a Mechanical compression Device In Cardiac arrest (PaRAMeDIC) trial. Warwick University. »» Developing of large multicentre randomised controlled study of adrenaline in pre-hospital cardiac arrest with Warwick University and other ambulance trusts. »» Integration with the Comprehensive Local Research Networks (CLRN) and Oxford Academic Health Science Network »» Working with National Ambulance Research Sub Group, Thames Valley Injuries and Emergency Specialty Group and Warwick University to identify and develop research projects.
»» Developing links with Local Authority Public Health to develop a project to review the use of emergent psychoactive substances. »» Lead organisation for a major project with Trauma Audit and Research Network looking at patient outcome with doctor-led pre-hospital care.
A proportion of SCAS’s income in 2012/13 was conditional upon achieving quality improvement and innovation goals agreed between SCAS and the commissioning PCTs. This is reflected in a contract, agreement or arrangement for the provision of relevant health services, through the Commissioning for Quality and Innovation (CQUIN) payment framework.
86 Annual Report and Accounts 2012/13
Further details of the agreed goals for 2012/13 and for the following 12 months period are available online at www.monitor-nhsft.gov.uk. CQUINS show that SCAS actively engages in quality improvements that cross the boundaries of our organisation. For this year the goals relate to: »» Increased use of Alternative Care Pathways (ACP’s) »» Implementation of the ePRF »» Digital sharing of information relating to falls.
£1.65
MILLION The total for CQUIN related income for 2012/13 is expected to be approximately £1.65 million.
South Central Ambulance Service NHS Foundation Trust is required to register with the Care Quality Commission (CQC) and its current registration status is registered without conditions in all essential standards. SCAS had not participated in any special reviews or investigations by the Care Quality Commission during the reporting period. In November 2012 the Care Quality Commission (CQC) carried out an unannounced inspection at SCAS. The inspectors focussed on seven outcomes: »» Outcome 4 (Regulation 9) – Care and Welfare of people who use services »» Outcome 6 (Regulation 24) – Co-operating with other providers »» Outcome 7 (Regulation 11) – Safeguarding vulnerable people who use our services »» Outcome 8 (Regulation 12) – Cleanliness and infection control
»» Outcome 11 (Regulation 16) – Safety, availability and suitability of equipment »» Outcome 12 (Regulation 21) – Requirements related to workers »» Outcome 16 (Regulation 10) – Assessing and monitoring the quality of service provision.
South Central Ambulance Service NHS Foundation Trust did not submit records during 2012/13 to the Secondary Uses service for inclusion in the hospital Episode Statistics which are included in the latest published data.
79% South Central Ambulance Service NHS Foundation Trust’s Information Governance Assessment Report overall score for 2012/13 was 79% and was graded green from the IGT Grading scheme. * Results should not be extrapolated further than the actual sample audited and the services which were reviewed within the sample.
South Central Ambulance Service Foundation NHS Trust was not subject to the Payment by Results clinical coding audit during the reporting period by the Audit Commission.
South Central Ambulance Service NHS Foundation Trust will be taking the following actions to improve data quality: »» Provision of an Integrated Performance Report that outlines all quality, operational and financial data »» Challenge and scrutiny of data at all levels within the organisation within the performance management framework »» Internal clinical audit plan »» Regular review by the Clinical Review Group (CRG).
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CPR demo with instructions in sign language at SONUS event
PART 3 Review of 2012/13
No.
1
2012/13 has been the first full year of operating as a Foundation Trust for SCAS. It has been a year of many challenges in the face of increased demand, budget constraints and difficult weather conditions which have stretched us.
We still face some challenges in the delivery of the quality agenda but our core values and strategic aims remain aligned with being patient focused and clinically led.
It remains important to us to act in a timely manner upon feedback we receive whether it is a concern or compliment. This part of the report shows the response we made in acting on things you, the public said, and what we did about it.
Improvement
Action
Outcome
REQUEST
WE DID
WHAT THIS MEANS
Patient feedback alerted SCAS to a problem with the coding of Addison’s Disease if declared by a 999 caller. Addisonian Crises is a life threatening condition which presents with a set of non specific symptoms that our AMPDS system did not consider a known diagnosis. This means instead of organising an immediate response, the system was referring calls for further assessment prior to the dispatch of an ambulance (as per local policy and DH guidance).
We looked at 2 cases where this had impacted on the level of response that the patient had received. As a result of investigations we have now added an additional question in the AMPDS protocol as a local policy variation, which ensures the ECT asks about Addison’s disease in card 26, in line with the neutropenic sepsis policy
In future where Addison’s disease is declared by the caller/patient, or the symptoms that they present with may be indicative of an Addison’s crises, the Emergency Call taker will use the appropriate “over ride” code to ensure an appropriate ambulance response is dispatched.
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Annual report 12/13 No.
Improvement
Action
Outcome
REQUEST
WE DID
WHAT THIS MEANS
2
Concern was raised about the lack of equipment available on frontline ambulances to allow bariatric patients to be moved in a safe and dignified manner.
Bespoke bariatric stretchers that fit into the stretcher mounts of all frontline vehicles have been purchased and placed at strategic locations throughout the Trust. Should movement of a bariatric patient be required, a suitable stretcher can be sourced rapidly without need for a bariatric specific ambulance and crew.
These bespoke stretchers allow our bariatric service users to be moved in enhanced safety and comfort, thereby greatly improving their patient experience.
No.
Improvement
Action
Outcome
REQUEST
WE DID
WHAT THIS MEANS
Patient feedback indicated that at times service users were experiencing slower response times in our more rural areas such as the New Forest.
SCAS undertook a comprehensive roster review examining all aspects of staffing and resource availability. Following extensive consultation a revised â&#x20AC;&#x2DC;team workingâ&#x20AC;&#x2122; structure has been implemented throughout the Trust.
Staffing has been increased to reflect the rising demand level. The new team roster system has resulted in more ambulances on the road than ever before, which in turn means we can provide enhanced strategic cover and access our most rural areas more readily.
3
90 Annual Report and Accounts 2012/13
No.
Improvement
Action
Outcome
REQUEST
WE DID
WHAT THIS MEANS
4
A patient contact asked for assurances surrounding how we meet the challenges of locating hard to find properties. Properties which our Sat Nav systems may fail to direct us to or properties which require specific entry instructions for example.
We reviewed our systems and have made it easier for ‘SS’ alerts to be added to addresses. ‘Special Situations’ are notes which can be added to an address and which pop up in the form of an alert on the dispatcher’s screen whenever an address is accessed. These alerts can take the form of entry codes, best access routes and road closures. They can now be added in real time by the Control Duty Manager and shared with the attending ambulance crew via text message to their cab. It should be noted however that alerts relating to safety issues for patients or crews still have to be investigated and go through due process.
Vital minutes can now be saved when searching for a hard to find address by sending a simple alert message directly to the attending ambulance crew. Updates to the special situation notes are readily available and alterations can be made with greater ease. This promotes patient safety and also enhances patient experience by providing a quicker response.
No.
Improvement
Action
Outcome
REQUEST
WE DID
WHAT THIS MEANS
Concern was raised over the discomfort caused by travelling on a Spinal Board in a moving ambulance
Our Clinical Team reviewed current best practice evidence and found that it suggested that the Orthopaedic Scoop Stretcher was superior to the Spinal Board both in terms of efficacy of immobilisation and patient comfort. Whilst the Scoop Stretcher cannot completely replace the Spinal Board, as this device is the only one suitable for extrication of patients from motor vehicle incidents, it was decided that the Scoop should become our ‘Gold Standard’ in all other situations.
A Clinical Directive was issued to all Frontline ambulance staff advising that the Spinal Board must only be used for extrication and that the Scoop Stretcher is to be used in all other situations requiring spinal immobilisation. Old aluminium Scoop Stretchers were also replaced with the new composite plastic version, which provide optimum comfort without compromising immobilisation.
5
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Annual report 12/13 No.
Improvement
Action
Outcome
REQUEST
WE DID
WHAT THIS MEANS
6
An enquiry was made about the provision of child seats on SCAS vehicles
SCAS double crew ambulances come with an integral child seat which provides safe transport for young children. To better provide for our infant passengers however, SCAS has invested in infant car seats which are located one per ambulance station. Should a seat be required, a rapid response car can deliver it to the crew in need. Furthermore a member of our Clinical Team made a very successful visit to a maternity unit to advise the staff and patients about SCAS provision for young travellers.
The ability to offer an infant child seat to a distressed family who are not able to provide their own, is one which has been simply achieved but which could make a huge difference to the quality of a service users experience. SCAS are pleased to be able to offer this capability and will continue to engage with patient groups to discuss other improvements.
No.
Improvement
Action
Outcome
REQUEST
WE DID
WHAT THIS MEANS
Assurance was sought regarding the scope of our falls assessment processes following the non conveyance of an elderly patient after a fall
SCAS Clinicians are making effective use of alternative care pathways to treat an increasing number of patients including elderly fallers in their own home. Providing on-going care through collaboration with other health care providers is of high importance to SCAS, and we were able to identify a deficiency in the falls assessment process. We were already referring fallers to the Community Falls Teams but discovered that the wait for assessment was often lengthy as the falls teams were overwhelmed by the triage of our referrals. This directly led to the creation of the â&#x20AC;&#x2DC;RAGâ&#x20AC;&#x2122; tool for falls patient triage.
SCAS crews now perform triage for the Community Falls Teams when making a referral. This ensures that those most likely to fall again and those in greatest need are seen rapidly by the Community Teams.
7
92 Annual Report and Accounts 2012/13
This prevents reoccurrence and promotes patient safety & experience whilst also lowering ambulance demand.
No.
Improvement
Action
Outcome
REQUEST
WE DID
WHAT THIS MEANS
8
SCAS acknowledges the importance of accurate medical records and took action when we received several separate complaints about incorrect and incomplete record keeping.
SCAS has implemented several initiatives to ensure improved standards of record keeping. 1. The introduction of a new roster structure has provided greater monitoring of clinicians. Clinical Mentorâ&#x20AC;&#x2122;s act as educators to teams of approx 20 members of staff and their role involves making regular checks on paperwork quality. 2. Bi-monthly audits are also taken by a member of our Clinical Team in conjunction with our area managers. 3. A new Patient Report Form (PRF) has been introduced to improve data capture. 4. Staff have also been provided with additional training at their last Clinical Update on use of the medical model.
Enhanced training, new forms and better supervision will all contribute to the quality of our clinicianâ&#x20AC;&#x2122;s record keeping. Regular audit by senior management and at local level by the clinical mentors of each team will ensure that poor performance is observed and addressed at the earliest opportunity.
No.
Improvement
Action
Outcome
REQUEST
WE DID
WHAT THIS MEANS
A contact was made about the excessive time a patient had to wait for pain relief to be provided during a period of high service demand. A first responder attended within a short period of time but the patient had to wait for a clinical response by a rapid response car or double manned ambulance to be offered pain relief options.
Great importance is placed upon effective pain management by SCAS and as such we undertook a review of this issue. After consultation by our Clinical Team, Education Department and Community First Responder Leads it was decided that Entonox gas is a safe and effective pain relief method that could be offered by our Community Responder Teams.
A selection of responders have gone through additional training and have been issued with Entonox administration equipment. Following a set of administration guidelines they can now offer this pain relief option prior to the arrival of a SCAS ambulance crew.
9
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Milly Stokes - Volunteer ambulance car driver for over 45 years.
Progress on the Quality Account 2012/13 Priorities The following section provides feedback and evidence on the progress of last yearâ&#x20AC;&#x2122;s work on our key quality priorities and our performance attainments.
Priority 1 - Patient Safety a. Continue to decrease the numbers of patients experiencing a delay in response
Current SCAS performance In the face of ever increasing demand SCAS continues to maintain and improve response times. Red 1 - National target = 75% Red 1 performance continues to hold well. Good progress made on improving Red 1 performance and this has been maintained with Red 1 performance now at a higher level than the overall Red performance year to date. Red 2 â&#x20AC;&#x201C; National target = 75% Good improvement has been made during January to date.
Target
2012/13
Red 1 (75%)
77.6 %
Red 2 (75%)
75.1%
Red 8 (75%)
75.3%
Red 19 (95%)
95.1%
Red 1&2 - Combined national target = 75% Remains above the required full year National standard.
Red 19 - National target = 95% Remains above the required full year National standard.
95
Annual report 12/13 New Year’s Eve Performance SCAS prepared and performed extremely well over the New Year’s Eve two day period (December 31st & New Year’s Day). Comparing directly with last year: »» Red 8 demand was up by 19.6% »» Total emergency demand was up by 16.26% »» Red 8 performance was 76.79%, compared with 73.47% the previous year.
January 2013 Adverse Weather SCAS, along with most of the rest of the country, experienced several days of snow and weather disruption. Adverse weather plans were put into action. Performance during the worst four day period are shown below in %.
January 2013 Fri 18th
Sat 19th
Sun 20th
Mon 21st
Tues 22nd
Red 8
63.3
75.4
72.4
74.1
82
Red 19
87.5
96.5
93.7
93.3
95
96 Annual Report and Accounts 2012/13
Call Answer Performance The two key indicators for EOC (999) call answer performance are: 1. To answer 95% of all inbound 999 calls within 28 seconds 2. The percentage of abandoned emergency calls not to exceed 1.3% Good progress has been made and we are ahead of both call answer and call abandonment trajectories:
120
Call Answer (T0 - T1) 95th Percentile (Seconds)
Target
100
Actual
80 60 40 20 0 8
Apr
May
Jun
Jul
Aug
Sep
Oct
Call Abandonment rate (%)
Nov
Dec
Jan
Feb
Actual
Mar
Target
7 6 5 4 3 2 1 0
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
97
Annual report 12/13 Demand
44000
Demand is running over 7% higher than last year. In December 2012 demand was 8.8% higher than in December 2011.
Overall Emergency Demand
42000 40000 38000 36000 34000
Daily demand in December 2012 compared with December 2011 demonstrates the peaks in demand associated with weekends that we are now experiencing.
2011/12 2012/13
32000 30000
1600
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Overall Emergency Demand - December - by day
2012 2011
1480 1360 1240 1120 1000
1
2
3
4
5
6
7
8
98 Annual Report and Accounts 2012/13
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
25 26 27 28 29 30 31
Such success in the face of this adversity has been achieved by undertaking detailed discussions with Commissioners and releasing additional funding which has enabled to SCAS to increase resource availability through the deployment of private providers and overtime incentive schemes for existing SCAS staff. Active recruitment has also contributed; the recruitment plan for 2012/13 was to recruit 70 Paramedics and 80 ECAS during 2012/13. The outturn for the year was 80 paramedics, and 106 ECAs. In order to identify further ways in which delays can be minimised, SCAS has implemented a series of delays audits in 2012/13. Audits were undertaken of all delayed responses in the red and amber categories for the first week in June, September and November 2012 (1st to 7th inclusive).
99
Annual report 12/13 Priority 1 - Patient Safety b. Maintain and improve the monitoring of cleanliness of all vehicles to provide assurance
Infection prevention and control across all areas of patient transport services and frontline patient contact and care remains a key priority for SCAS, and one which we know the public still want to know is being monitored and assessed. The necessity to ensure that all our vehicles have a high standard of cleanliness is paramount to prevent cross infection and the spread of MRSA, Clostridium Difficile and other healthcare acquired infections. Our ‘Make Ready’ teams continue to make a huge difference in the cleanliness of our vehicles and we are focusing on the effectiveness of that cleaning to ensure the highest standards.
Initiatives implemented during 2012/13 »» Regular leadership walkarounds to assess the cleanliness of vehicles »» Infection control audits for all stations »» Vehicle cleanliness audits including automated ATP testing »» An Operational Support Desk (OSD) has been introduced to help with the logistics of getting vehicles to the correct location when deep cleans are due
100 Annual Report and Accounts 2012/13
Current Status Significant progress has been shown by walkaround reports regarding the cleanliness of the vehicles and clinical equipment with the introduction of ‘Make Ready’. This whole system service which provides stock, equipment and deep cleaning of our ambulances has been introduced into the Trust to provide assurance on cleanliness, and also to release resources and time to deliver quality infection control standards.
Improve audit and monitoring of cleanliness of all patient vehicles using an automated system of Adenosine Trio-Phosphate (ATP) testing for recording the effectiveness of daily and deep cleaning across the whole of the fleet. ATP testing has shown good efficacy in our 6 week deep cleaning process. As a result we are investigating and researching optimum time scales associated with this programme.
Ensure 97% compliance with the cleaning plan. During 2012/13 we achieved 83% compliance with the deep cleaning plan. This was due to increased demand which reduced turnaround of vehicles. However ATP testing on vehicles, up to 5 weeks post deep clean, continued to show levels well within parameters.
Collect accurate audit data relating to the standard of cleanliness of vehicles. During 2012/13 SCAS collected data through a paper and/or email process of station and vehicle audits achieving 111% compliance with vehicle audit requirements. However a business plan has been put forward to improve the reporting of audits.
Using a web based system with remote handheld units, our clinical mentors and other nomintated staff can submit real time audit data at specific points throughout a shift. This add-on to our current system will also send reminders of due audits, ask for action plans to correct highlighted areas of concern and produce monthly reports of how we are doing in achieving targets. Using this system we hope to capture every vehicle in the fleet at least twice annually and every station will provide a minimum of two sets of audit data per month.
New Infection Control Initiatives to be implemented in 2013/14 »» Electronic audits pre, during and post patient care – to ensure accurate data in order to measure how we are performing with infection control during patient care episodes »» E-learning for staff relating to infection prevention and control launching Summer 2013 and looking to achieve 100% compliance with the hand hygiene section for all staff and 100% compliance with the infection prevention section for all frontline staff by March 2014 »» Setting up of an Infection Control Link Practitioner Team – to monitor on a station level by Summer 2013. There are currrently 10 in place at present »» Action plans will be put in place where we fall below desired and acceptable standards of cleaning and infection control practices »» Delivery of plan in daily and deep cleaning schedules to achieve no less than 97% compliance »» Ensure accurate data collection relating to standards of cleanliness of vehicles.
101
Annual report 12/13 Priority 1 - Patient Safety c. Reduce delays in handing over our patients to acute hospitals
SCAS realised a small but steady decline in hospital handover delays from June to September 2012, however we then saw significant month on month increases, with December, January and March recorded as the three highest months on record. These disappointing figures are despite several initiatives by SCAS, working and engaging with the wider healthcare system in which we work. SCAS has been successful in negotiations with most providers within its operating area to put in place agreed â&#x20AC;&#x2DC;Handover Plansâ&#x20AC;&#x2122; which ensure ambulances are not delayed. Plans for some sites are still to be finalised.
102 Annual Report and Accounts 2012/13
2011/12
2012/13
2500 2000
1500 1000
500
0
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Newsletters and directives have been used to educate staff in adherence to these handover plans so that problems arising are dealt with consistently. The A&E Escalation policy is also available to all staff through the internet.
SCAS will continue to work with the newly formed Clinical Commissioning Groups and our acute partners to reduce delays.
Frontline operational managers have been trained in escalation so that they may work in the role of Hospital Ambulance Liaison Officer (HALO). The purpose of this officer is to engage with the hospital emergency department and the hospital bed manager in order to find solutions to queuing problems. They also update the EOC so that they are well informed and can make best use of the SCAS resources they have available. Acting as â&#x20AC;&#x2DC;Bronzeâ&#x20AC;&#x2122;, The HALO Officer also makes decisions about when to contact more senior officers in the Silver and Gold Command structure, should they be unable to resolve the immediate issues.
103
Annual report 12/13 Priority 2 - Clinical Effectiveness a. DH Core Quality Indicators for STEMI and Stroke
Stemi care bundle % difference SCAS CB compliance confirmed pPCI patients
80 60 40 20
104 Annual Report and Accounts 2012/13
Yorkshire Ambulance
West Midlands Ambulance
South Western Ambulance
South East Coast Ambulance
South Central Ambulance
North West Ambulance
North East Ambulance
London Ambulance
-20
Isle of Wight
0 Great Western Ambulance
SCAS achieved the aim of being in the top quartile for the stroke care bundle nationally and has highlighted new areas of focus for stroke patients with regard to timely arrival at a hyper-acute stroke unit through the vascular network.
CTB <150 minutes
that are worthy of wider review when comparing care bundle compliance to achieving ‘Call to Balloon’ times.
100
East of England Ambulance
Update and results on identified areas
Unfortunately SCAS did not meet the aim for the care bundle for heart attack patients, but have highlighted national trends
East Midlands Ambulance
The care bundles for stroke and heart attack patients combine all the criteria in the ‘audit of best care’ and ensure that all essential steps are delivered to the patient. Therefore they are a much more robust indicator of care than an audit of individual criteria. SCAS aimed to be in the top four performing Trusts in the country for both care bundles.
When reviewing SCAS performance for STEMI care bundle compliance, those patients that are later confirmed suffering a heart attack and that have had an intervention, compliance is significantly higher. This is worthy of a wider national review to see if this is a national trend.
STEMI Care Bundle Compliance 2012/13 100 80 60 40 20 0
Apr
May
June
July
August
All chest pains of suspected cardiac origin Patients that have had pPCI
105
Annual report 12/13 Update on initiatives for 2012/13 Audit Commission - external review of the quality indicator chosen by our governors â&#x20AC;&#x201C; Stroke. The review was undertaken and three minor recommendations implemented.
Focused Programme on clinical quality metrics for Team Leaders and their staff Audits are shared with team leaders for cascade to their staff to highlight areas of clinical improvement required at local and trust wide level.
Internal forensic audit of data collection, analysis and quality The audit was completed and changes made which have improved case selection and analysis, which has improved data quality.
Annual clinician audit plan to target key areas Clinical performance is part of the clinicians annual appraisal where improvements will be targeted by the team leaders and clinical mentors.
106 Annual Report and Accounts 2012/13
Priority 2 - Clinical Effectiveness b. Monitor the effectiveness of the trauma pathway and bypass decisions
Regional Trauma Networks (RTNs) went live across England in April 2012 and the SCAS trauma care pathway is now fully operational with all partners in the both the Northern (Thames Valley) and Southern (Wessex) Cluster areas. Predictions showed that there would be an average of 5.4 major trauma cases per day across our region. Actual figures from the Major Trauma Centres and Trauma Units have shown that this was an accurate estimation. All qualified frontline staff have received a minimum of 2 days trauma training; 1 day of theory and 1 day of practical skills and assessment, including use of new drugs relating to major trauma.
To help crews decide when to ‘divert’ to the major trauma centres they have been issued with a Trauma Unit Bypass Tool (TUB Tool) which SCAS worked closely with South Western Ambulance Service and Great Western Ambulance Service and with the Wessex Trauma Network to create. The same TUB Tool is being used by all 3 ambulance services which ensures consistency for the receiving hospitals in the Network and creates commonality when ambulance services work together at cross-border incidents. A Specialist Incident Desk (SID) has been placed in the Emergency Control Room staffed by Paramedics with Air Ambulance experience.
The purpose of this desk is to: »» Identify calls that are likely to be major trauma »» Ensure that the correct resources are sent to the scene, such as Paramedic grade, the Air Ambulance, BASICS or HART teams. »» Give expert clinical advice to the crews »» Liaise with the receiving hospitals when capacity is an issue »» Retain clinical information for audit purposes Monitoring of the regional trauma networks is ongoing and a recent Department of Health peer review process highlighted excellent collaborative work with the Trauma Networks, strong clinical leadership and high-class training for staff.
Monitoring is based upon submission of evidence combined with a short site visit and it enables the sharing of best practice and learning across networks, whilst providing an indicator of progress and areas where further work is required. Locally within SCAS the TUB tool is being audited by means of a form called a CAS 999. This form is carried on all frontline vehicles, has been designed to aid staff in their decision-making and is electronically scanned enabling ease of data collection. A copy of this form is also left at the receiving unit to help with their TARN (Trauma Audit and Research Network) data collection.
107
Annual report 12/13 Priority 2 - Clinical Effectiveness c. Ensure the data we report on Return of Spontaneous Circulation (ROSC) is reliable, accurate and complete
Update and results on Identified areas If a patient suffers a cardiac arrest in our care it is important we can demonstrate the effectiveness of our interventions. Following significant improvements in the data validation in place since March 2012, our cardiac arrest performance remains well above trajectory although this data needs to be interpreted with caution as the dataset is small. »» Overall 1/3 of patients who suffer a cardiac arrest in the community are being resuscitated and arriving at hospital with a pulse
»» This figure rises to 48.9% of patients with witnessed cardiac arrest whose underlying rhythm was ‘shockable’ (i.e. most favourable prognostically) »» Survival to discharge for these two groups, which reflects whole systems performance is currently 15.5% and 24.4% respectively This performance benchmarks well nationally and we have action plans in place to further improve this as outlined in a paper to the Clinical Review Group in November 2012. These action plans centred around maintenance of response times and oxygen therapy.
108 Annual Report and Accounts 2012/13
There is assurance that the identification, selection and analysis process for all cardiac arrest patients is as accurate as possible within the timeframes of the submission dates of the DH ASCQI.
Priority 3 - Patient Experience a. Ensure we answer all concerns as quickly as possible
SCAS’s aim for 2012/13 relating to this priority was to respond to all complaints within the required 25 day time period at least 95% of the time. During the reporting period SCAS began implementation or completed the following initiatives in order to meet this target: »» Recruitment to increase our dedicated Patient Experience Team to 3 Patient Service Officers and a Head of Patient Experience
»» Distribution of a weekly update of all current concerns and enquiries to the heads of departments, to ensure they are aware of outstanding issues and matters awaiting resolution. This allows managers to prioritise individual cases »» Concerns received are noted and discussed where necessary at the executive weekly trigger conference call to ensure prompt attention »» The Head of Patient Experience has implemented a series of update briefing sessions with managers who may be required to investigate concerns, so that they may be reminded of best practice
»» Similar sessions on best practice in the handling of complaints are being included in clinical update training days Results of initiatives during 2012/13 Unfortunately actions taken have failed to result in complaints being resolved within 25 days at least 95%of the time. For the reporting year of 2012/13 SCAS resolved 86% of complaints within 25 days. Despite active recruitment to the Patient Experience Team, movement within this team has meant that we still require one additional Patient Services Officer.
This combined with increased service demand and a period of adjustment whilst the new team leader / team working structure was embedded, has meant that we have been unable to achieve our intended performance target. Initiatives going forward into 2013/14 »» Further recruitment to increase the Patient Experience Team »» Strengthen involvement of team leader management »» Continue to deliver our annual survey plan and introduce the Friends and Family Test (FFT)
109
Annual report 12/13 Priority 3 - Patient Experience b. Improve care for patients with dementia and learning disabilities
In June 2012 SCAS under took a patient experience survey which gathered feedback from people who have a learning disability, about their personal experience of using the ambulance service. Method: A short questionnaire was produced in an accessible (Easy Read) format. People who had used the ambulance service within the last year were invited to take part, and recruitment to the survey was completed by Options Day Centre staff.
Questions: 1. Did the ambulance come quickly? 2. Did the crew tell you their names? 3. Were the crew polite to you? 4. Did the crew tell you what they were doing? 5. Did you understand what they told you? 6. Were you involved in making choices about your treatment? 7. Were you happy with the treatment you had? 8. Were the crew nice and friendly to you? 9. Do you think you had good care? 10. Do you have any comments?
The purpose of the survey was explained to each participant, who was advised they did not have to answer any questions and could stop at any time.
110 Annual Report and Accounts 2012/13
Participants were asked to respond by indicating Yes, No, Don’t know / Can’t remember.
They were good
Don’t know / can't remember
No
Yes 4
Comments from participants
Number of respondents (n=4)
I was too poorly 3
2
I liked the lady because she had a nice smile
1
The man made me feel better
0 1
2
3
4
5
6
7
8
9
10
Question
111
Annual report 12/13 The data showed that the majority of respondents were very happy with the treatment they received from SCAS. There are plans to repeat this survey with a larger number of respondents in the coming months. In addition to this survey, other ways SCAS has addressed improving the care for patients with dementia and learning disabilities include: »» Partnerships with the Older People’s Mental Health Service in Southern Health have been strengthened, and work is progressing to develop a DVD learning resource on Dementia specifically for the ambulance service »» As part of the Dementia Clinical Fellowship (CF) a small survey of staff was completed relating to their experience of using the SCIE on-line learning resources for Dementia. The Kirkpatrick Model of Evaluation was used and this process is being evaluated as part of the CF project.
»» A small focus group has been established in Oxfordshire in conjunction with the local Alzheimer’s Society. This provides an opportunity for people who have dementia to contribute to developments within the ambulance service. »» In March 2012 we finished the DVD ‘First impressions’. This is used to inform frontline staff about key issues to consider when they are called to a person who has a learning disability. The script was produced using the lived experience of some people from Oxfordshire and Buckinghamshire LD services and they were also involved in the filming. »» A new link has been established with Milton Keynes Council creating potential access to additional dementia training resources.
112 Annual Report and Accounts 2012/13
»» Two new patient information leaflets in an accessible format specifically for patient with learning disabilities have been completed and are at the review stage prior to distribution. »» SCAS has supported a Paramedic to complete a one day course on accessible communication. SCAS now has access to the Valuing People ClipArt Collection and can produce Easy Read documents in-house using the ClipArt. »» A patient satisfaction survey of calls to the CSD regarding people over the age of 65 was completed in May 2012. The survey focused on qualitative aspects of the whole experience of using SCAS. The survey used 100 respondents and the response was very positive with 80% rating their patient experience as ‘excellent’.
Questions
%
Questions
%
1
In your opinion, was the call taker polite and courteous
81
10
See below
2
Did you understand everything they were asking you?
77
3
Were the instructions given clear and easy to understand?
79
In your opinion, did the ambulance arrive in a reasonable time?
88
5
Were the ambulance crew polite and courteous?
91
6
Did the ambulance crew introduce themselves 90 to you?
7
Did the ambulance crew explain why they were recording information about you and your condition?
82
8
Were you involved in the decisions affecting your or your family members care?
81
9
Were you happy with the treatment/care you or your family members received?
92
4
In your opinion how would you rate the patient experience Rating score
% of respondents
Excellent
10
80
Very good
8
11
Good
6
Fair
4
Poor
2
Very poor
0
No response
1
8
11
Given your experience, would you be confident in calling the ambulance service again?
12
Do you have any comments or suggestions on the service we provide? Five comments recorded: »» Couldn’t understand call taker very well »» Had to wait 40 minutes »» Had to wait 2.5 hours for ambulance »» Vehicle cold »» Referred to falls team
92
113
Annual report 12/13 »» Our first LD ‘Champion’ (a gentleman who has Asperger’s Syndrome) spoke very movingly at the Patient Safety Federation conference about his own experiences and his enthusiasm for becoming the first SCAS LD Champion. LD Champions will be included at every step in new developments and also the on-going monitoring and review of existing services. »» Other work the LD Champions have been involved in include the production of ‘Vehicle Communication Sheets’. These pictorial guides assist with communication when verbal skills are reduced »» A poster in an easy read made format detailing when to call an ambulance has been made available on the SCAS website with similar ones planned for other topics.
»» Self directed learning resources have been made available to staff, including approval of SCIE on-line resources about dementia. Roll out of this is now with Education Team. »» The next clinical development course will include in-depth face to face sessions on LD and Dementia, including input from patients with experience. Two x 2hr sessions have been produced on suicide risk assessment and self harm. »» In June 2012 SCAS ran two ‘open days’ in conjunction with LD service providers in Hants and Bucks. Service users were able to explore an ambulance and speak to a Paramedic. This type of event is extremely important in raising awareness and allaying fears. Both events were successful and awareness of Autism Alert Cards, Vehicle Communication Sheets and Health Passports were also included.
114 Annual Report and Accounts 2012/13
»» SCAS has taken expert advice regarding our Mental Capacity Assessment Forms (CAS150 v1.7) and they have been updated to include the following statement:
‘I have completed an assessment of capacity and reasonably believe that the patient does not have capacity to make the decision required at this time. I believe that the proposed care/treatment is in the patient’s best interests and is the least restrictive intervention, proportionate to the risk of not receiving further care/treatment” on our MCA assessment form to make it obvious that staff have followed due process, in accordance with the legislation’.
Priority 3 - Patient Experience c. Reduce the number of complaints about the attitude of our staff
SCAS take any complaint seriously but is particularly interested in reducing those that relate to staff attitude as we feel these are contradictory to our organisational aims. In light of the Francis Report, compassion, empathy and candour are even more relevant as a central theme to our approach. Update on initiatives for 2012/13 During 2012/13 SCAS undertook the following initiatives to try and reduce complaints relating to staff attitude:
»» A session on respect for patients and their next of kin and carers was included in the clinical update training days »» A similar session has also been included within the personal development plans of clinical staff »» Ensuring that awareness of the need for improved respect for patients is embedded in Trust practice by providing a ‘patient story’ to the Trust Board which is also used as a learning tool in education sessions
Results of initiatives during 2012/13
Initiatives going forward into 2013/14
Actions taken have resulted in a reduction of complaints in respect of staff attitude by 18%.
SCAS recognise how important it is that we continually improve in this area and we will be undertaking a further detailed analysis of complaints relating to attitude during 2013/14.
There have been 3 referrals to the Parliamentary Health Service Ombudsman by complainants in the last year. None of these were further investigated which clearly shows that the Trust is resolving complaints effectively.
»» A full audit was undertaken of all complaints relating to staff attitude to identify causes and possible trends
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Annual report 12/13 Performance of Trust against Selected Quality Metrics We have chosen to measure our performance against the following metrics: 2009/10
2010/11
2011/12
2012/13
76.35%
100%
63%
40.5%
100%
100%
(With target 45% higher than last year at start)
2009/10
2010/11
2011/12
2012/13
2,091
2,654
2,819
2,685
NPSA
80
291
218
(3.08% resulting in severe harm or death)
RIDDOR
96
97
126
53
Serious Incidents Requiring Investigation
29
21
17
23
191 (19 applicable to SCAS)
170
82 (5 applicable to SCAS)
Infection Control Training Infection control audits â&#x20AC;&#x201C; of target set 30 month
Adverse Incidents total reported
Alerts
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111%
356
2009/10
2010/11
2011/12
2012/13
Complaints
144
121
169
196
Feedback / concerns
790
666
554
692
Compliments
682
667
758
744
Clinical Outcome Measures Reported Aspect of Care
2008/09
2009/10
2010/11
2011/12
2012/13
National Average
Stroke
84.84
96.95
99.12
97.10*
96.70*
94.20*
STEMI
55.71
75.20
90.38
65.60*
68.00*
77.44*
Cardiac Arrest
44.11
47.01
51.50
55.59
56.60
N/A**
Asthma
74.40
81.51
92.37
95.03
94.93
93.62
Hypoglycaemia
97.24
97.43
99.17
99.69
99.72
89.29
* These figures are now taken from the Ambulance Service Clinical Quality Indicators and are measured differently to previous years. ** The cardiac arrest audit is no longer completed nationally so these figures are internal SCAS figures as the Trust has continued to monitor it for internal performance review
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Annual report 12/13 National targets and regulatory requirements Standard
Target
2008/09
2009/10
2010/11
2011/12
2012/13
Category A8 (Red 1 & 2) â&#x20AC;&#x201C; life threatening emergency calls who should receive an emergency response within 8 minutes
75%
72.60%
74.80%
77.5%
75.9%
76%
Category A19 (Red 1 & 2) life threatening emergency calls which require a fully equipped vehicle that should receive a response within 19 minutes
95%
94.40%
92.70%
95.3%
95.3%
95.5%
Category B 19 Non threatening but serious cases which must receive a response within 19 minutes * Note that SCAS has met the local commissioned target
95%
88%
88.30%
91.4%
90.8%
90%
92%
91.4%
91%
Reperfusion - Primary angioplasty (PCI) Call to balloon *note this is the first year for complete figures
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75% in 150 minutes
SCAS motorcycle Paramedic
Annual report 12/13 Other Quality Successes in 2012/13 The next section of this report highlights other successes in quality improvement which SCAS has made to improve the quality of our services to patients. »» SCAS implements ‘see and treat’ and ‘hear and treat’ more effectively than any other Ambulance service in England, with 43% of all our patients being referred through alternative care pathways, avoiding unnecessary A & E admissions.
NHS 111 service
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»» SCAS successfully tendered for the new 111 nonemergency telephone helpline service. This service started as a pilot for 2 years in Oxfordshire before going live in Autumn 2012. Hampshire came online in January 2013 and Berkshire is due to follow in Summer 2013. We work in partnership with Milton Keynes and Buckinghamshire. This number will in time completely replace NHS direct and the OOH GP service telephone numbers, giving the public a single point of access for non emergency care and advice. »» A framework of Standard Operating Procedures (SOP’s) have been developed for the 111 service. »» The majority of 111 and EOC staff have been trained to level 2 safeguarding for vulnerable adults and children, with training ongoing for remaining personnel.
»» In order to maximise educational opportunities and provide a more flexible approach to training the Trust has begun providing E Learning (electronic learning). This exciting and innovative development is reducing avoidable travel, offering flexibility for staff and reducing unnecessary costs. »» SCAS started the year 12th in a league table of 12 ambulance trusts for uptake of E learning resources but with the hard work and commitment of the Education Team it has now reached 2nd place nationally.
»» SCAS implemented the E-learning online system by creating its own IT platform to make use of existing software and resources. Through this medium staff can access 150 modules on a wide variety of topics which cover statutory and mandatory training, areas of key significance for SCAS and subject areas for Continued Professional Development (CPD). In addition to this staff can also access British Medical Journal (BMJ) modules.
Main uses and subject areas already covered by e learning are: »» »» »» »» »» »» »»
Information governance - Mandatory Fire training - Mandatory Infection Control – Mandatory Urinalysis (modules 1 & 2) Morphine for nurses Codeine PGD Falls RAG Project
New modules coming online in 2013/14: »» »» »» »» »» »» »»
Open dementia programme Autism Obstetrics Hyperventilation Syncope Sepsis Driving and driver safety
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Annual report 12/13 »» SCAS has offered staff computer skills courses through the National Learning Management System using their E learning user name and password. »» Face to face educational delivery has continued in the form of ‘Winter Workshops’ which have offered registrants courses in end of life care, chronic diseases, obstetrics and mentoring. The obstetric module has been filmed and will be made available on the E learning system so all staff can access it. »» Clinical Support Desk clinicians and our Emergency Care Practitioners have also undertaken 10 key modules relating to treatment pathways and ‘ethical approach’ through a combination of face to face delivery and E learning. »» During 2012/13 nonregistrants have also been offered mentorship courses for the first time.
»» SCAS undertook a viral video campaign utilising the social media site ‘You Tube’, to circulate educational videos under the banner of ‘Abuse Costs Lives’, in order to educate the public about inappropriate use of the service. This campaign won the trust a bronze award at the International Visual Communications Association Awards in 2012 and silver & bronze awards at the Institute of Practitioners in Advertising ‘Best of Health’ Awards 2012.
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SCAS Misue Costs Lives campaign livery on rapid response vehicle
»» The Hazardous Area Response Team (HART) and The Resilience and Specialist Operations Department have been constantly engaging in training, discourse and debriefs with other agencies such as Fire, Police, Coastguard, The MOD and other Industrial Operators, in order to build strong relationships. They have forged close contacts with key decision makers in every service, ensuring in-depth understanding of each other capabilities which is resulting in better patient care and best practice when it really matters.
»» HART team members are capable of cascading their specialist knowledge to all SCAS operational staff and have been doing so in the form of a set of training packages detailing subjects such as Trauma, Personal Protective Equipment, Radiation, Firearms, and Chemicals. They have been attending team training days to speak to staff in groups of around 20 per session. »» HART and the Resilience & Specialist Operations Department have been working closely with the EOC to ensure that the best possible actions are taken in response to Firearm, CBRN and other serious incidents. Specialist dispatcher protocols are now embedded and supported by a team of 6 Tactical Advisors who oversee the command process.
HART Polaris 6 x 6 all terrain vehicle
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Annual report 12/13 »» HART has added new equipment to their already impressive array of kit and vehicles. They have increased their number of tents and lighting rigs for large scale incidents and can now add heating capability. »» HART has also added a multi terrain vehicle to their fleet. The Polaris 6x6 is capable of scaling all surfaces and gradients and has been deployed 25 times in the last few months alone. This means that rural communities who are often cut off by extremes of weather can now be reached with ease whatever the time of day or night.
»» HART has also begun to add their skills to the Education Team by installing a Clinical Skills laboratory within their building. Here new staff, community responders and student paramedics can practice their skills under supervision. Plans are being implemented to install video cameras in all the training rooms so that students can review their performance in order to further aid their learning. »» Over 300 school children and more than 100 air cadets have spent time at the HART base learning about their work and that of SCAS in general, which has helped to raise the profile of the Trust within the local community.
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»» There has been continued improvement of availability and access to acute and hyper-acute stroke pathways across South Central, working with the South Central Cardiovascular Network to ensure that stroke patients receive the best care, using the latest technology to provide a full active life after treatment wherever possible. »» The SCAS website has been used to front the ‘Choose Well’ campaign which offers advice to the public on which healthcare service is best for them to access depending on the ailment. »» We continue to build and develop the Clinical Support Desk which is changing the way we care for our patients in the pre hospital setting. This helps many of our patients to be assessed and treated in their own homes reducing the need to convey patients to acute hospitals.
»» The Clinical Support Desk has taken over interactions with our Emergency Care Practitioners to ensure they are tasked as effectively as possible.
»» SCAS was involved with the development of National Norovirus pathways for both frontline and patient transport vehicles, which have been ratified by the RCN and implemented throughout the trust. »» The SCAS website has also been used as a tool to pass on the NHS ‘Flufighter’ message this winter. »» SCAS achieved a level 1 assessment in October 2012 when it was undertaken by the NHS Litigation Authority. Our aim is to achieve level 2 in the next two to three years. »» SCAS has continued its executive and non executive leadership walkabouts; which are a structured review of clinical areas and resource centres combining quality reviews with infection control, cleanliness and information governance requirements. This process also acts as an opportunity for staff to discuss practice issues with the executives.
»» Our Integrated Performance Report is robustly monitored and challenged in terms of quality performance indicators. »» We have introduced a ‘Medicines Sub Group’ to the Clinical Review Group. »» To ensure best practice proven by clinical research we have introduced five new medications to our Paramedic drugs remit and made them available on all SCAS resources: ›› Tranexamic Acid Promotes clotting in catastrophic hemorrhage ›› Ondansetron - Anti sickness ›› Codine - Pain relief ›› Oral Morphine - Pain relief ›› IV Paracetamol - Pain relief
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Helimed 56 - Hampshire and Isle of Wight Air Ambulance
Annual report 12/13 Statement of Directors’ Responsibilities in respect of the Quality Report
As outlined in the NHS Foundation Trust Annual Reporting Manual 2012/13 (Monitor). The directors are required under the Health Act 2009 and the National Health Service Quality Accounts Regulations to prepare Quality Accounts for each financial year. Monitor has issued guidance to NHS foundation trust boards on the form and content of annual quality reports (which incorporate the above legal requirements) and on the arrangements that foundation trust boards should put in place to support the data quality for the preparation of the quality report.
In preparing the Quality Report, directors are required to take steps to satisfy themselves that: »» the content of the Quality Report meets the requirements set out in the NHS Foundation Trust Annual Reporting Manual 2012/13; »» the content of the Quality Report is not inconsistent with internal and external sources of information including:
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»» Board minutes and papers for the period April 2012 to June 2013 »» Papers relating to Quality reported to the Board over the period April 2012 to June 2013 »» Feedback from the commissioners dated 13/05/2013
»» Feedback from governors dated 30/01/2013 »» Feedback from local Healthwatch organsiations dated 29/04/2013 »» The Trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, dated 30/04/2013; »» The [latest] national patient survey (not applicable to ambulance services currently) »» The [latest] national staff survey 28/02/2013 »» The Head of Internal Audit’s annual opinion over the Trust’s control environment dated 08/04/2013 »» CQC quality and risk profiles dated 29/03/2013
»» the Quality Report presents a balanced picture of the NHS Foundation Trust’s performance over the period covered; »» the performance information reported in the Quality Report is reliable and accurate; »» 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;
»» 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 the Quality Report has been prepared in accordance with Monitor’s annual reporting guidance (which incorporates the Quality Accounts regulations) (published at www.monitor-nhsft.gov. uk/annualreportingmanual) as well as the standards to support data quality for the preparation of the Quality Report (available at www.monitor-nhsft.gov.uk/ annualreportingmanual).
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 NB: sign and date in any colour ink except black
Trevor Jones Chairman Date: 29 May 2013
Will Hancock Chief Executive Date: 29 May 2013
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Annual report 12/13 Statements from the local Involvement Networks, the Overview and Scrutiny Committees, Commissioners and CQC A request was sent to all Health and Overview and Scrutiny committees and commissioners in February 2013 outlining our progress with our Quality Accounts and the proposed priorities for 2013/14. The following statements were received:
I have read your letter and at this time I have nothing to add. Thank you for contacting me. Chris Maskell Chair EOSC Reading Borough Council Councillor for Battle ward
I have looked at what is proposed and would make the following observations: 1. The structure of the report seems fine. Comprehensive. 2. One possible inclusion is a section commenting on direction of travel or strategic vision, perhaps after the bullet point on statutory requirements and before the priorities section. I look forward to reviewing the report, when it comes to my committee. Cllr Nigel Long Chair MKC Health and Adult Social care select committee.
â&#x20AC;&#x2DC;Members of the Wokingham Health Overview and Scrutiny Committee have reviewed the proposed areas and priorities for 2013/14 Quality Accounts. Members have noted the priorities and made the following comments: Members felt that it was difficult to comment on the suitability of the priorities at this stage as it was not clear how they would be achieved. Members questioned how the South Central Ambulance Service Trustâ&#x20AC;&#x2122;s priorities compared with those of other Ambulance Service Trusts. The Committee would welcome a copy of the final report when it is published. With regards to Priority 1 Members agreed that this was a relevant priority but felt that this should also cover excellent hygiene standards so as to avoid MRSA.
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Avoidance of severe harm incidents in particular was considered an appropriate priority. A Member commented that it was important that competence was high and communication skills good so as to minimise erroneous or incomplete information. Hopefully by cross-checking data if in doubt, accidental but harmful outcomes, would be avoided. A Member also questioned whether ensuring regular ambulance maintenance should also be covered as part of this priority. Whilst Members felt that Priority 2 Clinical Effectiveness was a relevant target they questioned how it would be achieved. With regards to Priority 3 Patient Experience sub category Using Feedback from patients and family/friends (and professionals) to improve the patients experience, a Member commented that when discharging a patient from hospital to go home, whether a day-visitor or a posttreatment resident, when an ambulance or similar transport or a skilled crew is needed, the wait for a vehicle could be long.
Buckinghamshire Health Overview and Scrutiny Committee support the chosen priorities. Improvements to the DH Core Indicators are particularly relevant in South Buckinghamshire. We would also like to highlight the following areas which are likely to be a factors in Priority 2 Clinical Effectiveness: »» The reliability and maintenance levels of your vehicles, and the need to ensure that service levels are not affected by vehicle reliability »» The need to work with hospital trusts to reduce patient handover delays Thank you for consulting with the HOSC on this. Regards James Povey Overview and Scrutiny Buckinghamshire County Council
Kind regards Madeleine Shopland Principal Democratic Services Officer Business Assurance & Democratic Services Wokingham Borough Council
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Annual report 12/13 Buckinghamshire HOSC Comment on South Central Ambulance Service NHS FT Quality Account 2013
We will continue to monitor this situation at our local hospitals. The Committee thanks the trust for its positive engagement with us during 2012/13.
Thank you for inviting comment from the Buckinghamshire County Council Health Overview and Scrutiny Committee on the trustâ&#x20AC;&#x2122;s 2012/13 quality account. During 2012 three of our committee members had the opportunity to shadow some of your ambulance crews on a shift. The members fed back some observations to the committee at our meeting in November. We also had an item on SCAS at our September meeting. It was observed during the shadowing that some of the ambulances seemed quite old. There is no information in the quality account on the age of the fleet, although maintenance of it was noted under priority 1c. Could some information on fleet age and renewal programmes be included? At our September meeting it was apparent that Red 8 response times for 2012 year to date had improved on 2011/12 levels in our four districts, but that these were still below target notably in Chiltern and South Bucks. Given this variance, it would be good if the quality account could summarise Red 8 performance variance at smaller spatial scales. This is of particular interest given the increased demand on the service experienced in 2012/13. During the shadowing of crew it was evident delays were being incurred at hospitals, and we are concerned to read these increased from October 2012 onwards. We recognise SCAS have made attempts to address this, and at our September HOSC it was clear come hospitals generate greater delays for SCAS than others.
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Many thanks for your email with the Annual Quality Reports for SCAS. As you will know Healthwatch Hampshire came into being on 1st April 2013. Due to the transition from LINks, it is unfortunate timing for Healthwatch to comment. We look forward to further communications as things progress. Best wishes Sarah Peters Healthwatch Hampshire
Extract from: Health and Adult Social Care Select Committee Quality Accounts Panel Report 9 April and 7 May 2013 i. It was not clear from the report whether or not all the local authorities in the area covered by the South Central Ambulance Trust were being asked to comment on the Quality Account; ii. If all local authorities were being asked to comment, then the lack of local information was considered to be unhelpful in understanding the local picture. A massive overview with statistics for the whole area was not meaningful on a local basis; iii. The Quality Account appeared to be written for an internal NHS readership, rather than a document that could be read and understood by the general public; iv. It was not clear whether the Service operated solely in the areas covered by the map on page 5 – for example, if called to a patient in Milton Keynes and the nearest appropriate care was provided by Bedford Hospital, whether the patient would be taken to Bedford, or whether they would be taken to a hospital in the South Central Area providing the same care, but which was further away; v. Ambulance Response Times (page 17) – the Panel would have liked to have seen the actual figures, as well as percentages, cited in this part of the Account. (Formatting note – point 2 is missing the % sign); vi. On page 23 the Panel thought that “Reduce the variability of station cleanliness” as a priority under Clinical Effectiveness was meaningless as a statement of intent. They understood what the Account was trying to say but felt that the aim could be expressed in a clearer, more robust and positive manner; vii. On pages 67 & 73 the charts needed to be reformatted slightly so that the legends could be read properly; viii. In relation to the chart on page 73 (Hospital Handover Delays) the
Panel would have been interested to know how many hospitals were covered by the data in the chart and whether there were local variations – ie was one area worse than another? ix. The Panel noted that the introduction of the 111 call number to replace NHS Direct was being phased in gradually across the region. They would be interested to review the impact of this new facility on the Milton Keynes area in the 2014 report. Milton Keynes HOSC
I forward West Berkshire Councils Health Scrutiny Panels response. 1) The Health Scrutiny Panel (HSP) welcomed the high standards attained by the trust. 2) In reviewing the outcomes of the priorities set for 2012/13 the HSP congratulate the Trust in its achievements and improvements. It notes the CQC’s report on Dignity and Nutrition for older people, and its outcomes. The results which complements the questionnaire responses commissioned by the HSP and carried out by LINK. 3) We note the Priorities for 2013/4 and the rational on how the Trust expects to reach its goals. 4) The Board appears to be assured of the monitoring systems in place and we urge them to regularly review all procedures and systems and test data and quality of recording robustly. Quentin Webb Chairman Health Scrutiny Panel
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Annual report 12/13 Fareham & Gosport Clinical Commissioning Group and the Associate Commissioners welcomed the opportunity to participate in the governance “sign off” process for the 2012/2013 Quality Account of South Central Ambulance Service NHS Foundation Trust (SCAS) – 999 Services Commissioner Statement Commissioners have a positive and inclusive working relationship with SCAS. They have embraced the new architecture of the NHS, working collaboratively with the newly established Clinical Commissioning Groups. This is evidenced through clinical engagement and partnership working to address identified quality development priorities across the health system. Following a clinical governance review by commissioners, SCAS are working collaboratively to review and further develop assurance around the governance structures for quality and safeguarding. In addition commissioners have engagement in the internal quality assurance meetings. In light of this review and the on-going actions in relation to the assessment against the Quality Governance Framework for MONITOR, commissioners will continue to be proactively involved in the process for quality assurance and delivery of actions arising. SCAS have embraced the opportunity to discuss commissioner feedback on any quality developments identified. This has been considered against the real challenges of expanding services and activity, for example, the 111 Service, as well as capacity issues, cost pressures and the ongoing development requirements for governance and safeguarding arrangements for children and adults.
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Report Structure The quality account provides information across the three elements of quality. These are: »» patient safety »» patient experience »» clinical effectiveness. It is important to note that the account clearly sets out how the learning from the Independent Inquiry report (2013) by Robert Francis QC will be driven through the organisation. An example of this is SCAS’ intention to continue to embed quality in the values, behaviours and strategic themes of the organisation. Their aspiration to remain a top performing ambulance service is welcomed and commissioners are committed to supporting the delivery of this through monitoring progress and analysis of performance against the key quality and performance priorities and engaging with SCAS to address whole health system issues. The account incorporates the mandated elements required and SCAS have used a variety of quality intelligence and external consultations with stakeholders to support the development of the quality priorities for 2013/2014. External assurance mechanisms have also featured in the assessment of the quality position to date, for example audits, surveys and benchmarking outcomes of care.  SCAS quite rightly outline the findings from the Care Quality Commission inspection in November 2012 which identified further work was required to ensure full compliance with outcome 8 (cleanliness and infection control) of the essential standards of quality & safety. Commissioners support this as a safety priority for 2013/2014 in conjunction with vehicle maintenance.
Quality Improvement Priorities for 2013/2014 SCAS has outlined its priorities for 2013/2014 and commissioners support the process SCAS has used to identify these and the priorities chosen. Patient Safety: Commissioners welcome the inclusion of continuous development of a safety culture within the organisation; including ensuring lessons are learnt from patient safety incidents and look forward to reviewing the outcomes achieved. It would be good to see the inclusion of safeguarding alerts, serious case reviews and safeguarding training data along with in year developments for future reports. The development of the falls pathway is a positive step and will help to ensure patients receive the appropriate treatment in a timely and effective way. It is evident that work has progressed on sharing information with partnership organisations in the form of anticipatory care plans and commissioners are keen for this to expand and improve further in the forthcoming year. We welcome improvements through the use of electronic patient records in supporting the recording of patient care interventions and the use of this information to direct care delivery. Clinical Effectiveness Commissioners support the aspiration for SCAS to continuously improve on performance for stroke and heart attacks. This includes the monitoring mechanisms they are establishing to drive performance, including external reviews. Likewise it is good to see a priority focus on waiting times, the intention to audit dispatch decisions and review high demand areas to maximise efficiency. Commissioners would welcome whole system working to ensure care is co-ordinated across partner organisations.
Patient Experience SCAS are embracing the principles of the “Friends and Family Test” and trialling this in front line services. Commissioners are keen to see the outcomes of this initiative. We are also supportive of the inclusion of partner agencies in the assessment of patient experience, and the intention to engage with health care professions to exchange opportunities for learning. Achievements reported against 2012/2013 priorities and overall Quality Performance Achievements against objectives and targets in 2012/2013 are outlined in Part 3 of the statement. Patient feedback is of equal value when assessing the delivery of quality and SCAS have outlined the 18% reduction in complaints concerning “staff attitude” as well as the numbers of incidents arising. It would be positive to have included more comparable data. There is good evidence of learning from feedback and this is demonstrated well in the “You said, we did” section of the account (Part 3). SCAS have reported organisational compliance for meeting the national targets on response times and this position is welcomed. It would be good to see how delays differ in urban and rural areas and the challenges and actions to eliminate delays across these demographics. Commissioners are also encouraged to see this is a maintained priority for 2013/2014 in conjunction with trajectories for reduction of long waits.
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Annual report 12/13 It will be good to see continued robust management of this alongside the monitoring of patient outcomes and patient experience as a result of delays. Ensuring appropriate deployment of resources and maintenance of vehicles will be crucial to the delivery of this. A key factor will also be whole system working to minimise delays in handing over patients to acute hospitals and commissioners welcome the pledge to continuously work in partnership to address this issue.
Data is given around performance against national targets and regulatory requirements. It would have been good to see this presented at cluster level.
It is encouraging to note the outcomes reported for compliance with the stroke care bundle. However the challenge of consistently meeting the stroke transfer times to acute hospital remains. It is also good to see a continued focus on compliance with the ST elevated myocardial infarction care bundle and return of spontaneous circulation performance.
SCAS quite rightly set out their aspiration to support quality through use of accurate relevant and useful information and commissioners are keen to ensure data quality is improved in the coming year and embedded across all services. It would have been good to see specific goals in relation to data challenges, for example full utilisation of NHS numbers and postcodes. Commissioners are committed to monitoring the progress of data quality and supporting improvements which will aid effective whole system working.
The patient experience priorities for 2012/2013 have been partially met. SCAS quite rightly state their commitment to responding to complaints within a designated time frame. This has been an on-going challenge in 2012/2013 and commissioners welcome the additional recruitment to ensure compliance. Staff attitude is a top reported complaint and it is good to see continued work to improve this. Commissioners also welcome the improvements made in call answering times and are keen to ensure these remain a continued picture of improvement in 2013/2014. Commissioners will be supporting the development of a care pathway for more vulnerable groups, for example patients suffering with mental health problems and we look forward to seeing the outcomes of this investment.
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SCAS reference the Commissioning for Quality incentive schemes and although detail on achievement is not included, a web link is given. Data Quality
Clinical Audit and Research The clinical audit section details that SCAS report they have participated in 100% of eligible national clinical audits and that zero national confidential enquiries were applicable. The data contribution to these audits is shown at 100%.
Commissioner Assessment Summary This account demonstrates the many positive outcomes that have been achieved during 2012/2013. It is also evident that quality priorities have been drawn from analysis against challenges experienced in 2012/2013, for example the CQC assessment. It is good to see that there is an intention to continue to strengthen the governance process, identified through MONITOR assessment and commissioner governance reviews. This will be a key piece of work in ensuring the continued robustness of assurance and governance throughout the organisation and commissioners welcome the opportunity to work in partnership to gain continued assurance that the reviews result in sustained improvements. Richard Samuel Chief Officer Fareham & Gosport and South Eastern Hampshire Clinical Commissioning Groups
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Annual report 12/13 Glossary AACP ACP ACS AMPDS ATP BASICS BMJ CAD CARS CBRN CCG CEO CF CFR CNST CPD CPI CQC CQUIN CSD DH ECP ECT EOC EoLC ePRF FFT FT
Ambulance Anticipatory Care Plan Anticipatory Care Plan Acute Coronary Syndrome Advanced Medical Priority Dispatch System Adenosine Triophosphate Testing British Association for Immediate Care British Medical Journal Computer aided dispatch system Clinical Audit Record System Chemical, Biological, Radiological, Nuclear Clinical Commissioning Group Chief Executive Officer Clinical Fellow Community First Responder Clinical Negligence Scheme for trusts Continuous Professional Development Clinical performance indicator Care Quality Commission Commissioning for Quality and Improvement Clinical support desk Department of Health Emergency care practitioner Emergency Call Taker Emergency Operations Centre End of Life Care Electronic Patient Report Form Friends and Family Test Foundation trust
138 Annual Report and Accounts 2012/13
HALO HART HCP HOSC JRCALC LD MINAP NHSLA PALS PCI PCT PCR PERG PRF PPCI PTS RAG RCN ROSC SCAS SCIE SHA SID SIRI SLA SOP STEIS STEMI TARN TUB uDNACPR
Hospital Ambulance Liaison Officer Hazardous Area Response Team Health Care Provider Health Overview and Scrutiny Committee Joint Royal Colleges Ambulance Liaison Committee Learning Disability Myocardial Ischaemia National Audit Project NHS Litigation Authority Patient Advice and Liaison Service Primary angioplasty Primary Care Trust Patient Clinical Record Patient Experience Review Group Patient Report From Primary Percutaneous Coronary Intervention Patient Transport Services Red, Amber, Green Royal College of Nursing Return of spontaneous circulation South Central Ambulance Service NHS Foundation trust Social Care Institute for Excellence Strategic Heath Authority (NHS South Central) Serious Incident Desk Serious Incidents Requiring Investigation Service level agreement Standard Operating Procedure Strategic Executive Information System ST elevation myocardial infarction (Heart Attack) Trauma Audit and Research Network Trauma Unit Bypass Unified Do Not Attempt Cardio-Pulmonary Resuscitation
Invite to Feedback on the Quality Account Please tell us what you thought of this report. »» Did you find it useful? »» Did the report tell you what you wanted to know? »» Do you agree with our priorities for 2013/14? »» Is there anything else you would like to see included in future reports? Please tell us by contacting SCAS in the following ways: Email: debbie.marrs@scas.nhs.uk Phone: 01869 365159 Post: Debbie Marrs Interim Director of Quality and Patient Care South Central Ambulance service NHS Foundation Trust 7 - 8 Talisman Business Centre Talisman Road Bicester Oxfordshire OX26 6HR Please note that the minutes for all SCAS committee meetings are also available on request.
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Annual report 12/13 Independent Auditor’s Report to the Council of Governors of South Central Ambulance Service NHS Foundation Trust We have been engaged by the Council of Governors of South Central Ambulance Service NHS Foundation Trust to perform an independent assurance engagement in respect of South Central Ambulance Service NHS Foundation Trust’s Quality Report for the year ended 31 March 2013 (the “Quality Report”) and certain performance indicators contained therein. Scope and subject matter The indicators for the year ended 31 March 2013 subject to limited assurance consist of the national priority indicators as mandated by Monitor: »» Category A call - emergency response within 8 minutes; and »» Category A call - ambulance vehicle arrives within 19 minutes. We refer to these national priority indicators collectively as the “indicators”. 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.
140 Annual Report and Accounts 2012/13
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: »» 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; »» the Quality Report is not consistent in all material respects with the sources specified in the Detailed Guidance for External Assurance on Quality Reports; and »» the indicators in the Quality Report identified as having been the subject of limited assurance in the Quality Report are not reasonably stated in all material respects in accordance with the NHS Foundation Trust Annual Reporting Manual and the six dimensions of data quality set out in the Detailed Guidance for External Assurance on Quality Reports. 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.
We read the other information contained in the Quality Report and consider whether it is materially inconsistent with: »» Board minutes for the period April 2012 to May 2013; »» Papers relating to Quality reported to the Board over the period April 2012 to May 2013; »» Feedback from the Commissioners dated 13 May 2013; »» Feedback from Governors dated 31 January 2013; »» Feedback from local Healthwatch organisations dated 29 April 2013; »» The Trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, 2012/13; »» The 2012/13 national staff survey; »» Care Quality Commission quality and risk profiles 2012/13; and »» The 2012/13 Head of Internal Audit’s annual opinion over the Trust’s control environment dated 08 April 2013.
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 South Central Ambulance Service 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 2013, to enable the Council of Governors to demonstrate they have discharged their governance responsibilities by commissioning an independent assurance report in connection with the indicators. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Council of Governors as a body and South Central Ambulance Service NHS Foundation Trust for our work or this report save where terms are expressly agreed and with our prior consent in writing.
We consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with those documents (collectively, the “documents”). Our responsibilities do not extend to any other information. We are in compliance with the applicable independence and competency requirements of the Institute of Chartered Accountants in England and Wales (ICAEW) Code of Ethics. Our team comprised assurance practitioners and relevant subject matter experts.
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Annual report 12/13
Assurance work performed
Limitations
We conducted this limited assurance engagement in accordance with International Standard on Assurance Engagements 3000 (Revised) ‘Assurance Engagements other than Audits or Reviews of Historical Financial Information’ issued by the International Auditing and Assurance Standards Board (‘ISAE 3000’). Our limited assurance procedures included:
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 impact 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 thereof, 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.
»» Evaluating the design and implementation of the key processes and controls for managing and reporting the indicators. »» Making enquiries of management. »» Testing key management controls. »» Limited testing, on a selective basis, of the data used to calculate the indicator back to supporting documentation. »» Comparing the content requirements of the NHS Foundation Trust Annual Reporting Manual to the categories reported in the Quality Report. »» Reading the documents. 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.
142 Annual Report and Accounts 2012/13
The scope of our assurance work has not included governance over quality or non-mandated indicators which have been determined locally by South Central Ambulance Service NHS Foundation Trust.
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 2013: »» 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; »» the Quality Report is not consistent in all material respects with the sources specified above; and »» 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.
Jonathan Brown, for and on behalf of KPMG LLP, Statutory Auditor Chartered Accountants 100 Temple Street Bristol BS1 6AG 29 May 2013
143
SCAS Hazardous Area Response Team (HART) specialist vehicles
HOW WE ARE ORGANISED 146 Annual Report and Accounts 2012/13
Board of Directors The Trust’s Board of Directors (the “Board”) held seven Board meetings in public between 1 April 2012 and 31 March 2013. The agendas, papers, presentations, and minutes of Board meetings are available on the Trust’s website.
Decisions taken by the Board and delegated to management The Board has overall and collective responsibility for the exercise of the powers and the performance of the Trust, and its duties include to: »» provide effective and proactive leadership of the Trust »» ensure compliance with the terms of authorisation, constitution, mandatory guidance issued by Monitor, and other relevant statutory obligations »» 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
»» 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 »» ensure that the Trust exercises its functions effectively, efficiently and economically, including in relation to service delivery »» set the Trust’s visions, values and standards of conduct and ensure that its obligations to patients and other key stakeholders are delivered.
All Board members (executive and non-executive) have joint responsibility for decisions of the Board and share the same liability. All members also have responsibility to constructively challenge the decisions of the Board and help develop proposals on priorities, risk mitigation, values, standards and strategy. The 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.
147
Annual report 12/13 Board of Directors performance evaluation and review
Executive Directors
Non Executive Directors
Board of Directors balance Throughout 2012/13, the Board comprised seven Directors from the Executive Team, including the Chief Executive, and seven Non Executive Directors, including the Chairman. All Board members had voting rights.
The Board continually reviews its composition and considered that the composition of the Board during 2012/13 reflected the skills and competencies required to enable the Trust to fulfil its obligations.
148 Annual Report and Accounts 2012/13
The evaluation of the impact and effectiveness of the Board and its committees are undertaken collectively via an internal review. The Board has a systematic approach to assessing its collective performance including through appraisal and away days. Reviews of the effectiveness of the key Board committees (e.g. Audit, Quality and Safety and Remuneration) are undertaken annually and presented to the Board. Governance The Board uses Monitorâ&#x20AC;&#x2122;s NHS Foundation Trust Code of Governance as best practice advice to improve governance practices across the Trust. Furthermore the effectiveness of the Trustâ&#x20AC;&#x2122;s governance arrangements is regularly assessed, including through internal audit.
The Trust had only one area of non-compliance with the Monitor Code during 2012/13, in terms of not having a majority of Non Executive Directors on the Board. However, the Trust considered that any risks associated with this were negated through the Trust Chairman (as a non-executive) having a second/casting vote in the relatively exceptional circumstances where a Board vote is required. That said, there are plans to make some refinements to the Board in 2013/14 and this will mean that there will be a majority of Non Executive Directors on the Board. The Trust was compliant with its Constitution at all times throughout 2012/13. 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.
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. Non Executive Directors Non Executive Directors are members of the Board of Directors. They are not involved in the day to day running of the business, but are instead guardians of the governance process and monitor the executive activity as well as contributing to the development of strategy. They have four specific areas of responsibility – strategy, performance, risk and people – and should provide independent views on resources, appointments and standards of conduct.
Non Executive Directors have a particular duty to ensure appropriate challenge is made, and that the Board acts in the best interests of the public. They should: »» bring independence, external skills and perspectives, and challenge strategy development »» scrutinise the performance of, and hold to account, the executive management in meeting agreed objectives, receive adequate information, and monitor the reporting of performance »» 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
»» 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.
149
Annual report 12/13 During 2012/13 the Trust had seven voting Non Executive Directors â&#x20AC;&#x201C; all of which are independent - with no in-year changes: Non Executive Director
Date appointed to FT Board
Current term of office
Trevor Jones (Chair)
1 March 2012
31 March 2015
Alastair Mitchell-Baker (Vice-Chair / Senior Independent Director)
1 March 2012
28 February 2016
Ilona Blue
1 March 2012
28 February 2015
Claire Carless
1 March 2012
31 January 2015
Keith Nuttall
1 March 2012
31 March 2014
Eddie Weiss
1 March 2012
7 June 2014
Professor David Williams
1 March 2012
31 December 2014
All Non Executive Directors are on their first term of appointment to the Foundation Trust Board, with the exception of Alastair MitchellBaker who is on his second having been reappointed by the Council of Governors for a three year period from 28 February 2013.
During the early part of 2013/14 the Council of Governors agreed to extend the current appointment term of Eddie Weiss by one year (from 7 June 2013 to 7 June 2014) to allow the Trust to run a competitive recruitment process for the appointment of a Non Executive Director.
150 Annual Report and Accounts 2012/13
Details of each Non Executive Director Board member, including any declared interests, can be seen on the Trustâ&#x20AC;&#x2122;s website at www.scas.nhs.uk
Executive Directors The Executive Directors are responsible for the day-to-day running of the organisation, and the Chief Executive, as Accounting Officer, is responsible for ensuring that the organisation works in accordance with national policy and public service values, and maintains proper financial stewardship. The Chief Executive is directly accountable to the Board for ensuring that its decisions are implemented.
At the end of the 2012/13 financial year there were seven voting Executive Directors on the Trust Board:
Executive Director
Position
Will Hancock
Chief Executive
Fizz Thompson
Director of Patient Care / Deputy Chief Executive
John Black
Medical Director
Duncan Burke
Director of Communications and Public Engagement
John Nichols
Interim Chief Operating Officer
Charles Porter
Director of Finance
James Underhay
Director of Strategy and Business Development
Ian Ferguson also served on the Trust Board during 2012/13, leaving in June 2012, being replaced by John Nichols.
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
Fizz Thompson left the Trust on 31 March 2013.
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Annual report 12/13 Board committees The Board has four committees: Audit, Quality and Safety, Remuneration and Nominations, 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 are Eddie Weiss (Chair), Ilona Blue, and Keith Nuttall, and five meetings were held during 2012/13. 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 are Keith Nuttall (Chair), Professor David Williams, and Alastair Mitchell-Baker, and six meetings were held during 2012/13.
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 are Alastair MitchellBaker (Chair), Trevor Jones, and Claire Carless, and nine meetings were held during 2012/13. The Charitable Funds Committee acts with delegated authority from the Board as the Corporate Trustee on all issues relating to the administration and use of Trust Funds (or non exchequer funds), its members are Claire Carless (Chair) and Eddie Weiss, and three meetings were held during 2012/13.
152 Annual Report and Accounts 2012/13
Trust Board
Audit Committee
Quality and Safety Committee
Remuneration Committee
Charitable Funds Committee
7
5
6
9
3
Trevor Jones
7
N/A
N/A
9
N/A
Alastair Mitchell-Baker
4
N/A
4
8
N/A
Ilona Blue
5
4
N/A
N/A
N/A
Claire Carless
7
N/A
N/A
8
3
Keith Nuttall
7
5
5
N/A
N/A
Eddie Weiss
7
5
N/A
N/A
3
Professor David Williams
6
N/A
6
N/A
N/A
Will Hancock
6
N/A
N/A
N/A
N/A
Fizz Thompson
6
N/A
6
N/A
N/A
John Black
6
N/A
3
N/A
N/A
Duncan Burke
7
N/A
N/A
N/A
N/A
Ian Ferguson
1/2
N/A
1/1
N/A
N/A
John Nichols
5/5
N/A
4/5
N/A
N/A
7
5
N/A
N/A
3
3/3
N/A
N/A
N/A
N/A
Name Total meetings NON EXECUTIVE DIRECTORS
EXECUTIVE DIRECTORS
Charles Porter James Underhay
153
Emergency Services Day at Newbury Racecourse.
Council of Governors Background The Trust’s Council of Governors (CoG) play an essential role in the governance of South Central Ambulance Service NHS Foundation Trust, providing a forum through which the Board of Directors is accountable to the local community. The Trust’s Constitution sets out the key requirements in respect of the functioning of the CoG. Its general functions are to: »» hold the non-executive directors individually and collectively to account for the performance of the Board of Directors, and »» represent the interests of the members of the Trust as a whole and the interests of the public.
Although the CoG operated for a period in shadow form in the run-up to the Trust becoming authorised as a Foundation Trust, the period 1 April 2012 to 31 March 2013 represents the first full year of working for the CoG, and the delivery of its statutory duties. Membership of the Council of Governors The CoG is chaired by the Trust Chairman. During 2012/13 the full composition of governors numbered twenty six, as follows: »» fifteen elected public governors across four constituencies (Hampshire, Berkshire, Oxfordshire and Buckinghamshire) »» five elected staff governors »» three appointed Local Authority governors »» two appointed PCT governors (until 31 March 2013) »» one appointed charity governor.
155
Annual report 12/13 The CoG has nominated a Lead Governor; Bob Duggan was appointed to the position for the period 1 March 2012 to 6 September 2012, and Melanie Hampton from 7 September 2012 for a one year period. During 2012/13, there have been the following changes to the composition of the CoG: »» three of the fifteen elected public governors – one from each of the Oxfordshire, Buckinghamshire, and Hampshire constituencies resigned towards the end of the financial year, and these positions were vacant at 31 March 2013 pending an election process »» one of the three appointed Local Authority governors resigned (in March 2013) and the Trust is currently liaising with the South East England Councils body to fill this vacancy
»» one of the two appointed PCT governors resigned in September 2012, and was duly replaced; both PCT governor terms of office then ended in March 2013 following the abolition of PCTs.
Appendix A reports on the attendance of governors at formal meetings of the CoG.
Details about each governor, including their declared interests, can be seen on the Trust’s website.
Other meetings of the CoG
Formal meetings of the CoG Four formal meetings of the CoG have been held during 2012/13: in April 2012, June, September, and January 2013. All meetings have been held in public, and fully in accordance with the Trust’s Constitution. Three of the four formal meetings have been chaired by the Trust Chairman, and the other by the Deputy Chairman / Senior Independent Director.
156 Annual Report and Accounts 2012/13
All meetings have been well attended by both executive and non-executive members of the Board of Directors.
The CoG has had two formal sub-committees during 2012/13; the Nominations Committee, and the Membership and Engagement Committee. Details of their meetings and work programmes are explained below. Two governor workshops have been held during the year; the first, in September 2012, to consider the role of the governors and how the CoG and Board of Directors can best work together, and, the second, in January 2013, to obtain the views of the governors on the Trust’s future strategic priorities.
Delivery of specific statutory duties The governors have a range of specific statutory duties, and these will be extended in 2013/14 as a result of the new Health and Social Care Act 2012. All of the statutory duties relevant to 2012/13 have been satisfactorily discharged as described here:
Duty
Comments
Receive annual accounts, auditor’s report and annual report
ü Received at 25 June 2012 meeting
Appoint and, if appropriate, remove the external auditor
ü The CoG approved the appointment of a new external auditor, KPMG, at 10 September 2012 meeting
Directors must have regard to governors’ views when preparing the forward plan
ü A specific workshop was held on 8 January 2013 to obtain the views of the governors
Appoint and, if appropriate, remove the Chair
ü The appointment of the SCAS Chairman was approved in March 2012. Procedures for any future appointment / removal were approved by the CoG in January 2013
Appoint and, if appropriate, remove the other Non Executive Directors (NEDs)
ü The appointment of the SCAS NEDs was approved in March 2012. Procedures for any future appointment / removal were approved by the CoG in January 2013
Decide remuneration and terms of conditions for Chair and other NEDs
ü Remuneration levels were reviewed by the Nominations Committee in 2012/13 and new levels were approved at the CoG meeting in January 2013.
Approve appointment of Chief Executive
ü Although the appointment of the Chief Executive is a duty of the Board, the CoG ratified the appointment in March 2012.
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. A range of mechanisms have been in place to support the govenors with their holding to account role, including: »» six Board meetings in public have been held, and governor attendance at these has been strongly promoted »» 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
157
Annual report 12/13 »» 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 »» all formal meetings of the CoG include an update from the Chief Executive on operational performance and other key issues, with an opportunity for governors to ask questions. In addition, there have been specific sessions on clinical quality assurance, financial management, and operational performance where the NEDs have outlined how they seek assurance and hold the Executive Directors to account.
The work of the Membership and Engagement Committee (see below) has been key to the governor’s other general duty of representing the interests of the members and the public. 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.
During 2012/13, the majority of the Trust’s governors have attended at least one Board meeting in public.
158 Annual Report and Accounts 2012/13
Council of Governors sub-committees Nominations Committee One of two formal subcommittees, 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 on five occasions during 2012/13, and meeting attendance levels can be seen at Appendix A. During the year, and with delegated authority from the CoG, the Nominations Committee has: »» developed procedures for the appointment, reappointment, removal and appraisal of the Trust Chair and NEDs (approved by the CoG in January 2013)
»» considered remuneration levels for the Trust Chair and NEDs and made recommendations regarding new levels (approved by the CoG in January 2013) »» developed formal role descriptions for the Trust Chair and NEDs 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 nine members (it had ten members for a time during the year), comprising seven public governors, one staff governor, and one appointed partner charity governor.
During the year, the Membership and Engagement Committee has: »» considered the Trust’s ongoing membership position and explored ways of recruiting new members to ensure the required levels of representation are achieved (helping the Trust successfully deliver its target of having 12,000 members by 31 March 2013) »» overseen the arrangements for the Trust’s first Annual Members Meeting in September 2012 »» developed a governor toolkit to help support membership recruitment and engagement activities.
Governor support, training and development Support, training and development The Trust has a formal duty to ensure that governors are equipped with the skills and knowledge they require to undertake their role. During the course of the year, the Trust has supported governors extensively in this respect. In addition to the mechanisms outlined in section 6 to support the general duties of governors, the Trust has: »» held a workshop, with the Foundation Trust Network in attendance, to consider the governor role in greater detail, including the impact of the Health and Social Care Act »» delivered presentations on clinical quality assurance, financial management, and operational performance to give the governors background to the Trust’s work
»» made buddying arrangements for certain governors with governors in other Foundation Trusts »» provided the opportunity for all governors to participate in Emergency Operations Centre tours, crew rideouts, and ambulance station visits to help support their understanding of the Trust and its business »» invited all governors to join one of three executive committees (Patient Experience Review Group, Clinical Review Group, and Equality and Diversity Steering Group) both to help their understanding and for the Trust to benefit from an external perspective »» issued regular briefings and bulletins, and established a governor portal to provide access to key materials and information.
In addition to internal sources of support, the Trust has joined both the Foundation Trust Governors Association and the Foundation Trust Network. The former, which is aimed primarily at governors, is a valuable on-line resource giving a range of support for governors and training events to attend. The latter, although largely intended to support the organisation, holds informative events, a number of which have been attended by SCAS governors. Governors are also given access to training and networking events held by Monitor.
159
Annual report 12/13 Conclusions and priorities for 2013/14 Conclusions Although the emphasis has been on embedding the governor role and supporting an understanding of the Trust and its business, the CoG has overseen some major achievements in its first year, and along with staff and volunteers contributed to a successful first year for SCAS as a Foundation Trust. 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 was demonstrated in the process to develop the 2013/14 annual forward plan.
Priorities for 2013/14 The CoG has identified the following priorities for 2013/14: »» with the target of recruiting 12,000 members now achieved, 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 »» reviewing and confirming that mechanisms are in place to ensure that the governors can hold the Board of Directors to account for the performance of the Trust via the Non Executive Directors; key to this will be governors attending Board meetings in public to observe the holding to account process first hand »» supporting the governors to understand and deliver their extended statutory duties, which are introduced from April 2013
160 Annual Report and Accounts 2012/13
»» reviewing 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.
Appendix A: Governor attendance at meetings in 2012/13 Original term of Office
CoG meetings
Membership and Engagement Committee
Nominations Committee
Kemi Adenubi [Public - Hampshire]
1/3/2012 – 1/3/2015
3/4
N/A
N/A
Mary Ballin (1) [Partner - LA]
1/3/2012 – 1/3/2015
1/4
N/A
N/A
Paul Carnell [Public - Hampshire]
1/3/2012 – 1/3/2015
4/4
N/A
N/A
Gary Clark (2) [Public - Berkshire]
1/3/2012 – 1/3/2014
4/4
0/2
N/A
Patrick Conafray [Public - Oxfordshire]
1/3/2012 – 1/3/2015
3/4
5/5
N/A
Eddie Cottrell [Staff]
1/3/2012 – 1/3/2015
4/4
N/A
4/5
John Donne [Staff]
1/3/2012 – 1/3/2015
3/4
N/A
N/A
Bob Duggan (3) [Public - Bucks]
1/3/2012 – 1/3/2015
4/4
4/5
1/1
Richard Fraser (4) [Public - Bucks]
1/3/2012 – 1/3/2015
1/4
N/A
N/A
Christina Fowler [Staff]
1/3/2012 – 1/3/2015
3/4
N/A
N/A
1/10/2012 – 31/3/2013
1/1
N/A
N/A
Melanie Hampton (6) [Public – Berks / Lead]
1/3/2012 – 1/3/2014
4/4
N/A
4/4
James Hartridge (7) [Public - Hampshire]
1/3/2012 – 1/3/2014
3/4
N/A
3/4
Simon Hoare [Partner - LA]
1/3/2012 – 1/3/2014
2/4
N/A
N/A
Keith House [Partner - LA]
1/3/2012 – 1/3/2015
2/4
N/A
2/5
Governor
Stewart George (5) [Partner - PCT]
NOTES 1. Mary Ballin resigned in March 2013 2. Gary Clark joined the Membership and Engagement Committee in August 2012 3. Bob Duggan was lead governor, and therefore a member of the Nominations Committee, until 6 September 2012
4. 5.
Richard Fraser resigned in March 2013 Stewart George replaced Fred Hucker as a PCT governor on 1 October 2012, and served until 31 March 2013 when PCTs were abolished
6. 7.
Melanie Hampton became lead governor on 7 September 2012 and therefore joined the Nominations Committee James Hartridge resigned in February 2013
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Annual report 12/13 Original term of Office
CoG meetings
Membership and Engagement Committee
Nominations Committee
Fred Hucker (8) [Partner - PCT]
1/3/2012 – 30/9/2012
1/3
N/A
N/A
Bob Lassam (9) [Public - Oxfordshire]
1/3/2012 – 12/2/2013
3/4
5/5
N/A
Barry Lipscomb [Partner - Charity]
1/3/2012 – 1/3/2015
3/4
4/5
N/A
David Palmer [Staff]
1/3/2012 – 1/3/2015
4/4
N/A
N/A
Benita Playfoot [Public - Berkshire]
1/3/2012 – 1/3/2015
2/4
N/A
N/A
Pauline Quan-Arrow (10) [Partner - PCT]
1/3/2012 – 1/3/2013
2/4
N/A
N/A
Allan Read [Public - Hampshire]
1/3/2012 – 1/3/2014
3/4
4/5
N/A
David Ridley [Public - Bucks]
1/3/2012 – 1/3/2014
3/4
3/5
N/A
Richard Ryan [Public - Hampshire]
1/3/2012 – 1/3/2014
3/4
4/5
N/A
Al Tottle [Public - Hampshire]
1/3/2012 – 1/3/2014
2/4
N/A
N/A
Carol Watts (11) [Staff]
1/3/2012 – 1/3/2015
2/4
1/2
N/A
Tim Windsor-Shaw (12) [Public - Oxfordshire]
1/3/2012 – 1/3/2014
3/4
3/4
N/A
Governor
NOTES 8. Fred Hucker left Oxfordshire PCT and therefore no longer qualified as a PCT governor from 30 September 2012 (he was replaced by Stewart George) 9. Bob Lassam resigned in February 2013
162 Annual Report and Accounts 2012/13
10. Pauline Quan-Arrow was appointed until 1 March 2014, but no longer qualified as a PCT governor from 31 March 2013 due to the abolition of PCTs 11. Carol Watts joined the Membership and Engagement Committee in August 2012
12. Tim Windsor-Shaw joined the Membership and Engagement Committee in June 2012
Membership report and details of constituencies Membership of South Central Ambulance Service NHS Foundation Trust is divided into two constituencies: public and staff. These are subdivided as follows: »» Public constituency - Members must be aged 14 or over and reside in Berkshire, Buckinghamshire, Hampshire or Oxfordshire »» Staff Constituency - Staff members must be on a permanent contract; under a contract of employment which has a fixed term of at least 12 months; or have been continuously employed by the Trust under a contract of employment for at least 12 months.
Staff constituencies are classed as follows: »» Emergency operations centre »» Operational clinical staff and managers »» Commercial Services and support staff. Information on the number of members and the number of members in each constituency South Central Ambulance Service NHS Foundation Trust achieved its 2012/13 membership target of 12,000 members.
Number of members for each public constituency on 31 March 2013 was as follows:
2,723
Oxfordshire
2,414
Buckinghamshire
2,551
Berkshire
4,471
Hampshire
Total 12,159 163
One of our mechanics preparing an ambulance
Below is a summary of the membership strategy, an assessment of the membership and a description of any steps taken during the year to ensure a representative membership. South Central Ambulance Service NHS Foundation Trust (SCAS) became a foundation trust on 1 March 2012 and during the last 12 months has focussed on its progression as an FT, establishing and working with its newly appointed Council of Governors (CoG) and achieving its target of gaining 12,000 members who represent the diverse communities that it serves. SCAS’s membership objectives for 2012/13 were as follows: »» achieve a target of 12,000 by 31 March 2013 »» have a membership that is representative of the diverse communities it serves in terms of geography, age, gender and ethnicity
Public membership grew by over 3,700 members during 2012/13 and at 31st March 2013 was just under 12,160 members. Table 1 As at 31 March 2013 Measure Public
Actual no.
Target no.
RAG
12,159
12,000
G
As at 31 March 2013
Commentary on exceptions (Red - action to correct, Amber - action to reduce risk, Green - nil)
Exceeded target by nearly 160 members
Commentary on exceptions (Red - action to correct, Amber - action to reduce risk, Green - nil)
Actual no.
Target no.
RAG
Berkshire
2,551
2,400
G
Exceeded target
Bucks
2,414
2,400
G
No comment required. Exceeded target
Hampshire
4,471
4,800
A
Target achieved: 93%.
Oxfordshire
2,723
2,400
G
Exceeded target
Geography
As at 31 March 2013
Commentary on exceptions (Red - action to correct, Amber - action to reduce risk, Green - nil)
Actual no.
Target no.
RAG
Male
4,956
5,934
G
Target achieved: 84%
Female
7,171
6,066
G
Exceeded target
Gender
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Annual report 12/13 As at 31 March 2013 Age
Actual no.
Target no.
RAG
0 - 16
180
17 - 21
978
802
G
Exceeded target
22 - 29
1,613
1,320
G
Exceeded target
30 - 39
2,031
1,598
G
Exceeded target
40 - 49
2,196
1,795
G
Exceeded target
50 - 59
1,906
1,449
G
Exceeded target
60 - 74
2,297
1,684
G
Exceeded target
920
923
A
Target achieved: 99.7%.
75+
n/a
Commentary on exceptions (Red - action to correct, Amber action to reduce risk, Green - nil)
As at 31 March 2013
No formal target set
Commentary on exceptions (Red - action to correct, Amber action to reduce risk, Green - nil)
Actual no.
Target no.
RAG
Wealthy Achievers [1]
3,769
4,192
A
Target achieved: 90%
Urban Prosperity [2]
1,092
1,195
A
Target achieved: 91%
Comfortably Off [3]
3,736
3,408
G
Exceeded target
Moderate Means [4]
1,435
1,420
G
No comment required
Hard Pressed [5]
1,750
1,493
G
Exceeded target
377
294
G
Exceeded target
Socio-economic
Not available [NA]
166 Annual Report and Accounts 2012/13
As at 31 March 2013 Ethnicity
Commentary on exceptions (Red - action to correct, Amber action to reduce risk, Green - nil)
Actual no.
Target no.
RAG
9,609
10,816
A
Target achieved: 89%
White - Irish
122
126
A
Target achieved: 97%
White - Any other White background
298
340
A
Target achieved: 88%
Mixed - White and Black Caribbean
46
72
A
Target achieved: 64%. Particular focus to increase this in 2013/14
Mixed - White and Black African
23
13
G
No comment required. Exceeded target
Mixed - White and Asian
55
43
G
No comment required. Exceeded target
Mixed - Any other mixed background
46
34
G
No comment required. Exceeded target
Asian or Asian British - Indian
181
162
G
No comment required. Exceeded target
Asian or Asian British - Pakistani
112
150
R
Target achieved: 75%. Particular focus to increase this in 2013/14
Asian or Asian British - Bangladeshi
24
25
A
Target achieved: 96%
Asian or Asian British - Any other Asian background
82
35
G
No comment required. Exceeded target
Black or Black British - Caribbean
61
62
A
Target achieved: 95%
Black or Black British - African
146
42
G
No comment required. Exceeded target
Black or Black British - Any other Black background
26
9
G
No comment required. Exceeded target
Other Ethnic Groups - Chinese
39
43
A
Target achieved: 71%. Particular focus to increase this in 2013/14
Other Ethnic Groups - Any other ethnic group
46
44
G
No comment required. Exceeded target
White - British
Not stated
1,218
n/a
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Annual report 12/13 Commentary on current membership The trust measures the promotional performance of each activity by monitoring and distributing IPRs (Integrated Performance Report) to internal stakeholders on a monthly basis. The column on the Table 1 concerning the Commentary on exceptions (Red - action to correct, Amber - action to reduce risk, Green - nil) shows the over and under representation with 100% being the ideal representation (as at 31 March 2013).
SCAS Foundation Trust member and Paralympian Peter Hull
168 Annual Report and Accounts 2012/13
The table shows that Berkshire, Buckinghamshire and Oxfordshire as a whole are strongly represented. Hampshire is slightly under-represented and the focus for this year will continue to be on meeting required target.
In terms of gender, the overall profile is well represented with the female membership showing an 18% excess compared to the related ONS data that represents SCASâ&#x20AC;&#x2122;s eligible membership. Male membership will require a 16% increase to be truly representative and further efforts will be made to achieve this. In the age groups SCAS is well represented. However, it is important to note that the 14-16 age group is difficult to quantify in terms of ideal representation as the ONS groups the under 17 from 0-16. It is also common for this group to suffer from recruitment apathy, particularly in the health sector as detailed in the next section.
The overall SCAS profile presents a good representation. The following would benefit from increased recruitment: White British, White - Any other White background, Mixed - White and Black Caribbean, Asian or Asian British – Pakistani and Other Ethnic Groups - Chinese. These groups have lower than optimal representation.
This over-representation is mirrored in three of the four constituencies with Hampshire being the only county where comfortably off are under represented.
Over 1,200 public members did not disclose their ethnicity and this represents 10% of the Trust’s overall public membership. This is a common factor among other trusts as members are under no obligation to complete the E&D section on the membership application form.
How SCAS achieved its objectives
An over-representation of 10% and 17% members respectively in the comfortably off and hard pressed socio-economic categories is found in the overall profile.
These members are people who are more likely to engage (e.g. participate, attend etc.) with any public body on a regular basis.
The following recruitment methods were used in the Trust’s membership campaigns: »» face to face contact »» appeal to staff to encourage them to help with direct recruitment »» online recruitment through link on website homepage »» membership forms at all Trust events and annual public meeting »» sign up of celebrities to raise awareness of our membership campaign
»» regular press releases to local press giving membership office contact details »» attendance at local community events including summers fairs and local health events »» attendance at local community group meetings »» information distributed to public places such as GP surgeries and libraries »» local neighbourhood leaflet drops »» programmes of engagement with hard-to-reach groups. The focus in 2012/13 was primarily on increasing the size of the membership as a whole in order to meet the overall target for the year. However, particular attention was given to counties and categories which were identified as being underrepresented as follows: »» Hampshire »» Males »» 14-16 and 75+ age groups
»» Mixed - White and Black Caribbean, Pakistani and Chinese »» Wealthy achievers and Urban prosperities. SCAS embarked on a robust programme of engagement/ educational and recruitment activities aimed at augmenting the number of members in the above categories. Specific areas were targeted based on the population profile of SCAS coverage area. These included attending events in areas where wealthy achievers and the urban prosperous would be likely to be such as county fairs and summer festivals in addition to events in certain urban areas. SCAS also held a series of successful events in residential homes, day centres, rotary clubs, British Legion clubs and DIY centres and these resulted in a considerable increase in members in the 75+ age group and in the male representation.
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Annual report 12/13 One of the groups often classed as â&#x20AC;&#x2DC;hard-to-reachâ&#x20AC;&#x2122; is young people, aged 12-14. This age group will often be underrepresented in foundation trust membership and other membership organisations and SCAS is no exception. The Trust attended and/or organised numerous events at secondary schools and colleges. The focus was on engaging and educating young people about its Misuse cost lives campaign, giving CPR and basic First Aid demos, while also providing membership information. The latter proved quite difficult to achieve due primarily to a general lack of interest from young people in becoming members. SCAS will continue to look at innovative ways to recruit more members in this age group.
SCAS contacted specific ethnic minority groups and attended and/or organised Equality and Diversity events and FT Roadshows in areas where there is a dense population of ethnic minorities such as Oxford, Slough, High Wycombe and Southampton. It is important to note that some minorities are proving more difficult than other to reach and SCAS will continue to focus on improving this.
The Trust also focused on increasing its membership in Hampshire. The combined figure for 2010/2011 and 2011/12 showed that SCAS had achieved just over 2,300 members in two years and needed to recruit a further 2,500 in just one year to meet the final target of 4,800 members (please see Table 2 below).
As at 31 Aug 2012
(2012/13) 31/03/2013
Hampshire
170 Annual Report and Accounts 2012/13
In 2012 from September to March SCAS concentrated mainly on recruiting in Hampshire by attending and / or organising a myriad of events across the whole county and thanks to these the Trust managed to increase the number of Hampshire members by 1,763 from 2,708 to just over 4,470 as shown on Table 2 below:
(2010/11 + 2011/12) 31/03/2012
Actual no.
Target
RAG
Achieved %
Actual no.
Actual no.
Target
RAG
Achieved %
4,471
4,800
A
93%
2,708
2,302
3,200
R
72%
Emergency Operations Centre, Southern House, Otterbourne
ACCOUNTING OFFICER’S STATEMENT OF RESPONSIBILITIES 172 Annual Report and Accounts 2012/13
Statement of the Chief Executive’s Responsibilities as the Accounting Officer of the South Central Ambulance Service NHS Foundation Trust The NHS Act 2006 states that the Chief Executive is the accounting officer of the NHS Foundation Trust. The relevant responsibilities of the accounting officer, including their responsibility for the propriety and regularity of public finances for which they are answerable, and for the keeping of proper accounts, are set out in the NHS Foundation Trust Accounting Officer Memorandum issued by the Independent Regulator of NHS Foundation Trusts (“Monitor”). Under the NHS Act 2006, Monitor has directed South Central Ambulance Service NHS Foundation Trust to prepare for each financial year a statement of accounts in the form and on the basis set out in the Accounts Direction.
The accounts are prepared on an accruals basis and must give a true and fair view of the state of affairs of South Central Ambulance Service NHS Foundation trust and of its income and expenditure, total recognised gains and losses and cash flows for the financial year. 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: »» Observe the Accounts Direction issued by Monitor including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis; »» Make judgements and estimates on a reasonable basis;
»» State whether applicable accounting standards as set out in the NHS Foundation Trust Annual Reporting Manual have been followed and disclose and explain any material departures in the financial statements; and »» Prepare the financial statements on a going concern basis.
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.
The Accounting Officer is responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the NHS Foundation Trust which enable him to ensure that the accounts comply with requirements outlined in the above mentioned Act. The Accounting Officer is also responsible for safeguarding the assets of the NHS Foundation Trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.
Will Hancock Chief Executive
Signed
Date: 29 May 2013
173
ANNUAL GOVERNANCE STATEMENT 174 Annual Report and Accounts 2012/13
Annual Governance Statement 2012/13 1. Scope of responsibility As Accounting Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the 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 the 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.
2. The purpose of the system of internal control The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control is based on an ongoing process designed to identify and prioritise the risks to the achievement of the policies, aims and objectives of South Central Ambulance Service NHS Foundation Trust (SCAS), to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control has been in place in SCAS for the year ended 31 March 2013 and up to the date of approval of the annual report and accounts.
3. Capacity to handle risk The Trust’s Risk Management Strategy comprehensively sets out arrangements in respect of the accountability for risk management in SCAS. Leadership is given in a number of ways including: »» as Chief Executive and Accounting Officer I have overall accountability for ensuring that the organisation has effective management systems in place, including in respect of risk. I have delegated specific areas of risk management activity to each of the Executive Directors; for example, as follows:
›› 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. Supported by the Risk Management Team, comprising a number of experienced risk management professionals, this includes acting as the designated lead for a range of responsibilities such as health and safety, security management, and infection prevention and control ›› the Medical Director has responsibility for the management of clinical standards. ›› the Director of Finance has responsibility for financial risk management and, in the role of Senior Information Risk Owner, for risks relating to information
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Annual report 12/13 ›› 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 and non-emergency ambulance services and fleet management, as well as being the lead for emergency planning and business continuity activities »» the Board, with overall responsibility for governance, considers the risks faced by the Trust on a regular basis. It receives the Board Assurance Framework at each public Board meeting. In addition, as further demonstration of the embedment of risk management, all Board meeting papers clearly summarise the key risks associated with the subject of the paper
»» the Quality and Safety Committee, with delegated authority from the Board, monitors and reviews the Trust’s clinical governance arrangements »» the Audit Committee, also with delegated authority from the Board, receives the Board Assurance Framework and strategic risk register at every meeting, with the purpose of seeking assurance that effective risk management practice is in place »» the Executive Team, underpinned by the work of its various sub-committees (e.g. Health, Safety and Risk Group), receives and reviews updates from all directorates relating to risk management, as well as the Trust’s Board Assurance Framework and strategic risk register
176 Annual Report and Accounts 2012/13
»» 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 nonclinical 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.
»» 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.
4a. The risk and control framework Strategy The Board Assurance Framework (BAF) governs the risk management structure, and is underpinned by the Risk Management Strategy, The BAF informs the Board of the primary strategic risks, control measures, and external assurances in relation to the delivery of the Trust’s Annual Business Plan and objectives. All risks are mapped against the strategic goals and objectives of the Trust, CQC standards and NHS Litigation Authority risk management standards. The Trust’s Risk Management Strategy is reviewed and updated annually; the Board approved the latest updated strategy in July 2012.
The strategy clearly sets out: »» specific risk management objectives for the year ahead »» organisational structures and accountability for risk »» the committee structure for risk management oversight and reporting »» risk management tools including training and education »» communicating risk and engaging staff »» the templates that are used for measuring, scoring and assessing risk. The key elements of our strategy are to: »» 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
»» provide clearly documented responsibilities and structure for managing risk to ensure a coordinated, standard methodology is adopted by every directorate/department »» encourage and support incident reporting in a ‘fair blame’ culture to ensure that the Chief Executive and Board are provided with evidence that risks are being appropriately identified, assessed, addressed and monitored »» 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
»» 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 a sub committees of the Board. Identification of risk A range of tools are used to identify and control risks, including: »» the monthly Integrated Performance Report, including SIRIs »» review of adverse incidents and accident reports »» quarterly reviews of claims and complaints »» workforce inspections and leadership walkarounds »» annual fire safety inspections »» review of performance against the NHSLA Risk Management Standards
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Annual report 12/13 »» self-assessments against the Care Quality Commission essential standards of quality and safety. The risks are identified through careful triangulation of the themes across the above reporting mechanisms recognising issues that effect patient safety, treatment and experience as the most reliable indicators. Appetite for risk The Trust has determined its appetite for risk by applying a zero tolerance to matters of safety and treatment building in practical measures to support service delivery and treatment change and evidence based practice through the Clinical Review Group.
Whilst it is acknowledged 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) 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. Quality governance arrangements The key elements of our quality governance arrangements are set out in the regular self-assessments we undertake against the Monitor Quality Governance Framework, and report to the Board. We are either compliant (mostly) or partly compliant for all elements.
178 Annual Report and Accounts 2012/13
Performance information is key to ensuring delivery of quality, and we have rigorous processes in place to ensure the quality of performance data. These include internal checking mechanisms, internal and external audit reviews, and a comprehensive review of the monthly Integrated Performance Report by the Executive Team prior to being presented to the Board. Information governance 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 2012/13 Information Governance Toolkit, achieving an overall score of 79%.
Key strategic risks We have a range of key strategic risks, which we have identified and are proactively managing. At the end of March 2013 our top four potential risks were seen as: »» the risk that response targets not consistently met, resulting in patients in the care of SCAS not reporting a positive experience of their care and experiencing delays in care and treatment »» the risk of protracted hospital turnaround times resulting in delays to patients »» the risk of poor operational performance in the 111 service »» the risk that we have non effective areas of stakeholder engagement, meaning we fail to build effective external relationships and enhance organisational reputation. Action plans are in place for these risks.
Involvement of public stakeholders
4b. Compliance with CQC registration requirements
Public stakeholders are involved in the management of risks which impact on them through the work of the governors, public meetings of the Board, our attendance at Health Overview and Scrutiny Committee meetings, and the Local Involvement Networks. 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.
The Foundation Trust is fully compliant with the registration requirements of the Care Quality Commission. A system to ensure continuing compliance with registration requirements is in place and mainstreamed within the Trust’s performance and governance arrangements. 4c. Compliance with NHS Pension Scheme Regulations 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.
4d. Compliance with equality, diversity and human rights legislation 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.
4e. Compliance with Climate Change Adaptation reporting to meet the requirements under the Climate Change Act 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.
179
Annual report 12/13 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: »» 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
»» savings targets are set annually in the form of cost improvement programmes. In 2011/12 we set an overall savings target of £6.3m and achieved this. The target for 2012/13 is £6.5m across the commercial, A&E and corporate divisions, and we expect to again deliver this target, whilst ensuring that the highest standards of quality of service and patient safety are maintained »» the Trust’s monthly Area Performance Reviews, chaired by the Director of Finance, 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
180 Annual Report and Accounts 2012/13
»» the Trust routinely carries out benchmarking reviews of its performance and efficiency levels with other NHS bodies, including those in the ambulance sector. It also benchmarks sickness and recruitment and retention rates. »» the 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. »» 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.
»» an annual programme of internal audits, monitored closely by the Audit Committee, allows further assurance to be given to the Board on the use of its resources. 6. 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.
In preparing the Quality Report which is included within the Annual Report, the Trust’s Directors have taken steps to satisfy themselves that: »» the content of the Quality Report meets the requirements set out in the NHS Foundation Trust Annual Reporting Manual 2012/13 »» the content of the Quality Report is not inconsistent with internal and external sources of information »» the officers accountable for the preparation of the Quality Report have the necessary skills and experience »» 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 »» the performance information reported in the Quality Report is reliable and accurate
»» 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 »» 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.
I have drawn on the content of the Quality Report attached to this Annual Report and other performance information available to me. My review is also informed by comments made by the external auditors in their management letter and other reports. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Board, the Audit Committee, and the Quality and Safety Committee, and a plan to address weaknesses and ensure continuous improvement of the system is in place.
7. 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.
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 is also informed by: »» internal and external audit reports »» the Annual Audit Letter »» the Head of Internal Audit Opinion »» reports to the Board from the Audit Committee, and Quality and Safety Committee »» the monthly Integrated Performance Report, which covers clinical, operational, service development, financial and human resources »» staff satisfaction surveys »» information governance toolkit compliance reports and associated action plans »» Care Quality Commission and NHS Litigation Authority assessment reports »» the Quality Accounts and Annual Report. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Board and Audit Committee.
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Annual report 12/13 There have been three particular key sources of assurance for me in 2012/13: »» the Care Quality Commission made an unannounced visit to the Trust in November 2012, concluding that we fully met six of the seven standards assessed. We took immediate action in respect of the minor improvement required to ensure full compliance with the other standard »» our NHS Litigation Authority inspection in the summer of 2012 resulted in a level 1 assessment, and a score of 47/50 »» we received an annual Head of Internal Audit Opinion for 2012/13 of “significant assurance”, defined as “there is generally a sound system of internal control, designed to meet the organisation’s objectives, and that controls are generally being applied consistently”.
8. Conclusion In my review I have found no significant control issues. 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.
Will Hancock Chief Executive Date 29 May 2013
182 Annual Report and Accounts 2012/13
One of the new SCAS Rapid Response Vehicles (RRV)
OPERATIONAL AND FINANCE REVIEW 184 Annual Report and Accounts 2012/13
The Trust has a strong financial track record and has once again met all of its financial duties in 2012/13 whilst at the same time achieving its operational performance duties. As a result we achieved a Monitor financial rating of 4 (5 is the best) for the last quarter of 2012/13 which is reflective of a financially sound Trust. We expect to maintain this performance during 2013/14. The trust is required to produce only 2011/12 comparatives for the one month that it was a Foundation Trust. The full year 2011/12 comparatives shown below cover the 11 months ending 28 February 2012 that SCAS was an NHS Trust. Summary of Financial Performance »» On Income and Expenditure the Trust reported a surplus of £1.6m for the year which was in line with the plan (1.1% of turnover).
»» Earnings Before Interest, Tax, Depreciation and Amortisation (EBITDA) of £10.3m representing 7.1% of turnover which is marginally below plan of £10.6m. »» Capital expenditure was £8.7m and Trust funded a number of projects including new ambulances, IT resilience and the establishment of a new 111 call handling service. »» It has been a financially challenging year with a £6.5m cost improvement target set at the commencement of 2012/13 which the Trust achieved. »» A year end cash balance of £8.3m which was lower than the cash balance in 2011/12. The trust generated £10.4m of cash which was applied on capital payments (£8.7m), PDC dividends/interest (£1.9m), repayment of loans (£1.4m) offset by a favourable movement in working capital (£0.3m). The Trust was anticipating receipt of proceeds through the sale of Battle but this is now forecast for 2013/14.
»» Total revenue income to meet pay and other day to day running costs reached £144.4m of which the majority was secured through various Service Level Agreements with Primary Care and Hospital NHS Trusts »» 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 £62.725m. »» During the period the Trust was set a prudential borrowing limit of £18.5m and the Trust has access to a working capital facility of £10.5 which it has not needed to access during the year.
185
Annual report 12 / 13 Analysis of Income The Trust reported income of £144.8 million for the year end 31 March 2013 (2012: £138.8 million). The increase of 4% is mainly due to increased income relating to the new 111 call handling service and additional income received for resources to meet additional emergency demand. Other income declined due to loss of equipment 2012/13 management service at the end of 2011/12.
£2.7m
186 Annual Report and Accounts 2012/13
Other
£3.1m HART
£16.7m
Patient Transport Services
TOTAL £144.4m
2012/13
The Trust principal source of income is from local NHS commissioning contracts for the provision of the emergency service. This income totalled £113.4 million (£107.7 million in 2012) which represented 78.5% of the Trust turnover (2012: 77.6%). The Trust confirms that the NHS income it receives for the provision of healthcare exceeds its income 2011/12 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 2012/13 was £141.3 million representing 97.8% of total income.
£8.5m
111 call handling service
£113.4m Emergency Services
£3.1m
£12.9m Other
HART
£15.1m
Patient Transport Services
2011/12
TOTAL £138.8m
£107.7m Emergency Services
Analysis of operating expenditure Total operating expenditure less depreciation for the Trust was £134.2 million for the year ended 31 March 2013 (2012: £128.1 million). The increase of 4.8% is mainly due to increased staff costs arising from the introduction of the new 111 call handling service and additional emergency front line staff recruited to replace use of private provider ambulance services.
£33.7m Other
£5.1m Vehicle fuel
2012/13
TOTAL £134.2m
£91.9m Staff costs
£3.5m
Clinical supplies & drugs expenditure
Staff costs represent 68.5% of total expenditure (2012: 66.6%). The fall in clinical supplies and drugs expenditure is due to fall in equipment related expenditure arising from the loss of equipment management service at the end of 2011/12.
£33.0m Other
£4.9m Vehicle fuel
2011/12
TOTAL £128.1m
£85.3m Staff costs
£4.9m
Clinical supplies & drugs expenditure
187
Annual report 12 / 13 Capital Investment Investment in capital resources for 2012/13 was £8.7 million (2012: £3.1 million) which was in line with the capital plan and is line with resources generated internally within the Trust. The Trust replaced all of its front line ambulance and first line responder vehicles that had reached the end of their useful economic life, as well as fund necessary infrastructure costs arising from the establishment of the new NHS 111 call handling service and necessary IT resilience costs.
£0.4m Other
£2.7m
Information Technology
TOTAL £8.7m
2012/13
£4.5m Fleet
£1.1m Estates
£0.1m Other
£0.6m
Information Technology
2011/12
£0.4m Estates
188 Annual Report and Accounts 2012/13
TOTAL £3.1m
£2.0m Fleet
Going Concern After making appropriate enquiries, the directors have a reasonable expectation that South Central Ambulance Service NHS Foundation trust has adequate resources to continue in operational existence in the foreseeable future. For this reason the accounts are prepared on a going concern basis. Disclosure of Information to the Auditors As far as each of the directors is aware, there is no relevant audit information of which the auditors are unaware. Each director has taken all the steps a director ought to have taken to avail themselves of any relevant audit information and to establish that the auditors are aware of such information.
The Trust has a dedicated local counter fraud specialist (LCFS) who agrees a counter fraud plan annually with the Audit Committee. The Trust raises awareness of fraud issues within the Trust through poster boards in staff areas and via staff newsletters. Cost Allocation and Charging Requirements The Trust has complied with the cost allocation and charging requirements as set out in HM Treasury and the Office of Public Sector Information guidance.
Countering Fraud The Trust has detailed Standing Financial Instructions, a Counter Fraud Policy and an Anti-Bribery Policy to counter fraud and corruption.
189
Annual report 12 / 13 Remuneration Report The remuneration and expenses for the Trust Chairman and non– executive directors is determined by the Council of Governors. Remuneration for the executive directors is determined by the Remuneration Committee which consists of the Chairman and selected non-executive directors. Details of remuneration, including the salaries and pension entitlements of the Board of Directors, is published on pages 191 and 192 of the Annual Report. The only non-cash element of senior managers’ remuneration packages are pension related benefits accrued under the NHS Pensions Scheme. Contributions are made by both the employer and employee in accordance with the rules of the national scheme which applies to all NHS staff in the scheme.
The Board of Directors are in receipt of contracts under the Very Senior Manager Framework for the NHS. Senior Managers are employed on contracts of service and are substantive employees of the Trust. Their contracts are open-ended and can be terminated by either party with six months notice. The Trust’s normal disciplinary policies apply to senior managers including the sanction of instant dismissal for gross misconduct. The Trust’s redundancy policy is consistent with NHS redundancy terms for all staff. During 2012/13, the principles under which Executive Director Remuneration is agreed remained the same as for the previous twelve months. As non-executive directors do not receive pensionable remuneration, there will be no entries in respect of pensions for non-executive directors.
Where appropriate, terms and conditions are consistent with Agenda for Change.
190 Annual Report and Accounts 2012/13
Reporting bodies are required to disclose the relationship between the remuneration of the highest paid director and the median remuneration of the organisation’s workforce. The banded remuneration of the highest paid director in SCAS in the financial year 2012-13 was £140 – 145k. This was 4.5 times the median remuneration of the workforce which was £32k. Total remuneration includes salary, benefits in kind as well as severance payments.
Will Hancock Chief Executive 29 May 2013
Directors salaries and benefits for the year ended 31 March 2013
Benefits in kind £100
Salary (bands of £5,000) £000
Benefits in kind £100
One month ended March 2012
Salary (bands of £5,000) £000
2012/13
Trevor Jones (Chairman)
20 - 25
0
0-5
0
Alastair Mitchell-Baker (Non-Executive Director)
5 - 10
0
0-5
0
Eddie Weiss (Non-Executive Director)
5 - 10
0
0-5
0
0
0
0
0
Clare Carless (Non-Executive Director)
5 - 10
0
0-5
0
Keith Nuttall (Non-Executive Director)
5 - 10
0
0-5
0
Professor David Williams (Non-Executive Director)
5 - 10
0
0-5
0
William Hancock (Chief Executive)
140 - 145
51.56
10 - 15
3.98
Fizz Thompson (Director of Patient Care / Deputy Chief Executive)
100 - 105
39.6
5 - 10
2.99
Charles Porter (Director of Finance)
100 - 105
40.23
5 - 10
2.71
Ian Ferguson (Chief Operating Officer) 1
20 - 25
9.82
5 - 10
3.85
John Nichols (Interim Chief Operating Officer) 2
95 - 100
7.52
n/a
n/a
Duncan Burke (Director of Communications & Public Engagement)
95 - 100
0
5 - 10
n/a
James Underhay (Director of Strategy and Business Reform) 3
45 - 50
2.38
n/a
n/a
John Black (Medical Director) 4, 5
85 - 90
44.86
5 - 10
7.08
Name and title
Ilona Blue (Non-Executive Director)
Band of highest paid Director’s total
140 - 145
10 - 15
Median total remuneration (£000)
32
2.45
Ratio
4.5
4.5
Notes. 1. Mr Ferguson left the Trust on 17 June 2012 2. Mr Nichols was appointed interim Chief Operating Officer from 18 June 2012 3. Mr Underhay joined the Trust on 8 October 2012
4. Dr Black is employed by the Oxford Radcliffe. The amount shown equates to the recharge for Dr Black’s seconded hours at SCAS. 5. Comparative monthly benefit in kind figure has been amended (7.08 was shown in last years annual report).
191
Annual report 12 / 13
Real increase in pension at age 60 (bands of £2,500)
Real increase in pension lump sum at age 60 (bands of £2,500)
Total accrued pension at age 60 at 31 March 2013 (bands of £5,000)
Lump sum at aged 60 related to accrued pension at 31 March 2013 (bands of £5,000)
Cash Equivalent Transfer Value at 31 March 2013
Cash Equivalent Transfer Value at 31 March 2012
Real increase in Cash Equivalent Transfer Value 31 March 2013
Pensions for the year ended 31 March 2013
£000
£000
£000
£000
£000
£000
£000
William Hancock (Chief Executive)
0 - 2.5
2.5 - 5
35 - 40
115 - 120
571
508
36
Fizz Thompson (Director of Patient Care / Deputy Chief Executive)
0 - 2.5
2.5 - 5
20 - 25
60 - 65
419
363
37
Charles Porter (Director of Finance)
0 - 2.5
2.5 - 5
5 - 10
20 - 25
124
101
18
Ian Ferguson (Chief Operating Officer) 1
0 - 2.5
2.5 - 5
10 - 15
30 - 35
n/a
246
n/a
n/a
n/a
40 - 45
125 - 130
824
n/a
n/a
0 - 2.5
n/a
0-5
n/a
51
31
18
James Underhay (Director of Strategy and Business Reform) 3
n/a
n/a
0-5
n/a
10
n/a
n/a
John Black (Medical Director) 4
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Name and title
John Nichols (Interim Chief Operating Officer) 2 Duncan Burke (Director of Communications & Public Engagement)
Notes. 1. Mr Ferguson left the Trust on 17 June 2012 so there were no CETV transfer values as at end of March 2013 2. Mr Nichols was appointed interim Chief Operating Officer from 18 June 2012. As Mr Nichols was not a Director as at 31 March 2012, no pension details were available. 3. Mr Underhay joined the Trust on 8 October 2012 4. Dr Black is seconded from the Oxford Radcliffe Trust.
192 Annual Report and Accounts 2012/13
Off Payroll Engagements
Cash Equivalent Transfer Value
As of 31 January 2012, the Trust had 3 off payroll engagement: two of these have now come to an end. There were a further two off payroll engagements that came into place between 1 February 2012 and 31 March 2013. Two of these engagements have contracts in place that allow the employer to seek assurance as to their tax status. The contract is being reviewed in the other case to allow for this. None of these staff have come on to the Trust’s payroll.
A Cash Equivalent Transfer Value (CETV) is the actuarially completed capital value of the pension scheme benefits accrued by a members 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.
The trust had no new off payroll engagements between 23 August 2012 and 31 March 2013.
A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme.
They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. Real Increase in CETV This reflects the increase in CETV affectively 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. 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.
193
Annual report 12 / 13
Foreword to the Accounts South Central Ambulance Service NHS Foundation Trust These accounts for the 12 months ended 31 March 2013 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 29 May 2013
194 Annual Report and Accounts 2012/13
STATEMENT OF COMPREHENSIVE INCOME Operating income from continuing operations Operating expenses of continuing operations
Note
2012/13 £000
1 month period ended 31 March 2012 £000
3 4
144,403
12,211
(140,923)
(11,974)
3,480
237
OPERATING SURPLUS / (DEFICIT) Finance costs Finance income
9
115
2
Finance expense - financial liabilities
10
(163)
(10)
Finance expense - unwinding of discount on provisions
32.2
(55)
(12)
PDC Dividends payable
(1,817)
(158)
NET FINANCE COSTS
(1,920)
(178)
1,560
59
0
0
1,560
59
Other comprehensive income
0
0
Impairments
0
0
Revaluations
0
0
Transfer to retained earnings on disposal of assets
0
0
Prior period adjustments
0
0
Merger adjustments
0
0
1,560
59
Surplus / (deficit) from continuing operations Surplus / (deficit) of discontinued operations and the gain/(loss) on disposal of discontinued operations SURPLUS/(DEFICIT) FOR THE YEAR
TOTAL COMPREHENSIVE INCOME / (EXPENSE) FOR THE YEAR
Continued overleaf 195
Annual report 12 / 13
STATEMENT OF COMPREHENSIVE INCOME contâ&#x20AC;&#x2122;d
Note: Allocation of Profits/(Losses) for the period:
2012/13
1 month period ended 31 March 2012 ÂŁ000
(i) minority interest, and
0
0
(ii) owners of the parent
1,560
59
1,560
59
(i) minority interest, and
0
0
(ii) owners of the parent
1,560
59
1,560
59
(a) Surplus/Deficit) for the period attributable to:
TOTAL (b) total comprehensive income / (expense) for the period attributable to:
TOTAL
196 Annual Report and Accounts 2012/13
STATEMENT OF FINANCIAL POSITION Note
31 March 2013 ÂŁ000
31 March 2012 ÂŁ000
Non-current assets Intangible assets
12
2,554
1,605
Property, plant and equipment
13
60,171
59,251
Investment property
17
0
0
Investments in associates (and joined controlled operations)
18
0
0
Other investments
17
0
0
Trade and other receivables
23
0
0
Other financial assets
21
0
0
Other assets
20
0
0
62,725
60,856
Total non-current assets Current assets Inventories
22
954
933
Trade and other receivables
23
7,087
6,506
Other financial assets
21
0
0
Non-current assets for sale and assets in disposal groups
19
3,865
3,865
Cash and cash equivalents
26
8,301
9,573
20,207
20,877
Total current assets Current liabilities Trade and other payables
27
(11,669)
(10,459)
Borrowings
28
(1,007)
(1,406)
Other financial liabilities
31
0
0
Provisions
32
(2,903)
(3,178)
Other liabilities
30
0
0
Liabilities in disposal groups
19
0
0
(15,579)
(15,043)
Total current liabilities
Continued overleaf 197
Annual report 12 / 13
STATEMENT OF FINANCIAL POSITION cont’d
Total assets less current liabilities
31 March 2013 £000
31 March 2012 £000
67,353
66,690
Non-current liabilities Trade and other payables
27
(40)
(26)
Borrowings
28
(1,842)
(2,849)
0
0
Other financial liabilities Provisions
32
(2,201)
(2,105)
Other liabilities
30
0
0
Total non-current liabilities
(4,083)
(4,980)
Total assets employed
63,270
61,710
0
0
57,874
57,874
6,465
6,440
0
0
(350)
(350)
0
0
(719)
(2,254)
63,270
61,710
Financed by Minority interest Public dividend capital Revaluation reserve
34
Available for sale investments reserve Other reserves Merger reserve Income and expenditure reserve Total taxpayers’ and others’ equity
The financial statements on pages 195 to 203 were approved by the Board on 29 May 2013 and signed on its behalf by Will Hancock Chief Executive: Date: 29 May 2013
198 Annual Report and Accounts 2012/13
STATEMENT OF CHANGES IN TAXPAYERS’ EQUITY Taxpayers’ Equity at 1 April 2012 - as previously stated Prior period adjustment Merger adjustments
Total £000
Minority Interest £000
Public Revaluation Dividend Reserve Capital £000 £000
61,710
0
57,874
0
0
0
Available for sale investment reserve £000
Other reserves £000
Merger reserves £000
Income and expenditure reserve £000
6,440
0
(350)
0
(2,254)
0
0
0
0
0
0
0
0
0
0
0
0
0
61,710
0
57,874
6,440
0
(350)
0
(2,254)
At start of period for new FTs
0
0
0
0
0
0
0
0
Surplus / (deficit) for the year
1,560
0
0
0
0
0
0
1560
Transfers by absorption: transfers between reserves
0
0
0
0
0
0
0
0
Transfers between reserves
0
0
0
25
0
0
0
(25)
Impairments
0
0
0
0
0
0
0
0
Revaluations - property, plant and equipment
0
0
0
0
0
0
0
0
Revaluations - intangible assets
0
0
0
0
0
0
0
0
Revaluations - financial assets
0
0
0
0
0
0
0
0
Transfer to retained earnings on disposal of assets
0
0
0
0
0
0
0
0
Share of comprehensive income from associates and joint ventures
0
0
0
0
0
0
0
0
Movements arising from classifying non current assets as assets held for sale
0
0
0
0
0
0
0
0
Fair value gains / (losses) on available-for-sale financial investments
0
0
0
0
0
0
0
0
Recycling gains / (losses) on available-for-sale financial investments
0
0
0
0
0
0
0
0
Other recognised gains and losses
0
0
0
0
0
0
0
0
Actuarial gains / (losses) on defined benefit pension scheme
0
0
0
0
0
0
0
0
Public Dividend Capital received
0
0
0
0
0
0
0
0
Public Dividend Capital repaid
0
0
0
0
0
0
0
0
Public Dividend Capital written off
0
0
0
0
0
0
0
0
Other movements in PDC in year
0
0
0
0
0
0
0
0
Reserves eliminated on dissolution (unlocked on request)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
63,270
0
57,874
6,465
0
(350)
0
(719)
Taxpayers’ equity at 1 April 2012 restated
Other reserve movements Taxpayers' Equity at 31 March 2013
Continued overleaf
199
Annual report 12 / 13
STATEMENT OF CHANGES IN TAXPAYERS’ EQUITY cont’d
Total £000
Minority Interest £000
Available for sale investment reserve £000
Other reserves £000
Merger reserves £000
Income and expenditure reserve £000
61,651
0
57,874
6,440
0
(350)
0
(2,313)
59
0
0
0
0
0
0
59
Transfers by absorption: transfers between reserves
0
0
0
0
0
0
0
0
Transfers between reserves
0
0
0
0
0
0
0
0
Impairments
0
0
0
0
0
0
0
0
Revaluations - property, plant and equipment
0
0
0
0
0
0
0
0
Revaluations - intangible assets
0
0
0
0
0
0
0
0
Revaluations - Financial assets
0
0
0
0
0
0
0
0
Transfer to retained earnings on disposal of assets
0
0
0
0
0
0
0
0
Share of comprehensive income from associates and joint ventures
0
0
0
0
0
0
0
0
Movements arising from classifying non current assets as Assets Held for Sale
0
0
0
0
0
0
0
0
Fair Value gains/(losses) on Available-for-sale financial investments
0
0
0
0
0
0
0
0
Recycling gains/(losses) on Available-for-sale financial investments
0
0
0
0
0
0
0
0
Other recognised gains and losses
0
0
0
0
0
0
0
0
Actuarial gains/(losses) on defined benefit pension schemes
0
0
0
0
0
0
0
0
Public Dividend Capital received
0
0
0
0
0
0
0
0
Public Dividend Capital repaid
0
0
0
0
0
0
0
0
Public Dividend Capital written off
0
0
0
0
0
0
0
0
Other movements in PDC in year
0
0
0
0
0
0
0
0
Reserves eliminated on dissolution (unlocked on request)
0
0
0
0
0
0
0
0
Other reserve movements
0
0
0
0
0
0
0
0
61,710
0
57,874
6,440
0
(350)
0
(2,254)
At start of period 1 March 2012 Surplus/(deficit) for the year
Taxpayers' Equity at 31 March 2012
200 Annual Report and Accounts 2012/13
Public Revaluation Dividend Reserve Capital £000 £000
STATEMENT OF CASH FLOWS 31 March 2013 ÂŁ000
1 month ended 31 March 2012 ÂŁ000
Operating surplus / (deficit) from continuing operations
3,480
237
Operating surplus / (deficit) of discontinued operations
0
0
3,480
237
6,823
577
Impairments
0
0
Reversals of impairments
0
0
(Profit)/Loss on asset disposal
(45)
0
Interest accrued and not paid
0
0
Dividends accrued and not paid or received
0
0
Amortisation of government grants
0
0
Amortisation of PFI credit
0
0
(581)
1,683
0
0
(Increase)/Decrease in Inventories
(21)
(17)
Increase/(Decrease) in Trade and Other Payables
862
(968)
Cash flows from operating activities
Operating surplus / (deficit) Non-cash income and expense: Depreciation and amortisation
(Increase)/Decrease in Trade and Other Receivables (Increase)/Decrease in Other Assets
Increase/(Decrease) in Other Liabilities
(70)
(792)
(179)
206
Tax (paid) / received
0
0
Movements in operating cash flow of discontinued operations
0
0
Movements in operating cash flow in respect of Transforming Community Services transaction
0
0
Other movements in operating cash flows
0
0
10,269
689
Increase/(Decrease) in Provisions
NET CASH GENERATED FROM/(USED IN) OPERATIONS
Continued overleaf 201
Annual report 12 / 13
STATEMENT OF CASH FLOWS cont’d
31 March 2013 £000
1 month ended 31 March 2012 £000
115
2
Purchase of financial assets
0
0
Sales of financial assets
0
0
(1,239)
(52)
0
0
(7,111)
(431)
65
1004
Cash flows attributable to investing activities of discontinued operations
0
0
Cash from acquisitions of business units and subsidiaries
0
0
Cash from (disposals) of business units and subsidiaries
0
0
(8,170)
523
Cash flows from investing activities Interest received
Purchase of intangible assets Sales of intangible assets Purchase of Property, Plant and Equipment Sales of Property, Plant and Equipment
Net cash generated from/(used in) investing activities
Continued overleaf 202 Annual Report and Accounts 2012/13
STATEMENT OF CASH FLOWS cont’d
31 March 2013 £000
1 month ended 31 March 2012 £000
Public dividend capital received
0
0
Public dividend capital repaid
0
0
Loans received from the Department of Health
0
0
Other loans received
0
0
(1,328)
(664)
0
0
(78)
(8)
0
0
Cash flows from financing activities
Loans repaid to the Department of Health Other loans repaid Capital element of finance lease rental payments Other capital receipts Capital element of Private Finance Initiative Obligations
0
0
(136)
(88)
(12)
(1)
0
0
(1,817)
(158)
Cash flows attributable to financing activities of discontinued operations
0
0
Cash flows from (used in) other financing activities
0
0
Net cash generated from/(used in) financing activities
(3,371)
(919)
Increase/(decrease) in cash and cash equivalents
(1,272)
530
9,573
0
0
9,043
8,301
9,573
Interest paid Interest element of finance lease Interest element of Private Finance Initiative obligations PDC Dividend paid
Cash and Cash equivalents at 1st April Cash and Cash equivalents at start of period for new FTs Cash and Cash equivalents at year end
203
Annual report 12 / 13
NOTES TO THE ACCOUNTS 1 Accounting Policies
1.2 Acquisitions and discontinued operations
Monitor has directed that the financial statements of NHS Foundation Trusts shall meet the accounting requirements of the NHS Foundation Trust Annual Reporting Manual which shall be agreed with HM Treasury. Consequently, the following financial statements have been prepared in accordance with the 2012/13 NHS Foundation Trust Annual Reporting Manual issued by Monitor. The accounting policies contained in that manual follow International Reporting Standards (IFRS) and HM Treasury’s Financial Reporting Manual to the extent that they are meaningful and appropriate to NHS Foundation Trusts. The accounting policies have been applied consistently in dealing with items considered material in relation to the accounts.
Activities are considered to be ‘acquired’ only if they are taken on from outside the public sector. Activities are considered to be ‘discontinued’ only if they cease entirely. They are not considered to be ‘discontinued’ if they transfer from one public sector body to another.
1.1 Accounting convention These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities. Going Concern The Foundation Trust Accounts have been prepared on a “going concern” basis. This means that the Trust expects to operate into the future and that the statement of financial position (assets and liabilities) reflects the ongoing nature of the Trust’s activities. The Trust Board of Directors have considered and declared that; “After making enquiries, the Board of Directors have a reasonable expectation that the Trust has adequate resources to continue in operational existence for the foreseeable future”. For this reason, they continue to adopt the going concern basis in preparing the accounts
204 Annual Report and Accounts 2012/13
1.3 Critical accounting judgements and key sources of estimation uncertainty In the application of the Foundation Trust’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. 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.
1.3.1 Critical judgements in applying accounting policies 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.
NOTES TO THE ACCOUNTS The Trust has used the professional services of an independent valuer to provide an indicative amount of the annual increase/decrease to be applied to the value of land carried forward from 1 April 2012. Indexation has not been applied to Buildings and any Non Current assets (i.e. Vehicles and Equipment, 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. The Trust reviews all lease contracts to determine whether they are operating or finance leases. Accruals for services received not yet invoiced are estimated on the basis of past experience. Income has been deferred where expenditure will take place during the year ending 31 March 2014.
1.3.2 Key sources of estimation uncertainty The following are the key assumptions concerning the future, and other key sources of estimation uncertainty at the end of the reporting period, that have a significant risk of causing a material adjustment to the carrying amounts of assets and liabilities within the next financial year.
The valuation of property is based on a full 2009 revaluation exercise undertaken by the Trustâ&#x20AC;&#x2122;s Independent Valuer updated as appropriate by the use of land and building indices. 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 ÂŁ34.6m as at 31 March 2013.
1.4 Revenue Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable. The main source of revenue for the trust is from commissioners for healthcare services. Where income is received for a specific activity that is to be delivered in the following year, that income is deferred. Income from sale of non-current assets is recognised only when all material conditions of sale have been met, and is measured as the sums due under the sale contract. The Trust receives income under the NHS Injury Cost Recovery Scheme, designed to reclaim the cost of treating injured individuals to whom personal injury compensation has subsequently been paid e.g. by an insurer. The Trust recognises the income when it receives notification from the Department of Work and Pensionâ&#x20AC;&#x2122;s Compensation Recovery Unit that the individual has lodged a compensation claim. The income is measured at the agreed tariff for the treatments provided to the injured individual.
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NOTES TO THE ACCOUNTS 1.5 Employee Benefits
1.6 Other expenses
Short-term employee benefits Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees.
Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable.
The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period. Retirement benefit costs Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. It is not possible for the NHS Foundation Trust to identify its share of the underlying scheme liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: 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. 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 for the additional costs is charged to expenditure at the time the Foundation Trust commits itself to the retirement, regardless of the method of payment.
206 Annual Report and Accounts 2012/13
1.7 Property, plant and equipment Recognition Property, plant and equipment is capitalised if: »» it is held for use in delivering services or for administrative purposes; »» it is probable that future economic benefits will flow to, or service potential will be supplied to, the Foundation Trust; »» it is expected to be used for more than one financial year; »» the cost of the item can be measured reliably; and »» the item has 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 »» Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost.
NOTES TO THE ACCOUNTS Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives. The Trust has assessed that adoption of component accounting would not materially affect the value of Trust assets and therefore it has not been applied. Valuation All property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at fair value. Land and buildings used for the Trust’s services, or for administrative purposes, are stated in the statement of financial position at their revalued amounts, being the fair value at the date of revaluation less any impairment. Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Fair values are determined as follows: »» Land and non-specialised buildings – market value for existing use »» Specialised buildings – depreciated replacement cost Until 31 March 2008, the depreciated replacement cost of specialised buildings has been estimated for an exact replacement of the asset in its present location.
HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and, where it would meet the location requirements of the service being provided, an alternative site can be valued. Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are revalued and depreciation commences when they are brought into use. Until 31 March 2008, fixtures and equipment were carried at replacement cost, as assessed by indexation and depreciation of historic cost. From 1 April 2008 indexation has ceased. The carrying value of existing assets at that date will be written off over their remaining useful lives and new fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from fair value. An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged there. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit should be taken to expenditure. Gains and losses recognised in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Income.
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NOTES TO THE ACCOUNTS Subsequent expenditure Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is written-out and charged to operating expenses.
1.8 Intangible assets Recognition
Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the Trust’s business or which arise from contractual or other legal rights. They are recognised only when it is probable that future economic benefits will flow to, or service potential be provided to, the Trust; where the cost of the asset can be measured reliably, and where the cost is at least £5000. Intangible assets acquired separately are initially recognised at fair value. Software that is integral to the operating of hardware, for example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on research is not capitalised: it is recognised as an operating expense in the period in which it is incurred.
208 Annual Report and Accounts 2012/13
Internally-generated assets are recognised if, and only if, all of the following have been demonstrated: »» the technical feasibility of completing the intangible asset so that it will be available for use »» the intention to complete the intangible asset and use it »» the ability to sell or use the intangible asset »» how the intangible asset will generate probable future economic benefits or service potential »» the availability of adequate technical, financial and other resources to complete the intangible asset and sell or use it »» the ability to measure reliably the expenditure attributable to the intangible asset during its development Measurement The amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred. Following initial recognition, intangible assets are carried at fair value by reference to an active market, or, where no active market exists, at amortised replacement cost (modern equivalent asset basis), indexed for relevant price increases, as a proxy for fair value. Internally-developed software is held at historic cost to reflect the opposing effects of increases in development costs and technological advances.
NOTES TO THE ACCOUNTS 1.9 Depreciation, amortisation and impairments Freehold land, properties under construction, and assets held for sale are not depreciated. Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the Trust expects to obtain economic benefits or service potential from the asset. This is specific to the Trust and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over their estimated useful lives At each reporting period end, the Trust checks whether there is any indication that any of its tangible or intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit should be taken to expenditure.
Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve.
1.10 Donated assets Following the accounting policy change outlined in the Treasury FREM for 2011-12, a donated asset reserve is no longer maintained. Donated noncurrent assets are capitalised at their fair value on receipt, with a matching credit to Income. They are valued, depreciated and impaired as described above for purchased assets. Gains and losses on revaluations, impairments and sales are as described above for purchased assets. Deferred income is recognised only where conditions attached to the donation preclude immediate recognition of the gain.
1.11 Government grants Following the accounting policy change, outlined in the Treasury FREM for 2011-12, a government grant reserve is no longer maintained. The value of assets, received by means of a government grant, are credited directly to income. Deferred income is recognised only where conditions attached to the grant preclude immediate recognition of the gain.
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NOTES TO THE ACCOUNTS 1.12 Non-current assets held for sale
1.13 Leases
Non-current assets are classified as held for sale if their carrying amount will be recovered principally through a sale transaction rather than through continuing use. This condition is regarded as met when the sale is highly probable, the asset is available for immediate sale in its present condition and management is committed to the sale, which is expected to qualify for recognition as a completed sale within one year from the date of classification. Non-current assets held for sale are measured at the lower of their previous carrying amount and fair value less costs to sell. Fair value is open market value including alternative uses.
Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases.
The profit or loss arising on disposal of an asset is the difference between the sale proceeds and the carrying amount and is recognised in the Statement of Comprehensive Income. On disposal, the balance for the asset on the revaluation reserve is transferred to retained earnings. For donated and government-granted assets, a transfer is made to or from the relevant reserve to the profit/loss on disposal account so that no profit or loss is recognised in income or expenses. The remaining surplus or deficit in reserves is then transferred to retained earnings. Property, plant and equipment that is to be scrapped or demolished does not qualify for recognition as held for sale. Instead, it is retained as an operational asset and its economic life adjusted. The asset is de-recognised when it is scrapped or demolished.
210 Annual Report and Accounts 2012/13
The trust as lessee Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the trustâ&#x20AC;&#x2122;s surplus/deficit. Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term. Contingent rentals are recognised as an expense in the period in which they are incurred. Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases.
NOTES TO THE ACCOUNTS The trust as lessor
1.16 Provisions
Amounts due from lessees under finance leases are recorded as receivables at the amount of the trustâ&#x20AC;&#x2122;s net investment in the leases. Finance lease income is allocated to accounting periods so as to reflect a constant periodic rate of return on the trustâ&#x20AC;&#x2122;s net investment outstanding in respect of the leases.
The NHS Foundation Trust recognises where it has a present legal or constructive obligation as a result of a past event, for which it is probable that there will be a future outflow of cash or other resources: and a reliable estimate can be made of the amount. The amount recognised in the Statement of Financial Position is the best estimate of the resources required to settle the obligation. Where the effect of the time value of money is significant, the estimated risk adjusted cash flows are discounted using HM Treasuryâ&#x20AC;&#x2122;s discount rate of 2.2% in real terms.
Rental income from operating leases is recognised on a straight-line basis over the term of the lease. Initial direct costs incurred in negotiating and arranging an operating lease are added to the carrying amount of the leased asset and recognised on a straight-line basis over the lease term.
1.14 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.
1.15 Cash and cash equivalents Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value.
When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably. Present obligations arising under onerous contracts are recognised and measured as a provision. An onerous contract is considered to exist where the Trust has a contract under which the unavoidable costs of meeting the obligations under the contract exceed the economic benefits expected to be received under it. A restructuring provision is recognised when the Foundation Trust has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The measurement of a restructuring provision includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with ongoing activities of the entity.
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NOTES TO THE ACCOUNTS 1.17 Clinical negligence costs The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the Trust pays an annual contribution to the NHSLA which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the NHSLA is administratively responsible for all clinical negligence cases the legal liability remains with the Trust. The total value of clinical negligence provisions carried by the NHSLA on behalf of the Foundation Trust is disclosed at note 32.3.
1.18 Non-clinical risk pooling The Trust participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the Trust pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due.
1.19 Contingencies A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the Trust, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote.
212 Annual Report and Accounts 2012/13
A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the Trust. A contingent asset is disclosed where an inflow of economic benefits is probable. Where the time value of money is material, contingencies are disclosed at their present value.
1.20 Financial assets Financial assets are recognised when the Trust becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred. Financial assets are initially recognised at fair value. Financial assets are classified into the following categories: financial assets at fair value through profit and loss; held to maturity investments; available for sale financial assets, and loans and receivables. The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition. All of the Trustâ&#x20AC;&#x2122;s financial assets are classified as loans and receivables.
NOTES TO THE ACCOUNTS Loans and receivables Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. After initial recognition, they are measured at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method. The Foundation Trust’s loans and receivables comprise cash and cash equivalents, NHS debtors, accrued income and other debtors. Loans and receivables are recognised initially at fair value, net of transaction costs, and are subsequently measured at amortised costs, using the effective interest method. The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, to the initial fair value of the financial asset. Interest on loans and receivables is calculated using the effective interest method and credited to the Statement of Comprehensive income. Impairment of financial assets At the end of the reporting period, the Trust assesses whether any financial assets, other than those held at ‘fair value through profit and loss’ are impaired. Financial assets are impaired and impairment losses recognised if, there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset.
For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in expenditure and the carrying amount of the asset is reduced directly/through a provision for impairment of receivables. If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not been recognised.
1.21 Financial liabilities Financial liabilities are recognised on the statement of financial position when the Trust becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired. Loans from the Department of Health are recognised at historical cost. Otherwise, financial liabilities are initially recognised at fair value.
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NOTES TO THE ACCOUNTS Other financial liabilities
1.24 Third party assets
After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except for loans from Department of Health, which are carried at historic cost. The effective interest rate is the rate that exactly discounts estimated future cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective interest method.
Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the Trust has no beneficial interest in them.
1.22 Value Added Tax Most of the activities of the trust are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.
1.23 Foreign currencies The Trustâ&#x20AC;&#x2122;s functional currency and presentational currency is sterling. Transactions denominated in a foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions. At the end of the reporting period, monetary items denominated in foreign currencies are retranslated at the spot exchange rate on 31 March. Resulting exchange gains and losses for either of these are recognised in the Trustâ&#x20AC;&#x2122;s surplus/deficit in the period in which they arise.
214 Annual Report and Accounts 2012/13
1.25 Public Dividend Capital (PDC) and PDC dividend Public dividend capital represents taxpayersâ&#x20AC;&#x2122; equity in the NHS Trust. At any time the Secretary of State can issue new PDC to, and require repayments of PDC from, the Trust. PDC is recorded at the value received. As PDC is issued under legislation rather than under contract, it is not treated as an equity financial instrument.
An annual charge, reflecting the cost of capital utilised by the Trust, is payable to the Department of Health as public dividend capital dividend. The charge is calculated at the real rate set by HM Treasury (currently 3.5%) on the average carrying amount of all assets less liabilities, except for donated assets and cash balances with the Government Banking Service. The average carrying amount of assets is calculated as a simple average of opening and closing relevant net assets.
NOTES TO THE ACCOUNTS 1.26 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 Trusts not been bearing their own risks (with insurance premiums then being included as normal revenue expenditure).
1.27 Accounting Standards that have been issued but have not yet been adopted
None of them are expected to impact upon the Trust’s financial statements: »» IFRS 9 Financial Assets and Financial Liabilities »» IFRS10 Consolidated Financial Statements »» IFRS 11 Joint Arrangements »» IFRS 12 Disclosure of Interests in Other Entities »» IFRS 13 Fair Value Measurement »» IAS12 Income Taxes amendment »» IAS1 Presentation of financial statements, on other comprehensive income »» IAS 27 Separate Financial Statements »» IAS 28 Associates and joint ventures »» IAS19 Revised 2011) Employee Benefits »» IAS 32 Financial Instruments Presentation - offsetting financial assets and liabilities »» IFRS 7 Financial Instruments Disclosures - offsetting financial assets and liabilities.
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.
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NOTES TO THE ACCOUNTS 2 Operating Segments Each segment is reported separately in the monthly Board report. Non-Emergency Services include Patient Transport Service (PTS), Logistic Services, Out of Hours Provision and 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.
216 Annual Report and Accounts 2012/13
Emergency Services
Non-Emergency Services
Total
2012/13 £000’s
2012/13 £000’s
2012/13 £000’s
Income
123,426
20,932
144,358
Direct Costs
(90,832)
(18,513)
(109,345)
32,594
2,419
35,013
Contribution Operational Activities Total Overheads Depreciation Total Costs Before Dividends and Interest Operating Surplus
(24,710) (6,823) (31,533) 3,480
The Trust reported one segment (Health) in its one month accounts for 2011/12. As the Trust had only been a Foundation Trust for one month these figures have been excluded as they would not provide any meaningful comparison with the figures reported above.
NOTES TO THE ACCOUNTS Note 3 Operating income from continuing operations Note 3.1 Income by classification 2012/13 £000
1 month period ended 31 March 2012 £000
Total
Total
A&E Income
121,048
9,565
PTS Income
16,723
1,368
893
712
Education, training and research
1,849
156
Non-patient care services to other bodies
2,566
215
Other revenue
1,324
195
144,403
12,211
Income from activities
Other Income Other operating income
Other revenue includes £390k commercial training, £286k radio mast income and £500k insurance refunds.
Note 3.2 Private patient income Section 44 of the 2006 Act has been superceded by 2012 Health and Social Care Act. Financial statement disclosures that were required as part of the 2006 Act are no longer required.
Note 3.3 Operating lease income
There is no operating lease income for the Trust. Income is from the supply of services and there is no income from sale of goods.
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Annual report 12 / 13
NOTES TO THE ACCOUNTS Note 3.4 Operating income by type 2012/13 £000
1 month period ended 31 March 2012 £000
0
0
1,044
174
129,120
10,321
6,240
603
Local authorities
100
0
Department of Health
336
27
0
0
Private patients
0
0
Overseas patients (non-reciprocal)
0
0
538
73
Other
1,286
447
Other operating income
5,739
566
144,403
12,211
Strategic health authorities NHS trusts Primary care trusts Foundation trusts
NHS other Non-NHS
Injury costs recovery
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. £117m of income received relates to mandatory services. All other income relates to non-mandatory services.
218 Annual Report and Accounts 2012/13
Note 3.5 Income generation activities The Trust undertakes income generation activities. No income generating activity exceeded £1m.
NOTES TO THE ACCOUNTS 4 Operating expenses 2012/13 ÂŁ000
1 month period ended 31 March 2012 ÂŁ000
Services from other NHS trusts
0
0
Services from PCTs
0
0
Services from other NHS bodies
0
0
Services from foundation trusts
0
0
Purchase of healthcare from non NHS bodies
0
42
Employee Expenses - Executive directors
669
63
Trust chair and non executive directors
53
6
91,183
6,899
223
10
3,221
528
989
85
4,015
295
Transport
20,839
1,921
Premises
5,081
451
(41)
16
4,357
502
0
0
Depreciation
6,212
533
Amortisation
611
44
Employee Expenses - Staff Supplies and services - drugs Supplies and services - clinical (excluding drugs costs) Supplies and services - general Establishment
Increase / (decrease) in provision for impairment of receivables Rentals under operating leases Inventories write down
Continued overleaf 219
Annual report 12 / 13
NOTES TO THE ACCOUNTS 4 Operating expenses (cont’d)
2012/13 £000
1 month period ended 31 March 2012 £000
Impairments and reversals of property, plant and equipment
0
0
Impairments and reversals of intangible assets
0
0
Impairments and reversals of financial assets
0
0
Impairments and reversals of non current assets held for sale
0
0
Impairments and reversals of investment properties
0
0
Audit services - statutory audit
53
67
Other auditor's remuneration
0
0
323
20
79
0
Consultancy services
901
43
Training, courses and conferences
278
115
1,143
87
734
247
140,923
11,974
Clinical negligence Legal Costs
Insurance Other
Insurance includes fleet premiums previously classified as part of Transport costs (prior year value £78k for the 1 month).
220 Annual Report and Accounts 2012/13
NOTES TO THE ACCOUNTS 5.1 Employee Expenses
2012/13 Total £000
2012/13 Permanently Employed £000
2012/13 Other £000
Salaries and wages
75,252
74,845
407
Social security costs
5,498
5,498
0
Employers contributions to NHS Pensions
8,153
8,153
0
Other employment benefits
0
0
0
Termination benefits
0
0
0
2,949
0
2,949
91,852
88,496
3,356
1 month period ended 31 March 2012 Total £000
1 month period ended 31 March 2012 Permanently employed £000
1 month period ended 31 March 2012 Other £000
Salaries and wages
5649
5649
0
Social security costs
437
437
0
Employers contributions to NHS Pensions
722
722
0
Other employment benefits
0
0
0
Termination benefits
0
0
0
154
0
154
6,962
6,808
154
Agency/contract staff TOTAL GROSS STAFF COSTS
5.1 Employee Expenses
Agency/contract staff TOTAL GROSS STAFF COSTS
221
Annual report 12 / 13
NOTES TO THE ACCOUNTS 5.2 Average number of employees (WTE basis)
Medical and dental Ambulance staff
2012/13 Total Number
2012/13 Permanent Number
2012/13 Other Number
0
0
0
1,298
1,298
0
Administration and estates
632
546
86
Healthcare assistants and other support staff
449
449
0
76
76
0
0
0
0
2,455
2,369
86
1 month period ended 31 March 2012 Total Number
1 month period ended 31 March 2012 Permanent Number
1 month period ended 31 March 2012 Other Number
0
0
0
1,275
1,275
0
Administration and estates
530
503
27
Healthcare assistants and other support staff
482
482
0
46
46
0
0
0
0
2,333
2,306
27
Nursing, midwifery and health visiting staff Other Total average numbers
5.2 Average number of employees (WTE basis)
Medical and dental Ambulance staff
Nursing, midwifery and health visiting staff Other Total average numbers
222 Annual Report and Accounts 2012/13
NOTES TO THE ACCOUNTS 5.3 Remuneration and other benefits received by Directors
Total
2012/13 £000
1 month period ended 31 March 2012 £000
669
69
5.4 Early retirements due to ill health There were no early retirements due to ill health in the reporting period
5.5 Analysis of Termination benefits 2012/13 Number of compulsory redundancies Number
2012/13 Cost of compulsory redundancies £000
1 month period ended 31 March 2012 Number and £000’s
<£10,000
15
70
0
£10,001 - £25,000
12
197
0
£25,001 - 50,000
6
223
0
£50,001 - £100,000
2
141
0
£100,001 - £150,000
0
0
0
£150,001 - £200,000
0
0
0
>£200,001
0
0
0
35
631
0
Exit package cost band (including any special payment element)
Total
223
Annual report 12 / 13
NOTES TO THE ACCOUNTS 5.6 Pension Costs 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. In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that â&#x20AC;&#x153;the period between formal valuations shall be four years, with approximate assessments in intervening yearsâ&#x20AC;?. An outline of these follows: a) Full actuarial (funding) valuation The purpose of this valuation is to assess the level of liability in respect of the benefits due under the scheme (taking into account its recent demographic experience), and to recommend the contribution rates. 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.
224 Annual Report and Accounts 2012/13
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. Employer and employee contribution rates are currently being determined under the new scheme design. b) Accounting valuation A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period. Actuarial assessments are undertaken in intervening years between formal valuations using updated membership data are accepted as providing suitably robust figures for financial reporting purposes. However, as the interval since the last formal valuation now exceeds four years, the valuation of the scheme liability as at 31 March 2013, is based on detailed membership data as at 31 March 2010 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. 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.
NOTES TO THE ACCOUNTS 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:
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 for the additional costs is charged to the employer. Members can purchase additional service in the NHS Scheme and contribute to money purchase AVC’s run by the Scheme’s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers.
The Scheme is a “final salary” scheme. 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. 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.
225
Annual report 12 / 13
NOTES TO THE ACCOUNTS 6.1 Analysis of Operating Lease Expenditure Minimum lease payments Contingent rents Less sublease payments received
2012/13 £000
1 month period ended 31 March 2012 £000
4,357
502
0
0
4,357
502
Total 2012/13 £000
Land 2012/13
Buildings 2012/13 £000
Other 2012/13 £000
- not later than one year;
3,087
0
1,367
1,720
- later than one year and not later than five years;
6,998
0
4,627
2,371
- later than five years.
11,196
0
11,196
0
Total
21,281
0
17,190
4,091
Total 2011/12 £000
Land 2011/12
Buildings 2011/12 £000
Other 2011/12 £000
- not later than one year;
3,508
0
1,540
1,968
- later than one year and not later than five years;
7,503
0
4,509
2,994
- later than five years.
11,400
0
11,400
0
Total
22,411
0
17,449
4,962
Future minimum lease payments due:
Future minimum lease payments due:
226 Annual Report and Accounts 2012/13
NOTES TO THE ACCOUNTS 6.2 Limitation on Auditors Liability 2012/13 £000
2011/12 £000
1,000
0
The Trust’s contract with its auditors for 2011/12, as set out in the engagement letter, provided for no limitation of auditor’s liability.
6.3 The Late Payment of Commercial Debts Interest Act 1998 No interest payments were made by the Trust in the reporting period
6.4 Other Audit remuneration No other payments were made to the Trust’s Auditors
7 Discontinued operations The Trust has no discontinued operations
8 Corporation Tax The Trust has determined that it has no corporation tax liability as it has no private income from non operational areas.
227
Annual report 12 / 13
NOTES TO THE ACCOUNTS 9 Finance income
Interest on bank accounts
2012/13 £000
1 month period ended 31 March 2012 £000
115
2
Other
0
0
Total
115
2
2012/13 £000
1 month period ended 31 March 2012 £000
136
9
Commercial loans
0
0
Overdrafts
0
0
12
1
0
0
15
0
163
10
10 Finance costs Interest expense: Loans from the Department of Health
Finance leases Interest on late payment of commercial debt Other Finance Costs Total
11 Impairment of Assets There were no asset impairments in the reporting period
228 Annual Report and Accounts 2012/13
NOTES TO THE ACCOUNTS 12.1 Intangible assets Total £000
Software licences (purchased) £000
Information technology (internally generated) £000
Development expenditure (internally generated) £000
Other (purchased) £000
Other (internally generated) £000
Goodwill £000
Intangible Assets Under Construction £000
2,917
2,917
0
0
0
0
0
0
0
0
Prior period adjustments
0
0
0
0
0
0
0
0
0
0
TCS and merger adjustments
0
0
0
0
0
0
0
0
0
0
2,917
2,917
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1,264
429
0
0
0
0
0
0
0
835
Additions - donated
0
0
0
0
0
0
0
0
0
0
Additions - internally generated
0
0
0
0
0
0
0
0
0
0
Additions - government granted
0
0
0
0
0
0
0
0
0
0
Impairments
0
0
0
0
0
0
0
0
0
0
Reversal of impairments
0
0
0
0
0
0
0
0
0
0
Valuation/Gross Cost at 1 April 2012 - as previously stated
Valuation / Gross cost at start of period for new FTs Additions - purchased
Licences & Patents trademarks (purchased ) (purchased) £000 £000
296
296
0
0
0
0
0
0
0
0
Revaluations
0
0
0
0
0
0
0
0
0
0
Transferred to disposal group as asset held for sale
0
0
0
0
0
0
0
0
0
0
Disposals
0
0
0
0
0
0
0
0
0
0
4,477
3,642
0
0
0
0
0
0
0
835
Prior period adjustments
0
0
0
0
0
0
0
0
0
0
TCS and merger adjustments
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Reclassifications
Continued overleaf 229
Annual report 12 / 13
NOTES TO THE ACCOUNTS 12.1 Intangible assets (cont’d)
Total £000
Software licences (purchased) £000
Information technology (internally generated) £000
Development expenditure (internally generated) £000
Other (purchased) £000
Other (internally generated) £000
Goodwill £000
Intangible Assets Under Construction £000
1,312
1,312
0
0
0
0
0
0
0
0
611
611
0
0
0
0
0
0
0
0
Impairments
0
0
0
0
0
0
0
0
0
0
Reversal of impairments
0
0
0
0
0
0
0
0
0
0
Reclassifications
0
0
0
0
0
0
0
0
0
0
Revaluation surpluses
0
0
0
0
0
0
0
0
0
0
Transferred to disposal group as asset held for sale
0
0
0
0
0
0
0
0
0
0
Disposals
0
0
0
0
0
0
0
0
0
0
1,923
1,923
0
0
0
0
0
0
0
0
Amortisation at 1 April 2012 as previously stated Provided during the year
Amortisation at 31 March 2013
230 Annual Report and Accounts 2012/13
Licences & Patents trademarks (purchased ) (purchased) £000 £000
NOTES TO THE ACCOUNTS 12.2 Intangible assets Total £000
Software licences (purchased) £000
Licences & Patents trademarks (purchased ) (purchased) £000 £000
Information technology (internally generated) £000
Development expenditure (internally generated) £000
Other (purchased) £000
Other (internally generated) £000
Goodwill £000
Intangible Assets Under Construction £000
2,554
1,719
0
0
0
0
0
0
0
835
NBV - Finance leases at 31 March 2013
0
0
0
0
0
0
0
0
0
0
NBV - Donated at 31 March 2013
0
0
0
0
0
0
0
0
0
0
2,554
1,719
0
0
0
0
0
0
0
835
Net book value NBV - Purchased at 31 March 2013
NBV total at 31 March 2013
12.3 NBV of Intangible assets in the revaluation reserve
2012/13 £000
2011/12 £000
Carrying Value at 1 April
0
0
Prior Period Adjustment
0
0
TCS and merger adjustments
0
0
Carrying value at 1 April (restated)
0
0
At start of period for new FTs
0
0
Movement in year
0
0
Carrying Value at 31 March
0
0
231
Annual report 12 / 13
NOTES TO THE ACCOUNTS 12.4 Intangible assets 2011/12
Gross cost at start of period for new FTs
Total £000
Software licences (purchased) £000
Licences & Patents trademarks (purchased ) (purchased) £000 £000
2,865
2,865
0
Information technology (internally generated) £000
Development expenditure (internally generated) £000
Other (purchased) £000
Other (internally generated) £000
Goodwill £000
Intangible Assets Under Construction £000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
52
52
0
0
0
0
0
0
0
0
Additions - Leased
0
0
0
0
0
0
0
0
0
0
Additons - donated
0
0
0
0
0
0
0
0
0
0
Additions - internally generated
0
0
0
0
0
0
0
0
0
0
Additions - government granted
0
0
0
0
0
0
0
0
0
0
Impairments
0
0
0
0
0
0
0
0
0
0
Reversal of impairments
0
0
0
0
0
0
0
0
0
0
Reclassifications
0
0
0
0
0
0
0
0
0
0
Revaluations
0
0
0
0
0
0
0
0
0
0
Transfers to/from assets held for sale and assets in disposal groups
0
0
0
0
0
0
0
0
0
0
Disposals
0
0
0
0
0
0
0
0
0
0
2,917
2,917
0
0
0
0
0
0
0
0
Transfers by absorption Additions - purchased
Valuation/Gross cost at 31 March 2012
Continued overleaf 232 Annual Report and Accounts 2012/13
NOTES TO THE ACCOUNTS 12.4 Intangible assets 2011/12 (cont’d)
Amortisation at start of period for new FTs
Total £000
Software licences (purchased) £000
Licences & Patents trademarks (purchased ) (purchased) £000 £000
1,268
1,268
0
Information technology (internally generated) £000
Development expenditure (internally generated) £000
Other (purchased) £000
Other (internally generated) £000
Goodwill £000
Intangible Assets Under Construction £000
0
0
0
0
0
0
0
Transfers by absorption
0
0
0
0
0
0
0
0
0
0
Provided during the year
44
44
0
0
0
0
0
0
0
0
Impairments
0
0
0
0
0
0
0
0
0
0
Reversal of impairments
0
0
0
0
0
0
0
0
0
0
Reclassifications
0
0
0
0
0
0
0
0
0
0
Revaluations
0
0
0
0
0
0
0
0
0
0
Transfers to/from assets held for sale and assets in disposal groups
0
0
0
0
0
0
0
0
0
0
Disposals
0
0
0
0
0
0
0
0
0
0
1,312
1,312
0
0
0
0
0
0
0
0
Amortisation at 31 March 2012
233
Annual report 12 / 13
NOTES TO THE ACCOUNTS 13.1 Property, plant and equipment 2012/13 Total £000
Land £000
Buildings excluding dwellings £000
Plant and machinery £000
Transport equipment £000
Information technology £000
Furniture and fittings £000
95,415
8,950
29,572
137
1,518
8,569
37,053
8,448
1,168
Prior Period adjustments
0
0
0
Merger adjustments
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
95,415
8,950
29,572
137
1,518
8,569
37,053
8,448
1,168
Valuation/Gross cost at start of period for new FTs
0
0
0
0
0
0
0
0
0
Transfers by absorption
0
0
0
0
0
0
0
0
0
7,448
0
220
0
2,623
936
3,601
68
0
Additions - Leased
0
0
0
0
0
0
0
0
0
Additions - donated
0
0
0
0
0
0
0
0
0
Additions - government granted
0
0
0
0
0
0
0
0
0
Impairments
0
0
0
0
0
0
0
0
0
Reversal of impairments
0
0
0
0
0
0
0
0
0
(296)
0
184
0
(1,224)
224
352
164
4
Revaluations
0
0
0
0
0
0
0
0
0
Transfers to/from assets held for sale and assets in disposal groups
0
0
0
0
0
0
0
0
0
Disposals
(2,828)
0
0
0
0
(373)
(1,603)
(852)
0
Valuation/Gross cost at 31 March 2013
99,739
8,950
29,976
137
2,917
9,356
39,403
7,828
1,172
Valuation/Gross cost at 1 April 2012 - as previously stated
Valuation/Gross cost at 1 April 2012 - restated
Additions - purchased
Reclassifications
Dwellings Assets under £000 construction & payments on account £000
Continued overleaf 234 Annual Report and Accounts 2012/13
NOTES TO THE ACCOUNTS 13.1 Property, plant and equipment 2012/13 (cont’d) Total £000
Land £000
Buildings excluding dwellings £000
Plant and machinery £000
Transport equipment £000
Information technology £000
Furniture and fittings £000
36,164
0
3,178
9
0
6,008
20,713
5,591
665
Prior period adjustments
0
0
0
Merger adjustments
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Accumulated depreciation at 1 April 2012 restated
36,164
0
3,178
9
0
6,008
20,713
5,591
665
Depreciation at start of period for new FTs
0
0
0
0
0
0
0
0
0
Transfers by absorption
0
0
0
0
0
0
0
0
0
6,212
0
1,150
5
0
598
3,597
720
142
Impairments
0
0
0
0
0
0
0
0
0
Reversal of impairments
0
0
0
0
0
0
0
0
0
Reclassifications
0
0
0
0
0
0
0
0
0
Revaluations
0
0
0
0
0
0
0
0
0
Transfers to/from assets held for sale and assets in disposal groups
0
0
0
0
0
0
0
0
0
Disposals
(2,808)
0
0
0
0
(373)
(1,583)
(852)
0
Accumulated depreciation at 31 March 2013
39,568
0
4,328
14
0
6,233
22,727
5,459
807
Accumulated depreciation at 1 April 2012 - as previously stated
Provided during the year
Dwellings Assets under £000 construction & payments on account £000
235
Annual report 12 / 13
NOTES TO THE ACCOUNTS 13.2 Property, plant and equipment financing Total £000
Land £000
Buildings excluding dwellings £000
Dwellings £000
Assets under construction & payments on account £000
Plant and machinery £000
Transport equipment £000
Information technology £000
Furniture and fittings £000
58,585
8,090
24,959
123
2,917
3,123
16,656
2,369
365
20
0
0
0
0
0
20
0
0
On-balance-sheet PFI contracts and other service concession arrangements
0
0
0
0
0
0
0
0
0
PFI residual interests
0
0
0
0
0
0
0
0
0
Government granted
0
0
0
0
0
0
0
0
0
1,566
860
689
0
0
0
0
0
0
60,171
8,950
25,648
123
2,917
3,123
16,676
2,369
365
Owned Finance Leased
Donated NBV total at 31 March 2013
236 Annual Report and Accounts 2012/13
NOTES TO THE ACCOUNTS 13.2 Property, plant and equipment 2011/12 Total £000
Land £000
Buildings excluding dwellings £000
Plant and machinery £000
Transport equipment £000
Information technology £000
Furniture and fittings £000
94,983
8,950
29,572
137
1,086
8,569
37,053
8,448
1,168
0
0
0
0
0
0
0
0
0
432
0
0
0
432
0
0
0
0
Additions - Leased
0
0
0
0
0
0
0
0
0
Additions - donated Additions - government granted
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Impairments
0
0
0
0
0
0
0
0
0
Reversal of impairments
0
0
0
0
0
0
0
0
0
Reclassifications
0
0
0
0
0
0
0
0
0
Revaluations
0
0
0
0
0
0
0
0
0
Transfers to/from assets held for sale and assets in disposal groups
0
0
0
0
0
0
0
0
0
Disposals
0
0
0
0
0
0
0
0
0
95,415
8,950
29,572
137
1,518
8,569
37,053
8,448
1,168
Valuation/Gross cost at start of period for new FTs Transfers by absorption Additions - purchased
Valuation/Gross cost at 31 March 2012
Dwellings Assets under £000 construction & payments on account £000
Continued overleaf 237
Annual report 12 / 13
NOTES TO THE ACCOUNTS 13.2 Property, plant and equipment 2011/12 (cont’d)
Depreciation at start of period for new FTs
Total £000
Land £000
Buildings excluding dwellings £000
Dwellings Assets under £000 construction & payments on account £000
35,631
0
3,083
9
0
Plant and machinery £000
Transport equipment £000
Information technology £000
Furniture and fittings £000
5,963
20,389
5,534
653
0
0
0
0
0
0
0
0
0
533
0
95
0
0
45
324
57
12
Impairments
0
0
0
0
0
0
0
0
0
Reversal of impairments
0
0
0
0
0
0
0
0
0
Reclassifications
0
0
0
0
0
0
0
0
0
Revaluations
0
0
0
0
0
0
0
0
0
Transfers to/from assets held for sale and assets in disposal groups
0
0
0
0
0
0
0
0
0
Disposals
0
0
0
0
0
0
0
0
0
36,164
0
3,178
9
0
6,008
20,713
5,591
665
Transfers by absorption Provided during the year
Accumulated depreciation at 31 March 2012
238 Annual Report and Accounts 2012/13
NOTES TO THE ACCOUNTS 14 Intangible assets acquired by government grant
15.2 Economic life of property, plant and equipment
There were no intangible assets acquired by government grant
Max Life Years
Buildings excluding dwellings
20
70
Dwellings
20
70
Plant & Machinery
5
15
Transport Equipment
5
10
Information Technology
5
5
Furniture & Fittings
5
15
Land
15.1 Economic life of intangible assets Min Life Years
Max Life Years
3
5
Intangible assets - purchased Software
Min Life Years
16.1 Analysis of property, plant and equipment at 31 March 2013 Total £000
Land £000
Buildings excluding dwellings £000
Dwellings £000
Assets under construction and payments on account £000
Plant and machinery £000
Transport equipment £000
Information technology £000
Furniture and fittings £000
6,495
0
6,495
0
0
0
0
0
0
Unprotected assets
53,576
8,950
19,153
123
2,917
3,123
16,676
2,369
365
Total
60,171
8,950
25,648
123
2,917
3,123
16,676
2,369
365
Protected assets
16.2 Analysis of property, plant and equipment at 31 March 2012 Total £000
Land £000
Buildings excluding dwellings £000
Dwellings £000
Assets under construction and payments on account £000
Plant and machinery £000
Transport equipment £000
Information technology £000
Furniture and fittings £000
6,767
0
6,767
0
0
0
0
0
0
Unprotected assets
52,484
8,950
19,627
128
1,518
2,561
16,340
2,857
503
Total
59,251
8,950
26,394
128
1,518
2,561
16,340
2,857
503
Protected assets
239
Annual report 12 / 13
NOTES TO THE ACCOUNTS 17 Investments The trust had no investments at 31 March 2013
18 Investments in associate or jointly controlled operations. The trust had no investments in associate or jointly controlled operations
19.1 Non-current assets for sale and assets in disposal groups 2012/13 Total £000
Intangible assets £000
Property, plant & equipment £000
Financial investments £000
Other £000
3,865
0
3,865
0
0
Prior Period Adjustment
0
0
0
0
0
TCS and merger adjustments
0
0
0
0
0
3,865
0
3,865
0
0
At start of period for new FTs
0
0
0
0
0
Plus assets classified as available for sale in the year
0
0
0
0
0
Less assets sold in year
0
0
0
0
0
Less Impairment of assets held for sale
0
0
0
0
0
Plus Reversal of impairment of assets held for sale
0
0
0
0
0
Less assets no longer classified as held for sale, for reasons other than disposal by sale
0
0
0
0
0
3,865
0
3,865
0
0
NBV of non-current assets for sale and assets in disposal groups at 1 April 2012
NBV of non-current assets for sale and assets in disposal groups at 1 April 2012 - restated
NBV of non-current assets for sale and assets in disposal groups at 31 March 2013
The balance for assets held for sale as at 31 March is the total open market value for Trust property that has been declared as available for sale that includes sites at Deanshanger, Battle, Banbury and Totton.
240 Annual Report and Accounts 2012/13
NOTES TO THE ACCOUNTS 19.2 Non-current assets for sale and assets in disposal groups 2011/12 Total £000
Intangible assets £000
Property, plant & equipment £000
Financial investments £000
Other £000
0
0
0
0
0
3,865
0
3,865
0
0
Plus assets classified as available for sale in the year
0
0
0
0
0
Less assets sold in year
0
0
0
0
0
Less Impairment of assets held for sale
0
0
0
0
0
Plus Reversal of impairment of assets held for sale
0
0
0
0
0
Less assets no longer classified as held for sale, for reasons other than disposal by sale
0
0
0
0
0
3,865
0
3,865
0
0
NBV of non-current assets for sale and assets in disposal groups at 1 April 2011 At start of period for new FTs
NBV of non-current assets for sale and assets in disposal groups at 31 March 2012
19.3 Liabilities in disposal groups The Trust held no liabilities in disposal groups as at 31 March 2013
20 Other assets The Trust held no other assets as at 31 March 2013
21 Other financial assets The Trust held no other financial assets as at 31 March 2013
241
Annual report 12 / 13
NOTES TO THE ACCOUNTS 22.1 Inventories 2012/13 ÂŁ000
2011/12 ÂŁ000
Drugs
0
0
Work in progress
0
0
Consumables
845
777
Energy
109
156
Carrying Value as at 31 March
954
933
22.2 Inventories recognised in expenses There were no inventories recognised in expenses during the reported period
242 Annual Report and Accounts 2012/13
NOTES TO THE ACCOUNTS 23 Trade receivables and other receivables 31 March 2013 £000
31 March 2012 £000
1,028
646
0
0
12
0
Receivables due from NHS charities – Capital
0
0
Other receivables with related parties - Revenue
0
459
Other receivables with related parties - Capital
0
0
(500)
(541)
Deposits and Advances
0
0
Prepayments (Non-PFI)
2,624
3,497
Accrued income
2,919
1,803
Interest Receivable
0
3
Corporation tax receivable
0
0
PDC dividend receivable
0
0
VAT receivable
343
222
Other receivables - Revenue
661
417
0
0
7,087
6,506
Current NHS Receivables - Revenue NHS Receivables - Capital Receivables due from NHS charities – Revenue
Provision for impaired receivables
Other receivables - Capital TOTAL CURRENT TRADE AND OTHER RECEIVABLES
Continued overleaf 243
Annual report 12 / 13
NOTES TO THE ACCOUNTS 23 Trade receivables and other receivables (cont’d) 31 March 2013 £000
31 March 2012 £000
NHS Receivables - Revenue
0
0
NHS Receivables - Capital
0
0
Receivables due from NHS charities – Revenue
0
0
Receivables due from NHS charities – Capital
0
0
Other receivables with related parties - Revenue
0
0
Prepayments (Non-PFI)
0
0
Accrued income
0
0
Interest Receivable
0
0
Corporation tax receivable
0
0
VAT receivable
0
0
Other receivables - Revenue
0
0
Other receivables - Capital
0
0
TOTAL NON CURRENT TRADE AND OTHER RECEIVABLES
0
0
Non-Current
The majority of trade receivables is due from Primary Care Trusts, as commissioners for NHS patient care services. As Primary Care Trusts are funded by Government to commission NHS patient care services, no credit scoring of them is considered necessary.
244 Annual Report and Accounts 2012/13
NOTES TO THE ACCOUNTS 24.1 Provision for impairment of receivables At 1 April as previously stated Prior Period adjustments TCS and merger adjustments
31 March 2013 £000
31 March 2012 £000
541
0
0
0
0
0
541
0
At start of period for new FTs
0
525
Transfers by absorption
0
0
Increase in provision
0
16
(41)
0
0
0
500
541
At 1 April (restated)
Amounts utilised Unused amounts reversed At 31 Mar / 31 Mar
The provision relates to £342k Injury cost recovery, £116k trade receivables and £42k overpaid salaries.
245
Annual report 12 / 13
NOTES TO THE ACCOUNTS 24.2 Analysis of impaired receivables
31 March 2013 Trade Receivables £000
31 March 2013 Other Receivables £000
31 March 2012 Trade Receivables £000
31 March 2012 Other Receivables £000
0 - 30 days
0
0
0
0
30-60 Days
0
0
0
36
60-90 days
0
0
0
0
90- 180 days (was "In three to six months")
0
342
341
111
over 180 days (was "Over six months")
0
158
0
53
Total
0
500
341
200
0 - 30 days
225
123
168
44
30-60 Days
127
15
13
8
60-90 days
51
0
48
38
90- 180 days (was "In three to six months")
0
5
0
29
over 180 days (was "Over six months")
0
58
0
0
403
201
229
119
Ageing of impaired receivables
Ageing of non-impaired receivables past their due date
Total
25.1 Finance lease receivables The Trust had no finance lease receivables as at 31 March 2013
246 Annual Report and Accounts 2012/13
NOTES TO THE ACCOUNTS 26.1 Cash and cash equivalents 31 March 2013 ÂŁ000
31 March 2012 ÂŁ000
9,573
0
Prior period adjustments
0
0
TCS and merger adjustments
0
0
9,573
0
At start of period for new FTs
0
9,043
Transfers by absorption
0
0
(1,272)
530
8,301
9,573
44
11
8,257
9,562
0
0
8,301
9,573
Bank Overdrafts (GBS and commercial banks)
0
0
Drawdown in committed facility
0
0
8,301
9,573
At 1 April
At 1 April (restated)
Net change in year At 31 March Broken down into: Cash at commercial banks and in hand Cash with the Government Banking Service Other current investments Cash and cash equivalents as in SoFP
Cash and cash equivalents as in SoCF
The Trust held no third party assets as at 31 March 2013
247
Annual report 12 / 13
NOTES TO THE ACCOUNTS 27.1 Trade and other payables
31 March 2013 Total £000
31 March 2012 Total £000
12
0
0
11
NHS payables - revenue
62
397
NHS payables - Early retirement costs payable within one year
48
0
0
0
1,211
1,046
540
167
1,147
569
973
877
0
0
907
881
21
21
6,748
6,490
PDC dividend payable
0
0
Reclassified to liabilities held in disposal groups in year
0
0
11,669
10,459
Non-current
0
0
NHS payables - capital
0
0
40
26
0
0
40
26
Current Receipts in advance NHS payables - capital
Amounts due to other related parties - capital Amounts due to other related parties - revenue Other trade payables - capital Other trade payables - revenue Social Security costs VAT payable Other taxes payable Other payables Accruals
Total current trade and other payables
Other payables Accruals Total non current trade and other payables
Amounts due to related parties represents £1,211k outstanding pensions contributions as at 31 March 2013 (prior year £1,046k reclassified from Other payables). There were no early retirement payments in the above. 248 Annual Report and Accounts 2012/13
NOTES TO THE ACCOUNTS 27.2 Better payment practice code
31 March 2013 Number
31 March 2013 £000
1 month ended 31 March 2012 Number
1 month ended 31 March 2012 £000
Total Non-NHS Trade Invoices Paid in the Year
38,030
53,609
3,483
6,347
Total Non-NHS Trade Invoices Paid Within Target
33,426
50,155
3,033
6,085
Percentage of NHS Trade Invoices Paid Within Target
87.9%
93.6%
87.1%
95.9%
1,021
1,969
223
96
Measure of compliance Non-NHS Payables
NHS Payables Total NHS Trade Invoices Paid in the Year Total NHS Trade Invoices Paid Within Target Percentage of NHS Trade Invoices Paid Within Target
885
1,840
215
95
86.7%
93.4%
96.4%
99.0%
The Better Payment Practice Code requires the Trust to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later.
249
Annual report 12 / 13
NOTES TO THE ACCOUNTS 28 Borrowings
31 March 2013 £000
31 March 2012 £000
Bank overdrafts - Government Banking Service
0
0
Bank overdrafts - Commercial banks
0
0
Drawdown in committed facility
0
0
Loans from Foundation Trust Financing Facility
0
0
987
1,328
0
0
20
78
PFI lifecycle replacement received in advance
0
0
Obligations under PFI contracts (excl. lifecycle)
0
0
1,007
1,406
0
0
1,842
2,829
Other Loans
0
0
Obligations under finance leases
0
20
Obligations under Private Finance Initiative contracts
0
0
1,842
2,849
Current
Loans from Department of Health Other Loans Obligations under finance leases
Total current borrowings Non-current Loans from Foundation Trust Financing Facility Loans from Department of Health
Total non current borrowings
The Trust has two capital loans of £3,454,000 (payable over 5 years) and £3,551,000 (payable over 10 years) taken in 2008/09, and a further loan of £1,500,000 (payable over 5 years) taken in 2009/10.
250 Annual Report and Accounts 2012/13
NOTES TO THE ACCOUNTS 29 Prudential borrowing limit
31 March 2013 £000
31 March 2012 £000
Total long term borrowing limit set by Monitor (per Schedule 5 of Trust's terms of Authorisation)
18,100
18,100
Working capital facility limit agreed by Monitor (per Schedule 5 of Trust's terms of Authorisation)
10,500
10,500
Total Prudential Bollowing Limit
28,600
28,600
31 March 2013 £000
31 March 2012 £000
4,255
0
0
4,928
(1,406)
(673)
Long term borrowing at 31 March
2,849
4,255
Working capital borrowing at 1 April
0
0
Working capital borrowing at start of period for new FTs
0
0
Net actual borrowing/(repayment) in year - working capital
0
0
Working capital borrowing at 31 March
0
0
The Foundation Trust has £10.5m of approved working capital facility which has not been utilised during 2012/13.
Borrowing (as defined in the Prudential Borrowing Code) at 1 April Borrowing (as defined in the Prudential Borrowing Code) at start of period for new FTs Net actual borrowing/(repayment) in year
The Foundation Trust is required to comply and remain within a prudential borrowing limit. This is made up of two elements; • The maximum cumulative amount of long term borrowing. This is set by reference to the five ratio test set out in Monitors Prudential Borrowing Code. The financial risk rating set under Monitors Compliance Framework determines one of the ratios (Maximum Debt / Capital ratio) and therefore can impact on the allowed level of long term borrowing. • the amount of working capital facility approved by Monitor. Further information on the NHS foundation trusts Prudential Borrowing Code and Compliance Framework can be found on the website of Monitor, the Independent Regulator of Foundation Trusts.
Financial Ratio
Actual ratios March 2013
Approved PBL ratios March 2013
Actual ratios March 2012
Approved PBL ratios March 2012
Minimum dividend cover
5.6x
5.6x
5.1x
5.6x
Minimum interest cover
63.2x
48.7x
80.8x
48.7x
Minimum debt service cover
6.8x
6.5x
6.3x
6.5x
Maximum debt service to revenue
1.1%
1.2%
1.1%
1.2%
251
Annual report 12 / 13
NOTES TO THE ACCOUNTS 30 Other liabilities The Trust had no other liabilities as at 31 March 2013
31 Other Financial Liabilities The Trust had no other financial liabilities as at 31 March 2013
32.1 Provisions for liabilities and charges Current
Non-current
31 March 2013 £000
31 March 2013 £000
31 March 2012 £000
31 March 2012 £000
0
0
0
0
Pensions relating to other staff
143
312
1,912
1,810
Other legal claims
126
102
200
226
0
0
0
0
930
505
0
0
Continuing care
0
0
0
0
Equal pay
0
0
0
0
Redundancy
0
0
0
0
Other
1,704
2,259
89
69
Total
2,903
3,178
2,201
2,105
Pensions relating to former directors
Agenda for Change Restructurings
252 Annual Report and Accounts 2012/13
NOTES TO THE ACCOUNTS 32.2 Provisions for liabilities and charges analysis Total £000
Pensions - former directors £000
Pensions other staff £000
Other legal claims £000
Agenda for change £000
Re-structurings £000
Other £000
5,283
0
2,122
328
0
505
2,328
Prior period adjustments (current)
0
0
0
0
0
0
0
Prior period adjustments (non-current)
0
0
0
0
0
0
0
Merger adjustments
0
0
0
0
0
0
0
At 1 April 2012 as restated
5,283
0
2,122
328
0
505
2,328
At start of period for new FTs
0
0
0
0
0
0
0
Transfers by absorption
0
0
0
0
0
0
0
16
0
16
0
0
0
0
1,905
0
174
65
0
1,132
534
0
0
0
0
0
0
0
(1,775)
0
(146)
(10)
0
(707)
(912)
0
0
0
0
0
0
0
(380)
0
(166)
(57)
0
0
(157)
55
0
55
0
0
0
0
5,104
0
2,055
326
0
930
1,793
2,903
0
143
126
0
930
1,704
792
0
535
200
0
0
57
- later than five years.
1,409
0
1,377
0
0
0
32
Total
5,104
0
2,055
326
0
930
1,793
At 1 April 2012
Change in the discount rate Arising during the year Utilised during the year - accruals Utilised during the year - cash Reclassified to liabilities held in disposal groups in year Reversed unused Unwinding of discount At 31 March 2013 Expected timing of cashflows: - not later than one year; - later than one year and not later than five years;
The provision for other includes £65k for provision of fuel bunkering, £655k staff related costs, £144k estates related issues, £427k for property dilapidations, £462k provision for credit notes and £40k for other legal costs.
253
Annual report 12 / 13
NOTES TO THE ACCOUNTS 32.3 Clinical Negligence Liabilities
Total £000
Amount included in provisions of the NHSLA at 31 March 2013 in respect of clinical negligence liabilities of South Central Ambulance Service NHS Foundation Trust
3,723
Amount included in provisions of the NHSLA at 31 March 2012 in respect of clinical negligence liabilities of South Central Ambulance Service NHS Foundation Trust
1,346
33 Contingent Liabilities / Assets 31 March 2013 £000
31 March 2012 £000
Value of contingent liabilities Equal pay
0
0
Other
(31)
(47)
Gross value of contingent liabilities
(31)
(47)
Amounts recoverable against liabilities
0
0
Net value of contingent liabilities*
(31)
(47)
0
0
Net value of contingent assets
* Additional liability on legal claims at 100% probability
254 Annual Report and Accounts 2012/13
NOTES TO THE ACCOUNTS 34.1 Revaluation Reserve 2012/13 31 March 2013 ÂŁ000 Revaluation reserve at 1 April 2012
6,440
Prior period adjustment
0
TCS and merger adjustments
0
Revaluation reserve at 1 April 2012 - restated
31 March 2012 ÂŁ000
6,440
At start of period for new FTs
0
6,440
Impairments
0
0
Revaluations
0
0
25
0
Asset disposals
0
0
Fair Value gains/(losses) on Available-for-sale financial investments
0
0
Recycling gains/(losses) on Available-for-sale financial investments
0
0
Other recognised gains and losses
0
0
Other reserve movements
0
0
6,465
6,440
Transfers to other reserves
Revaluation reserve at 31 March
255
Annual report 12 / 13
NOTES TO THE ACCOUNTS 35 Related party transactions During the year none of the Board Members or members of the key management staff or parties related to them has undertaken any material transactions with South Central Ambulance Service NHS Foundation Trust.
The Department of Health is regarded as a related party. During the year South Central Ambulance Service NHS Foundation Trust has had a significant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department. These entities are listed below:
Note 35.1
Note 35.2
Payments to related party £000
Receipts from related party £000
Amounts owed to related party £000
Amounts due from related party £000
4
970
0
0
Oxford Health (was Oxford and Buckinghamshire) NHS Foundation Trust
24
2,161
9
372
Berkshire Healthcare NHS Foundation Trust
12
4,981
0
3
Buckinghamshire Healthcare NHS Trust
14
1,104
0
200
Berkshire East PCT
0
12,525
0
382
Berkshire West PCT
0
14,173
0
238
Buckinghamshire PCT
0
16,791
0
314
South Central Strategic Health Authority
Hampshire PCT
69
38,136
0
348
Milton Keynes PCT
0
8,306
0
2
Oxfordshire PCT
3
23,244
0
780
Portsmouth City Teaching PCT
6
6,996
30
0
Southampton City PCT
0
8,080
30
0
During the period South Central Ambulance NHS Foundation Trust had charitable funds of £0.5m as at 31 March 2013. 256 Annual Report and Accounts 2012/13
NOTES TO THE ACCOUNTS 36.1 Contractual capital commitments
31 March 2013 £000
31 March 2012 £000
152
1,073
85
91
237
1,164
31 March 2013 £000
31 March 2012 £000
20
98
20
78
- later than one year and not later than five years;
0
20
- later than five years.
0
0
Finance charges allocated to future periods
0
0
Net lease liabilities
20
98
- not later than one year;
20
78
- later than one year and not later than five years;
0
20
- later than five years.
0
0
Property, Plant and Equipment Intangible assets Total
36.2 Other Financial Commitments The trust has no other commitments under non-cancellable contracts as at 31 March 2013
37 Finance lease obligations Gross lease liabilities of which liabilities are due - not later than one year;
The finance leases refer to emergency operations vehicles
Note 38 On SoFP PFI obligations The Trust has no on SoFP PFI obligations or commitments
Note 39 Off SoFP PFI obligations The Trust has no off SoFP PFI obligations or commitments
Note 40 Events after the reporting period The Trust has no events after the reporting period 257
Annual report 12 / 13
NOTES TO THE ACCOUNTS 41 Financial Instruments
Interest rate risk
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 primary care trusts and the way those primary care trusts 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-today operational activities rather than being held to change the risks facing the Trust in undertaking its activities.
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.
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.
258 Annual Report and Accounts 2012/13
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 2012 are in receivables from customers, as disclosed in the trade and other receivables note. Liquidity risk The Foundation Trust’s operating costs are incurred under contracts with primary care trusts, which are financed from resources voted annually by Parliament . The Foundation Trust funds its capital expenditure from funds obtained within its Prudential Borrowing Limit. The Foundation Trust is not, therefore, exposed to significant liquidity risks.
NOTES TO THE ACCOUNTS 41.1 Financial assets by category
31 March 2013 £000
31 March 2012 £000
NHS Trade and other receivables excluding non financial assets (at 31 March 2013)
2,849
1,349
Non-NHS Trade and other receivables excluding non financial assets (at 31 March 2013)
1,163
1,345
Non current assets held for sale and assets held in disposal group excluding non financial assets (at 31 March 2013)
3,865
3,865
Cash and cash equivalents at bank and in hand (at 31 March 2013)
8,301
9,573
16,178
16,132
31 March 2013 £000
31 March 2012 £000
2,829
4,157
20
98
287
514
6,980
6,634
Assets as per SoFP
Total at 31 March 2013
41.2 Financial liabilities by category Liabilities as per SoFP; Borrowings excluding Finance lease and PFI liabilities (at 31 March 2013) Obligations under finance leases (at 31 March 2013) NHS Trade and other payables excluding non financial assets (at 31 March 2013) Non-NHS Trade and other payables excluding non financial assets (at 31 March 2013) Provisions under contract (at 31 March 2013) Total at 31 March 2013
1,229
1,100
11,345
12,503
259
Annual report 12 / 13
NOTES TO THE ACCOUNTS 41.3 Fair values of financial assets at 31 March 2013
Book value £000
Fair value £000
Non current trade and other receivables excluding non financial assets
0
0
Other Investments
0
0
Other
0
0
Total
0
0
Book value £000
Fair value £000
0
0
89
89
0
0
41.4 Fair values of financial liabilities at 31 March 2013 Non current trade and other receivables excluding non financial assets Provisions under contract Loans Other
0
0
Total
89
89
31 March 2013 £000
31 march 2012 £000
11,256
12,435
In more than one year but not more than two years
3
1
In more than two years but not more than five years
1
48
85
19
11,345
12,503
42 Maturity of Financial liabilities In one year or less
In more than five years Total
260 Annual Report and Accounts 2012/13
NOTES TO THE ACCOUNTS 43 Losses and special payments The total number of losses cases in 2012/13 and their total value was as follows:
Total value of cases £000’s
Total number of cases
Losses
235
64
Special payments
228
32
Total losses and special payments
463
96
Total value of cases £000’s
Total number of cases
42
7
3
1
45
8
The total number of losses cases in March 2012 and their total value was as follows: Losses Special payments Total losses and special payments
These amounts are stated on an accruals basis and exclude provision for future losses.
261
Annual report 12 / 13
Independent Auditor’s Report to the Council of Governors of South Central Ambulance Service NHS Foundation Trust We have audited the financial statements of South Central Ambulance Service NHS Foundation Trust for the year ended 31 March 2013 on pages 194 to 261. These financial statements have been prepared under applicable law and the NHS Foundation Trust Annual Reporting Manual 2012/13. This report is made solely to the Council of Governors of South Central Ambulance Service NHS Foundation Trust 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 auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Council of Governors of the Trust, as a body, for our audit work, for this report or for the opinions we have formed. Respective responsibilities of the accounting officer and the auditor As described more fully in the Statement of Accounting Officer’s Responsibilities on page 173 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 Auditing Practice’s Board’s Ethical Standards for Auditors. Scope of the audit of the financial statements An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. 262 Annual Report and Accounts 2012/13
This includes an assessment of whether the accounting policies are appropriate to the Trust’s circumstances and have been consistently applied and adequately disclosed, the reasonableness of significant accounting estimates made by the accounting officer and the overall presentation of the financial statements. In addition we read all the financial and non-financial information in the annual report to identify material inconsistencies with the audited financial statements. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report. Opinion on financial statements In our opinion the financial statements: »» Give a true and fair view of the state of South Central Ambulance Service NHS Foundation Trust’s affairs as at 31 March 2013 and of its income and expenditure for year then ended; and »» Have been prepared in accordance with the NHS Foundation Trust Annual Reporting Manual 2012/13. Opinion on other matters prescribed by the Audit Code for NHS Foundation Trusts In our opinion the information given in the Director’s Report for the financial year for which the financial statements are prepared is consistent with the financial statements.
Matters on which we are required to report by exception We have nothing to report where under the Audit Code for NHS Foundation Trusts we are required to report to you if, in our opinion, the Annual Governance Statement does not reflect the disclosure requirements set out in the NHS Foundation Trust Annual Reporting Manual, is misleading or is not consistent with our knowledge of the Trust and other information of which we are aware from our audit of the financial statements. We are not required to assess, nor have assessed, whether all risks and controls have been addressed by the Annual Governance Statement or that risks are satisfactorily addressed by internal controls. Certificate We certify that we have completed the audit of the accounts of South Central Ambulance Service NHS Foundation Trust in accordance with the requirements of Chapter 5 of Part 2 of the National Health Service Act 2006 and the Audit Code for NHS Foundation Trusts issued by Monitor.
Jonathan Brown, for and on behalf of KPMG LLP, Statutory Auditor Chartered Accountants 100 Temple Street Bristol BS1 6AG 29 May 2013
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Public Access Defibrillator (PAD) at Frieth Village Hall, Buckinghamshire
GLOSSARY
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Annual report 12/13 Glossary A and E AACP ACP ACS Agenda for change AMPDS ATP BASICS BMJ CAD CARS CBRN CCG CEO CF CFR CNST CPD CPI CPR CQC CQUIN CSD
Accident and Emergency Ambulance Anticipatory Care Plan Anticipatory Care Plan Acute Coronary Syndrome National pay system implemented in 2004 for NHS staff Advanced Medical Priority Dispatch System Adenosine Triophosphate Testing British Association for Immediate Care British Medical Journal Computer aided dispatch system Clinical Audit Record System Chemical, Biological, Radiological, Nuclear Clinical Commissioning Group Chief Executive Officer Clinical Fellow Community First Responder Clinical Negligence Scheme for trusts Continuous Professional Development Clinical performance indicator Cardiopulmonary resuscitation Care Quality Commission Commissioning for Quality and Improvement Clinical support desk
266 Annual Report and Accounts 2012/13
DH E and D ECP ECT EOC EoLC ePRF FFT Frem FT GBS GPS HALO HART HCP HOSC IAS IFRS JRCALC KPMG LD MINAP NBV NHSLA PALS PBL PCI
Department of Health Equality and Diversity Emergency care practitioner Emergency Call Taker Emergency Operations Centre End of Life Care Electronic Patient Report Form Friends and Family Test Financial Reporting Manual Foundation trust Government Banking Service Global Positioning System Hospital Ambulance Liaison Officer Hazardous Area Response Team Health Care Provider Health Overview and Scrutiny Committee International Accounting Standards International Financial Reporting Standards Joint Royal Colleges Ambulance Liaison Committee Trustâ&#x20AC;&#x2122;s appointed external auditors Learning Disability Myocardial Ischaemia National Audit Project Net Book Value NHS Litigation Authority Patient Advice and Liaison Service Prudential Borrowing Limit Primary angioplasty
PCT PCR PDC PERG PFI PRF PPCI PTS RAG RCN ROSC SCAS SCIE SHA SID SIRI SLA SOP STEIS STEMI TARN TUB uDNACPR UKcip
Primary Care Trust Patient Clinical Record Public Dividend Capital Patient Experience Review Group Public Finance Initiative Patient Report From Primary Percutaneous Coronary Intervention Patient Transport Services Red, Amber, Green Royal College of Nursing Return of spontaneous circulation South Central Ambulance Service NHS Foundation trust Social Care Institute for Excellence Strategic Heath Authority (NHS South Central) Serious Incident Desk Serious Incidents Requiring Investigation Service level agreement Standard Operating Procedure Strategic Executive Information System ST elevation myocardial infarction (Heart Attack) Trauma Audit and Research Network Trauma Unit Bypass Unified Do Not Attempt CardioPulmonary Resuscitation United Kingdom Climates Impacts Programme
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