South Central Ambulance Service - Annual Report 2013/14 by SCAS

ANNUAL REPORT ACCOUNTS 2013/14

SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST ANNUAL REPORT & ACCOUNTS 2013/14 Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006.

A word from our Chief Executive and Chairman

What we do

Strategic Report

Annual Quality Report

144 184 Directorâ&#x20AC;&#x2122;s Report

188 Operational and Financial Review

Accounting Officerâ&#x20AC;&#x2122;s Statement of Responsibilities

579,430 873,657

calls answered through the non-emergency NHS 111 service

calls received a SCAS response or were dealt with by our clinical support desks

678,583 PTS (Patient Transport Service) journeys

Residential population of over

4 million

A WORD FROM OUR CHIEF EXECUTIVE AND CHAIRMAN

South Central Ambulance Service

IN WHAT SEEMS LIKE NO TIME AT ALL – NEVER MIND A WHOLE-YEAR, HERE WE ARE AGAIN WRITING AN INTRODUCTION TO AN ANNUAL REPORT THAT LOOKS BACK ON THE LAST 12 MONTHS WITHIN SOUTH CENTRAL AMBULANCE SERVICE. By doing so, we realise not only the scale of the challenges we have faced and the achievements we have delivered, but also it gives us time to pause and reflect on the amazing people – our employees, our volunteers, our members and governors – without whose hard work, enthusiasm and dedication, we could not have delivered so much. We are currently in the process of finalising our next five-year Integrated Business Plan (IBP) that will set the organisation’s future direction and outline how we will continue to save more lives of patients suffering major trauma, improving outcomes for all patients and reducing the need to take patients to hospital by continuing to develop our ability to provide high quality safe and effective care and advice at the right time and place. This process will of course be influenced by key national policies and drivers.

For example, our new IBP will detail how the Trust will respond to the findings and recommendations of the recent Keogh and Francis Reports, identifying how, for example, we will share expertise and data with other trusts to more effectively deliver high quality care, how we will more closely involve the patients, carers and public we serve and how we will maintain an open, honest and transparent organisation with caring, compassionate staff who have a shared zero tolerance of sub-standard care. This is the first year for SCAS, as it has been for trusts up and down the country, to operate under the auspices of the new commissioning arrangements with the arrival of local Clinical Commissioning Groups (CCGs) and the specialist commissioning responsibilities of NHS England.

Annual Report & Accounts 2013/14

As a result, we have as an organisation moved away from managing a small number of commissioner contracts, to the added organisational challenges of managing multiple and complex commissioning relationships. The Trust also became the formal successor body to NHS Direct which was abolished at the end of March 2014. As well as taking on a number of their services, this also means the Trust will oversee the closedown process and legacy management activities. Despite the increasing demand on our services and the sustained pressure on public finances, we have not only steadfastly maintained our ability to meet all our performance and financial targets, but also introduced a number of innovations across SCAS including the adoption of GPS-based app technology to help our crews make the right decision as to where to transport patients based on their condition and location, and identifying the nearest Automatic External Defibrillator (AED) when members of the public come across a person in cardiac arrest. 9

The Trust was delighted to win the award for Efficiency in Transport and Logistics at the Health Service Journal Awards in September 2013 in recognition of the solar panels we have placed on 36 of our rapid response vehicles. Over the last 12 months we have also considerably expanded our NHS 111 services, and we see further investment and expansion of NHS 111 services as key to the future of SCAS. We have again this year taken part in the BBC’s Real Rescues series that helps the viewing public witness at first hand some of the dramatic day-to-day work our staff undertake. The dangers they face were brought tragically in to focus at the end of April 2013 with the death of Gill Randall, killed when her ambulance transporting an emergency patient to hospital was involved in a road accident. Her loss, along with the patient being transported who also died, reminds us and the general public, never to take for granted the people we all rely on in an emergency. In January 2014, we were delighted to host a visit to SCAS from the Prime Minister and MP for Witney (Oxfordshire). Mr Cameron spent time in our Emergency Operations Centre in Bicester, talking with clinicians and call handlers who help deliver our 999 and 111 services. 10

His visit happened to coincide with the severe flooding that affected parts of our region, placing more demand on our emergency services and making it more challenging to deliver our other services. This year, however, it wasn’t only in winter when we suffered the effects of adverse weather. During parts of the summer 2013 heat wave, we responded at weekends to around 10% more emergency calls, and around 10% more potentially lifethreatening situations, than average for the time of year. Higher demand coupled with severe weather and travel disruption makes it more challenging for SCAS – particularly given we serve both a predominantly rural area but also a few major urban cities – to continually meet response times and deliver the service we want and the public needs. But, as will become clear when you read this year’s Annual Report, deliver it we most certainly did. We can, thanks to the efforts of our employees, volunteers, supporters and members, look forward to the future with confidence and know that, whatever the next 12 months has in store for us, we have the tenacity, character and resolve to meet any challenge and to build on our successes.

South Central Ambulance Service

Trevor Jones Chairman

Will Hancock Chief Executive

WE ARE ALSO INTEGRATING SMARTPHONE TECHNOLOGY TO HELP OUR PARAMEDICS.

Annual Report & Accounts 2013/14

South Central Ambulance Service

Annual Report & Accounts 2013/14

ABOUT US South Central Ambulance Service NHS Foundation Trust (SCAS) is an innovative, healthcare organisation providing traditional ambulance services as well as clinical assessment, signposting, transport, logistics and training services to a population of around 4 million people who live and work in an area the size of Cyprus. SCAS covers the counties of Berkshire, Buckinghamshire, Hampshire and Oxfordshire and became an NHS Foundation Trust on 1 March 2012. Despite a number of densely populated urban cities such as Southampton, Portsmouth, Reading, Oxford and Milton Keynes within our patch, our operational area is classified as predominantly rural.

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

Our vision >

We deliver our services from: »» our headquarters in Bicester, Oxfordshire, and a regional office in Otterbourne, Hampshire. Each of these sites also houses an Emergency Operations Centre where 999 and NHS 111 calls are received, clinical advice provided and emergency vehicles dispatched if needed. »» 27 ambulance stations and resource centres »» 312 frontline ambulances. We rely on: »» 2,843 members of staff »» 946 Community First Responders (CFRs) »» 143 volunteer drivers »» 26 governors »» 13,168 Foundation Trust members.

ENABLING YOU TO GET THE CARE YOU NEED, WHEN YOU NEED IT 14

South Central Ambulance Service

STRATEGIC REPORT

Annual Report & Accounts 2013/14

NATIONAL PERFORMANCE TARGETS Challenging national targets are set by the Department of Health and they apply to every ambulance service in England. The targets ensure the Trust is measured against the percentage of calls responded to in 8 or 19 minutes depending on the priority of call with Category A calls measured as the highest priority. This data is extracted from the Trustâ&#x20AC;&#x2122;s Computer Aided Dispatch (CAD) systems.

Category A calls are subdivided into Red 1 calls covering response to patients with critical conditions which are measured against an 8 minute response time and Red 2 calls where the condition is less critical but still measured against an 8 minute response. All other red calls are measured against a 19 minute response.

In spite of being faced with continually increasing demand we have again achieved our three key national response time targets for red 8 and red 19 calls. This has been achieved whilst in year activity has increased by 6.4% over the number of incidents responded to in 2012/13.

TARGET

NATIONAL TARGET

ACTUAL 2013/14

ACTUAL 2012/13

RED 1

(75%)

79.2%

77.6 %

RED 2

(75%)

75.7%

75.1%

RED 8

(75%)

76.0%

75.3%

RED 19

(95%)

95.4%

95.1%

South Central Ambulance Service

ACTIVITY (999 INCIDENTS) 46,000 44,000 42,000 2013-14 actual

40,000

2012-13 actual

38,000

STRATEGIC REPORT

36,000

b M

n Ja

c De

v No

ct O

p Se

g Au

ly Ju

ne Ju

34,000

HOSPITAL HANDOVER DELAYS BY MONTH 2,500 2,000

1,500 1,000 2013-14 actual

500

2012-13 actual

ch M

b Fe

n Ja

c De

v No

ct O

p Se

g Au

ly Ju

ne Ju

Annual Report & Accounts 2013/14

REGULATORY RATINGS As part of its regulatory regime, Monitor assigns risk ratings to each NHS Foundation Trust as an indicator of the Trustâ&#x20AC;&#x2122;s compliance with the conditions of its licence. South Central Ambulance Service NHS Foundation Trust (SCAS) was authorised as an NHS Foundation Trust on 1 March 2012 and has been assessed under this framework since that date.

Monitor amended the risk ratings on 1 October 2013 replacing the financial risk rating with a new continuity of service rating. This comprises a liquidity rating and a capital servicing rating. SCAS achieved the following risk ratings for 2013/14 and 2012/13 based on assessment of its submissions:

Annual Business Plan

Quarter 1 2013/14

Quarter 2 2013/14

Quarter 3 2013/14

Quarter 4 2013/14

Financial Risk Rating

n/a

Continuity of Service Rating

n/a

Amber/Green

Green

Annual Business Plan

Quarter 1 2012/13

Quarter 2 2012/13

Quarter 3 2012/13

Quarter 4 2012/13

Green

Amber/Green

Green

Governance Risk Rating

Financial Risk Rating Governance Risk Rating

The Trust achieved a financial risk rating of 3 under the discontinued financial risk rating which identified that Monitor had no concerns. The Trust achieved a 4 rating for Continuity of Service which identified that Monitor had no evident concerns. The Trust achieved a green rating for governance. 18

South Central Ambulance Service

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.

►►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 reputation

STRATEGIC REPORT

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

THE TRUST’S MAIN POTENTIAL STRATEGIC RISKS HAVE BEEN IDENTIFIED AS FOLLOWS:

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

Annual Report & Accounts 2013/14

DEVELOPMENTS Once again, despite facing an increasing demand for services at a time of continuing pressure on healthcare spending, the Trust was able to meet all its annual operational and financial targets.

Our achievement is all the more impressive considering that we were also able to implement a range of innovative changes at an operational and clinical level to improve the efficiency and effectiveness of the organisation and its people. A summary of our key achievements over the past 12 months includes: »» Launching and embedding our new, expanded range of NHS 111 provision across the Trust »» Upgrading our computer aided dispatch system, which is used by both Emergency 999 and NHS 111 services

South Central Ambulance Service

»» Implementing a new tool to more accurately predict emergency demand in each dispatch area based on historical data that can also be modelled using information about inclement weather or events »» Establishment of a team to analyse the needs of frequent callers and work with partner agencies to put any necessary plans and services in place »» Restructured our commercial management team in order to ensure the Trust has the leadership, skills and experience to continue to thrive in an increasingly more competitive healthcare market »» Setting up homeaccess for our time and attendance system, so that road staff can look at their rosters more easily »» Replacing the Portsmouth, Fareham, Gosport and Havant stations with the South East Hampshire Resource Centre, which supports our operational strategy to move towards hub and spoke models.

Our focus over the next 12 months, as part of our fiveyear Integrated Business Plan, will address: Assessment and signposting »» Establishing a virtual call taking environment across SCAS for 999 and NHS 111 services »» Completing the transition of our 999 service to the NHS Pathways, which will enable us to make better clinical assessment of patient needs and direct them to the most appropriate service (which may not be an ambulance to the emergency department) »» Modernising our Patient Transport Services, including a single, virtual computeraided dispatch system, dynamic scheduling and electronic communication with road staff.

Right care, right time, right place »» Implement an electronic patient record system to personalise care and link specialist notes from GPs and other health professionals to the Trust’s electronic records. This will allow clinical staff to make more informed decisions in the field. »» Continue to monitor and refine rosters across our clinical hubs, mobile healthcare teams and patient transport, to more accurately, and flexibly, align our capacity with overall demand patterns. Taking healthcare to you »» Work with commissioners and partner agencies to fully populate and maintain a comprehensive and accurate Directory of Services available in each area »» Review the use of emergency care practitioners as part of a wider national review of emergency and urgent care

»» Implement the redesigned Healthcare Professional Service model (formerly referred to as GP Urgent Services) to meet the needs of local CCGs and more effectively support the local healthcare system as a whole. Going Concern After making appropriate enquiries, the directors have a reasonable expectation that South Central Ambulance Service NHS Foundation Trust has adequate resources to continue in operational existence in the foreseeable future. For his reason the accounts are prepared on a going concern basis.

Will Hancock Chief Executive 28 May 2014

Annual Report & Accounts 2013/14

STRATEGIC REPORT

Looking forward to 2014/15, we want to continue our efforts to improve clinical excellence, deliver a consistently excellent patient experience, maintain and improve upon our operational efficiencies and performance, and continue to inspire and motivate our workforce.

South Central Ambulance Service

Annual Report & Accounts 2013/14

OUR CORE BUSINESS IS TO RESPOND TO EMERGENCY 999 AND URGENT GP CALLS, GETTING THE RIGHT TREATMENT TO PATIENTS WITH URGENT AND EMERGENCY CARE NEEDS. Our Emergency Operations Centres (EOC) based in Bicester and Otterbourne receive well over 1,000 emergency calls every day, which are handled by over 500 call centre staff. To meet this demand we have more than 1,400 paramedics, technicians and emergency care assistants on the road delivering excellent front line care. We have a fleet of 312 specially-equipped emergency vehicles from over 30 sites across the region. Our paramedic practitioners work in the community with additional skills such as being able to supply medication for a range of minor illnesses, provide advanced care for long term conditions, and manage a range of minor injuries at home.

South Central Ambulance Service

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

WHAT WE DO

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

In addition, we utilise a number of other options, provided by specialist inhouse teams, as well as 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.

Annual Report & Accounts 2013/14

We have a number of resources at our disposal which include:

HART (HAZARDOUS AREA RESPONSE TEAM) HART is a team of paramedics specifically trained and equipped to work in hazardous areas where traditionally it would be unsafe for ambulance staff to work.

Incidents where HART has been deployed include major incidents, chemical incidents, widespread flooding, patients injured while at height and complex road traffic accidents. By providing excellent clinical care in these hazardous areas, we can ensure that our patients receive the best appropriate medical management.

AIR AMBULANCES Where speed is vital because of the severity or nature of a patientâ&#x20AC;&#x2122;s injuries, or if the emergency cannot be reached easily by road, we rely on our air ambulance partners, Thames Valley and Chiltern Air Ambulance (TVCAA), and Hampshire and Isle of Wight Air Ambulance (HIOWAA), who work with us on a daily basis. We now operate extended flying hours during the summer months with availability from 06:00 to 21:00 ensuring a Pre Hospital Qualified Doctor is available at all times during the day. We will be working closely with both charities over the next 12 months to build a robust model to extend the flying hours into night time operations from June 2015.

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 the specially-trained medics are affiliated to the British Association for Immediate Care (BASICS).

COMMUNITY FIRST AND CORESPONDERS SCAS has a large, well-trained group of Community and CoResponders made up of members of the public, fire service, police community support officers, coastguards and military responders who volunteer and undertake training to be able to support people in their community with the support of SCAS. These groups also spend significant time, voluntarily, to raise funds to provide vehicles and equipment in their local community. In the last year, SCAS and its volunteers have raised funds to buy over 200 defibrillators to go into the community over the next year and have trained over 400 people in local communities so far to operate those defibrillators in an emergency.

South Central Ambulance Service

Over the next 12 months we plan to ramp up our campaign to have a defibrillator in every community across SCAS and to engage with our local communities and our children to prepare them for action should they come across an emergency situation.

NHS 111 Over the last 12 months the Trust’s investment in expanding and developing its NHS 111 service has been significant. NHS 111 is a new ‘one stop number’ for the public to access information and local services to support their health needs. Like the 999 emergency service provided by SCAS, NHS 111 is free to the caller and accessible 24/7, 365 days a year. Over the last 12 months, the Trust delivered seven NHS 111 contracts, operated from three call centres in Bicester, Otterbourne and Milton Keynes. SCAS has provided the NHS 111 service for Oxfordshire since its launch in October 2012 and mainland Hampshire since January 2013.

As a result, we now expect to receive approximately 1.2 million calls annually from people using the NHS 111 service in these areas. In addition, the Trust also provided the 111 National Resilience Winter Contingency Service between November 2013 and March 2014. The service has now ended, as planned, on 31 March 2014. Over the five months of the contract the call centre answered 37,737 calls and was called on around 40 times to take out of area calls to support the national 111 service. The 111 service is provided using NHS Pathways trained call handlers and professional clinicians (nurses/paramedics). The Trust is justifiably proud of meeting the NHS 111 service contract key performance indicators (KPIs) on most occasions: 95% of calls are answered within 60 seconds; call abandonment rate is well below the 5% target; and transfer to 999 is consistently lower than the national average 9% 11%.

Annual Report & Accounts 2013/14

Delivering such a high quality service has not been without its challenges. As well as the logistical difficulties of finding space within the Trust’s existing estate footprint to accommodate the increased numbers of call centre handlers and equipment, the increasing growth in overall call volumes provides a recruitment and training challenge to ensure that the quality, and responsiveness, of the NHS 111 service can be maintained as demand increases. At an operational level, there are large fluctuations in call volumes by hour which can prove a rostering challenge. However, by continually analysing and monitoring call volumes, the Trust has been able to identify some peaks in demand and therefore anticipate and plan for additional capacity in the service accordingly. Furthermore we have a very flexible workforce who help us ensure the service is always covered and can cope with unexpected surges. We have recruited and trained a large number of staff in the last year and we are working to support them and embed the new services in order to meet contractual KPIs.

WHAT WE DO

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

In 2013, SCAS expanded its NHS 111 service provision to include Berkshire, Buckinghamshire and, more recently in 2014, Bedfordshire & Luton.

Continuing to overcome these challenges as we have successfully been doing during 2013/14 will be a key focus over the next 12 months as the service continues to grow. The quality and effectiveness of the existing NHS 111 service is evident in the clinical governance reviews we regularly undertake with local Clinical Commissioning Groups (CCGs). These are undertaken in each area and the numerous examples of positive patient feedback we have received, such as journalist Jo-Anne Rowney’s experience below. In early January 2014, Jo-Anne had been feeling short of breath and was off work. However, on waking up one morning she felt noticeably worse, finding it hard to breathe and virtually unable to talk. Having called 111, she was advised to get to hospital but with her housemates all having left for work, Jo-Anne was unable to get there. Whilst explaining this with great difficulty, the 111 operator realised Jo-Anne was having an asthma attack and starting to panic, and, as a result, immediately dispatched an ambulance to her.

Jo-Anne recalls what happened next:

“It seemed like virtually no time at all until a paramedic arrived. He kept me calm, explained what had happened and what he was going to do. He took my stats and again explained clearly what they meant. He reassured me and nebulised me, staying with me until I felt better and making sure I had a doctor’s appointment booked for later that day.” As evident in Jo-Anne’s case, when you call 111, if the trained operator recognises a medical emergency an ambulance or paramedic can be despatched in the same way as if you had called 999. For Jo-Anne, a significant factor she remembers was how calm her paramedic was able to make her feel and she was impressed with how he didn’t just treat her symptoms of panic and the asthma attack itself, but explained what was going on constantly and advised her what she should do next.

South Central Ambulance Service

“I definitely felt better once he left and whilst I’m fine now, I am more careful to make sure I use my inhaler”, says Jo-Anne. “My experience reminded me how careful I have to be with my asthma but more importantly it made me appreciate the work the ambulance service does. Everyone I interacted with that day was very helpful, very caring and very professional.” For more information about the 111 service provided by SCAS visit our website at: www.scas.nhs.uk

WHAT WE DO

Annual Report & Accounts 2013/14

COMMERCIAL SERVICES An additional range of services, including Patient Transport Services, Logistics & Courier Services and Commercial Training, is provided by the Trust and managed by the SCAS Commercial Services Team. These markets are open to any company or organisation, both public and private sector, and are often highly competitive.

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

The service is provided by over 350 care assistants, drivers, team leaders and managers, supported by over 70 contact centre staff based in Bicester and Otterbourne. In 2013/14, we undertook 678,583 PTS journeys, a 10% increase on demand over the previous 12 months. The rise was in response to ongoing changes in urgent care services across our region and a higher volume of short notice requests to improve discharges and patient flow within the regional healthcare system. We are particularly indebted to our volunteer car drivers who give their time freely and, over the last year, undertook 15% of all patient journeys. Satisfaction amongst patients with the service provided by SCAS remains high. The Trust has a permanent online survey that allows any patient transported by the PTS to quickly and easily provide feedback on their experience. In the last quarter of 2013/14 alone, over 500 online responses were received. All respondents rated their experience of the quality of service, staff appearance, staff conduct and patient care as satisfactory or very satisfactory.

South Central Ambulance Service

With a highly competitive marketplace characterised by frequent retendering, the Trust is focused on improving efficiencies to continue to deliver a cost-effective option for commissioners (such as reviewing and rigorously enforcing eligibility criteria), whilst maintaining a customer and patient focused service and expanding our successful PTS beyond our current regional borders. Already delivering alltime high levels of patient satisfaction, we intend to build on this further by implementing technical and operational improvements with the aim of positioning the Trust as both the market leader and the employer of choice.

LOGISTICS & COURIER SERVICES Non-patient transport is provided by the Trustâ&#x20AC;&#x2122;s Logistics & Courier Service, moving parcels, mail, passengers and medical specimens safely and securely thanks to a pool of experienced drivers and using a variety of fleet options. During 2013/14, we transported 12,890,212 items, split as follows:

Parcel movements

373,419 [2012/13] 339,472

Passenger movements

54,096 WHAT WE DO

[2012/13] 49,178 Goods and other mail movements

12,163,007 [2012/13] 11,583,816

Medical specimen movements

299,691 [2012/13] 272,446

Total

12,890,212 [2012/13] 12,244,912

Annual Report & Accounts 2013/14

We deliver mainly for the NHS between departments, hospitals and GP surgeries. Overall logistical activity continued to go up nearly 5.3% compared with last yearâ&#x20AC;&#x2122;s movements due to increased demand.

COMMERCIAL TRAINING As you would expect within an ambulance service, we provide a wide range of clinical training to our front line paramedics. As a result, the Trust is ideally placed to provide first aid training to the general public along with bespoke workplace first aid training to companies and organisations in order to help ensure all workplaces meet the minimum legal standards in providing first aid to staff. All trainers provided by SCAS are healthcare professional clinicians experienced in operational and practical situations, as well as being skilled instructors. With a very strong commercial offer when it comes to first aid training, we continue to see a rising demand for our training services. Having secured two important new contracts in 2013/14, we anticipate the trend for strong growth and improving margins to continue over the next 12 months.

South Central Ambulance Service

WHAT WE DO

Annual Report & Accounts 2013/14

SOCIAL AND COMMUNITY ISSUES As well as playing a vital part in providing healthcare and other services for the communities we serve, the Trust is committed to investing in our local areas to help build a better society. One way of how we do this is by recruiting, training and developing a diverse team of community based volunteers who work side by side with our frontline staff to deliver care in medical emergencies. SCAS is able to call upon 946 Community First Responders and over the last 12 months, this team was assigned 42,343 incidents.

However when bystanders provide CPR and use such defibrillators before emergency services arrive, as many as 4 in 10 victims survive. 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 volunteer Community First Responders.

Having installed 35 automated public access defibrillators (PADs) in 2012/13, we are delighted to have been able to increase this total to 99 at the end of 2013/14. We continue to raise awareness amongst our local communities about the lifesaving benefits such installations can bring. Statistics show that in cases of sudden cardiac arrest outside hospital, only 1 in 10 people survive.

South Central Ambulance Service

VALUING STAFF OUR WORKFORCE

Recruitment remains a key part of our workforce strategy for 2014/15, for both NHS 111 and 999. With neighbouring trusts again actively recruiting increasing numbers of paramedics, our challenge remains to recruit our own staff and reduce the usage of private providers. We are actively looking at other projects to increase our numbers of paramedics, including offering flexible contracts to paramedics considering a return to the workforce and working in partnership with the RAF to attract service personnel with medical training to SCAS once they leave military service.

We continue to invest in the development of our staff. This year we have seen 26 of our staff qualify as paramedics, and are currently supporting 48 on foundation degree programmes. Next year these numbers will increase to 57. We support a wide range of staff to further their education, with support for studies from GCSE and A levels, to BSc and post graduate qualifications. Our apprenticeship schemes have enabled 101 staff to study for qualifications in a range of subjects including customer services, business admin and leadership. This year we have further developed the range of Continuing Professional Development available to staff through eLearning. This is in addition to the statutory and mandatory modules available, and the face to face teaching, this year focusing on safeguarding and lessons from the Francis Report.

Annual Report & Accounts 2013/14

Next year sees a wider range of face to face training for operational staff, including Electronic Patient Record, Human Factors, Dementia, JRCALC, Anaphylaxis, Learning Disability, Mental Health and Sepsis. In addition team leaders, clinical mentors and some managers will undertake Joint Emergency Services Interoperability Programme (JESIP), 7 Habits Leadership, Commanders Training and Driving Assessors. Thames Valley and Wessex Leadership Academy continue to act in partnership with us to support leadership development within SCAS. Our staff have attended a range of high quality events including: Influencing Skills, Vital Conversations, Coaching and Mentoring Skills and Leadership Development Centres.

WHAT WE DO

This year we have continued to grow our workforce, increasing numbers in front line 999, EOC and 111 control rooms to meet demand. Staffing to meet the new NHS 111 contracts has presented challenges, as staffing needs to be flexible to meet peaks in demand at certain times on certain days, and while many of the staff are part time, they receive the same training and support as our full time staff.

STAFF DEVELOPMENT

We participate in the Leadership Faculty which includes NHS organisations across Wessex and Thames Valley and our staff have benefited from access to the Coaching Register as well as a range of other leadership development diagnostics and tools, including Leadership Framework 360 and Myers Briggs.

STAFF SURVEY Listening to our staff is very important, and this year after a decision to ask staff to complete the staff survey online, we got the best result ever: a 60% response rate, with some departments reaching 90%. Our response rate was the result of 1,550 staff at SCAS taking part in the survey and, at 60%, was not only above average for ambulance trusts in England but was the highest response rate of all ambulance trusts. This is a significant improvement on the response rate of 32% achieved by the Trust in the 2012 survey.

RESPONSE RATE TRUST

NATIONAL AVERAGE

2011/12

41%

54%

2012/13

32%

50%

2013/14

60%

49%

Our survey benchmarked well against other ambulance trusts, being above average on 14 of the 28 key findings. Compared to the previous yearâ&#x20AC;&#x2122;s result, most findings showed little significant change, but two areas where there was a significant improvement were staff having received Equality and Diversity and Health and Safety training. These were both areas of concern last year, and therefore on our action plan for 2013. Our scores deteriorated on four of the 28 key findings, and we will again put plans in place to address these.

South Central Ambulance Service

Last year we were able to provide detailed reports for all areas, and local managers agreed pledges with their staff to address issues which were important to them. This approach will be followed in 2014, with regular staff communications to monitor progress.

TOP 5 RANKING SCORES - STAFF SURVEY 2013 TRUST SCORE

NATIONAL AVERAGE (AMBULANCE TRUSTS)

Support from immediate managers *

3.59

3.16

% of staff have well structured appraisals in last 12 months *

23%

19%

% of staff appraised in last 12 months *

79%

67%

% of staff experiencing physical violence from staff in last 12 months †

% of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months †

43%

48%

WHAT WE DO

* the higher the score the better

† the lower the score the better

BOTTOM 5 RANKING SCORES - STAFF SURVEY 2013 TRUST SCORE

NATIONAL AVERAGE (AMBULANCE TRUSTS)

% of staff saying hand washing materials are always available *

26%

38%

% of staff receiving job-relevant training, learning or development in last 12 months *

70%

71%

% of staff reporting errors, near misses or incidents witnessed in the last month *

78%

79%

Effective team working *

3.26

3.27

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

66%

68%

* the higher the score the better

Annual Report & Accounts 2013/14

ACTIONS ARISING FROM 2013 SURVEY RESULTS As a Trust, actions have been agreed to address the four key findings of concern in the 2013 survey. Appraisals have been noted as lower this year across the Trust. However, in addition to improving the completion of appraisals the Trust also wants to ensure the quality is improved. The Trust is to undertake work during Q1 to review the appraisal process and develop a behaviour framework to underpin the process. Managers will continue to be supported in completing their appraisals through training and reminded of the process for recording appraisals. We continue to work with our Occupational Health service to reduce absence and support staff through return to work programmes. A pilot has begun in one department with high sickness levels to determine if earlier interventions with staff reporting absence due to stress can enable a faster return to work. Further investment is also being made in Trauma Risk Management (TRiM) practitioners to support staff who feel under pressure at work and spotting symptoms of stress at an early stage.

The Trust continues to monitor and report on recruitment of external candidates and internal promotion, for evidence of any discrimination against the protected characteristics as defined by the Equality Act. While none has been detected, the Trust will continue to monitor all opportunities for progression for equality of access. Greater opportunities for progression have become available this year with additional supported places at university on Paramedic Foundation degree programmes. We also encourage all staff, including those from EOC, NHS 111, PTS and administrative staff to undertake apprenticeships and are delighted that we currently have 121 members of staff on apprenticeship programmes. Local action plans and pledges are now also being developed and will be monitored by the Executive Team. A series of communications will provide further feedback to staff on progress against key findings and pledges, both at a Trust and a local level. The Trust will continue to communicate and engage with staff, acting on staff feedback and monitoring staff motivation.

South Central Ambulance Service

STAFF ENGAGEMENT Our formal routes for staff engagement remain our Joint Consultative Committee and local staff forums, with staff side representatives joining managers on major committee and project boards. Our staff side have been fully engaged and committed to work in partnership with the Trust in our bids for commercial contracts. All operational and HR policies are developed in partnership through joint working groups. Informal routes for staff engagement exist in a variety of ways, access to the Chief Executive and members of the Board through CEO meetings and leadership walkarounds, feedback to the Chief Executive through a dedicated confidential email address, staff and station meetings.

SUPPORTING STAFF HEALTH AND WELLBEING We provide support to our staff through Team Prevent, our Occupational Health service. This year we have launched the Team Prevent â&#x20AC;&#x2DC;Wellbeingâ&#x20AC;&#x2122; website, a resource that has been developed exclusively for managers and staff.

The site aims to help anyone:

PPC, our confidential counselling service, available to staff and their families, offers a wide range of advice and help both in person and online, and work with Occupational Health to promote healthy life styles and health choices. We have a team of trained practitioners to support staff who may appear stressed at work. The TRiM team follow established protocols to support staff in the early stages after dealing with, for example, a distressing or traumatic incident, and assess whether there is need for further intervention.

CELEBRATING DIVERSITY Equality Delivery System The Trust has completed two years of the adopted Equality Delivery System designed to support NHS commissioners and providers to deliver better outcomes for patients and communities and better working environments for staff, which are personal, fair and diverse. The grading was carried out by our staff and staff side on “EDS Objective 3 Empowered, Engaged and Included Staff”. There were a total of 35 focuses to be considered and graded. Overall, the feedback was positive with 23 graded green (achieving), five graded purple (excelling), two graded amber (developing) and five graded undeveloped. The amber (developing) and red (undeveloped) were set as objectives for EDS 20122016.

Annual Report & Accounts 2013/14

Progress on the objectives currently stands at 28 greens (achieving) with two reds (undeveloped). The Disability Symbol South Central Ambulance Service NHS Foundation Trust has for the fourth year achieved the disability symbol awarded by Jobcentre Plus to employers who show their commitment to employing disabled people. It demonstrates to disabled people which employers will be positive about their abilities. In achieving the disability symbol status SCAS has demonstrated that it will: »» interview all disabled applicants who meet the minimum criteria for a job vacancy and consider them on their abilities »» ensure that there is a mechanism in place to discuss, at any time but at least once a year, with disabled employees, what both parties can do to make sure disabled employees can develop and use their abilities »» make every effort when employees become disabled to make sure they stay in employment

WHAT WE DO

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

All TRiM practitioners are volunteers and receive training and support to fulfil this difficult but essential role. During August 2013 SCAS successfully completed the pensions auto-enrolment exercise, enrolling all remaining eligible staff into the NHS Scheme or National Employment Savings Trust (NEST) as appropriate.

»» Take action to ensure that all employees develop the appropriate levels of disability awareness needed to make sure these commitments work »» Review these commitments each year and assess what has been achieved, plan ways to improve on them and let employees and JobCentre Plus know about the progress and future plans. Equality and Diversity Training SCAS continues to deliver: »» induction training for all new members of staff, and a roll out to all existing staff »» manager and supervisor training to aid “line of sight” of corporate strategy (roles and responsibilities) »» impact assessment training and guidance for appropriate staff, to enable quality impact assessments of SCAS functions and services.

Lesbian, Gay, Bisexual and Transgender Network SCAS has supported the establishment of the LGBT Network now in its third year. Its aim is to celebrate and promote equality and diversity, eliminate discrimination experienced by LGBT staff and support staff with LGBT issues. NHS Staff Survey SCAS is the leading ambulance trust for the delivery of equality and diversity training.

WORKFORCE STATISTICS Throughout the year, the Trust has continued to increase its workforce in response to rising demand and the launch of the new NHS 111 service. We have recruited a mix of both clinical and nonclinical staff to meet this new demand. The increase is in both its whole time equivalents (WTEs) and staff in post. The following tables show a breakdown of the Trust’s workforce by age, ethnicity and gender, as well as disability information for 2012/13 and 2013/14 respectively.

South Central Ambulance Service

The Trust had a total of 946 community first responders (1,298 in 2013) as at the year ended 31 March 2014. The Trust had a total of 143 volunteer car drivers (123 in 2013) as at the year ended 31 March 2014.

AGE AGE

2012/13

2013/14

SIP

FTE

SIP

FTE

<20

17.39

2.76

20 - 29

534

499.44

593

549.47

30 - 39

754

666.45

700

612.21

40 - 49

825

735.70

829

737.24

50 - 59

515

480.88

557

517.03

60 - 69

141

119.60

146

126.59

70 - 79

7.51

8.53

SCAS Total

2,805

2526.97

2,843

2553.82

WHAT WE DO

GENDER GENDER

2012/13

2013/14

SIP

FTE

SIP

FTE

Female

1,397

1,238.22

1,427

1220.61

Male

1,408

1,288.75

1,416

1333.21

SCAS Total

2,805

2,526.97

2,843

2553.82

DISABILITY DISABILITY

2012/13

2013/14

SIP

FTE

SIP

FTE

1,686

1525.89

1,918

1729.21

Non disclosure

993

888.18

785

700.38

Yes

126

112.90

140

124.23

SCAS Total

2,805

2526.97

2,843

2553.82

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

Annual Report & Accounts 2013/14

2012/13

ETHNICITY

2013/14

SIP

FTE

SIP

FTE

2,333

2100.14

2,417

2172.86

B White - Irish

8.41

13.61

C White - Any other White background

39.63

41.13

C2 White Northern Irish

1.00

0.00

C3 White Unspecified

8.92

7.92

CA White English

60.75

50.91

CB White Scottish

2.07

CC White Welsh

4.00

3.80

CD White Cornish

1.00

CK White Italian

1.00

CP White Polish

1.00

CX White Mixed

1.00

0.00

CY White Other European

1.00

0.00

D Mixed - White & Black Caribbean

2.76

1.07

E Mixed - White & Black African

2.00

F Mixed - White & Asian

8.00

G Mixed - Any other mixed background

6.59

8.00

GD Mixed - Chinese & White

1.00

H Asian or Asian British - Indian

6.83

5.00

J Asian or Asian British - Pakistani

3.91

5.05

K Asian or Asian British - Bangladeshi

0.91

1.00

L Asian or Asian British - Any other Asian background

4.51

5.96

LH Asian British

0.93

LK Asian Unspecified

1.00

1.43

M Black or Black British - Caribbean

9.24

10.20

N Black or Black British - African

10.12

9.23

P Black or Black British - Any other Black background

2.00

PC Black Nigerian

1.00

0.00

PD Black British

0.03

0.00

R Chinese

0.48

S Any other Ethnic Group

2.80

2.41

SC Filipino

0.88

0.00

SE Other Specified

1.00

261

233.09

219

193.76

2,805

2,526.97

2,843

2,553.82

A White

Z Not stated Total

KEY: SIP = Staff in post 42

FTE = Full time equivalent South Central Ambulance Service

ENVIRONMENTAL REPORTING

Known within the Trust as the Green Team, this band of volunteers has successfully pioneered a range of effective awareness campaigns, such as “waste watchers”, as well as regularly publishing valuable and helpful environmental information, such as the Green Newsletter. The Trust is signed up to the overall Department of Health initiative which requires trusts to reduce their 2007/08 CO2 baseline by 10% by 2015.

FUNCTION

2008/9 ACTUAL CO2

2013/14 Forecast CO2

Fleet

10,009

10,798

Estates related

5,034

2,911

Total

15,043

13,709

The table above demonstrates the Trust’s achievement towards this goal and despite increasing activity pressures remains confident that this target will be met. 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. Amongst some of the initiatives that have had a direct impact in the reduction of our carbon footprint are: »» replacement of outdated estate with new buildings »» introduction of thermal solar panels on the roof to heat water

Annual Report & Accounts 2013/14

»» improvements in lighting technology incorporating latest in auto switch off technology »» CO2 limitation of company allocated vehicles to 120mg CO2 »» fitting of solar panels on roofs of new vehicles »» fitting of telemetry in new vehicles »» introduction of video conferencing to reduce requirement of staff needing to travel. The Trust’s developments in the use of solar panel technology on vehicles’ roofs resulted in the Trust winning the prestigious fleet award at the National Health Service Efficiency Awards. The Trust has also played an active part in the NHS Forest initiative with several new trees being planted around the Trust’s estate.

WHAT WE DO

The Trust takes its responsibilities towards the environment very seriously. The Trust has recently updated its Sustainable Development Management Plan in 2013 and a copy of the new Strategy is available on our website. The Trust has a dedicated individual whose responsibilities are to ensure that the Trust is managing its resources in a manner which minimises impact on the wider environment. He is supported by over 60 active green champions who are Trust staff volunteers responsible for supporting him in this objective.

South Central Ambulance Service

Annual Report & Accounts Annual Report 2013/14 & Accounts | Annual 2013/14 Quality Report 2013/14

CONTENTS

PART 1 47 Introduction

What are quality accounts?

48 Background

CQC and governance activity

49 How the Board assure themselves on quality

Department of Health and Monitor Core Quality Indicators

Statement on quality from the Chief Executive of South Central Ambulance Service NHS Foundation Trust â&#x20AC;&#x201C; Will Hancock

How we have prioritised our quality improvement initiatives/rationale

PART 2 68 Areas for improvement for SCAS 2014/15 70

Priority 2 Clinical Effectiveness

Priority 3 Patient Experience

86 Statements of assurance from the Board

Priority 1 Patient Safety

PART 3 93

Review of 2012/13 including reporting against core indicators

120 Other Quality Successes in 2012/13 122

136 Statement of directorsâ&#x20AC;&#x2122; responsibility in respect of the Quality Report

Statements from the Local Involvement Networks, the Overview & Scrutiny Committee, Commissioners and the CQC

South Central Ambulance Service

PART 1 INTRODUCTION We are pleased to present our 2013/14 Quality Report and mandated Quality Accounts.

Our key challenge is to protect and improve upon current levels of service for all our patients while nurturing a culture of reporting and learning, engaging with other healthcare providers and reducing costs in order to deliver the highest quality care.

QUALITY REPORT

Part of the purpose of this report is to raise the profile of quality by outlining our quality improvement successes and challenges and set further goals to improving patient care.

SCAS acknowledges the changing architecture and landscape of the NHS which now features an underpinning structure of Clinical Commissioning Groups; and as such operates an ongoing programme of change.

CLINICAL EFFECTIVENESS SAFETY EXPERIENCE

Underpinning our priorities are the three dimensions of quality as defined by Lord Darzi and later enshrined in the Health and Social Act (2012). Annual Report & Accounts 2013/14

Annual Quality Report 2013/14

This Quality Report is designed to help our service users, staff, partner agencies and the wider community to understand our quality agenda and priorities. We provide an essential service to our patients and the public, and our services are vital for the whole health economy.

SCAS welcomes this opportunity to share details of our approach to quality improvement, particularly in the context of increasing emphasis on transparency as detailed by The Francis Inquiry: Creating the Right Culture of Care (2013). All sections which reference the Inquiry and its recommendations are marked with this clear symbol so that they are easily identified as a response or action.

The Quality Accounts are aligned with the requirements and targets set by the NHS standard contract for ambulance services, the Department of Health (DH) National Ambulance Indicators, the CQUIN (Commissioning for Quality Improvements) payment framework and those of our regulators Monitor and the CQC. We will seek to continuously improve care while maintaining existing standards and aim to demonstrate our robust reporting processes which are supported by strong leadership, set actions for dealing with poor performance and a sound financial standing.

BACKGROUND On 1 March 2012, SCAS became 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 and their feedback. 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: »» Public Governors - Elected by public Foundation Trust who live in their county »» Staff Governors - Elected by SCAS staff members »» Appointed Governors - Elected from organisations that work closely with SCAS such as local charities, Clinical Commissioning Groups, and other local authorities. At the end of March 2014, SCAS had 13,168 public members.

South Central Ambulance Service

We believe strongly in patient and public engagement and regularly undertake promotional activities regarding our Foundation Trust membership.

HOW DOES THE BOARD ASSURE ITSELF ON QUALITY? Our Trust Board comprises of six executive directors and seven non-executive directors who come from a wide variety of backgrounds, bringing with them a wealth of knowledge from commercial, public, healthcare and other industries.

The Trust Board hears real patient stories and concerns from patients at alternate meetings to ensure they are informed and understand where changes can be made to improve services and outcomes. The Board also take into account information on 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 prehospital and urgent care. The governance structure is managed through the Quality and Safety Committee which reports to each Board and is responsible for monitoring and seeking assurances with regards to clinical quality, patient safety and patient experience. Sub groups submit new guidelines and learning actions from incidents, complaints and SIRI (Serious Incident Requiring Investigation) activities to the Quality and Safety Committee.

Annual Report & Accounts 2013/14

The purpose of the Quality and Safety committee is: To enable the Board to obtain assurance that high standards of care are provided by the Trust and, in particular, that adequate and appropriate governance structures, processes and controls are in place throughout the Trust to: »» promote safety and excellence in patient care; »» identify, prioritise and manage risk arising from clinical care; »» ensure the effective and efficient use of resources through evidence-based clinical practice; and »» protect the health and safety of Trust employees. In 2013 the Board began a robust process of improving and redefining clinical governance systems in the organisation to ensure what the Board reads, sees and hears gives assurances on quality. All membership and terms of reference of committees have been reviewed and realigned and the leadership walkaround template rewritten to include improved staff engagement, safety indicators and links to the Francis recommendations.

Annual Quality Report 2013/14

QUALITY REPORT

SCAS plays a key role in improving patient care through clinical networks in Milton Keynes, the Thames Valley and Southern Health Partners. We are involved in stroke, heart attack and trauma networks. We work 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.

The SCAS Board of Directors acknowledge the changing NHS and social care landscape and new architecture of the health service.

TRUST BOARD CHAIR - CHAIRMAN

Quality & Safety Committee Chair - Non-Executive Director

Audit Committee Chair - Non-Executive Director

Clinical Review Group Chair - Medical Director

Medicines Management Group

Education Review Group

Patient Experience Review Group Chair - Chief Executive Officer

Joint Operational Air Ambulance Delivery Group

Patient Safety Group Chair - Director of Patient Care

Serious Incident Requiring Investigation Panel

Quality Governance & Risk Directors Group

Health & Safety Group Chair - Chief Operating Officer

Equipment and Vehicle Review Group

National Ambulance Service Medical Directors Group

The changes will be implemented throughout the year to enable the Board to gain assurance that high quality care is being delivered and ensure staff can escalate concerns and refined as required on an ongoing basis. 50

Executive Team Chair - Chief Executive Officer

The processes set clear standards and facilitate the management of risk. The review was in line with the guidance from Monitors Quality Governance document (April 2013):

South Central Ambulance Service

How does a Board know that its organisation is working effectively to improve patient care?

SCAS RESPONSE TO FRANCIS, BERWICK AND KEOGH REPORTS

SCAS responded immediately to the Inquiry’s recommendations with a series of internal updates to the Board, seminars and workshops which involved senior management, our Council of Governors and our executive and nonexecutive directors. SCAS immediately analysed the 290 recommendations made and developed a response and action plan.

►► STANDARDS AND METHODS OF COMPLIANCE ►► OPENNESS, TRANSPARENCY AND CANDOUR ►► SUPPORT FOR COMPASSIONATE CARE ►► STRONGER PATIENT CENTRED LEADERSHIP ►► ACCURATE RELEVANT USEFUL INFORMATION

Annual Report & Accounts 2013/14

Annual Quality Report 2013/14

QUALITY REPORT

As an organisation SCAS fully recognises the seriousness of the findings identified in the Francis Report, and feels that it is important that this Quality Report includes workstreams relating to the relevant recommendations from the Francis Inquiry to underpin our quality position. 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 to be learnt.

THE FRANCIS REPORT’S KEY THEMES ARE:

INITIATIVES ALREADY IMPLEMENTED INCLUDE 52

South Central Ambulance Service

►► ►►

►►

►► ►►

►► ►► ►►

Annual Report & Accounts 2013/14

Annual Quality Report 2013/14

QUALITY REPORT

►►

AN UPDATED CLINICAL SUPERVISION POLICY WE STRENGTHENED OUR CLINICAL GOVERNANCE MEETINGS AND CHECKS WITH THE PRIVATE PROVIDERS WE USE WE BENCHMARKED NATIONALLY ON CORE AMBULANCE QUALITY AND CLINICAL METRICS A ROBUST REVIEW OF OUR INTEGRATED PERFORMANCE REPORT METRICS INTRODUCED AN ELECTRONIC INCIDENT REPORTING SYSTEM WE CARRIED OUT INVESTIGATION AND ROOT CAUSE ANALYSIS TRAINING A REVISION OF OUR PUBLIC ENGAGEMENT STRATEGY THE INTRODUCTION OF THE FRIENDS AND FAMILY TEST OUR DUTY OF CANDOUR REQUIREMENTS AND REPORTING WERE STRENGTHENED A COMPASSION ELEMENT INCLUDED IN ALL STAFF APPRAISALS OUR SAFETY WALKROUNDS REVISED A STAFF SAFETY CULTURE AUDIT USING A RECOGNISED TOOL 53

As described in the section on Board assurance, the review of our quality assurances have been carefully aligned with themes from these key reports. From the Berwick Report (in response to the Francis Report) change will require:

WILLINGNESS >

Recognition of the need for wide systemic change and a culture firmly rooted in continual improvement

OPENNESS >

Abandonment of blame, trust in good intentions

ENGAGEMENT >

Close working with patients and carers to achieve goals at all times

QUALITY FIRST >

Better care as a goal instead of quantitative targets

TRANSPARENCY >

Ought not to be optional and instead insisted upon at all levels, embracing and encouraging whistle blowing and reporting to identify risks and where things have gone wrong

RESPONSIBILITY >

Clear lines of responsibility throughout agencies

LEARNING SUPPORT >

Fostering career-long support for staff growth, support and quality planning

ACTION >

Response to safety alerts sanctions applied to reckless or wilful neglect

PRIDE >

In our work

South Central Ambulance Service

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.

OUR STRATEGIC AIMS AND HOW THEY ALIGN WITH THE FRANCIS REPORT ARE DETAILED BELOW: µµ CLINICAL EXCELLENCE Providing a positive patient experience while improving clinical outcomes and ensuring patient safety through feedback, accountability and recognised best practice

QUALITY REPORT

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 that this is the case for the last 12 months we have undertaken an in-depth process of restructuring all operational and corporate roles to maximise the efficiency and performance of the Trust.

µµ OPERATIONAL EXCELLENCE

Achieving response time performance standards, resilience and efficiency whilst still putting the patient first

µµ EFFECTIVE STAKEHOLDER RELATIONSHIPS, SOUND GOVERNANCE, VALUE FOR MONEY AND A STRONG FINANCIAL STANDARDS

Developing whole system solutions and seamless pathways of care

µµ 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

µµ A NETWORK OF PROFITABLE AND HIGH QUALITY NON-EMERGENCY CONTRACTS

Which operate to the highest standards and always put the patient first

Annual Report & Accounts 2013/14

Annual Quality Report 2013/14

INTRODUCTION FROM CHIEF EXECUTIVE, WILL HANCOCK Welcome to our Quality Accounts 2013/14, our third since becoming a Foundation Trust. Our intention is to give you a real understanding of our quality performance looking back over the last 12 months and setting our improvement targets for the coming year. SCAS faced another busy and demanding year in 2013/14. We have expanded our geographical footprint for NHS 111 services to include Berkshire, Buckinghamshire, Bedfordshire and Luton and the National Resilience service for NHS 111 based at Milton Keynes.

South Central Ambulance Service

Our CQC inspection in August 2013 was successful and we achieved full compliance. But this does not mean we are complacent. We still face some challenges to deliver consistently high quality services to all and these areas are identified in our priorities. By achieving a collective Board understanding of the transformation required I am confident we will continue to deliver improvements.

QUALITY REPORT

2014/15 will continue to see NHS trusts working in a tough economic climate and we need to be evermore efficient and transformational. This will include development of local care setting initiatives, scanning the potential to provide care at home schemes and enhancing our engagement with GPs. This will involve better coordination between teams providing emergency and planned care to ensure proactive support at home for patients to prevent emergency crisis and enable people to stay at home safely. We have also been adapting to the Clinical Commissioning Groups and strengthening our engagement with them to develop patient services across our area. We will continue to work together to reshape services and improve quality. The coming year will continue to be challenging. But by listening to our patients, our foundation trust members, our staff and the general public, and by continuing to focus on good quality outcomes and positive patient experiences at every contact point, I am confident we can meet every challenge and enhance our reputation as a quality-focused healthcare provider. This Quality Account has been prepared and written by South Central Ambulance Service NHS Foundation Trust under the National Health Service (Quality Accounts regulations) 2010 statutory instrument No 279. The Trust has reviewed all the data and information available on the quality of care that all the service arms provide on a daily basis. To the best of my knowledge the information in this document is accurate.

Will Hancock Chief Executive 28 May 2014

Annual Report & Accounts 2013/14

Annual Quality Report 2013/14

WHAT ARE QUALITY ACCOUNTS?

Quality is defined by both staff and patient experiences.

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 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.

QUALITY

{

PATIENT EXPERIENCE

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. In concluding his review Mr Francis stated:

SAFETY

EVIDENCE BASED MEDICINE

South Central Ambulance Service

Annual Report & Accounts 2013/14

Annual Quality Report 2013/14

QUALITY REPORT

“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 NHS.”

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 enables us to 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 2013/14. Effective auality accounts raise the profile of quality improvement across the organisation from the Board to road crews and the staff in 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, our commissioners and Health Overview and Scrutiny Panels.

External assurance for this account will be provided by our external auditors, KPMG, who will review the content of this report in line with Monitorâ&#x20AC;&#x2122;s requirements as outlined in the NHS Foundation Trust Reporting Manual 2013/14. They will also review the report for consistency with other sources of data available, provide a limited assurance report on two mandated indicators and one locally selected indicator.

CQC REGULATION AND COMPLIANCE In August 2013 the Care Quality Commission (CQC) carried out a scheduled inspection at SCAS. The inspectors focused on the following five outcomes:

OUTCOME 4 (REGULATION 9) Care and welfare of people who use services

Met this standard

OUTCOME 6 (REGULATION 24) Cooperating with other providers

Met this standard

OUTCOME 8 (REGULATION 12) Cleanliness and infection control

Met this standard

OUTCOME 11 (REGULATION 16) Safety and suitability of premises

Met this standard

OUTCOME 16 (REGULATION 10) Assessing and monitoring the quality of service provision

Met this standard

South Central Ambulance Service

The inspectors spoke to staff, examined records and reviewed what our stakeholders had to say. They looked at the personal care or treatment records of people who use the service, carried out visits on 7 August 2013, 8 August 2013 and 15 August 2013, talked with people who use the service and met with staff.

“We found there was a thorough system of monitoring of quality and performance of all areas of SCAS’s operation. We found any of the concerns raised with us had already been identified and action either had or was being taken to address them as far as possible. “We found there were robust systems in place which identified, assessed and managed risks to patient safety and that of staff. Formal processes were in place to learn from adverse incidents; this included any findings from complaints. We were informed of concerns which had been raised about the confidentiality of patient records held at ambulance stations and resource centres. This had been addressed and we saw at the stations we visited secure, lockable storage was now provided. This provided evidence learning from incidents and investigations took place and appropriate changes were made where appropriate.”

Annual Report & Accounts 2013/14

Annual Quality Report 2013/14

QUALITY REPORT

EXTRACTS FROM THE CQC REPORT STATED:

GOVERNANCE AND ACTIVITY

SCAS was deemed fully compliant with the essential standards, shown previously, something which we aim to maintain.

The total number of adverse incidents reported internally was 3,489. Of these there were 16 Serious Incidents Requiring Investigation (SIRIs) which we reported externally to the Department of Health and the Clinical Commissioning Groups. These incidents are ones that have resulted in moderate or severe harm or death.

SCAS has introduced a new electronic incident reporting system in 2013 (Datix) and we have seen our reporting levels rise. This is regarded as positive as it demonstrates an open safety culture in which our staff feel able to report incidents and raise concerns. Francis reported that increases in incident reporting is a healthy position if the incidents can result in learning and not consistently harming patients.

The report can be viewed in full on the CQC website. http://www.cqc.org.uk/ sites/default/files/media/ reports/RYEA3_Bucks_ and_Oxon_Divisional_ HQ_INS1-888811695_ Scheduled_01-10-2013.pdf

SCAS received 579,430 contacts from the public during the 2013/14 reporting period. We received 883 compliments, which far outweighed our complaints, which numbered only 382. We also received 740 concerns or comments.

ACTIVITY (999 INCIDENTS)

46,000 44,000 42,000 2013-14 actual

40,000

2012-13 actual

38,000 36,000

ch ar

b M

n Ja

c De

v No

ct O

p Se

g Au

ly Ju

ne Ju

ay M

34,000

South Central Ambulance Service

During the year 2013/2014 there have been three referrals to the Parliamentary Health Service Ombudsman, only two of which were investigated. However, it is good to note that neither was upheld, which was a positive outcome for the Trust and shows that we are resolving any complaints we receive in an open and honest way.

AMBULANCE RESPONSE TIMES (RED 1 & RED 2) ÜÜ The percentage of Red 1 and Red 2 telephone calls resulting in an emergency response by the Trust that were responded to within eight minutes of receipt of that call during the reporting period. ÜÜ The percentage of telephone calls resulting in an ambulance response by the Trust at scene of the emergency within 19 minutes of the receipt of that call during the reporting period.

AMBULANCE CLINICAL OUTCOMES: ACUTE ST-ELEVATION MYOCARDIAL INFARCTION (STEMI) AND STROKE

SCAS reported on mandatory core quality indicators set by Monitor and the Department of Health in last year’s accounts. These indicators are intended to strengthen the reporting process and create a comparable set of targets across all UK ambulance trusts.

Patients that undergo a pre-hospital 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 mandated core quality indicators are outlined in: Department of Health Reporting arrangements for Quality Accounts Gateway ref: 00931 NHS England letter dated 9 January 2014 The mandatory core quality indicators relevant during 2013/14 are:

QUALITY REPORT

MONITOR MANDATED QUALITY INDICATORS

The core indicator requirements for the 2013/14 Quality Account are the following: ÜÜ The percentage of patients with a pre-existing diagnosis of suspected ST elevation myocardial infarction who received an appropriate care bundle from the Trust during the reporting period. ÜÜ The percentage of patients with suspected stroke assessed face to face who received an appropriate care bundle from the Trust during the reporting period. An appropriate care bundle is a package of clinical interventions that are known to benefit patients’ clinical outcomes, for instance, patients with STEMI should be administered pain relief medication to help alleviate discomfort.

Annual Report & Accounts 2013/14

Annual Quality Report 2013/14

OTHER MANDATED INDICATORS ÜÜ The number and, where available, rate of patient safety incidents reported within the Trust during the reporting period, and the number and percentage of such patient safety incidents that resulted in severe harm or death. ÜÜ The percentage of staff employed by, or under contract to, the Trust during the reporting period who would recommend the Trust as a provider of care to their family or friends.

South Central Ambulance Service NHS Foundation Trust considers that the data is as described for the following reasons: »» Use of licensed clinical assessment tools »» Data validation by external auditors »» Scrutiny internal/external and national. South Central Ambulance Service NHS Foundation Trust has taken the following actions to improve the indicators and data and so the quality of its services, by: »» policy implementation »» clinical campaign approach »» benchmarking »» scrutiny (internal and external) »» internal auditors (validating data) »» introduction of NHS Pathways »» clinical audit »» Board Assurance Framework and IPR »» IT systems maintenance »» training and support »» reviewing quality assurance committee structure.

South Central Ambulance Service

PART 2 QUALITY PRIORITIES FOR 2014/15 Our ambition is to deliver continuous improvement in patient care and outcomes...

Improve clinical effectiveness and outcomes »» Clinical teams will all be involved in improvement activities to ensure effective clinical pathways. Improve patient experience »» Ensure patient satisfaction improves across all areas of service provision and benchmark well against national figures.

Demonstrate quality improvement »» Robust quality measurement through sound governance and audit. »» Introduce a new clinical quality and safety dashboard. »» Assurance for Board, public, Clinical Commissioning Groups (CCGs) and regulatory bodies (Care Quality Commission (CQC), NHS Litigation Authority (NHSLA) and Monitor. Continuously improve »» Increase organisational improvement capability by training and equipping staff with improvement skills. »» Evidence of organisational learning from feedback, measures and incidents. »» Trust Board view quality improvement as a core function. Evidence increased efficiency »» Demonstrate increased efficiency linked with quality improvement.

Annual Report & Accounts 2013/14

Annual Quality Report 2013/14

QUALITY REPORT

Improve safety and reduce harm »» Show evidence of a growing safety culture within the organisation »» Reduce the number of the most frequent and potentially serious incidents.

HOW WE HAVE PRIORITISED THIS YEARâ&#x20AC;&#x2122;S QUALITY IMPROVEMENT INITIATIVES Each year the Quality Accounts outline a number of areas where quality improvements can and should be made. Engagement with all our internal and external partners is invaluable and imperative when defining our goals for quality improvement.

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 remain committed to learning lessons, implementing changes and supporting staff in training, learning and supervision. Our indicators cover all services provided (111, PTS, 999) where applicable.

FRANCIS KEOGH BERWICK

AUDIT, INCIDENTS

CONTRACT SCHEDULES

QUALITY PRIORITIES

LEADERSHIP WALKAROUNDS

PATIENT COMPLAINTS, CONCERNS, COMPLIMENTS & SURVEYS. STAFF SURVEYS

South Central Ambulance Service

NHS OPERATING FRAMEWORK

We have listened to feedback from patients and other professionals who tell us that they want safe, timely care delivered by competent, professional and caring staff members. Our clinical audit programmes and outcomes also assist in shaping our priorities.

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 this 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 and this remains a high priority. Local health overview and scrutiny panels (HOSP) have given their views as have our commissioners in Clinical Commissioning Groups (CCGs) who are responsible for contracting our services. As a Foundation Trust we engage with our Council of Governors and we have welcomed their input.

Leadership walkarounds by the executive and nonexecutive 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. Our leadership walkaround template has also been revised to provide stronger assurances on elements of the Francis Report. 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. Following all of the above, we refined our priorities to those which we felt would ‘stretch us’ in delivering the highest possible quality of care. These include the mandated priorities.

Annual Report & Accounts 2013/14

The initiatives were assessed in terms of:

IMPACT

QUALITY REPORT

We have also used our internal monitoring systems such as incident reports and audit to examine our key priorities.

Engagement on selecting our priorities needs to be relevant and credible and through the above processes we can show that the public view and a clinical view has been listened to and included in planning our priorities.

By considering the likely improvement in safety, outcomes and experience.

FEASIBILITY

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

MEASURABILITY Can the priority we have set be measured accurately in order that we can show improvements?

OUTCOMES

Will the initiative improve patient outcomes in the areas of safety, effectiveness and experience?

Annual Quality Report 2013/14

AREAS FOR IMPROVEMENT FOR SCAS 2014/15 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 Quality Accounts 2013/14:

1 PATIENT SAFETY

To ensure that decisions to keep patients â&#x20AC;&#x2DC;at homeâ&#x20AC;&#x2122; are consistently clinically safe and appropriate for the patient condition with referral to accessible/ available community services.

To reduce potential harm or poor patient experience as a result of waiting too long for a response for our 999 service.

To report on the number of patient safety incidents and the percentage and number that resulted in severe harm or death for all of our services (111, PTS and 999).

South Central Ambulance Service

2 CLINICAL EFFECTIVENESS To report on the percentage of patients with stroke and heart attacks who receive an appropriate care bundle (mandated indicators).

To report on the data of responses to Red 1 and 2 calls, and calls requiring a 19 minute response and benchmark nationally (core mandated indicators).

To improve the responsiveness of consistently identifying and appropriately transferring stroke patients to a hyperacute unit within 60 minutes.

To ensure patients receive adequate pain relief.

QUALITY REPORT

3 PATIENT EXPERIENCE 3a

To ensure that all patient complaints and concerns are consistently responded to within a mutually agreed timeframe for all of our services (111, PTS and 999)

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

To proactively seek patient feedback through surveying patients to improve our services, including the Friends and Family Test and gaining feedback from harder to reach groups for all of our services.

Each of our priorities and our proposed initiatives for 2014/2015 are described in detail on the following pages. They will be monitored through the quality improvement plans that are presented to the executive and senior management teams and the Quality and Safety Committee.

All the quality metrics are included in the Trust’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. This includes all SCAS provided services.

Annual Report & Accounts 2013/14

External audit assurance is provided by KPMG and through an internal audit programme.

Annual Quality Report 2013/14

PRIORITY 1 - PATIENT SAFETY a. To ensure that decisions to keep patients ‘at home’ are consistently, clinically

safe and appropriate for the patient condition with referral to accessible/available community services.

RATIONALE The ambulance service works in partnership with other healthcare providers to keep patients at home where possible. To do this we work with commissioners and GPs to ensure patients left at home have the right advice or referral to another service. We have chosen this indicator to ensure decisions to convey to hospital or to refer on are clinically safe and appropriate for our patients. We will build on work already undertaken in collaboration with our healthcare partners and through our contracted quality schedule. We are currently compliant with CQC Outcome 4 (Care and welfare of people who use services)

TO ACHIEVE THIS WE NEED TO: »» produce and analyse information on non conveyance »» review patient clinical records where nonconveyance has resulted in a recontact or subsequent admission »» analyse recontact rates/ unexpected deaths within 24 hours of SCAS attendance »» review incidents and complaints relating to conveyance/nonconveyance »» analyse HCP (Healthcare Professional) feedback and actions »» conduct GP triage audits and show improvements in attempts »» report data by area to create heat maps »» introduce and embed the use of the Electronic Patient Record (ePR) by Quarter 3 (December 2014) to enable real time data to be sent to healthcare partners and teams »» extract monthly GP triage data per CCG

South Central Ambulance Service

»» monitor monthly GP triage attempts and GP accept or decline by CCG »» conduct GP triage audits analysing appropriate utilisation and improvement plans where variance exists.

Board Sponsor Sue Byrne Chief Operating Officer

Implementation Leads Mark Ainsworth Operations Director South Steve West Operations Director North

PRIORITY 1 - PATIENT SAFETY b. To reduce potential harm or poor patient experience as a result of waiting too long for a response for our 999 service.

RATIONALE

Any delay can present as a complaint or incident requiring investigation and using an investigative process can help us understand where and how problems arise. Consequently SCAS is 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. The Clinical and Operations teams recognise the importance of reducing long waits to patients.

Long wait audit meetings are conducted monthly where an in-depth review of the top ten longest waits for each dispatch area is undertaken. The review includes an audit of the processes in the Emergency Operations Centre (EOC) to ensure there were no avoidable delays along with a review of the patient care record to identify any patients placed at risk or where harm has been caused by a delay in responding. These audits have confirmed that the three main reasons for the delays are: »» all operational resources are committed at the time of the call »» higher priority calls requiring attendance »» repeat calls to patients waiting our arrival where the category of call changes It is also anticipated that the transition of 999 from AMPDS to NHS Pathways will further improve our assessment and allocation of resources thereby reducing long waits.

Annual Report & Accounts 2013/14

NHS Pathways will start rolling out to our 999 services in Quarter 3.

TO ACHIEVE THIS WE NEED TO: »» audit long waits and produce actions to reduce waits and improve the patient experience (each month) (remove regraded calls from the sample) »» analyse any complaints or concerns received which relate to long waits and ensure learning is extracted and implemented »» ensure staff submit an incident report when unable to get a timely response from a GP triage attempt »» review our backup responses to solo responders and introduce a categorisation system in EOC/dispatch »» report data by area to create heat maps (including complaints and incidents)

Annual Quality Report 2013/14

QUALITY REPORT

PRIORITY 1 - PATIENT SAFETY b. To reduce potential harm or poor patient experience as a result of waiting to long for a response for our 999 service.

»» carry out weekly and daily reviews of resource availability against our unit hour utilisation planned demand profile »» Clinical Support Desk (CSD) will contact any patient who experiences a long wait to assess the patient and offer appropriate clinical advice »» patients who make a repeat call will be passed through to CSD for assessment. »» work with GPs on appropriate HCP admissions using our service.

Board Sponsor Sue Byrne Chief Operating Officer

Implementation Leads Luci Stephens Assistant Director of Operations (EOC) Operations Directors North and South

PLAN »» Implement a zero tolerance approach to long waits for Red 2 calls over 30 minutes »» Reduce long waits in line with IPR trajectory.

South Central Ambulance Service

PRIORITY 1 - PATIENT SAFETY c. To report on the number of patient safety incidents and the percentage and

number that resulted in severe harm or death for all of our services (111, PTS, 999)

RATIONALE

Adverse incidents are logged through our Datix reporting system and can be reported by any grade of staff. Early review of submitted Datix incidents by a dedicated management team means that any incident classified as a serious incident requiring investigation (SIRI) can be rapidly ‘flagged up’ and acted on appropriately. SIRIs are registered on the Strategic Executive Information System (STEIS) and fully investigated in a timely manner as agreed with commissioners. All actions relating to SIRIs are monitored by the SIRI Review Group.

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

TO ACHIEVE THIS WE NEED TO: »» report on patient safety incidents (numbers and severity) »» triangulate SIRIs with complaints to maximise learning »» further improve our partnership working on serious incidents which cross health and social care boundaries

Board Sponsor

QUALITY REPORT

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

Deirdre Thompson Director of Patient Care

Implementation Leads John Dunn Head of Risk and Security Debbie Marrs Assistant Director of Quality

PLAN

»» Reduce incidents which result in moderate or severe harm by 10%. »» Benchmark nationally with other ambulance services to enable best practice to be shared and improve outcomes for patients. »» Adhere to the duty of candour as outlined in the Francis Report and our contractual requirements.

Annual Report & Accounts 2013/14

Annual Quality Report 2013/14

PRIORITY 2 - CLINICAL EFFECTIVENESS a. To report on the percentage of patients with stroke and heart attacks who receive an appropriate care bundle (mandated indicators)

RATIONALE Our challenge going forward is to improve the percentage of patients with suspected heart attack receiving the appropriate care bundle.

SCAS has a proven track record of improvement in performance in relation to use of the stroke care bundle (98.7% *YTD Apr 13 to Dec 13).

STROKE CARE BUNDLE 100.00% 99.00% 98.00% 97.00% 96.00% 95.00% 94.00%

Stroke

93.00%

Target

92.00% 91.00%

b Fe

Ja n

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No v

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Se pt

Au g

y Ju l

e Ju n

M ay

Ap r il

90.00%

STEMI CARE BUNDLE STEMI

90.00%

Target

85.00% 80.00% 75.00% 70.00% 65.00% 60.00%

South Central Ambulance Service

ar M

b Fe

n Ja

De c

No v

ct O

Se pt

Au g

y Ju l

e Ju n

M ay

Ap r il

55.00%

PRIORITY 2 - CLINICAL EFFECTIVENESS a. To report on the percentage of patients with stroke and heart attacks who receive

an appropriate care bundle (mandated indicators)

SCAS has devised and is implementing a STEMI care bundle action plan which will concentrate on the assessment, treatment, feedback and the leadership that underpins this and will build on the previous initiative such as “Time is Myocardium“. It will also run similar support and review systems to the stroke plan in ‘controlling the controllables’ to enable focus on the aspects of the outcomes that we can affect. This indicator covers all our services and Datix affords SCAS the opportunity to triangulate information where incidents cross service boundaries.

TO ACHIEVE THIS WE NEED TO: »» benchmark with other ambulance services as per the DH mandatory indicators and be in the top national quartile »» develop a campaign approach to include education, support and information to develop focus on treatment and time to specialist unit. »» review the human factors and behaviours which affect delivery of the care bundles »» link with specialist units - both pre-alerting and providing a feedback mechanism for crew and system learning. »» wider system networking - providing information to inform the clinical networks »» conduct regular clinical audits of patient report forms (PRFs) to analyse the quality of care provided and care pathway compliance »» a focused programme of clinical quality metrics for team leaders and their staff

Annual Report & Accounts 2013/14

»» use technology developments in apps for phones and ePR to provide real time proximity information to crews which will include forced fields for care bundles.

PLAN »» STEMI - To achieve 80% by year end from an average in 2013/14 of 69% (1% month on month improvement)

Board Sponsor John Black Medical Director

Implementation Leads Dave Sherwood Clinical Excellence Lead Operations Directors North and South Rob Kemp Area Manager

Annual Quality Report 2013/14

QUALITY REPORT

This indicator is mandated for our Quality Accounts; however, SCAS recognises the need to improve on care bundle application with STEMI patients in particular. We have analysed why this is the case and found it to relate to analgesics given to this cohort of patients.

PRIORITY 2 - CLINICAL EFFECTIVENESS b. To report on the data of responses to Red 1 and Red 2 calls, and calls requiring a 19 minute response and benchmark nationally (core mandated indicators).

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

TO ACHIEVE THIS WE NEED TO: »» report on the response times as per the indicator »» review daily »» utilise data on high demand times to match our resources »» learn from complaints and incidents relating to response times.

PLAN »» maintain a consistent plan of achieving 75% + of response times for Red 1 and 2 calls and 95% + for Red 19 calls.

Board Sponsor Sue Byrne Chief Operating Officer

Implementation Leads Mark Ainsworth Operations Director South Steve West Operations Director North

South Central Ambulance Service

PRIORITY 2 - CLINICAL EFFECTIVENESS c. To improve the responsiveness of consistently identifying and appropriately

transferring stroke patients to a hyper-acute unit within 60 minutes.

RATIONALE

SCAS covers a broad urban and rural geographical area which overlaps with two vascular networks following the breakup of the South Central Cardio Vascular Network. The Wessex and Thames Valley networks cover SCAS with hyper-acute stroke units (HASU) coverage that does not completely cover the SCAS population within 21 minutes to HASU. The Clinical Networks continue to review pathways and SCAS is ensuring that we have representation at all meetings. There are two clinical networks in our region and SCAS is working with both networks to ensure consistency and ensure the best clinical pathway for our patients.

SCAS performance and data can support and inform the networks on access to stroke units in the future. Calls to Hyper-Acute Stroke Unit (HASU) within 60 minutes for all FAST+ve stroke patients is still proving to be a challenge and will remain a key focus for improvement. Our improvements will come from bringing together under a single campaign the ideas and initiatives that led the success of the trauma campaign. This faced similar challenges, in location, early identification, crew support, on scene times and the front end model. These issues lead to a cross departmental, proactive campaign which aim to “Control the Controllable” and define outcome based results.

Annual Report & Accounts 2013/14

Work has been undertaken to improve the stroke call to hyper-acute stroke unit times by way of directives that authorise immediate backup if a solo response is sent and escalating if it is identified as a FAST+ve patient. Team leaders and clinical mentors are encouraged to include stroke and STEMI care performance indicators in the appraisal process. This is to be further developed. Work is underway to issue a new aide memoire to all frontline staff which names all stroke centres, their locations, entry routes and drop off points.

Annual Quality Report 2013/14

QUALITY REPORT

Stroke performance has been a SCAS and partner priority for a number of years since “Mending Hearts and Brains” in 2006 where the quality of life and long term health benefits of early thrombolysis were first outlined.

FACE

HAS THEIR FACE FALLEN ON ONE SIDE? CAN THEY SMILE?

ARMS

CAN THEY RAISE BOTH ARMS AND KEEP THEM THERE?

SPEECH IS THEIR SPEECH SLURRED?

TIME

TO CALL 999 IF YOU SEE ANY SINGLE ONE OF THESE SIGNS nhs.uk/actfast

•

stroke.org.uk

W H E N S T R O K E S T R I K E S , A C T F. A . S .T.

South Central Ambulance Service

HYPER-ACUTE STROKE PATHWAY

999 call received at EOC

AMPDS disposition not card 28

19 minute response required DCA if available

Crew suspect stroke patient on arrival

QUALITY REPORT

Card 28 stroke identified

Crew verify stroke on arrival FAST+ve

Establish onset of symptoms <4 hrs is BGL >4.0mmol/l

Yes

Aim to leave scene within 20 minutes

If BGL <4.0mmol/l treat as hypo as per JCALC

Take patient to the nearest ED or ASU

Blue light transfer to nearest HASU

If BGL increases to >4.0mmol/l and FAST symptoms persist

Transfer under normal road speed

Pre-alert receiving HASU on route

If BGL remains <4.0mmol/l after treatment

Aim to arrive at HASU within 60 minutes of call time Annual Report & Accounts 2013/14

Annual Quality Report 2013/14

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

TO ACHIEVE THIS WE NEED TO: »» Work within emergency operations centre (EOC) to increase recognition of stroke patients using the priority dispatch system »» increase resource utilisation plans to prioritise stroke patients in the community »» reissue the stroke Pathway to frontline staff »» develop a campaign approach “FAST means Fast” to include education, review, support and information to develop focus on treatment and time to unit. »» Implement early identification of stroke patients and proactive support, including prealert and advising on distance to HASU. »» develop local leadership - (Performance and Patients: One Outcome, One Agenda) »» ensure wider system networking providing information to inform the network

»» embrace network and technologies including apps, ePR and capitalising on any changes to pathways. The transition from AMPDS to NHS Pathways will facilitate earlier identification of FAST+ve patients.

Board Sponsor John Black Medical Director

Implementation Leads Rob Kemp Area Manager

PLAN

Dave Sherwood Clinical Excellence Lead

»» reduce on scene times »» map the HASU run times to ascertain if 21 minutes run time is always possible using isochrome data »» plan to increase response time to 59% by December 2014 with a month on month improvement.

Operations Directors

FAST TEST

STROKE

BLOOD PRESSURE

South Central Ambulance Service

BLOOD GLUCOSE

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

RATIONALE

TO ACHIEVE THIS WE NEED TO: »» audit and review incidents and complaints relating to poor pain relief »» audit how many patients have appropriate analgesia »» re-educate staff on effective pain management.

Board Sponsor

QUALITY REPORT

Patients in our care often have pain. SCAS want to ensure adequate and appropriate pain relief is given to all our patients. We know pain is often distressing so want to ensure this does not contribute to poor experience.

Deirdre Thompson Director of Patient Care

Implementation Leads Ed England Lead Pharmacist Ian Teague Head of Education

PLAN »» audit how many patients have an appropriate pain score recorded (analysed by area) »» this indicator is linked with 2a STEMI care bundle plan.

Annual Report & Accounts 2013/14

Annual Quality Report 2013/14

PRIORITY 3 - PATIENT EXPERIENCE a. To ensure that all patient complaints and concerns are consistently responded to within a mutually agreed timeframe for all of our services (NHS 111, PTS and 999).

RATIONALE 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, but we also need to agree timeframes for responses.

TO ACHIEVE THIS WE NEED TO: »» ensure timeframes are agreed at the point of contact »» work in line with the national complaints requirements »» respond to concerns individually »» listen to patients concerns, and find answers to their queries in an agreed timeframe »» work with patients and the public to make sure their views are used to improve the service

»» review, once published, the national complaints policy and apply locally »» monitor by area and service

PLAN »» To achieve and maintain a 95% response rate within 25 days.

Board Sponsor Deirdre Thompson Director of Patient Care

Implementation Leads Liz Rees Head of Patient Experience

South Central Ambulance Service

PRIORITY 3 - PATIENT EXPERIENCE b. To learn from concerns by using ‘face to face / end to end reviews’ with partners

and patients and publish the findings and actions to improve our services.

RATIONALE

Dignity and compassion are key themes of the Francis Report, both of which are never more relevant than when dealing with patients. A huge spectrum of emotion and clinical care pathways dictates the wishes of patients and their families and SCAS recognises that being able to offer a unified, comprehensive yet flexible approach for patients is paramount.

»» proactively gain feedback from patients who call 999 and NHS 111 in end to end face to face reviews »» use the information to make service changes »» publish findings and themes and any action we take

QUALITY REPORT

Patient experience is very important to us and our staff, who strive to deliver high quality care for all whether on the front line, on the telephone, providing routine transport or in a supporting role. While 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.

TO ACHIEVE THIS WE NEED TO:

Board Sponsor Deirdre Thompson Director of Patient Care

Implementation Leads Debbie Marrs Assistant Director of Quality Liz Rees Head of Patient Experience

Annual Report & Accounts 2013/14

Annual Quality Report 2013/14

PRIORITY 3 - PATIENT EXPERIENCE c. To proactively seek patient feedback through surveying patients to improve our

services, including the Friends and Family Test and gaining feedback from harder to reach groups for all of our services.

RATIONALE SCAS welcomes new initiatives that help us engage with our service users by collecting real time patient experience data, and in April 2013 the launch of the DH’s Friends and Family Test (FFT) question was implemented for acute providers. We are required to introduce a friends and family test to staff from April 2014 and for patients from 2015. It is important that we ask staff if they feel they could recommend our services and if not, why not. The FFT test will ask staff and patients one simple question:

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 recommendations about listening to patients and other feedback to improve our services. Patient surveys are an additional way to collect feedback that may not be presented via other routes. SCAS wants to proactively seek patient feedback through surveying patients in harder to reach groups such as mental health sufferers, children, and adolescents.

“Would you recommend SCAS to a friend or relative?” It is proposed that responses to this “Friends and Family Test” question will then be published on a locally determined basis.

South Central Ambulance Service

TO ACHIEVE THIS WE NEED TO: »» carry out our survey plan to include harder to reach groups such as mental health patients »» ensure feedback is acted upon and service improvements made as a result of feedback »» implement further, the friends and family test for 999 patients by conducting end to end reviews »» utilise our staff survey results to improve staff and patient experience »» maintain existing patient survey routes with a minimum of six surveys in 2014/15. [Planned surveys can be seen in the table on the right] »» align FFT response data with local patient experience data to drive improvements in the commissioning and regulatory system »» utilise survey data to inform our quality priorities

PRIORITY 3 - PATIENT EXPERIENCE c. To proactively seek patient feedback through surveying patients to improve our

services; including the Friends and Family test and gaining feedback from harder to reach groups for all of our services.

PLAN »» Report on FFT results for NHS 111, PTS and FT members surveys »» Conduct leadership and safety walkrounds to ask our staff if they would recommend our service

»» Conduct a staff FFT survey quarterly and analyse results »» Aim for 15% + response rate

QUALITY REPORT

»» put action plans in place at a local level to implement changes required illustrated by survey responses »» take part in the national ambulance hear and treat survey (CQC) »» publish complaint themes »» use patient stories at Trust Board meetings.

Type of Experience Survey

Type / medium

Date of implementation and committee reported to

Responsible person

Patient Transport Service (PTS) – including FFT

Postal questionnaire / online

Quarterly reported to Patient Experience Review Group (PERG)

PTS Manager

Complainant satisfaction

Postal questionnaire

July 2014

Head of Patient Experience

Harder to reach groups

Telephone questionnaire

November 2014

Clinical Lead - Mental health and learning disabilities

NHS 111 patient satisfaction Hants / Oxford / Berks / Beds / Bucks – including FFT

Postal questionnaire (including Friends and Family Test)

- Hants quarterly - Oxford monthly - Berks quarterly - Bucks July 2014

Clinical Governance NHS 111 leads

Foundation Trust Members Survey – including FFT

Postal questionnaire (including Friends and Family Test)

May 2014

Communications

Front line patient satisfaction – Including FFT

Face to face/ End to end reviews

Quarter 2 and 3

Clinical Team - Corporate

National Hear and Treat (CQC)

Questionnaire

Report to PERG April 2014

Picker Institute

National Staff Survey

Online questionnaire

December 2014

Director of HR

Safety Culture

Online survey

June 2014

Clinical Risk Manager

Annual Report & Accounts 2013/14

Annual Quality Report 2013/14

STATEMENT OF ASSURANCE FROM THE BOARD

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

During 2013/14 South Central Ambulance Service NHS Foundation Trust (SCAS) provided and / or sub contracted three relevant services: »» Emergency 999 Ambulance Service »» Non-Emergency Patient Transport Service »» NHS 111 Urgent Telephone Advice Service. SCAS has reviewed all the data available to it on the quality of care in these three 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

South Central Ambulance Service

»» External reviews of quality »» Leadership walkarounds »» Bi-monthly committee meetings »» Staff meetings. The income generated by the relevant services reviewed in 2013/14 represents 100% of the total income generated from the provision of relevant services by SCAS for 2013/14.

During 2013/14 11 national clinical audits and nil national confidential enquiries covered relevant health services that SCAS provides. During 2013/14 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 2013/14 were as follows:

The national clinical audits and national confidential enquires that SCAS participated in during 2013/14 were 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 Non-Conveyance Audit »» Ambulance Service Clinical Quality Indicator - Stroke Care Bundle »» Ambulance Service Clinical Quality Indicator - Cardiac Arrest ROSC Rates (and separate witnessed arrest ROSC rates)

Annual Report & Accounts 2013/14

»» 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.

Annual Quality Report 2013/14

QUALITY REPORT

»» 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 Non-Conveyance 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 2013/14, are listed here alongside the numbers of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry.

National clinical audit

% 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.

2,275 April to December 13

100%

National Clinical Performance Indicator - Asthma

528

100%

National Clinical Performance Indicator - Hypoglycaemia

600

100%

National Clinical Performance Indicator - Febrile Convulsions

182

100%

National Clinical Performance Indicator - Below Knee Fractures

163

100%

National Ambulance NonConveyance Audit

1,246

100%

Ambulance Service Clinical Quality Indicator - Stroke Care Bundle

4,742 April to December 13

100%

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

970 April to December 13

100%

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

818 April to December 13

100%

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

Number of cases

South Central Ambulance Service

939 April to December 13

695 as at April 14

100%

The reports of 11 national clinical audits were reviewed by the provider in 2013/14 and the Trust intends to take the following actions to improve the quality of health care provided:

The reports of four local clinical audits were reviewed by the provider in 2013/14 and the Trust intends to take the following actions to improve the quality of health care provided:

Identified Issues

Actions

Delayed responses

»» Call categories inappropriate »» Increase in demand

»» Categories are being reviewed »» Resources being reviewed against demand

Trauma Pathway

»» Trauma unit bypass tool not being used

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

Transient Ischemic Attack pathway

»» Time taken to fax referral improved but needs further improvement

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

ACQI data quality

»» Improvement needed in identifying patients for inclusion

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

The number of patients receiving NHS services provided or sub contracted by SCAS in 2012/13 that were recruited to participate in research, approved by a research ethics committee, was 101 (507 over the trial).

Annual Report & Accounts 2013/14

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

Annual Quality Report 2013/14

QUALITY REPORT

»» Ensure quality of data in the changeover to Electronic Patient Records (ePR) »» Implement real time data utilising ePR »» Improve call to depart scene time for stroke patients and early identification of patients affected by stroke »» Continue to reduce the number of delayed responses to patients »» Continue to review the appropriateness of conveyance decisions »» Introduce NHS Pathways to 999

Audit of

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

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

►► Deakin CD, Shewry E, Gray HH. Public access defibrillation remains out of reach for most victims of out-of-hospital sudden cardiac arrest. Heart 2014. doi:10.1136/ heartjnl-2013-305030. Deakin CD, Fothergill R, Moore F, Watson L, Whitbread M. Level of consciousness on admission to a heart attack centre is a predictor of survival from out-ofhospital cardiac arrest. Resuscitation 2014 In press. ►► England E, Redesigning ambulance medicines administration processes using Failure Mode and Effects Analysis (FMEA). International Journal of Pharmacy Practice 2013. doi./10.1111/ ijpp.12064 ►► Pocock H Adaptation of a tool measuring attitudes towards pain in paramedics, Int. Emerg. Nurs, 2013, Jul; 21 (3):210215. Doi:10.1016/j. ienj.2012.07.003

►► 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 prehospital cardiac arrest with Warwick University and other ambulance trusts. ►► Integration with the new Comprehensive Research Networks (CRN) ►► Working with National Ambulance Research Sub Group: »» to develop a proposal to “Widen the Impact of the Ambulance Services Cardiovascular Quality Initiative (ASCQI) project”; »» to participate in “Understanding variation in rates of ‘non-conveyance to an emergency department’ of emergency ambulance users”.

South Central Ambulance Service

»» to develop a proposal “Exploring factors increasing Paramedics’ Likelihood of initiating Analgesia IN pre-hospital Pain (EXPLAIN)” ►► Contributing data to the “Out of Hospital Cardiac Arrest Outcomes” study.

A proportion of the Trust’s income in 2013/14 was conditional upon achieving quality improvement and innovation goals agreed between SCAS and the Clinical Commissioning Groups, and any person or body they entered into a contract, agreement or arrangement with for the provision of relevant health services, through the Commissioning for Quality and Innovation (CQUIN) payment framework.

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

The income from CQUIN in 2013/14 was £2,247,182.

4 2 . 2 £ LION MIL

The total for CQUIN related income for 2014/15 is expected to be approximately £2,160,000.

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

SCAS did not submit records during 2013/14 to the Secondary Uses Service for inclusion in the Hospital Episode Statistics which are included in the latest published data.

The Care Quality Commission has not taken enforcement action against SCAS during 2013/14.

Removed from the legislation by the 2011 amendments.

The Trust’s Information Governance Assessment Report overall score for 2013/14 was 83% and was graded green from the IGT Grading scheme.

10 7 SCAS had not participated in any special reviews or investigations by the Care Quality Commission during the reporting period.

Annual Report & Accounts 2013/14

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.

Annual Quality Report 2013/14

QUALITY REPORT

µµ implementing the staff and patient friends and family test (FFT) µµ whole system mental health improvements µµ implementation of electronic patient records µµ reducing conveyance further µµ improving special patient notes

5 8

11 The 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 »» Scrutinise and challenge data at all levels within the organisation within the performance management framework »» Timeliness of patient data improvements with ePR »» Ensure alignment and consistency across contract schedules »» Internal clinical audit plan to validate relevant data »» Internal auditors BDO to review clinical data sets »» Regular review by the Clinical Review Group (CRG) of reliability and accuracy of data »» Board assurance framework and corporate risk register to escalate data quality concerns.

South Central Ambulance Service

PART 3 REVIEW OF 2013/14 In the 2012/13 Quality Accounts SCAS set priorities for 2013/14 which have been reviewed throughout the year and progress is presented in this part of the report.

QUALITY REPORT

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. The next part of this report shows the response we made in acting on things you, the public said, and what we did about it.

Annual Report & Accounts 2013/14

Annual Quality Report 2013/14

PROGRESS ON THE QUALITY ACCOUNT 2013/14 PRIORITIES The following section provides feedback and evidence on the progress of last year’s work on our key quality priorities and our performance attainments. The table below provides an ‘at a glance’ summary of where we believe we have met, partially met or not achieved last year’s indicators.

PRIORITY

ACHIEVED

1a. Ensure staff can work in a culture where patient safety is paramount.

PARTIALLY MET

1b. Ensure patients who contact us after a fall are managed safely and appropriately.

ACHIEVED

1c. Ensure the regular maintenance of clinical equipment and ensure the cleanliness of vehicles.

ACHIEVED

1d. To investigate and maximise learning from incidents resulting in severe harm.

ACHIEVED

2a. Maintain and improve care bundle advancements for patients with stroke.

ACHIEVED PARTIALLY MET

(as above for heart attack) 2b. Reduce the variation of station cleanliness.

ACHIEVED

2c. Comply with the DH core indicators for Red 1 and Red 2 calls.

ACHIEVED

2d. Improve the utilisation of Community First Responders (CFR) and other indirect resources.

ACHIEVED

3a. Utilise feedback from other professionals to improve patient experience.

ACHIEVED

3b. Use feedback from patient satisfaction surveys to improve service delivery.

ACHIEVED

3c. Improve the experience our patients have at the end of their life.

ACHIEVED

South Central Ambulance Service

PRIORITY 1 - PATIENT SAFETY INDICATORS a. Ensure staff can work in a culture where patient safety is paramount.

OUR AIMS WERE:

We have partially met this indicator as we feel there is still work to do. SCAS did conduct a staff safety culture survey in the reporting year in order to establish the safety culture and will be repeating this survey to identify further actions needed. A staff survey was designed using the MaPSaF (Manchester Patient Safety Framework). This is a system where an organisation can have its current patient safety culture evaluated by its employees.

We know that the introduction of Datix (electronic reporting system) in July 2013 has received positive feedback from staff. In fact we have seen reporting rise as staff find it an easier tool to use. SCAS is working on categorisation of reported safety incidents and severity of harm in order that transparency and learning are maximised. The risk team is attending and participating in the national benchmarking meetings, which enable experienced and knowledgeable managers to share their expertise and experiences. This is helping to ensure improved patient outcomes and patient experience through greater awareness of patient safety culture.

Annual Report & Accounts 2013/14

An example of a safety improvement can be demonstrated by the trial of the FERNO Pedi-mate (a paediatric transportation system), which will cater for our child passengers between the ages of 1 month (12 lbs) and 5 years (40 lbs) (of age / weight respectively). This ensures a safer transport system by reducing the current practice of the ‘babe in arms’. It will be trialled within SCAS over the next few months after cascade training has been completed. All of the above is also monitored through senior leader safety walkrounds and feedback.

Annual Quality Report 2013/14

QUALITY REPORT

»» 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 »» conducting a recognised staff safety culture audit in 2013/14 using the Manchester Patient Safety Tool. »» creation of action plans based on survey results

It was designed to help the organisation measure staff perception of our current patient safety culture.

PRIORITY 1 - PATIENT SAFETY INDICATORS b. Ensure patients who contact us following a fall are managed safely and appropriately.

OUR AIMS WERE: »» 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%. We have met this indicator. 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 nonconveyed, by working in partnership with other services.

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.

Using the Red, Amber, Green (RAG) assessment within the referral provides a way of identifying patients that are at risk of repeat events. RAG rating reduces risks for patients and for some, will prevent them from sustaining serious injury and harm, following a further event.

Ambulance services receive high volumes of calls from patients who fall and the challenge is to ensure they are managed safely and appropriately. In SCAS we attend significant numbers of fallers who are not taken to hospital.

The timeliness of community responses varies across the SCAS region.

We know that approximately 75% of ‘falls’ patients are medically unwell and have an underlying cause. Ambulance clinicians are the ‘eyes and ears’ in the community setting and have a real opportunity to understand contributing factors behind the fall i.e. the ‘causational factors’. Understanding the underlying event enables us to better influence the referral, so that the patient gets the correct assessment and care they need. South Central Ambulance Service

A CQUIN on falls referrals improvements and training has resulted in a focused quality improvement initiative in 2013/14, including the introduction of a new falls referral form to ensure consistency across SCAS. Alongside this an e-learning package has been developed. There are approximately 45 different teams (Rapid Response, CCT, Falls Services) within the SCAS area that respond to falls referrals. This creates risk for some patients, which was supported by staff and patient feedback, informing us that some patients had not received follow up, a call or appointment.

PRIORITY 1 - PATIENT SAFETY INDICATORS b. Ensure patients who contact us following a fall are managed safely and appropriately.

SCAS contacted a number of teams to understand actual response times to falls referrals. In some cases we spoke to persons directly involved and in other cases it was information provided, from an individual who was not directly involved with assessment, but was aware of local working practices. SCAS therefore redesigned the RAG tool model, to give commissioners local flexibility in the falls pathway and to reduce the risk. Implementation of this pathway has been successful with crews referring 60% of all nonconveyed patients who fell for ongoing care.

SCAS ACTIONS »» We redesigned the Falls Referral and Assessment Tool (FRAT), incorporating the RAG tool into a single document, creating a single process to ensure consistency. »» We added new clinical questions to the routine falls assessment such as the recording of blood pressure, pulse and ECG results (in consultation with other partners). »» Determined RAG triggers for classification »» We issued and reviewed the e-learning package to accommodate local variance in services. »» We are reviewing the e-learning DVD to accommodate local variance. »» Printed and distributed SCAS wide new falls referral forms . »» We communicated changes, benefits and new style falls referral form to all recipient teams and provided supporting information.

Annual Report & Accounts 2013/14

Annual Quality Report 2013/14

QUALITY REPORT

In light of the above SCAS sought to understand the level of risk for patients who were referred to local providers for assessment and follow up. SCAS asked managers of some services (and their staff) in the different areas what their response times to patients were, once a referral was received.

PRIORITY 1 - PATIENT SAFETY INDICATORS c. Ensure the regular maintenance of clinical equipment and ensure the cleanliness of vehicles.

OUR AIMS WERE: »» 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 Testing (ATP) testing to assess and ensure the cleanliness of vehicles »» achieving 97% compliance with the cleaning plan. We have met this indicator.

VEHICLE CLEANLINESS Vehicle cleanliness remains a top priority in the fight to reduce healthcare associated infections (HCAI) and ensuring our vehicles are free from harmful bacteria and pathogens.

Vehicle cleanliness audits are carried out in three different ways: »» Crews monitor the cleanliness of the vehicle by visual inspection at the start of, and during their shift »» Each vehicle has a full cleanliness audit twice each year »» Vehicles are now subject to ATP Testing to ensure the cleaning standards are maintained Adenosine Triphosphate (ATP) testing is now performed on a random 5% of our vehicles annually. Both Frontline and Patient Transport Services are tested. This procedure has been reviewed and percentages adjusted to reduce costs but also maintain a close watch on vehicle cleanliness.

ACHIEVING 97% COMPLIANCE WITH THE CLEANING PLAN Audit reports are now provided on a daily, weekly and monthly basis to monitor against the 97% cleaning plan. If targets are being missed then discussions are undertaken and a plan developed to address the problems that are identified to bring us back on track. A 12 week ATP assessment was carried out on two vehicles in Oxford December 2013, to consider a move to a 12-weekly deep clean programme instead of six-weekly deep clean cycle. A comparative ATP assessment was carried out on four random vehicles from other areas of SCAS to ensure the same standard is being achieved. Following this we have moved to a nine week cleaning schedule.

South Central Ambulance Service

PRIORITY 1 - PATIENT SAFETY INDICATORS c. Ensure the regular maintenance of clinical equipment and ensure the cleanliness of vehicles.

PLANNED MAKE READY

ACTUAL MAKE READY

% MAKE READY

TARGET DEEP CLEAN

ACTUAL DEEP CLEAN

% DEEP CLEAN

March 2013

7,045

4,695

66.64%

270

192

71.11%

April 2013

6,818

4,879

71.56%

270

215

79.63%

May 2013

7,045

4,949

70.25%

270

169

62.59%

June 2013

6,818

4,766

69.90%

270

159

58.89%

July 2013

7,045

4,997

70.93%

270

196

72.59%

August 2013

7,045

5,083

72.15%

270

246

91.11%

September 2013

6,818

4,669

68.48%

270

272

100.74%

October 2013

7,045

5,264

74.72%

270

269

99.63%

November 2013

6,818

5,403

79.25%

261

223

85.44%

December 2013

7,045

5,609

79.62%

261

210

80.46%

January 2014

5,604

5,502

98.18%

261

270

103.45%

February 2014

5,056

4,967

98.24%

261

234

89.66%

A regular review with our Make Ready (MR) contract providers has been established with weekly reporting on KPI improvements. SCAS is working towards an ‘intelligent’ audit system that will request an action plan where failings are found within vehicle cleanliness and infection control equipment/PPE audits (implementation in Q1 2014).

CLINICAL EQUIPMENT MAINTENANCE Our asset register is now comprehensive and a great deal of progress has been made on the tagging of devices with Trust asset labels and with corresponding RFID tags. We are working closely with Churchill Support Services who will be scanning the devices through their Make Ready systems and relaying the information to us.

Annual Report & Accounts 2013/14

QUALITY REPORT

MONTH/YEAR

We are confident that 98% of the critical devices on front-line double crew ambulances (DCAs) and RRVs have been serviced and a database of all equipment that requires servicing / maintenance has been developed which ensures monitoring is undertaken and timescales are adhered to. A report is produced to identify any equipment outstanding so the appropriate action can be taken.

Annual Quality Report 2013/14

PRIORITY 1 - PATIENT SAFETY INDICATORS c. Ensure the regular maintenance of clinical equipment and ensure the cleanliness of vehicles.

Currently we are in the process of setting up an equipment asset/database of all of our medical/clinical â&#x20AC;&#x2DC;hard kitâ&#x20AC;&#x2122;, e.g. defibrillators. We are now in the process of inviting various companies who will be able to integrate the database with our other systems, to link all the maintenance and servicing records together. We are currently designing a specification to develop a complete maintenance package. SCAS has delivered all its devices to the mobile field service engineers working for the various service suppliers contracted to SCAS during the 2012/13 fiscal year. SCAS is about to be a partner in a new national service collaborative designed to keep service costs down, due to start in April 2014 for the airways devices. A new service contract with Physio Control for the Lifepak devices is due to be agreed in 2014.

100

South Central Ambulance Service

PRIORITY 1 - PATIENT SAFETY INDICATORS d. To investigate and maximise learning from incidents resulting in severe harm.

OUR AIMS WERE:

We have met this indicator. SCAS has made significant improvements in learning from incidents. We have reviewed our processes for reporting and the Risk Team is continuing to strengthen its current investigation process by continually monitoring submitted Datix incidents following its successful launch. In Q3 an analysis and review of all categories and sub categories in the Datix system was undertaken to ensure accurate risk reporting.

The Francis Report (2013) ‘Duty of Candour’ states clearly that doctors and all other healthcare professionals must be open and truthful when mistakes have occurred which requires that all incidents that have caused death or severe harm to any patient to be reported as soon as possible. The Trust will maintain its current standard of reporting all incidents that have caused harm or death in our care to the NRLS (National Reporting and Learning System). As a result of Datix, the Trust is capturing in a more timely manner, those incidents reported nationally enabling national benchmarking to be more meaningful.

Annual Report & Accounts 2013/14

A new staff learning tool has been launched called SCASCADE to identify incidents where whole organisational learning can take place. This is sent anonymised to all clinical staff. The Serious Incident Requiring Investigation (SIRI) reporting template and 72 hour report template have been improved to ensure Duty of Candour requirements have been met and deadlines are visible and achieved.

Annual Quality Report 2013/14

101

QUALITY REPORT

»» to improve patient safety and experience by strengthening the existing investigative processes »» adhere to the duty of candour as outlined in the Francis Report »» increase partnership working for serious incidents with other healthcare providers

As members of the Health and Safety and Risk Group, any areas that are discussed or raised as concerns are accordingly addressed. If needed, clinical equipment issues are also raised and actioned within the Equipment & Vehicle Review Group (EVRG).

PRIORITY 2 - CLINICAL EFFECTIVENESS a. Maintain and improve care bundle advancements for patients with stroke and heart attacks.

OUR AIMS WERE: ÂťÂť to benchmark with other ambulance services as per the DH mandatory indicators and be in the top national quartile We met this indicator for the stroke care bundle but not fully for the heart attack (STEMI) care bundle. SCAS was required to report on the mandated indicators on the percentage of care bundles appropriately used for STEMI and stroke patients. However SCAS wanted to go further than reporting numbers and show an improvement. Clinical Quality Indicator

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. Issues still exist with analgesics for STEMI patients but this is being targeted by the Clinical Review Group; the issue is around the administration of morphine and / or entonox.

Other analgesics are being used which would add 6% to the compliance rates but these are not counted in the care bundle. A new interactive training DVD has been devised to ensure staff understand the analgesia to be given to STEMI patients.

Units

East Midlands

East of England

Great Western

Isle of Wight

London

North East

STEMI - Care

76.0

84.6

76.0

76.7

84.5

Stroke - Care

97.3

95.7

97.4

94.5

98.0

Clinical Quality Indicator

Units

North West

South Central

South East Coast

South Western

West Midlands

Yorkshire

All

STEMI - Care

86.4

66.0

79.9

89.3

74.9

84.8

80.5

Stroke - Care

99.3

98.2

91.5

97.2

94.1

97.8

96.3

102

South Central Ambulance Service

PRIORITY 2 - CLINICAL EFFECTIVENESS a. Maintain and improve care bundle advancements for patients with stroke and heart attacks.

STROKE CARE BUNDLE

QUALITY REPORT

100.00% 99.00% 98.00% 97.00% 96.00%

2013/14 Actual

95.00%

2013/14 Target

94.00% 93.00%

b Fe

n Ja

De c

No v

ct O

Se pt

Au g

y Ju l

e Ju n

M ay

Ap r il

92.00%

STEMI CARE BUNDLE 90.00% 85.00% 80.00% 75.00% 70.00% 65.00%

2013/14 Actual

60.00%

2013/14 Target

Annual Report & Accounts 2013/14

ar M

Fe b

n Ja

De c

No v

ct O

Se pt

Au g

y Ju l

e Ju n

M ay

Ap r il

55.00%

Annual Quality Report 2013/14

103

PRIORITY 2 - CLINICAL EFFECTIVENESS a. Maintain and improve care bundle advancements for patients with stroke and heart attacks.

We have continued to drill into data in key priority areas and these have informed action plans with significant challenges aimed at improving care bundle compliance. SCAS has continued high compliance in all other areas of the care bundles with the exception of the above areas. Current internal initiatives within SCAS to ensure that the indicator targets are met include: »» regular clinical audits of patient report forms (PRFs) 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 »» successful roll-out of increased analgesia and anti-emetic drug options throughout the Trust

104

»» on-going training in the stroke and heart attack pathways through face to face delivery at bimonthly training sessions and through e-learning. »» work with EOC to improve intelligent dispatch methods »» working with team leaders and clinical mentors to include stroke and STEMI care performance indicators in the appraisal process. SCAS issued a new aide memoire to all frontline staff which names all PPCI centres, their locations, entry routes and drop off points.

South Central Ambulance Service

PRIORITY 2 - CLINICAL EFFECTIVENESS b. Reduce the variability of station cleanliness.

OUR AIMS WERE:

We have met this indicator. 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. We focused on our stations to ensure the standards were consistently delivered.

The make ready teams have also been asked to review their stock holdings and reduce where possible.

QUALITY REPORT

»» to reduce the variability of station cleanliness and become fully compliant with CQC Outcome 8 – Infection Control »» ensure 97% compliance with delivery of daily and deep cleaning schedules.

These are monitored through the Clinical Review Group.

A Trust-wide facilities database of all property floor finishes and room finishes has been completed and transfer of cleaning responsibilities has moved from in-house staff to external contractors, thus ensuring provision of services during periods of annual leave and sickness. Following a CQC inspection in August 2013 SCAS is fully compliant in the essential standards including Outcome 8 (Infection Control).

Each month, the stations and stand by points go through an audit process for area cleanliness. These audits measure how the stations and stand by points are performing against Outcome 8 (Regulation 12) of the CQC regulations.

Annual Report & Accounts 2013/14

Annual Quality Report 2013/14

105

PRIORITY 2 - CLINICAL EFFECTIVENESS c. Comply with the DH core quality indicators for Red 1 & Red 2 calls.

RED 1

% ON SCENE WITHIN 8 MINUTES

RED 2

% ON SCENE WITHIN 8 MINUTES

79.2%

PLAN 75.0%

75.7%

PLAN 75.0%

2013/14

2012/13

Clinical Quality Indicator

Red 1 %

Red 2 %

A19 %

Red 1 %

Red 2 %

A19 %

East Midlands

71.3

71.4

93.8

70.0

75.5

91.9

East of England

73.6

69.4

92.9

74.2

72.8

93.5

Great Western

75.3

76.9

95.7

Isle of Wight

80.2

76.1

96.6

78.7

76.6

97.4

London

77.4

75.3

97.9

77.7

76.3

98.2

North East

76.9

78.4

96.9

76.6

76.5

97.0

North West

75.9

77.4

95.8

73.5

76.6

95.1

South Central

79.2

75.7

95.4

78.2

75.2

95.0

South East Coast

76.8

73.9

97.0

75.1

97.3

South Western

73.1

77.2

95.8

73.0

75.9

95.4

West Midlands

80.0

73.6

97.0

78.9

75.5

97.3

Yorkshire

77.4

75.1

97.3

71.7

75.2

97.0

All

75.6

74.8

96.1

74.0

75.6

96.9

Trust

106

South Central Ambulance Service

PRIORITY 2 - CLINICAL EFFECTIVENESS c. Comply with the DH core quality indicators for Red 1 & Red 2 calls.

RED 1 PERFORMANCE 84.0%

83.6%

82.7%

79.7%

80.9%

80.0%

79.5%

79.6%

78.2%

79.1%

78.0%

2013-14 actual

76.7%

76.0%

77.0%

76.8%

2013-14 target 2012-13 actual

75.0%

74.0%

QUALITY REPORT

82.0%

72.0%

ch M

c De

v No

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p Se

g Au

ly Ju

ne Ju

ay M

ril

70.0%

RED 2 PERFORMANCE 84.0% 82.0% 80.0%

78.5%

78.1%

78.0% 76.0%

76.9%

77.1%

75.1%

76.7%

76.3% 75.5%

75.2%

2013-14 target 2012-13 actual

75.0%

74.0%

2013-14 actual

74.3% 73.3%

72.0%

Annual Report & Accounts 2013/14

ch ar

b M

n Ja

c De

v No

ct O

p Se

g Au

ly Ju

ne Ju

ay M

ril

70.0%

Annual Quality Report 2013/14

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PRIORITY 2 - CLINICAL EFFECTIVENESS c. Comply with the DH core quality indicators for Red 1 & Red 2 calls.

RED 19 PERFORMANCE 100.0% 99.0% 98.0%

96.6%

97.0%

96.1%

96.0%

95.9%

95.0%

94.0%

95.5%

95.8% 95.2%

95.3%

94.9%

2013-14 actual

93.9%

93.0%

2013-14 target

92.0% 91.9% ch ar

b M

n Ja

c De

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p Se

g Au

ly Ju

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ay M

ril

70.0%

OUR AIMS WERE »» 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 and Red 2 Calls

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. 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.

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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.

PRIORITY 2 - CLINICAL EFFECTIVENESS d. Improve utilisation of CFR’s and other indirect resources.

OUR AIMS WERE

SCAS already has a network of around 1600 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. During 2013/14 SCAS has worked with CFR teams to ensure their views are listened to and enable improved utilisation of indirect resources. In 2013/14, 224 schemes across SCAS will have airwave pagers that will cut communication time from the existing process.

There are still some category of calls that will remain unsuitable for CFR responses, these are: »» fire incidents »» known violent incidents (unless a police presence is in attendance) »» industrial incidents involving chemicals or gases »» hangings »» known mental health problems »» road traffic collisions »» maternity and gynaecological incidents. Reviews of dispatch decisions are being monitored on a daily basis with the responder department and a new scorecard detailing performance is now underway with weekly performance management meetings.

Recruitment of CFRs is now focused only on areas that require an increase in numbers; however SCAS is still processing over 48 new recruits a month across the Trust and this has resulted in the introduction of additional courses. Over 30 Public Access Defibrillation (PAD) sites have been identified in the North and nine in the South. North Hampshire has been the primary focus so far. As part of the assessment of the needs of high demand sites such as nursing and care homes, fusion workshops have been taking place in the South West and awareness and action plans on those with high demand have been encouraging.

The CFR training package has been rewritten and the category of calls that CFR’s can go to has been increased.

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QUALITY REPORT

»» to increase utilisation of Community First Responders (CFRs) and other indirect resources across the Trust to 10% globally.

PRIORITY 2 - CLINICAL EFFECTIVENESS d. Improve utilisation of CFRâ&#x20AC;&#x2122;s and other indirect resources CFR RESPONDERS 1200

10.00% 9.00%

1000

8.00% 7.00%

800

6.00%

600

5.00% 4.00%

400

3.00% 2.00%

200

1.00%

b M

n Ja

c De

v No

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p Se

g Au

ly Ju

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0.00%

ril

Red 8 (on scene) 12/13

Red 8 (on scene) 13/14

Red 8 unique performance 12/13

Red 8 unique performance 13/14

CO-RESPONDERS 300

2.50%

No. Incidents

250

2.00%

200

1.50%

150 1.00%

100

0.50%

b M

n Ja

c De

v No

ct O

p Se

g Au

ly Ju

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Ap 110

0.00% ril

Red 8 (on scene) 12/13

Red 8 (on scene) 13/14

Red 8 unique performance 12/13

Red 8 unique performance 13/14

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PRIORITY 2 - CLINICAL EFFECTIVENESS d. Improve utilisation of CFRs and other indirect resources

Identified areas for further Improvement and actions to date

Annual Report & Accounts 2013/14

»» 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. We will monitor the usage of these units through our regular performance review meetings. »» A program of assessment of the needs of high demand sites such as nursing and care homes.

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QUALITY REPORT

»» Enhanced staff training to improve identification of CFR appropriate calls, maximise allocation and ensure rapid dispatch ›› Dedicated Indirect Resources dispatch desk in North and South Emergency Operations Centres to dispatch CFR and Co Responders. This is improving activations and response times for these resources to red calls. ›› SCAS is developing an indirect resources scorecard on Qlikview to monitor the performance of the indirect resources. This will provide us with the ability to monitor log on times for each scheme, allocation times, mobilisation times and response times.

»» Regular audit of dispatch decisions conducted and supported by weekly performance management meetings at area level. Qlikview will be able to look at dispatch decisions by individual and can be monitored. These will be monitored through meetings between our operational and EOC teams. »» Continued CFR recruitment with a focus on high requirement areas. SCAS reviews all the missed red calls on the EOC daily shift report to identify areas where a CFR scheme would benefit the Trust. Each Community Liaison and Training Officer (CLATO) is aware of the areas requiring improvement in indirect contribution across the area they cover. Consequently they develop recruitment plans to increase numbers of responders in each scheme working with other groups in the community.

PRIORITY 3 - PATIENT EXPERIENCE a. Utilise feedback from other professionals to improve patient experience

OUR AIMS WERE TO: »» improve patient experience by increasing our learning actions from patient feedback collated by other professionals »» establish a link with primary care patient experience teams including those of the NHS 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 Health Care Professional (HCP) feedback and actions through the Patient Experience Review Group (PERG) We have met this indicator.

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The Patient Experience Review Group (PERG) continues to meet quarterly to review all patient feedback and ensure that learning has been put in place and good practice has been shared across the whole organisation. The complaints module in Datix has been in use since November 2013 with refining work on categories ongoing. HCP feedback is to be used in the module going forward. An example of an improvement as a result of professional feedback was to improve emergency responses when requested by a doctor. This included reissuing response guidance to EOC staff.

South Central Ambulance Service

Processes are in place to improve and separate HCP reporting from patient and service user feedback to ensure that learning and good practice is shared with appropriate organisations. This has particularly improved for NHS 111 services with dedicated processes for the governance of HCP feedback. Procedures for the management of patient experience issues requires regular contact between the SCAS Patient Experience Team and those of other organisations which helps improve relationships and ensure that learning is shared across all organisations. Patients and contacts receive a ‘joined up’ response to their concerns.

PRIORITY 3 - PATIENT EXPERIENCE a. Utilise feedback from other professionals to improve patient experience

In the NHS 111 services SCAS provide, the HCP feedback process has rapidly improved and developed. In Q3 the creation of a streamlined process to ensure that all HCP feedback and complaints are dealt with in a timely and chronicled manner and lessons identified and learnt going forward has been introduced. This is documented and recognised by the Clinical Assurance Groups (CAG). Specific examples from NHS 111 HCP feedback to improve the service and change practice are outlined:

»» Themes from HCP feedback and incidents have been used to identify specialist speakers for the clinical development sessions (pharmacy, toxbase, social services). »» Following feedback from the NHS 111 Clinical Governance Lead in Oxfordshire, MENCAP’s guidelines for accessible writing ‘Am I making myself clear?’ was made available to all investigating managers and patient liaison personnel. »» Following investigation into a Buckinghamshire dental incident, the regional dental commissioners raised concerns over NHS Pathways; SCAS facilitated a face to face meeting with the regional dental commissioners to explore NHS Pathways solo, and this provided assurance to regional dental commissioners.

Annual Report & Accounts 2013/14

»» HCP feedback has also resulted in SCAS feedback to the national NHS Pathways teams via requests for change. »» The SCAS Education Department is initiating inclusion of elements of learning related to trends from complaints within regular update training as a thread for good practice. »» The safety walkaround programme was introduced as part of the Quality Assurance Programme for NHS 111 to ensure quality is embedded in our values, behaviours and strategic themes. This was initiated by a senior clinical colleague in the NHS 111 service to allow for transparent practice and assurance.

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QUALITY REPORT

NHS 111 HEALTH CARE PROFESSIONAL (HCP) FEEDBACK TO IMPROVE SERVICE DELIVERY

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PRIORITY 3 - PATIENT EXPERIENCE a. Utilise feedback from other professionals to improve patient experience.

QUALITY REPORT

THE AIM OF THE WALKAROUND IS TO: ■■INCREASE THE AWARENESS OF QUALITY AND SAFETY ISSUES AMONG ALL STAFF ■■MAKE SURE SAFETY REMAINS A PRIORITY FOR SENIOR LEADERS ■■INCREASE UNDERSTANDING OF SERVICE USER SAFETY CONCEPTS SUCH AS INCIDENT REPORTING ■■ACT ON INFORMATION THAT IDENTIFIES AREAS FOR IMPROVEMENT ■■BUILD RELATIONSHIPS WITH FRONTLINE STAFF ■■ACT AS A CLINICAL FRIEND

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PRIORITY 3 - PATIENT EXPERIENCE b. Utilise feedback from other professionals to improve patient experience.

OUR AIMS WERE TO: »» improve patient experience through analysis and action plans formed using established patient surveys and the new Friends and Family test question We have met this indicator. A yearly plan of satisfaction surveys is generated and updated as the year develops to ensure that new initiatives and contracts are surveyed; outcomes of satisfaction surveys are a routine item on the agenda of PERG. In December 2013 a survey was undertaken to elicit the experience of patients over 65 years old with a view to extracting any themes from dementia/carer perspectives. The results demonstrate that the majority of callers were very satisfied with the care and treatment they received from SCAS. 116

Crews were perceived to be polite and considerate, and good at communicating. 100% of people questioned would be happy to use the ambulance service again. As a result of this survey SCAS will take the following steps: »» Increasing education on dementia and communication skills to EOC staff. »» SCAS has also surveyed patients using NHS 111 services with satisfaction levels reported between 78% and 91.5%. »» Action plans from surveys are shared with commissioners taking into account local needs. »» The Head of Patient Experience is now attending the Foundation Trust members’ panel to listen to and act on feedback. »» SCAS has submitted data to the Picker Institute in December 2013 to participate in the trial CQC national ambulance Hear and Treat survey.

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FRIENDS AND FAMILY TEST (FFT) Surveys have been adapted to ensure that national guidelines are being followed in how the Friends and Family Test (FFT) test is applied and delivered. It can be challenging for emergency ambulance services to initiate real time surveys, which is the ideal for FFT; however some have taken place with patients within the ED, NHS 111 and PTS. PTS is particularly effective at collecting FFT data and the outcomes are being monitored by PERG; these surveys are being further developed. NHS 111 Hants, Berks and Oxford services have all contained a FFT question in 2013. Data from patient experience surveys is included in the performance report at Board level.

PRIORITY 3 - PATIENT EXPERIENCE c. Improve the experience our patients have at the end of their life.

OUR AIMS WERE TO:

We have met this indicator. SCAS has maintained its approach to ensure that all patients that contact SCAS when nearing the end of their life, receive care that is specifically tailored to their needs. Through ongoing training SCAS staff (which includes PTS, CSD, NHS 111 and EOC) are given the correct tools to ensure that high quality care is delivered to patients nearing the end of their life and that their families receive the appropriate support.

Engagement with local steering groups ensures that SCAS maintains its presence in the locality to support the groups and offer input where required.

QUALITY REPORT

ÂťÂť ensure that all patients that contact SCAS when nearing the end of their life receive care that is specifically tailored to their needs

SCAS is fully committed to investigate any adverse incidents relating to End of Life Care (EoLC) and Unified Do Not Attempt Cardiopulmonary Resuscitation (uDNACPR) and to extract and disseminate its findings for organisational learning. Currently a learning resource pack is being developed to allow staff to have a greater understanding of EoLC and uDNACPR to enable them to deliver the correct care at the time of need.

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PERFORMANCE OF TRUST AGAINST MANDATED QUALITY METRICS SAFETY MEASURES 2009/10

2010/11

2011/12

2012/13

2013/14

76.35

100

100%

2009/10

2010/11

2011/12

2012/13

2013/14

2,091

2,654

2,819

2,685

3,489

NPSA (patient safety incidents)

291

218

260

740

RIDDOR

126

Serious Incidents Requiring Investigation

2009/10

2010/11

2011/12

2012/13

2013/14

Complaints

144

121

169

209

382

Feedback / concerns

790

666

554

604

708

Compliments

682

667

758

695

883

Infection Control Training (% of all frontline staff) Infection control audits â&#x20AC;&#x201C; of target set 30 month

Adverse Incidents total reported

* The clinical outcome measures in table 4 have been revised and amended from previously published Quality Accounts back to 2009/10

and recalculated using the care bundle analyses method so each year can be measured more accurately against the previous year. All cells in white are National Clinical Performance Indicators (NCPI); all cells in blue are Ambulance Clinical Quality indicators (ACQI). NCPIs are twice yearly audits and published as ambulance national benchmarking; the figure is based on the average care bundle score for the two audits. The ACQIâ&#x20AC;&#x2122;s are published monthly to the Department of Health as performance measures as care bundles so the figure is the average over the 12 months, except 2013/14 as the figures are submitted 3 months in arrears; this is 9 months averaged to December 2013.

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CLINICAL OUTCOME MEASURES 2008/ 09

2009/ 10*

2010/ 11

2011/ 12

2012/ 13

2013/ 14

National Average 2013/ 14

Stroke

84.84

91.42

96.70

97.10

97.64

98.70

96.30

STEMI

55.71

35.84

58.15

65.60

67.88

66.75

80.50

Cardiac Arrest

44.11

18.58

26.30

21.90

36.03

39.80

26.00

Asthma

74.40

40.90

62.85

73.20

75.20

83.30

77.50

Hypoglycaemia

97.24

96.30

95.80

98.35

98.20

98.67

95.90

QUALITY REPORT

Clinical Outcome Measures Reported Aspect of Care

National targets and regulatory requirements standard

Target

2008/ 09

2009/ 10

2010/ 11

2011/ 12

2012/ 13

2013/ 14

Red 1 & 2 - life threatening emergency calls who should receive an emergency response within 8 minutes

75%

72.60%

74.80%

77.5%

75.9%

76%

77.4%

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%

95.5%

95.4%

Category B19 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%

95.4%

92%

91.4%

91%

89.2%

Reperfusion - Primary angioplasty (PCI) Call to balloon

75% in 150 minutes

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OTHER QUALITY SUCCESSES IN 2013/14 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 has updated the Emergency Care Assistant (ECA) course in relation to Mental Health and Learning Disability learning outcomes to reflect pertinent issues at relevant places within the curriculum (e.g. teaching about feeding tubes when considering abdominal complaints). »» Clinical update course on suicide assessment delivered including a recap of the Mental Capacity Act (MCA). »» We introduced a new process for collecting and auditing alternative care pathways for mental health. Identifying actions to better access pathways of care for this patient group.

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»» Patient satisfaction survey of those people who are over 65 years of age. Actions will include improving education on dementia and communication with a bespoke MH session for call centre staff. »» SCAS is working closely with our GP commissioning groups to ensure that advanced care plans, end of life instructions and other patient care relevant data is shared in a timely manner and kept constantly updated. This information is accessible by our emergency and urgent call handlers allowing them to tailor the advice and level of response provided to a patient based on what is most appropriate to them.

South Central Ambulance Service

»» Use of computer technologies including tablet computers on our frontline resources also provides SCAS with media through which clinicians can access software applications (apps) that provide care summaries and quick reference guides for complex pathways including End of Life and Mental Health. These apps will also be accessible through the personal devices that many staff members choose to carry. »» SCAS rolled out an e-learning module together with dexamethasone for the management of croup. »» We introduced activated charcoal for the immediate treatment of poisoning. »» Introduced an oral antihistamine for the treatment of less severe allergic reactions. »» SCAS reviewed and provided an increased range of medicines on the air ambulances for the treatment of critically ill patients. »» We have revised our bereavement leaflet for patients families and carers.

»» SCAS has increased its engagement with social services resulting in improved feedback following our safeguarding referrals. »» Construction of new SCAS safeguarding form and development of an electronic version for EOC and NHS 111. »» SCAS successfully tendered for the new NHS 111 nonemergency telephone helpline service in Buckinghamshire and Bedfordshire and Luton. »» SCAS has launched a new intranet in 2014 making it easier for staff to access necessary information. »» SCAS has continued its executive and nonexecutive leadership walkabout; 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.

Annual Report & Accounts 2013/14

»» Our Integrated Performance Report is robustly monitored and challenged in terms of quality performance indicators. »» We have rolled out a new electronic reporting tool for incidents and accidents called Datix. »» SCAS has introduced a monthly education and feedback tool called SCASCADE to ensure organisational learning from incidents. »» We have trained some of our resilience and specialist operations/ HART staff to become certified instructors in breathing apparatus. »» HART inland water training to Level 3 to ensure safety of our patients.

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QUALITY REPORT

»» SCAS delivered training to all frontline staff in safeguarding adults and children. »» We recruited additional resource in the form of a clinical support officer for safeguarding. »» Safeguarding referrals for both children and adults have increased. Children have increased by 94% from last year. Adult referrals have increased by 191% from last year, indicating good staff awareness. »» The introduction of a pilot in South West Hampshire of safeguarding champions at ambulance stations. This is to be rolled out over the whole Trust in the next six months. »» SCAS involvement in peer reviews with other ambulance trusts for Infection Control and Safeguarding. »» Implemented an information sharing protocol with Fire and Rescue services across SCAS to ensure patient safety.

STATEMENTS FROM HEALTHWATCH, THE OVERVIEW AND SCRUTINY PANELS AND COMMISSIONERS A letter was sent to all Health Overview and Scrutiny Panels, Healthwatch and commissioners in February 2014 outlining our progress with our Quality Accounts and the proposed priorities for 2014/15 which asked for any comments or suggestions. The following statements were received:

HEALTHWATCH WOKINGHAM BOROUGH 22 April 2014 Healthwatch Wokingham Borough commends SCAS for such a detailed and open Quality Account. It is especially encouraging to see how you have responded to Francis Inquiry recommendations. With regards Priority 3a it would be good to have some benchmark timeframes when dealing with complaints. With regards Priority 3b to further enhance your commitment to patient engagement and involvement it would be good if you could formally incorporate some independent feedback of your services. Healthwatch would welcome an opportunity to regularly share the data and intelligence we have on SCAS services. Whilst you can only have so many priorities to focus on we would have expected to have seen a statement about ambulance turnaround times as this issue has been prominent the last year or so. Kind regards Nicola Strudley Locality Manager Healthwatch Wokingham Borough

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QUALITY REPORT

WOKINGHAM COUNCIL HOSC 02 May 2014 SCAS Draft Quality Accounts - comment Thank you for inviting comment from the Wokingham Borough Council Health Overview and Scrutiny Committee on the Trustâ&#x20AC;&#x2122;s 2013/14 quality account. Members have individually reviewed the Trustâ&#x20AC;&#x2122;s Draft Annual Quality Report 2013-14 and noted the proposed priorities for 2014/15. The marking of all sections which reference the Francis Inquiry and its recommendations with a clear symbol so that they are easily identified as a response or action, is welcomed. Regards Madeleine Shopland

Principal Democratic Services Officer Governance and Improvement Services Wokingham Borough Council

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STATEMENTS FROM HEALTHWATCH, THE OVERVIEW AND SCRUTINY PANELS AND COMMISSIONERS HEALTHWATCH READING 5 May 2014 Thank you for your request to comment on the Quality Accounts for SCAS. Please see below comments from Healthwatch Reading. Apologies that these did not reach you yesterday. Thank you for the opportunity to comment on the Quality Account for 2013/14. It is comprehensive although at this stage not fully complete with further data to be added. We were pleased to read about the effective new structure to be put in place from 1 April 2014 and supportive of the strategic aims of the Trust in particular those where appropriate that put the patient first. Safeguarding is also another important area for all trusts and commissioning groups and reference is made to the appointment of a clinical support officer to concentrate support within the trust. It is also important that the Trust demonstrates how this service will interrelate to similar services provided by the local authorities and other services to demonstrate joint working in this area. Finally the Trust is an important contributor to the Urgent Care Programme Board led by North and West Reading CCG and more comment about how effective these arrangements are would be welcomed. Also please can you add me to your distribution list as the contact for Healthwatch Reading. These accounts were received via a forward from a colleague and these are the first draft we have seen. If you have any questions about any comments please do not hesitate to contact me. Many thanks Mandeep

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HEALTHWATCH MILTON KEYNES 9th May 2014 The following is the response that I have been asked to forward to you following your consultation on the above Quality Accounts. “We welcome the opportunity to comment on the SCAS Annual Quality Accounts. The document contains a considerable amount of information and we believe that the report reflects a positive attitude to service provision.

We would like to point out that some targets are unspecific such as “mutually agreed timeframes” for complaints. We believe that more specific targets can be developed to ensure measurable and continuous improvements are achieved by the Trust. To date complaints about the emergency services have not been a feature of feedback to Healthwatch Milton Keynes, but there are some local concerns about non urgent patient transport. This largely relates to the fact that potential users are not clear about the availability of this transport or the criteria that are applied to enable people to access these services. We believe that better and more informative communication with the public would alleviate this situation. A small point relates to the need to update “Statements from Local Involvement Networks” which should be altered to reflect the fact that this now refers to “Healthwatch”- final section of the report. We are pleased to have involvement in the Buckinghamshire Patient Forum and look forward to acting as a “critical friend” to the Trust as it works to improve working practices”. Many thanks for consulting with us. Yours sincerely Rachel Lewis Support Team Manager

On behalf of Healthwatch Milton Keynes Management Group

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QUALITY REPORT

The Trust covers a wide geographical area meaning that performance at a Milton Keynes level is not clearly defined in the report. Unfortunately this makes informed judgement impossible about whether the standards are being achieved for our resident population.

STATEMENTS FROM HEALTHWATCH, THE OVERVIEW AND SCRUTINY PANELS AND COMMISSIONERS HEALTH AND ADULT SOCIAL CARE SELECT COMMITTEE (MILTON KEYNES) QUALITY ACCOUNTS PANEL REPORT 8 May 2014 The Panel felt that the Quality Account presented by SCAS was a big improvement on previous years. However, even as a draft report, the Panel considered that too much information was missing and there was no explanation of the gaps or who was responsible for completing them. SCAS covers a large area and the Panel felt that the use of average data across the region was not particularly helpful. It was difficult to identify any particular issues in local areas and the use of average data could be used to hide a poor performance in a particular locality. The information in the Quality Account dealt with the organisation as a whole and once again the Panel commented on the lack of a local focus and felt that this must be an issue for all the local authorities in the SCAS region which had been asked to comment on the Quality Account. The Panel would like to see a short (4 sides of A4) appendix specifically relating to the work being done and progress made for each of the local authority areas in the SCAS region. However, the Panel was not aware of any significant problems with the ambulance service provided by SCAS in Milton Keynes. Representatives of the Milton Keynes Hospital NHS Foundation Trust who were attending the meeting were able to give the Panel first-hand feedback on SCAS. They considered that they had a good relationship with SCAS and that at present there were no issues with either the emergency or non-emergency ambulance service in Milton Keynes. SCAS crews now alerted the hospital with an estimated time of arrival, which hospital staff were finding particularly helpful. The representatives of the Milton Keynes Community Health Service commented that the SCAS response to 999 calls, and where appropriate linking to community health services, was very good and they had no complaints either. The Panel was pleased to note the year on year improvements to the SCAS Quality Account and complimented SCAS on making the Account increasingly more accessible to the general reader.

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Quality Account Statement South Central Ambulance Service Healthwatch Bracknell Forest collects both positive and negative feedback/concerns from their population. We also receive data from East Berkshireâ&#x20AC;&#x2122;s quality committee. As a result of information received Healthwatch Bracknell Forest reviewed all complaints received by SCAS and are confident that there are no patterns for the complaints and no major areas which need to be improved. Healthwatch Bracknell Forest work with three acute trusts in the area and some feedback has indicated an increase in ambulance arrivals at Accident & Emergency departments. We will be undertaking work to see if there is a correlation with the current 111 service delivery model and, if so, if this is a positive or negative outcome. Healthwatch Bracknell Forest have agreed to work with SCAS, where appropriate, to improve the patient experience.

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QUALITY REPORT

HEALTHWATCH BRACKNELL FOREST

STATEMENTS FROM HEALTHWATCH, THE OVERVIEW AND SCRUTINY PANELS AND COMMISSIONERS COMMISSIONER STATEMENT Fareham & Gosport Clinical Commissioning Group and the Associate Commissioners welcomed the opportunity to participate in the governance “sign off” process for the 2013/14 Quality Account of South Central Ambulance Service NHS Foundation Trust (SCAS) for 999 Services. Commissioners have continued to have a positive and inclusive working relationship with SCAS since the authorisation of Clinical Commissioning Groups in April 2013. SCAS works consistently with all partners in an open and receptive manner. They are further developing the priorities for future quality improvement through the recognition of the need for a collaborative approach across the whole health system.

128

With advancements of IT solutions, including the introduction of an electronic patient record, and the commitment to improve data quality, commissioners anticipate that information exchange will accelerate the pace in which sustainable service improvements can be made for our population. The quality account demonstrates the revised internal governance structure. This reflects the assurance processes for quality review and improvement. This year, SCAS has developed the governance structures which underpin the subcontracting arrangements with private providers and has continued to strengthen this.

South Central Ambulance Service

This account rightly recognises the role of the “independent” voice in quality processes and includes details of the external assurance mechanisms, illustrating how the public view is incorporated into priority setting and monitoring the delivery of quality improvements. For example, through the trust’s annual survey programme and “Friends and Family Test” implementation, the public has an opportunity to feed in their views. Ensuring that all staff are actively engaged in this process is also being supported by the commitment to embed a safety and listening culture across all levels of the organisation. An example of this is the introduction of “SCASCADE”, an informative bulletin to all staff sharing lessons learnt from incidents and feedback and the utilisation of an electronic based tool to record all patient safety incidents.

Commissioners welcome that SCAS continue to develop their strategic aims, structures and priorities taking into account the recommendations from key national quality reviews, such as Keogh, Berwick and Francis. In addition Commissioners were pleased to hear about the trust’s unconditional registration from the Care Quality Commission and full compliance with the assessed quality outcomes.

This assurance may be further strengthened in the quality account by including outcomes from other external assessments. For example, commissioners are aware that the trust has received the recommendations from the safeguarding peer review. A statement within the quality account highlighting the progress made with implementation of the recommendations and the outstanding actions would have been welcomed. The phased introduction of a common clinically based assessment tool (NHS Pathways), aims to enable seamless transfer of calls between the 999 and 111 telephone operation centres. With the reported increased demand on SCAS 999 services, it will be essential that the open and collaborative relationship between commissioners and SCAS is maintained, to jointly address challenges of transition, quality, capacity and efficiency.

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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. The account incorporates the mandated elements required and SCAS has used a variety of quality intelligence and external consultations with stakeholders to support the development of the quality priorities for 2014/15. External assurance mechanisms have also featured in the assessment of the quality position to date, for example audits. In future accounts, more extensive use of benchmarking data will enhance the presentation of quality information.

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Commissioners recognise the value of senior leadership and accountability in this process and are pleased to see that “quality improvement” is stated as a core function of the trust’s board. The trust has also committed, for 2014/15, to fully implement the duty of candour requirements by including patient safety incidents which result in moderate as well as severe harm.

STATEMENTS FROM HEALTHWATCH, THE OVERVIEW AND SCRUTINY PANELS AND COMMISSIONERS Quality Improvement Priorities for 2014/15 SCAS has outlined its priorities for 2014/15 and commissioners support the process the trust has used to identify these and in principle, the priorities chosen. However, some priorities are those which are mandated, for example response times to calls, and it will be good to see how the stretch in quality improvement is driven across the organisation in the coming year. Patient Safety Commissioners welcome the focus on ensuring that decisions to keep patients at home and not convey to hospital, are safe and appropriate. This is an essential safety priority and will support caring for people in the most appropriate place. This will rely on having access to a variety of services and a commitment to work with other health partners.

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In addition, commissioners are aware of the real challenge, and potential quality concerns, arising when people wait too long for an emergency response. This includes calls generated from the public and health care professionals. It is essential that the needs of patients are met in a timely manner across the whole geographical area, irrespective of rural or urban demographics and that the resource despatched is aligned with the clinical need of the patient. It would have been good to set a measure around this to provide public assurance that â&#x20AC;&#x153;very long waitsâ&#x20AC;? are being eliminated. Commissioners are committed to work with SCAS to support the quality initiatives to improve safety and patient experience. SCAS has set an ambition to reduce, by 10%, incidents which cause moderate and severe harm to patients. South Central Ambulance Service

Commissioners support this and will work with the trust to ensure that lessons learnt from incident analysis are fed into demonstrable service improvements. It would be good to review performance against other ambulance providers in future reports. Commissioners will also monitor the progress of improving medicines management within the service. A welcome addition would have been reference to any continued commitment to supporting the safeguarding agenda and the inter-agency work needed to strengthen this service. The progression of these priorities will obviously be dependent on ensuring the appropriately skilled workforce to meet patient needs and it is welcomed that SCAS will ensure that safety reviews include analysis of staffing issues.

Clinical Effectiveness SCAS has set a priority for improvement on performance for two care bundles, both of which are mandatory elements. Commissioners support this, although it is noted that compliance with the stroke care bundle is already in the top performance bracket. It is recognised that improvements are required for the ST Elevated Myocardial Infarction (STEMI) care bundle, primarily around pain management. In this respect, it is good to see this as a priority. Both care bundles were highlighted as priorities for 2013/2014.

Again, the priority for reporting emergency response times is mandated, and for this year, SCAS commit to learning from complaints and incidents in relation to response times. A recognised area of underperformance has been in the identification and timely response to stroke patients. Commissioners support this quality priority and are aware of the work programmes in place to support sustainable improvements. Commissioners will review the delivery of the improvement trajectories and work in partnership with SCAS to enable better outcomes for patients. The trust may wish to consider setting specific in year milestones and targets for improvement in this area. In addition, commissioners are aware that the “Return of Spontaneous Circulation” following cardiac arrest performance data is currently being reviewed.

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Patient Experience Commissioners have committed to incentivise the further utilisation of the “Friends and Family Test” for both patients who are using the 999 service and the staff working for the service. It is essential that patient and staff satisfaction are interlinked in any analysis and work programmes. SCAS quite rightly, has acknowledged that they need to sustain improvements in responding to complaints and have linked the Francis recommendations into their aspiration for complaints management. It will be useful to see within the next quality account, the service improvements which have been made, especially in relation to key themes, such as “staff attitude.” SCAS set a commitment to learn from concerns from both patients and partners in health care. It is anticipated that staff will also proactively feed into this intelligence.

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One further area of consideration is promoting safety for the more vulnerable groups of our population, for example patients with mental health needs. Commissioners will be working with the trust to support improvements.

STATEMENTS FROM HEALTHWATCH, THE OVERVIEW AND SCRUTINY PANELS AND COMMISSIONERS We look forward to receiving assurance through improved patient and staff reported experience. Commissioners support the focus on “seldom heard groups”, which is essential in providing an equitable service for the population. Achievements reported against 2013/14 priorities and overall Quality Performance Achievements against objectives and targets in 2013/14 are outlined in Part 3 of the account. SCAS provide a chart demonstrating where they consider the priorities have been achieved or partially met. It would be good to have cross referenced where the same priorities have been set for 2014/15. Commissioners support the assessment of “partially met” for staff culture. The survey was used with a small number of staff and SCAS are committed to extend this to other staff groups.

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In addition, it would have been useful to reflect the outcomes of the survey in this account. Excellent progress has been made in improving the care management for patients who have fallen and SCAS will continue to work with other health partners to sustain this and address challenges of timely responses to referrals. The priority set for equipment maintenance and vehicle cleanliness has provided some good outcomes. However, in spite of regular audits, compliance with the cleaning plan appears variable. We understand that SCAS has strengthened their monitoring with their “make ready” teams. SCAS has indicated that they have met the priority to maximise learning from severe harm incidents. Commissioners consider this a fair statement and have seen progress in the quality of data reported from Datix (an electronic storage and analysis system for quality data). South Central Ambulance Service

This is an ongoing area for improvement. SCAS has also complied with duty of candour requirements for severe harm incidents and will include moderate harm incidents in the forthcoming year. Future quality accounts, may be strengthened by providing a summary of the analysis undertaken on patient safety incidents and evidence of clinical practice changes made. SCAS has reported organisational compliance for meeting the national targets on Department of Health core response times and this position is welcomed. However, performance does show variation and it would be good to see how delays differ in urban and rural areas and the challenges and actions to eliminate delays across these geographical areas.

Examples are also given on how feedback on dementia care has led to education programmes for staff. The information contained in the quality account, as evidence for improving end of life care provision, does provide some assurance that the processes put in place have enhanced staff awareness.

The target of improving utilisation of community first responders was set at 10%. However we are unclear, from the quality account, whether the threshold has been consistently met.

Mandatory data is given around performance against national targets and regulatory requirements. However, from the quality account version reviewed, more data presented at CCG level would have been beneficial. It would also be helpful to include compliance levels for mandatory training. SCAS reference the Commissioning for Quality (CQUIN) incentive schemes and although detail on achievement is not included, a web link is given.

The patient experience priorities for 2013/14 are reported as being achieved. Examples are given of how feedback from health care professionals have also been used to support service changes and it would now be advantageous for SCAS to consider how this can be consistent across 999, 111 and patient transport services.

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Data Quality SCAS quite rightly commit to ongoing improvements in data quality. This will be enhanced by the implementation of the electronic patient record and integrated IT systems. We have seen improvements in data analysis for incidents and agree with SCAS that further improvements are still required. 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%. Commissioners have used national data sets to verify the numbers presented in the quality account and, where any variance exists, this has been communicated to SCAS.

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Further information on long waits in respect of call outs from health care professionals and the range of waiting times would also be useful. It will be good to see continued robust management of this alongside the monitoring of patient outcomes and experience as a result of delays.

STATEMENTS FROM HEALTHWATCH, THE OVERVIEW AND SCRUTINY PANELS AND COMMISSIONERS Commissioner Assessment Summary This account demonstrates the many positive outcomes which continue to be driven through the quality agenda and collaborative working. The open and transparent working ethos of SCAS is welcomed. We would like to see quality indicators presented through benchmarking, where possible, and continued work to improve data quality and analysis. It was good to see the outcomes of the priorities identified in 2013/14, which may have been further strengthened with quantifiable trajectories.

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Commissioners recognise some key challenges in the forthcoming year and will welcome secure governance processes to ensure the safe transition to NHS Pathways and electronic patient records and improved performance for stroke patients and patients who are experiencing long waits. SCAS has identified the more vulnerable patient in their quality priorities and it would be good to have seen greater focus on patients with mental health issues. Likewise it would be good to have included the commitment to support improvements in the safeguarding agenda. Commissioners welcome the opportunity to continue the good work with SCAS as a health care partner for the benefit of our population.

South Central Ambulance Service

Richard Samuel Chief Officer

Fareham & Gosport and South Eastern Hampshire Clinical Commissioning Groups

SOUTH CENTRAL AMBULANCE SERVICE COUNCIL OF GOVERNORS The Chairman stated that the Trust was looking for the input of governors on the proposed priorities for 2014/15 across the categories of patient safety, clinical effectiveness and patient experience. Comments were received as follows:

QUALITY REPORT

»» Patient safety – it was felt that, in the delivery of these priorities, the Trust needed to focus on recruiting more community first responders in rural areas (e.g. West Oxfordshire) »» Clinical effectiveness – it was noted two of the four priorities were mandated and that the Trust were likely to add adequate pain relief as a further priority based on the feedback received »» Patient experience – the Council highlighted the importance of gaining patient feedback on the experience of using telephone-based advisory services (e.g. NHS 111) and also of ensuring that the SCAScade system was not used to the extent of burdening staff with too much information. Finally, it was agreed that governors would feed any further thoughts on the proposed quality account priorities for 2014/15 to the Company Secretary, and that a discussion would be held at the next meeting on how the governors could contribute to the delivery of the priorities.

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STATEMENT OF DIRECTORS’ RESPONSIBILITIES IN RESPECT OF THE QUALITY REPORT Directors’ responsibilities in respect of the Quality Report as outlined in the NHS Foundation Trust Annual Reporting Manual 2013/14 (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 NHS foundation trust boards should put in place to support the data quality for the preparation of the Quality Report.

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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 2013/14 »» the content of the Quality Report is not inconsistent with internal and external sources of information including: ›› Board minutes and papers for the period April 2013 to March 2014 ›› papers relating to quality reported to the board over the period April 2013 to March 2014 ›› feedback from the commissioners dated 7 May 2014 ›› feedback from governors dated 24 March 2014 ›› feedback from Local Healthwatch organsiations dated April 2014 - May 2014

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›› the Trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, dated 2 May 2014; ›› the national patient survey - not applicable ›› the national staff survey dated November 2013 ›› the Head of Internal Audit’s annual opinion over the Trust’s control environment dated 28 May 2014 ›› CQC quality and risk profiles dated April 2013 to March 2014 »» 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;

»» 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.gov.uk/ annualreportingmanual) as well as the standards to support data quality for the preparation of the Quality Report (available at www.monitor.gov.uk/ annualreportingmanual)).

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: 28 May 2014

Will Hancock Chief Executive Date: 28 May 2014

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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 2014 (the “Quality Report”) and certain performance indicators contained therein. Scope and subject matter The indicators for the year ended 31 March 2014 subject to limited assurance consist of the national priority indicators as mandated by Monitor: »» 1) category A call – emergency response within eight minutes; and »» 2) category A call – ambulance vehicle arrives within 19 minutes. We refer to these national priority indicators collectively as the “indicators”.

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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. 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.

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»» 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 2013 to March 2014;

We consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with those documents (collectively, the “documents”).

Our responsibilities do not extend to any other information. We are in compliance with the applicable independence and competency requirements of the Institute of Chartered Accountants in England and Wales (ICAEW) Code of Ethics. Our team comprised assurance practitioners and relevant subject matter experts. This report, including the conclusion, has been prepared solely for the Council of Governors of South Central Ambulance Service NHS Foundation Trust as a body, to assist the Council of Governors in reporting South Central Ambulance Service NHS Foundation Trust’s quality agenda, performance and activities.

Annual Report & Accounts 2013/14

We permit the disclosure of this report within the Annual Report for the year ended 31 March 2014, 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.

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»» Papers relating to Quality reported to the Board over the period April 2013 to March 2014; »» Feedback from the Commissioners dated May 2014; »» Feedback from local Healthwatch organisations dated May 2014; »» The Trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, 2013/14; »» The 2013/14 national staff survey; »» CQC quality and risk profiles dated 2013/14; and »» The 2013/14 Head of Internal Audit’s annual opinion over the Trust’s control environment.

INDEPENDENT AUDITOR’S REPORT TO THE COUNCIL OF GOVERNORS OF SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST Assurance work performed We conducted this limited assurance engagement in accordance with International Standard on Assurance Engagements 3000 (Revised) – ‘Assurance Engagements other than Audits or Reviews of Historical Financial Information’ issued by the International Auditing and Assurance Standards Board (‘ISAE 3000’). Our limited assurance procedures included: »» 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.

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»» 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. Limitations 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.

South Central Ambulance Service

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. 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

QUALITY REPORT

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 2014: »» 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. KPMG LLP Chartered Accountants 100 Temple Street Bristol BS1 6AG 29 May 2014 Annual Report & Accounts 2013/14

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INVITATION TO FEEDBACK ON THE QUALITY ACCOUNT µDid µ you find it useful? µDid µ the report tell you what you wanted to know? µDo µ you agree with our priorities for 2014/15? µIs µ there anything else you would like to see included in future reports? Please tell us by contacting SCAS in the following ways:

EMAIL: patientexperience@scas.nhs.uk

PHONE: 01869 365159

POST: Debbie Marrs Assistant Director of Quality South Central Ambulance Service 7 & 8 Talisman Business Centre Talisman Road Bicester Oxfordshire OX26 6HR

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PLEASE TELL US WHAT YOU THOUGHT OF THIS REPORT:

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BOARD OF DIRECTORS The Trust’s Board of Directors (the “Board”) held six Board meetings in public between 1 April 2013 and 31 March 2014. 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:

ÜÜprovide effective and proactive leadership of the Trust ÜÜensure compliance with the provider license, constitution, mandatory guidance issued by Monitor, and other relevant statutory obligations ÜÜset 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 ÜÜensure 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 ÜÜensure that the Trust exercises its functions effectively, efficiently and economically, including in relation to service delivery ÜÜset the Trust’s visions, values and standards of conduct and ensure that its obligations to patients and other key stakeholders are delivered.

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All Board members (executive and nonexecutive) have joint responsibility for decisions of the Board and share the same liability. All members also have responsibility to constructively challenge the decisions of the Board and help develop proposals on priorities, risk mitigation, values, standards and strategy.

The Board continually reviews its composition to ensure that it reflects the skills and competencies required to enable the Trust to fulfil its obligations. Some changes to the composition of the Board were made at the start of 2013/14 to ensure that the Trust had a majority of non-executive directors on the Board. The Board of Directors started the year with seven non-executive directors, including the Chairman, and five Executive directors, including the Chief Executive. All twelve members had voting rights. As a result of further movements in year, the Board concluded 2013/14 with eight non-executive directors including the Chairman (this will reduce to seven in June 2014) and six executive directors including the Chief Executive.

Annual Report & Accounts 2013/14

BOARD OF DIRECTORS PERFORMANCE EVALUATION AND REVIEW 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. In 2013/14 the Board carried out a major review of its quality assurance processes and made a number of refinements.

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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.

BOARD OF DIRECTORS BALANCE

BOARD OF DIRECTORS GOVERNANCE The Board uses Monitor’s NHS Foundation Trust Code of Governance (updated in August 2013) as best practice advice to improve governance practices across the Trust. Furthermore the effectiveness of the Trust’s governance arrangements are regularly assessed, including through internal audit.

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.

The Trust had no areas of non-compliance with the Monitor Code during 2013/14, helped by the adjustments to the composition of the Board of Directors which meant that there has been a majority of non-executive directors on the Board throughout the year.

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.

The Trust was compliant with its Constitution at all times throughout 2013/14. 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.

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NON EXECUTIVE DIRECTORS (NED)

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They should: ÜÜbring independence, external skills and perspectives, and challenge strategy development ÜÜscrutinise the performance of, and hold to account, the executive management in meeting agreed objectives, receive adequate information, and monitor the reporting of performance.

DIRECTOR’S REPORT

ÜÜsatisfy 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. ÜÜbe 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 nonexecutive 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.

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BOARD OF DIRECTORS During 2013/14 the Trust had eight serving and voting Non Executive Directors, all of whom are independent:

NED

Date appointed to FT Board

Current term of office

Term (reset at FT)

Trevor Jones (Chair)

1 March 2012

31 March 2015

First

Alastair Mitchell-Baker (Vice-Chair / Senior Independent Director)

1 March 2012

28 February 2016

Second

Ilona Blue

1 March 2012

28 February 2015

First

Claire Carless

1 March 2012

31 December 2015

First

Mike Hawker

1 January 2014

31 December 2017

First

Keith Nuttall

1 March 2012

31 March 2017

Second

Eddie Weiss

1 March 2012

7 June 2014

First (extended)

Professor David Williams

1 March 2012

31 December 2014

First

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All non-executive Directors are on their first term of appointment to the Foundation Trust Board, with the exceptions of Alastair Mitchell-Baker and Keith Nuttall who are on their second having been reappointed by the Council of Governors.

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 2013/14 financial year there were six voting executive directors on the Trust Board: WILL HANCOCK Chief Executive

DIRECTORâ&#x20AC;&#x2122;S REPORT

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 position of Audit Committee Chair. Mike Hawker was subsequently appointed with effect from 1 January 2014.

EXECUTIVE DIRECTORS

JOHN BLACK Medical Director SUE BYRNE Chief Operating Officer CHARLES PORTER Director of Finance DEIRDRE THOMPSON Director of Patient Care JAMES UNDERHAY Director of Strategy, Business Development, Communications and Engagement

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

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BOARD OF DIRECTORS John Nichols (Director of NHS 111) and Sharon Walters (Director of Human Resources) have also attended Board meetings during 2013/14 but do not have voting rights.

BOARD COMMITTEES

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

The Audit and Quality and Safety Committees jointly oversee governance, quality and risk within the organisation and provide assurance to the Board.

The Board has four committees: Audit, Quality and Safety, Remuneration and Nominations, and Charitable Funds.

The Audit Committee also seeks assurance that financial reporting and internal control principles are applied. Its members are currently Eddie Weiss (Chair), Ilona Blue, Mike Hawker, and Keith Nuttall, and five meetings were held during 2013/14. 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 five meetings were held during 2013/14.

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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 Mitchell-Baker (Chair), Trevor Jones, and Claire Carless, and four meetings were held during 2013/14. 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 four meetings were held during 2013/14.

ATTENDANCE AT MEETINGS DURING 2013/14

Name

The attendance at meetings during 2013/14 of those who have served on the Board, and reflecting their membership of the various committees, is as follows:

Audit Committee

Quality and Safety Committee

Remuneration Committee

Charitable Funds Committee

Trevor Jones

N/A

Alastair Mitchell-Baker

N/A

Ilona Blue

N/A

Claire Carless

N/A

Mike Hawker

2/2

1/1

N/A

Keith Nuttall

N/A

Eddie Weiss

N/A

Professor David Williams

N/A

Will Hancock

N/A

John Black

N/A

Sue Byrne

5/5

N/A

4/5

N/A

3/4

N/A

Total meetings

DIRECTORâ&#x20AC;&#x2122;S REPORT

Trust Board

NON-EXECUTIVE DIRECTORS

EXECUTIVE DIRECTORS

Charles Porter Deirdre Thompson James Underhay

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COUNCIL OF GOVERNORS The Trust’s Council of Governors (CoG) play an essential role in the governance of South Central Ambulance Service NHS Foundation Trust, providing a forum through which the Board of Directors is accountable to the local community. The 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 »» represent the interests of the members of the Trust as a whole and the interests of the public. The period 1 April 2013 to 31 March 2014 represents the second full year of working for the CoG and the delivery of its statutory duties.

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MEMBERSHIP OF THE COUNCIL OF GOVERNORS The CoG is chaired by the Trust Chairman, and the full composition of governors numbers twenty six, as follows: »» fifteen elected public governors across four constituencies (Hampshire, Berkshire, Oxfordshire and Buckinghamshire) »» five elected staff governors »» three appointed Local Authority governors »» two appointed Clinical Commissioning Group governors »» one appointed charity governor. There were a number of movements in the composition of the governors during the year (see below) and at 31 March 2014 twenty four governors were in place with two vacancies. The CoG elects a lead governor and Melanie Hampton served in this position throughout 2013/14. In March 2014 she was elected for a further year running from 1 April 2014 to 31 March 2015. South Central Ambulance Service

During 2013/14, there have been the following changes to the composition of the CoG: »» Two of the fifteen elected public governors – one from each of the Berkshire and Hampshire constituencies resigned and these positions remain vacant at 31 March 2014 (their resignations came subsequent to the elections in December 2013). »» Public governor elections were held in December 2013; one governor chose not to stand for re-election, four were successful in seeking re-election, one was unsuccessful in seeking re-election, and six new governors were elected. »» Two appointed Local Authority governors joined the CoG during 2013/14 to fill vacancies that had arisen. »» Two appointed Clinical Commissioning Group governors were appointed to fill vacancies that resulted from the abolition of Primary Care Trusts.

THE COUNCIL OF GOVERNORS IS MADE UP OF TWENTY SIX MEMBERS

DIRECTOR’S REPORT

Annual Report & Accounts 2013/14

155

COUNCIL OF GOVERNORS Details about each governor, including biographies and declared interests, can be seen on the Trust’s website at www.scas.nhs.uk. FORMAL MEETINGS OF THE COG Six formal meetings of the CoG have been held during 2013/14: in April 2013, July, October, December, January 2014 and March. All meetings have been held in public, and fully in accordance with the Trust’s Constitution. All meetings were chaired by the Trust Chairman, with Board members, including non-executive directors, in attendance.

Details of their meetings and work programmes are explained below. Three governor workshops have been held during the year: the first, in June 2013 on finance, the second, in October 2013, on quality and safety, and the third, in January 2014, to obtain the views of the governors on the Trust’s future strategic priorities. Task and finish groups have also been established to undertake pieces of work that related to the role and statutory duties of the governors. These were attended by a selection of the governors.

Appendix A reports on the attendance of governors at formal meetings of the CoG. OTHER MEETINGS OF THE COG The CoG has had two formal sub-committees during 2013/14: the Nominations Committee, and the Membership and Engagement Committee.

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DUTIES AND FUNCTIONS Delivery of specific statutory duties The governors have a range of specific statutory duties, which were extended in 2013/14 as a result of the new Health and Social Care Act 2012. All of the statutory duties relevant to 2013/14 have either been satisfactorily discharged, or were not relevant, as described on the right:

Duty

Comments

Receive annual accounts, auditor’s report and annual report

Received at July 2013 meeting

Appoint and, if appropriate, remove the external auditor

N/A

Directors must have regard to governors’ views when preparing the forward plan

A specific workshop was held on 14 January 2014 to obtain the views of the governors

Appoint and, if appropriate, remove the Chair

N/A

Although procedures for any future appointment / removal were approved by the CoG in January 2013, their application was not required in 2013/14 (the Chairman’s current term of office expires in March 2015)

Appoint and, if appropriate, remove the other nonexecutive directors (NEDs)

One of the NEDs was reappointed by the CoG in 2013/14, and another NED was appointed following a competitive recruitment process

Decide remuneration and terms of conditions for Chair and other NEDs

New remuneration levels were approved at the CoG meeting in January 2013, and came into effect from 1 April 2013. During 2013/14 the CoG has approved a Chair and NED Remuneration Policy

The CoG approved the appointment of a new external auditor, KPMG, in September 2012 for three years with an option of a further two year extension

N/A

No new appointment was made in 2013/14

Approve significant transactions

N/A

No significant transactions required approval in 2013/14

Approve an application by the Trust to enter into a merger, acquisition, separation or dissolution

N/A

No such applications occurred in 2013/14

Decide whether the Trust’s non-NHS work would significantly interfere with its ‘principle purpose’

N/A

This was not required during 2013/14

Approve amendments to the Constitution

Constitutional amendments were approved by the CoG in both April 2013 and March 2014

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157

DIRECTOR’S REPORT

Approve appointment of Chief Executive

COUNCIL OF GOVERNORS 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 governors 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. »» 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. 158

»» 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 planning where the NEDs have outlined how they seek assurance and hold the executive directors to account. During 2013/14, a number of the Trust’s governors attended at least one of the Board meetings in public, and two of the six Board meetings in 2014/15 will be held in the evening to help facilitate greater governor attendance. The work of the Membership and Engagement Committee (see below) has been key to the governors’ other general duty of representing the interests of the members and the public.

South Central Ambulance Service

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.

COG SUB-COMMITTEES Nominations Committee

The Nominations Committee has met on five occasions during 2013/14, and meeting attendance levels can be seen at Appendix A. During the year, and with delegated authority from the CoG, the Nominations Committee has: »» overseen the process for the appointment of a new NED, and the re-appointment of an existing NED, making recommendations as appropriate to the full CoG

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.

During the year, the Membership and Engagement Committee has: »» developed a strategy for membership engagement and communication, and a governor toolkit to help support membership recruitment and engagement activities »» helped shape the delivery of a member satisfaction survey and analysed the results »» overseen the arrangements for the Trust’s second Annual Members Meeting in September 2013.

The Membership and Engagement Committee ended the year with six members (it had nine members for a time during the year), comprising four public governors, one staff governor, and one appointed partner charity governor. Membership of the Committee is currently being reviewed.

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DIRECTOR’S REPORT

One of two formal sub-committees, and a statutory requirement, the CoG has established a Nominations Committee, which is chaired by the Trust Chairman and has four other governor members (the Lead Governor and one governor each from the categories of local authority, staff and public).

»» considered NED succession planning arrangements which will help shape future decisions regarding Chair and NED appointments »» developed a Chair and NED Remuneration Policy, which was approved by the CoG in December 2013 »» finalised arrangements for the 2013/14 appraisals of the Chair and NEDs.

COUNCIL OF GOVERNORS 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: »» provided a comprehensive and tailored induction programme for all new governors; »» held two internallyled training sessions on quality and patient safety and financial management; »» provided access to relevant external training as provided by Monitor, the Foundation Trust Network and the Foundation Trust Governors Association

160

»» implemented an informal ‘buddying’ scheme between individual governors and NEDs »» provided the opportunity for governors to participate in Emergency Operations Centre tours, crew ride-outs, and ambulance station visits to help support their understanding of the Trust and its business; »» issued regular briefings and bulletins, and established a governor portal to provide access to key materials and information.

South Central Ambulance Service

CONCLUSIONS AND PRIORITIES FOR 2014/15 Conclusions The Council of Governors has overseen some major achievements during 2013/14 and helped contribute to the overall success of the Trust. Additionally, the new statutory duties that came in during the year, linked to the Health and Social Care Act 2012, have been effectively delivered. It is considered that the Council of Governors has a good working relationship with the Board of Directors, and directors regularly attend Council of Governors meetings to answer questions, participate in discussions, and help the governors deliver their statutory duties. In turn, the Trust has benefitted from the perspectives brought by a diverse group of governors, and this was demonstrated in the process to develop the two-year operational plan that was submitted to Monitor in April 2014.

Priorities for 2014/15 The CoG has identified the following priorities for 2014/15:

Annual Report & Accounts 2013/14

DIRECTOR’S REPORT

»» With a continually growing membership that now stands at 15,600 (public and staff), further arrangements need to be developed 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 »» Given the challenges, including financial, faced by the NHS, continuing the strong focus that the governors have in terms of holding the Board to account, via the nonexecutive directors, for the performance of the Trust; »» Overseeing the appointment/reappointment process for a number of Non Executive Director positions that are due to expire in 2014/15

»» Ensuring that successful public and staff governor elections are held in late 2014, with high levels of membership engagement »» Contributing to the development of the Trust’s future strategic priorities and forward plans »» Continuing to review the effectiveness of the Council of Governors to ensure that the governors are appropriately supported to deliver their roles, that value is added where appropriate, and the functioning of the CoG is delivered in the most cost effective way.

161

162

South Central Ambulance Service 5/6 4/4 1/1 6/6

1/3/2012 – 1/3/2015 1/8/2013 – 1/3/2015 1/3/2014 – 1/3/2017 1/3/2012 – 1/3/2014 1/3/2014 – 1/3/2017

Christina Fowler [Staff]

Allan Glass (5) [Partner – LA]

Ian Hammond (6) [Public – Berkshire]

Melanie Hampton (7) [Public – Berks / Lead]

N/A

3/4

N/A

2/4

N/A

Membership and Engagement Committee

5/5

N/A

4/5

N/A

4/5

N/A

Nominations Committee

Elected as a Hampshire public governor with a term of office commencing on 1 March 2014 Appointed from 1 August 2013 as a local authority governor Elected as a Berkshire public governor with a term of office commencing on 1 March 2014 Re-elected as a Berkshire public governor with a second term of office commencing on 1 March 2014

6/6

1/3/2012 – 1/3/2015

Bob Duggan [Public – Bucks]

2/6

1/3/2012 – 1/3/2015

John Donne [Staff]

NOTES 1. Elected as a Hampshire public governor with a term of office commencing on 1 March 2014 2. Appointed from 1 August 2013 as a clinical commissioning group governor (North) 3. Appointed from 1 July 2013 as a clinical commissioning group governor (South)

3/6

1/3/2012 – 1/3/2015

Eddie Cottrell [Staff]

3/4

1/3/2012 – 1/3/2014

Gary Clark [Public – Berkshire]

1/1

3/5

1/7/2013 – 30/6/2015

David Chilvers (3) [Partner - CCG]

1/3/2014 – 1/3/2017

3/4

1/8/2013 – 30/6/2015

Sabrina Chetcuti (2) [Partner – CCG]

John Cotterell (4) [Public – Hampshire]

6/6

1/3/2012 – 1/3/2015

Paul Carnell [Public – Hampshire]

3/6

1/1

1/3/2014 – 1/3/2017

Jeni Bremner (1) [Public – Hampshire]

1/3/2012 – 1/3/2015

5/6

1/3/2012 – 1/3/2015

Kemi Adenubi [ Public - Hampshire]

Patrick Conafray [Public – Oxfordshire]

CoG meetings

Term of Office

Governor

APPENDIX A: GOVERNOR ATTENDANCE AT MEETINGS IN 2013/14

163

0/1 1/1 1/1 5/6 5/6 4/4 4/5 6/6 3/4 1/1 3/5 1/6 6/6

1/3/2014 – 1/3/2017 1/3/2014 – 1/3/2017 1/3/2014 – 1/3/2017 1/3/2012 – 1/3/2015 1/3/2012 – 1/3/2015 1/3/2012 – 16/12/2013 1/3/2012 – 1/3/2014 1/3/2012 – 1/3/2014 1/3/2014 – 1/3/2017 1/3/2012 – 27/12/2013 1/3/2014 – 1/3/2017 1/3/2012 – 1/3/2014 1/3/2012 - 1/3/2015 1/3/2012 – 1/3/2014 1/3/2014 - 1/3/2017

Dave Johnson (8) [Public – Bucks]

Tricia Kelly (9) [Public – Hampshire]

Steve Lacey (10) [Partner – LA]

Barry Lipscomb [Partner – Charity]

David Palmer [Staff]

Allan Read [Public – Hampshire]

David Ridley (12) [Public – Bucks]

Richard Ryan (13) [Public – Hampshire]

Mike Shread (14) [Public – Oxfordshire]

Al Tottle [Public – Hampshire]

Carol Watts [Staff]

Tim Windsor-Shaw (15) [Public - Oxfordshire]

11.

10.

NOTES Elected as a Buckinghamshire governor with a term of office commencing on 1 March 2014 Elected as a Hampshire public governor with a term of office commencing on 1 March 2014 Appointed from 1 March 2014 as a local authority governor Resigned in December 2013 during term of office

15.

14.

13.

3/4

0/4

N/A

2/3

4/4

3/4

N/A

3/4

N/A

Membership and Engagement Committee

N/A

1/5

N/A

Nominations Committee

Re-elected as a Buckinghamshire public governor with a second term of office commencing on 1 March 2014 Resigned in December 2013 during term of office Elected as an Oxfordshire public governor with a term of office commencing on 1 March 2014 Re-elected as an Oxfordshire public governor with a second term of office commencing on 1 March 2014

4/6

1/3/2012 – 1/3/2015

Keith House [Partner – LA]

12.

1/4

1/3/2012 – 1/3/2014

Simon Hoare [Partner - LA]

Benita Playfoot (11) [Public – Berkshire]

CoG meetings

Term of Office

Governor

DIRECTOR’S REPORT

Annual Report & Accounts 2013/14

MEMBERSHIP REPORT 2013/14

THIRTEEN THOUSAND ONE HUNDRED AND SIXTY EIGHT MEMBERS. 164

South Central Ambulance Service

INTRODUCTION South Central Ambulance Service NHS Foundation Trust (SCAS) became a Foundation Trust on 1 March 2012 and in the past two years it has been concentrating in meeting the following objectives:

MEMBERSHIP BREAKDOWN (AT 31 MARCH 2014)

The Trust achieved its objectives through the delivery of the following activities:

The public membership breakdown by category on 31 March 2014 was as shown on Table 1 on the next page:

»» Annual General Meeting and Annual Members Meeting »» Bespoke support for governors when necessary »» Constituency meetings »» Patient forums »» Links with local organisations »» Guest speaking at aspiring governors events »» Governors election »» Regular analysis of membership database »» Annual member and patient survey »» Attendance at public events »» Governor updates as part of the regular Membership newsletter

Annual Report & Accounts 2013/14

DIRECTOR’S REPORT

»» Achieving its March 2013 target of recruiting 12,000 public members »» Recruiting more members in the Trust membership’s underrepresented groups »» Offering a wider range of engagement activities to existing members »» Attracting a wider audience of SCAS local communities »» Keeping the membership quota »» Maintaining the interest of all audiences in the Trust’s development »» Recruiting more members in the 14-16 age group

HOW SCAS ACHIEVED ITS OBJECTIVES

165

TABLE 1 - PUBLIC MEMBERSHIP 31 MARCH 2014

YTD March 2014

Measure Public - all counties

Actual No. 13,168

Plan No. 12,100

YTD March 2014

Measure

Actual No.

Plan No.

Population (No.)

Population (%)

YTD Achieved (%)

4,107,393

100

109%

Population (No.)

Population (%)

YTD Achieved (%)

Geography Berkshire

2,634

2,417

884,889

21.73

109%

Buckinghamshire

2,676

2,417

771,644

18.51

111%

Hampshire

4,990

4,849

1,788,597

43.59

103%

Oxfordshire

2,859

2,417

662,264

16.17

118%

Population (No.)

Population (%)

YTD Achieved (%)

YTD March 2014

Measure

Actual No.

Plan No.

Age 0-16

17-21

938

782

254,686

6.46

120%

22-29

1,822

1,319

428,492

10.90

138%

30-39

2,189

1,581

542,253

13.07

138%

40-49

2,443

1,797

601,145

14.85

136%

50-59

2,092

1,505

518,430

12.44

139%

60-74

2,515

1,719

587,621

14.21

146%

75+

1,044

939

318,926

7.76

111%

Population (No.)

Population (%)

YTD Achieved (%)

YTD March 2014

Measure

Actual No.

Plan No.

Gender Male

5,393

5,989

2,032,156

49.49

90%

Female

7,752

6,111

2,075,238

50.51

127%

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South Central Ambulance Service

YTD March 2014

Measure

Actual No.

Plan No.

Population (No.)

Population (%)

YTD Achieved (%)

Ethnicity White - English, Welsh, Scottish, Northern Irish, British

10,375

10,008

3,332,676

82.71

104%

135

102

33,910

0.84

133%

4,906

0.12

White - Any other White background

320

555

184,987

4.59

58%

Mixed - White and Black Caribbean

25,542

0.63

63%

Mixed - White and Black African

11,131

0.28

89%

Mixed - White and Asian

29,099

0.72

68%

White - Irish White - Gypsy or Irish Traveller

19,410

0.48

83%

Asian or Asian British - Indian

218

275

91,289

2.27

79%

Asian or Asian British - Pakistani

144

235

78,224

1.94

61%

Asian or Asian British - Bangladeshi

14,980

0.37

65%

Asian or Asian British - Chinese

28,448

0.71

52%

Asian or Asian British - Other Asian

192

64,105

1.59

46%

Black or Black British - African

154

162

53,849

1.34

95%

Black or Black British - Caribbean

23,097

0.57

101%

Black or Black British - Other Black

9,209

0.23

104%

Other Ethnic Group - Arab

9,255

0.23

86%

Other Ethnic Group - Any Other Ethnic Group

15,381

0.38

115%

1,298

Population (No.)

Population (%)

YTD Achieved (%)

Not stated

YTD March 2014

Measure

Actual No.

Plan No.

DIRECTORâ&#x20AC;&#x2122;S REPORT

Mixed - Other Mixed

Socio-economic Affluent Achievers [1]

3,856

3,971

1,347,927

32.82

97%

Rising Prosperity [2]

1,467

1,352

458,889

11.17

109%

Comfortable Communities [3]

3,653

3,128

1,061,949

25.85

117%

Financially Stretched [4]

2,652

2,349

797,306

19.41

113%

Urban Adversity [5]

1,279

1,165

395,512

9.63

110%

Not Private Households [6]

206

135

45,811

1.12

153%

Not available [NA]

Annual Report & Accounts 2013/14

0.00

167

MEMBERSHIP REPORT 2013/14 COMMENTARY ON CURRENT MEMBERSHIP Membership v catchment area The Trust has 13,168 public members and 2,436 staff members. Representation by constituency Table 1 shows that the Trust is well represented in all our four counties. Age representation The Trust is overrepresented in all age groups with the exception of the 14-16 age range. This is a common denominator in several other trusts and the Trust will continue to engage with this age group and increase representation. Gender representation The Trust has a reasonably balanced male/female representation.

168

Ethnicity representation Ethnicities are well represented with the exception of White - Any other White background, Asian or Asian British – Chinese and Asian or Asian British - Other Asian and White - Gypsy or Irish Traveller. The SCAS FT recruitment campaign focused on increasing the membership within ethnic minorities and in particular of the above categories by attending and/or organising events in areas where there is a dense population of ethnic minorities and also where local groups organise annual Equality and Diversity events. SCAS attended the following events: »» Mosque Open Day at the Mansel Way Mosque, Cowley, Oxford »» School visit at Islamic Shaksiya Foundation, Berkshire »» Culture Fest 2013, Newbury Racecourse, Berkshire »» Ramadan Evening, Wycombe Islamic Centre, Buckinghamshire

South Central Ambulance Service

»» MK Islamic Arts & Craft Festival, Milton Keynes, Hampshire »» Eastleigh Mela Festival, Eastleigh, Hampshire Chinese Trust’s members and members of the Bucks Chinese Association were also contacted to help the Trust with membership recruitment. In January 2014, in line with the Office for National Statistics, old ethnicity groupings were configured into the new formats. ‘Gypsy or Irish traveller’ and ‘Arab’ were created in the ‘White’ and ‘Other’ broad groups respectively. ‘Chinese’ was moved from ‘Other’ to ‘Asian’ in the broad groupings. Both member and population data were merged into these new formats. During the coming year, we will seek more opportunities to recruit more members from these groups. Socio-economic representation The Trust is over represented in all groupings while remaining representative at near 100% target in the affluent achievers group.

MAP SHOWING MEMBERSHIP BY COUNTY

59e 2,8 xfordshir

2,67Bu6 cks

DIRECTOR’S REPORT

4 2,6r3 kshire Be

4,9am9ps0 hire H

Annual Report & Accounts 2013/14

169

MEMBERSHIP REPORT 2013/14 MEMBERSHIP AND ENGAGEMENT ACTIVITIES SCAS organised 86 membership and/or engagement events in 2013/14 (see table 2 below). This number does not include school visits to pre-schools, primary schools and cub and scout groups. The table shows that the number of events is commensurate to the size, population and configuration of each county. Table 2 â&#x20AC;&#x201C; 2013 membership and/or engagement events

BY TYPE OF EVENT Year

Internal events (organised by SCAS)

April 2013 26 March 2014

170

BY CONSTITUENCY

TOTAL

External events

Berks events

Bucks events

Hants events

Oxon events

Total no. of events attended by SCAS

South Central Ambulance Service

SCAS achieved its overall target of 12,000 by 31 March 2013 and in the 2013/14 financial year the Trust concentrated on engaging with its existing members while at the same ensuring that the public as a whole was kept involved in the Trust’s engagement activities. The Trust launched the following membership and engagement initiatives in 2013/14:

The first annual membership survey was undertaken in June 2013 and the results were published in the summer issue of Foundation Times. 10% responded to postal survey and 1.2% to online survey and we aim to increase these figures this year.

99 “Fortunately we have only used your services about six times in 60 years but each time, we have found them prompt, kind, understanding and compassionate, which I think is important as it helps everyone at a most difficult time feel more at ease. After all you can’t help being ill or old and you need people who have patience, compassion and understanding. After all you are the first people you come in contact with before hospital and first impressions make a big difference”.

DIRECTOR’S REPORT

»» ANNUAL MEMBERSHIP SATISFACTION AND PATIENT CARE SURVEY

PLEASE TELL US ONE THING THAT WOULD MOST IMPROVE YOUR EXPERIENCE OF THE 999 SCAS SERVICE:

99 “Impossible to improve an already excellent service”. 99 “There was the opportunity to be treated with prejudice but I was treated very kindly”. 99 “I would like slightly more reassurance”.

ANY COMMENTS YOU WOULD LIKE TO ADD ABOUT SCAS PTS?

99 “All the drivers and crew I have met have been terrifically friendly and helpful”. 99 “Long wait for transport from hospital to home”. 99 “Very helpful”.

Annual Report & Accounts 2013/14

171

MEMBERSHIP REPORT 2013/14 »» CONSTITUENCY MEETINGS In 2013 the Trust embarked on a programme of constituency meetings across the four counties we serve thus ensuring that the views of patients, members and the public at large are heard. Events were held in Hampshire, Berkshire and Buckinghamshire and we will hold two more in Oxfordshire in spring 2014. »» 111 ROADSHOWS As part of our winter pressure campaign, the Trust worked with our 111 Education Department and Clinical Commissioning Groups in promoting NHS 111. A series of NHS 111 roadshows were scheduled from autumn 2013 to spring 2014 and governors attended some of these events with the aim of gathering public’s views about this service and how we could continually improve it.

172

»» PATIENT FORUMS In September 2013 the Trust launched our first patient forum at our Bucks constituency meeting. A Hants patient forum was held last December and we are planning to hold Berks and Oxon ones in spring and summer 2014. »» ‘SPEAK UP IF YOU’RE AGED 14-16’ CAMPAIGN The Trust wanted to hear more views and opinions from young people aged 14 - 16 about their local ambulance service and launched a press campaign throughout our four counties. The Trust also held several events in secondary schools with the aim of educating young people about the misuse of the 999 service and the benefits of becoming a Foundation Trust member.

South Central Ambulance Service

»» JOINT EVENTS WITH OTHER TRUSTS In November 2013 SCAS embarked on a programme of exclusive members-only events, in collaboration with other trusts, aimed at showing how NHS trusts work together. The first event (Emergency Care Specialist eveningBehind the scenes of health emergencies) was held with great success at Southampton General Hospital, with Solent Trust and the hospital trust. More events will be held in 2014 in the remaining three counties, with other local trusts.

»» EVENTS AT PRIVATE COMPANIES

DIRECTOR’S REPORT

In June 2013 SCAS attended its second health oriented campaign at a global company based in Berkshire, facilitated by one of our public members. This gave the Trust the opportunity to educate its members about health issues and at the same recruit more members from ethnic minorities. In November 2013 the Trust also attended a Driving at Work educational event at the Oxfordshire branch of a major national company, together with the local police and fire services. More health events will be held in 2014/15 with other companies with the support of our public members.

Will Hancock Chief Executive 28 May 2014 Annual Report & Accounts 2013/14

173

ANNUAL GOVERNANCE STATEMENT 2013/14 1. SCOPE OF RESPONSIBILITY As Accounting Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of South Central Ambulance Service NHS Foundation Trust’s policies, aims and objectives, whilst safeguarding the public funds and departmental assets for which I am personally responsible, in accordance with the responsibilities assigned to me. I am also responsible for ensuring that South Central Ambulance Service NHS Foundation Trust is administered prudently and economically and that resources are applied efficiently and effectively. I also acknowledge my responsibilities as set out in the NHS Foundation Trust Accounting Officer Memorandum.

174

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 2014 and up to the date of approval of the annual report and accounts.

South Central Ambulance Service

3. CAPACITY TO HANDLE RISK The Risk Management Strategy comprehensively sets out arrangements in respect of the accountability for risk management in SCAS. Leadership »» as Chief Executive and Accounting Officer I have overall accountability for ensuring that the organisation has effective risk management systems in place. I have delegated specific areas of risk management activity to each of the Executive Directors; for example, as follows: ››the Director of Patient Care has day-today responsibility for managing the strategic development and implementation of organisational risk management, clinical effectiveness and clinical governance. This includes acting as the designated lead for a range of responsibilities such as health and safety, security management, and infection prevention and control

››the Director of Strategy, Business Development, Communications and Engagement has responsibility for managing the risks associated with the provision of non-emergency ambulance services, including patient transport services »» the Board, with overall responsibility for governance, considers the risks faced by the Trust on a regular basis. For example, it receives the Board Assurance Framework at each public Board meeting. »» the Quality and Safety Committee, with delegated authority from the Board, monitors and reviews the Trust’s clinical governance arrangement »» 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

Annual Report & Accounts 2013/14

»» the Executive Team, underpinned by the work of its various sub-committees, receives and reviews updates from all directorates relating to risk management, as well as the Trust’s Board Assurance Framework and strategic risk register »» in a new development in 2013/14, the Executive Team have established a Risk, Assurance and Compliance Committee. This committee, comprising the Executive Directors of the Trust and the Company Secretary, carries out a deep-dive review of the Trust’s biggest risks and ensures that appropriate mechanisms are in place to provide assurance over the management of those risks.

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DIRECTOR’S REPORT

››the Medical Director has responsibility for the management and development 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 ››the Chief Operating Officer has responsibility for managing the strategic development and implementation of clinical and non-clinical risk management (operational risks) associated with the provision of emergency ambulance services and fleet management, as well as being the lead for emergency planning and business continuity activities

ANNUAL GOVERNANCE STATEMENT 2013/14 Training »» officers involved in leading the Trust’s risk management processes (e.g. Head of Risk and Security Management, Clinical and Non-Clinical Risk Managers) are suitably qualified and experienced governance and risk management professionals. A wide range of training has been delivered to staff to enable them to manage identified clinical and non-clinical risks effectively. This training has been informed by a detailed training needs analysis based on external training requirements outlined by the NHSLA and CQC, in addition to training needs identified internally by the Trust. Our corporate induction training programme for new staff covers health and safety, awareness of risk, and incident reporting.

176

»» 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 Trust has a comprehensive Risk Management Strategy which is reviewed annually, and the Board approved the most recent amendments in July 2012.

South Central Ambulance Service

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

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 engagement and leadership walkarounds

»» annual fire safety inspections review of performance against the NHSLA Risk Management Standards »» 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 acknowledges that delivery of healthcare and, in particular, the provision of ambulance services, will always involve a degree of risk (potentially heightened during periods of demand and change management). However, the Trust is fully committed to taking all necessary actions to ensure that risk is both minimised and mitigated. We adopt a positive approach to risk management and are particularly cautious on matters affecting our reputation, or when pursuing new service developments. Annual Report & Accounts 2013/14

Quality governance arrangements The key elements of our quality governance arrangements are set out in the regular selfassessments we have undertaken against the Monitor Quality Governance Framework, and report to the Board. We are either compliant (mostly) or partly compliant for all elements. Performance information is key to ensuring delivery of quality, and we have rigorous processes in place to ensure the quality of performance data. These include internal checking mechanisms, internal and external audit reviews, and a comprehensive review of the monthly Integrated Performance Report by the Executive Team prior to being presented to the Board. Information governance Information governance and data security risks are identified through the use of the NHS Connecting for Health Information Governance Toolkit.

177

DIRECTOR’S REPORT

»» 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

ANNUAL GOVERNANCE STATEMENT 2013/14 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 2013/14 Information Governance Toolkit, achieving an overall score of 83%. The Trust identified a major data security breach in April 2014, involving the publication of staff personal data on the Trust’s website. An independent investigation into the circumstances surrounding this is taking place, and the Trust has resolved to carry out a comprehensive review of its information governance processes.

The amber rated risks fell into the following categories: clinical excellence, emergency performance, sound governance, leadership and culture, and commercial viability. Comprehensive action plans are in place for all of the risks reported in the BAF. NHS Foundation Trust licence condition 4 – FT Governance The Trust undertakes regular reviews of its position against all of the conditions contained within its Monitor provider licence, and reports to the Board accordingly. No risks have been identified within 2013/14.

»» it has carried out a detailed review of the Trust’s corporate governance arrangements against the Monitor Code of Governance; this was considered by the Board in July 2013 »» it assessed in detail the requirements of the Monitor Corporate Governance Statement declarations, presenting a self-assessment with supporting evidence to the Board in May 2013. Involvement of public stakeholders Public stakeholders are involved in the management of risks which impact on them through the work of the governors, public meetings of the Board, and our attendance at Health Overview and Scrutiny Committee meetings.

Key strategic risks We have a range of key strategic risks, which we have identified and are proactively managing. The Board considers the Board Assurance Framework at every Board meeting in public, and at the final meeting of 2013/14 (in March 2014) the submitted BAF had no red risks and eleven rated as amber. 178

In terms of condition 4 – FT governance, the Trust has undertaken a number of steps during 2013/14 to identify any potential risks, including:

South Central Ambulance Service

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.

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.

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.

In addition all papers presented to the Board highlight any relevant equality and diversity issues and implications.

Annual Report & Accounts 2013/14

179

DIRECTOR’S REPORT

4B. COMPLIANCE WITH CQC REGISTRATION REQUIREMENTS

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.

ANNUAL GOVERNANCE STATEMENT 2013/14 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. The Trust has a strong track record in terms of delivering annual savings targets, whilst ensuring that quality of service is in no way compromised

180

»» the Trust’s monthly Operational Performance Reviews are designed to review performance against key financial, operational, clinical and workforce targets as agreed at the start of the year. In addition, a programme of visits by directors across the service gives additional assurance on the management of the organisation »» 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. South Central Ambulance Service

»» 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:

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. Annual Report & Accounts 2013/14

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. 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.

181

DIRECTOR’S REPORT

»» the content of the Quality Report meets the requirements set out in the NHS Foundation Trust Annual Reporting Manual 2013/14 »» 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.

ANNUAL GOVERNANCE STATEMENT 2013/14 My review is also informed by: »» internal and external audit reports »» the Annual Audit/ Management Letter »» the Head of Internal Audit Opinion »» reports to the Board from the Audit Committee, and Quality and Safety Committee »» reviews of serious incidents requiring investigation and the associated learning from these »» reports to the Executive Management Committee from its relevant subcommittees, as well as the work of the Risk, Assurance and Compliance Committee »» the monthly Integrated Performance Report, which covers clinical, operational, service development, financial and human resources »» staff satisfaction surveys »» Care Quality Commission and NHS Litigation Authority assessment reports »» the Quality Accounts and Annual Report

182

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. There have been three particular key sources of assurance for me in 2013/14: »» in August 2013 the Care Quality Commission followedup their unannounced visit to the Trust in November 2012, concluding that we now fully meet all of the standards assessed. »» the Board has been undertaking a comprehensive review of clinical assurance processes. Whilst this has found no major concerns, the Board identified a number of areas and processes were either introduced or refined to help strengthen the overall assurance arrangements

»» we received an annual Head of Internal Audit Opinion for 2013/14 of “moderate 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 The data security breach referred to in section 4a represents a significant control issue and robust action is being taken in response to this. Aside from this particular issue, my review confirms that South Central Ambulance Service NHS Foundation Trust has a generally sound system of internal control that supports the achievement of its policies, aims and objectives.

Will Hancock Chief Executive

28 May 2014

South Central Ambulance Service

DIRECTOR’S REPORT

Annual Report & Accounts 2013/14

183

184

South Central Ambulance Service

Annual Report & Accounts 2013/14

185

ACCOUNTING OFFICER’S STATEMENT OF RESPONSIBILITIES STATEMENT OF THE CHIEF EXECUTIVE’S RESPONSIBILITIES AS THE ACCOUNTING OFFICER OF THE SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST The NHS Act 2006 states that the Chief Executive is the accounting officer of the NHS Foundation Trust. The relevant responsibilities of the accounting officer, including their responsibility for the propriety and regularity of public finances for which they are answerable, and for the keeping of proper accounts, are set out in the NHS Foundation Trust Accounting Officer Memorandum issued by the Independent Regulator of NHS Foundation Trusts (“Monitor”). 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.

186

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 South Central Ambulance Service

»» ensure that the use of public funds complies with the relevant legislation, delegated authorities and guidance; and »» Prepare the financial statements on a going concern basis. 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.

ACCOUNTING OFFICER’S STATEMENT OF RESPONSIBILITY

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.

Will Hancock Chief Executive

28 May 2014

Annual Report & Accounts 2013/14

187

188

South Central Ambulance Service

Annual Report & Accounts 2013/14

189

OPERATIONAL AND FINANCIAL REVIEW The Trust has a strong financial track record and has once again met all of its financial duties in 2013/14. The Trust has seen a significant growth in its income due mainly to growth in 111 services. This strong financial performance should be seen in the context of the Trust achieving all of its operational performance duties. Monitor changed the way in which it monitors the Trust with regard to the monitoring of financial performance. The Trust achieved a 3 for the first two quarters under the old financial monitoring system (5 is the highest) and achieved an overall 4 for the new continuity of service risk rating (where 4 is the highest rating). This is a reflection of an improved financial position in the second half of the year as the Trust’s cost improvement programme became established. The Trust is forecasting to remain at a 4 for the new continuity of risk rating for the next two years which is reflective of a financially sound Trust.

190

The Trust has undertaken a significant revaluation exercise of it estate in 2013/14 as part of its quinnquenial revaluation and the results of this are reflected in the annual accounts. In line with the general uplift in land and building values this has led to an increase in the overall land and building values. Summary of Financial Performance »» On Income and Expenditure the Trust reported a surplus of £1.5m for the year which was in line with plan and last year (0.9% of turnover). »» Earnings Before Interest, Tax, Depreciation and Amortisation (EBITDA) of £11.2m representing 6.9% of turnover which is £1.0m ahead of last year. »» Capital expenditure was £8.5m which has allowed the Trust to fund a number of projects including new ambulances. IT resilience and the establishment of a new 111 call handling service.

South Central Ambulance Service

»» It has been a financially challenging year with a £6.2 million cost improvement target set at the commencement of 2013/14 which the Trust achieved. »» A year end cash balance of £8.3m which was in line with last year and represents a strong cash position, enabling the repayment of £1m of capital loan. »» Total revenue income to meet pay and other day to day running costs reached £162.4m 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 non-current assets (land, buildings and capital equipment) of the Trust were valued at £66m.

ANALYSIS OF INCOME The Trust reported income of £162.4 million for the year end 31 March 2014 (2013: £144.4 million). The increase of over 12% is mainly due to increased income for the provision of taking on the new 111 call handling service. Other income was higher in 2012/13 due to receipt of non-recurrent insurance refunds and discontinuation of GP Out of Hours service. The Trust’s principal source of income is from local NHS commissioning contracts for the provision of the emergency service. This income totalled £118 million (£113.4 million in 2013) which represented 73% of the Trust turnover (2013: 78.5%).

£15.3m

£7.4m

111 call handling service

Other

2013/14

£3.1m HART

£18.6m

TOTAL £162.4m

Patient Transport Services

£2.7m

111 call handling service

£3.1m

£8.5m Other

£118.0m Emergency Services

2012/13

HART

£16.7m

Patient Transport Services

TOTAL £144.4m

Annual Report & Accounts 2013/14

£113.4m Emergency Services

191

OPERATIONAL AND FINANCIAL REVIEW

The Trust confirms that the NHS income it receives for the provision of healthcare exceeds the income it receives for any other purpose in accordance with the requirements of the Health and Social Care Act 2012. The amount of income that the Trust received in this regard for 2013/14 was £156.4m representing 96.3% of total income.

ANALYSIS OF OPERATING EXPENDITURE Total operating expenditure for the Trust (excluding depreciation, amortisation and impairments) was £150.5 million for the year ended 31 March 2014 (2013: £134.1 million). The increase of 12.2% is mainly due to increased staff costs arising from the further development of the NHS 111 call handling service and additional emergency front line staff recruited to replace the use of private provider ambulance services. Staff costs represent 66.9% of total operating expenditure (2013 68.5 %). The increase in other expenditure is due to an increase in use of front line ambulance private providers and an increase in the use of 111 service providers as a consequence of providing services for 111 national resilience.

2013/14

£41.5m Other

£5.1m Vehicle fuel

TOTAL £150.5m

£100.7m Staff costs

£3.2m

Clinical supplies & drugs expenditure

2012/13

£33.6m Other

£5.1m Vehicle fuel

TOTAL £134.1m

£3.5m

Clinical supplies & drugs expenditure

192

South Central Ambulance Service

£91.9m Staff costs

CAPITAL INVESTMENT Investment in capital resources for 2013/14 was £8.5 million (2013: £8.7 million) which was slightly below the initial capital plan and in line with resources generated internally within the Trust. The Trust was able to replace 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 111 call handling service and necessary IT resilience costs. There has been a major capital construction in the south of the area (South East Resource Centre) which will replace 4 existing ambulance stations

Other

£1.4m

Information Technology

TOTAL £8.5m

£2.7m

£4.1m Fleet

Estates

2012/13

£0.4m Other

£2.7m

Information Technology

TOTAL £8.7m

£4.5m Fleet

£1.1m Estates

Annual Report & Accounts 2013/14

193

OPERATIONAL AND FINANCIAL REVIEW

2013/14

£0.3m

Disclosure of Information to the Auditors As far as each of the directors is aware, there is no relevant audit information of which the auditors are unaware. Each director has taken all the steps a director ought to have taken to make themselves aware of any relevant audit information and to establish that the auditors are aware of such information.

Cost Allocation and Charging South Central Ambulance Service NHS Foundation Trust has complied with the cost allocation and charging requirements set out in HM Treasury and Office of Public Sector information guidance.

Data Loss or Confidentiality Breach The Trust identified a major security breach in April 2014, involving the publication of staff personal data on the Trust’s website.

194

The Information Commissioner is aware of this issue and the Trust has commissioned an independent investigation into the circumstances surrounding this breach and has resolved to undertake a comprehensive review of its governance processes.

Sickness Absence The overall sickness rate for the Trust for 2013 was 5.6% (5.9% in 2012), which equated to 12.6 days lost per person (13.3 days lost in 2012).

Countering Fraud South Central Ambulance Service NHS Foundation Trust seeks to prevent and deter fraud, bribery and corruption through the development, implementation and review of specific Counter Fraud / Anti-Bribery policies which also link to other related Trust policies and controls. This area of prevention / deterrents is intrinsically linked to work promoting a strong anti-fraud culture through the “Inform and Involve” activity of the Counter Fraud work programme.

South Central Ambulance Service

REMUNERATION REPORT 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.

The mid band remuneration of the highest paid director in the SCAS in the financial year was £147.5k. This was 5.61 times the median remuneration of the workforce which was £26.3k.

Details of the remuneration including the salaries and pension entitlements of the Board of Directors, is published on pages 196 and 197 of the Annual Report. The only noncash element of senior managers’ remuneration packages are pension related benefits accrued under the NHS Pensions Scheme. Contributions are made by both the both the employer and employee in accordance with the rules of the national scheme which applies to all NHS staff in the scheme.

During 2013/14, the principles under which Executive Director remuneration is agreed remained the same as for the previous years. It is envisaged that the same principles will be used in 2014/15.

Will Hancock Chief Executive

Where appropriate, terms and conditions are consistent with Agenda for Change. The Board of Directors are in receipt of contracts under the Very Senior Manager Framework for the NHS.

Total remuneration included salary, benefits in kind as well as severance payments.

28 May 2014

As non-executive directors do not receive pensionable remuneration, there will be no entries in respect of pensions for non-executive directors. 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.

Annual Report & Accounts 2013/14

195

OPERATIONAL AND FINANCIAL REVIEW

The remuneration and expenses for the Trust Chairman and nonexecutive directors is determined by the Council of Governors. Remuneration for the executive directors is determined by the Remuneration and Nominations Committee which consists of the Chairman and selected nonexecutive directors (further details of membership of this committee are contained in the ‘How we are organised section’.

196 15-20 15-20 0

Alastair Mitchell - Baker (Non - Executive Director)

Eddie Weiss (Non - Executive Director)

Ilona Blue (Non - Executive Director)

Taxable benefits rounded to the nearest £100

140-145

South Central Ambulance Service 16.15 2.01

85-90 25-30

Sue Byrne (Chief Operating Officer) 5

John Black (Medical Director)

Development)

James Underhay (Director of Strategy and Business

Engagement)

Duncan Burke (Director of Communications and Public

John Nichols (Interim Chief Operating Officer) 6

85-90

100-105

49.97

39.25

0.00

38.56

100-105

Charles Porter (Director of Finance) 9

Deborah Marrs (Interim Director of Patient Care)

50-55

5.78

10-15

30.08

Deirdre Thompson (Director of Patient Care) 3

90-95

Executive)

Fizz Thompson (Director of Patient Care/Deputy Chief

5 -10

5-10

Performance related bonuses in bands of £5,000 9

William Hancock (Chief Executive) 9

97.5-100

10-12.5

5-7.5

30-32.5

25-27.5

50-52.5

All pension related benefits (bands of £2,500)

0.00

27.65

0-5

85-90

45-50

95-100

100-105

140-145

5 -10

5-10

20-25

44.86

2.38

7.52

40.23

39.6

51.56

25-27.5

20-22.5

17.5-20

42.5-45

57.5-60

All pension related benefits (bands of £2,500)

0.00

10-15

Professor David Williams (Non - Executive )

Mike Hawker 1

0.00

15-20

Keith Nuttall (Non - Executive Director)

0.00

Salary (bands of £5,000) £000

10-15

20-25

Trevor Jones (Chairman)

2012/13 Taxable benefits rounded to the nearest £100

Clare Carless (Non - Executive Director)

Salary (bands of £5,000) £000

Name and title

2013/14

DIRECTORS SALARIES AND BENEFITS FOR THE YEAR ENDED 31 MARCH 2014

Real increase in pension at age 60 (bands of £2,500) 0 - 2.5 0 - 2.5 5 - 7.5

John Nichols (Interim Chief Operating Officer) 6

Duncan Burke (Director of Communications and Public Engagement) 7

James Underhay (Director of Strategy and Business Development) na

5 -10

5 - 10

40 -45

0-5

5 - 10

30 - 35

130 - 135

25 - 30

90 - 95

120 - 125

879

155

509

633

824

124

571

£000

John Nichols was interim Chief Operating Officer until 7 July 2013 Duncan Burke left the Trust on 23 October 2013 John Black is a recharge from the Oxford Radcliffe Hospitals Trust Part of the Director’s pay is performance related. This is directly linked to the achievement of pre-determined performance objectives, that are reviewed and updated annually. The awards were in the range of 0 - 5% 10. Pension related benefit is higher in 2013/14 as equivalent figure for 2012/13 was a part year figure.

6. 7. 8. 9.

0 - 2.5

2.5 - 5

40 - 45

£000

OPERATIONAL AND FINANCIAL REVIEW

Annual Report & Accounts 2013/14

Notes. 1. Mike Hawker joined the Trust on 1 Jan 2014 2. Fizz Thompson left the Trust on 31 March 2013 3. Deirdre Thompson joined the Trust on 3 June 2013 4. Deborah Marrs was Interim Director of Patient Care until 2 June 2013. 5. Sue Byrne joined the Trust on 8 July 2013

0 - 2.5

Sue Byrne (Chief Operating Officer) 5

John Black (Medical Director) 8

0 - 2.5

Charles Porter (Director of Finance)

Deirdre Thompson (Director of Patient Care) 3

Total accrued pension at age 60 at 31 March 2014 (bands of £5,000) £000

Lump sum at aged 60 related to accrued pension at 31 March 2014 (bands of £5,000)

£000

Cash Equivalent Transfer Value at 31 March 2014

5 - 7.5

£000

Cash Equivalent Transfer Value at 31 March 2013

0 - 2.5

Real increase in pension lump sum at age 60 (bands of £2,500)

£000

Real increase in Cash Equivalent Transfer Value 31 March 2014

Will Hancock (Chief Executive)

Name and title

PENSIONS FOR THE YEAR ENDED 31 MARCH 2014

197

Cash Equivalent Transfer Value A Cash Equivalent Transfer Value (CETV) is the actuarially completed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme.

CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. Real Increase in CETV This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period. 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.

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.

198

South Central Ambulance Service

Expenses Details of number and value of expenses claimed by governors and directors are attached below.

2013/14

2012/13 Aggregate Sum of Expenses paid (£00)

Total Number in Office

Total Number Receiving Expenses

Aggregate Sum of Expenses paid (£00)

Governors

45.04

34.13

Directors

192.2

216.2

Off Payroll Engagements Details of the Trust’s Off Payroll Engagements are shown in the following tables. Off-Payroll Engagements as at 31 March 2014 (greater than £220 / day) lasting longer than 6 months Total number of engagements as of 31 March 2014.

Number of engagements which have existed for less than 1 year at time of reporting.

Number of engagements which have existed for between 1 and 2 years at time of reporting.

Number of engagements which have existed between 4 years or more at time of reporting.

Declaration that all existing off-payroll engagements, outlined above, have at some point been subject to risk based assessment as to whether assurances needs to be sought that the individual is paying the right amount of tax and where necessary that assurance has been sought.

All persons identified and included in the above have advised on their taxation status and willingness to comply with any information requests in respect of such. All have appointed accountancy services managing their accounts (such is not managed by the Trust).

Annual Report & Accounts 2013/14

199

OPERATIONAL AND FINANCIAL REVIEW

Total Total Number in Number Office Receiving Expenses

Off-Payroll Engagements for engagements which reached six months in duration between 1 April 2013 and 31 March 2014 (greater than ÂŁ 220 / day) and that last for longer than 6 months Number of new engagements, or those that reached 6 months in duration, during the reporting period.

Number of engagements which include contractual clauses giving the Trust the right to request assurance in relation to income tax and National Insurance obligations.

Number for whom assurance has been requested.

Number for whom assurance has been requested and received.

There were no off-payroll engagements of Board members, and/or senior officials with significant financial responsibility between 1 April 2013 and 31 March 2014.

200

South Central Ambulance Service

FOREWORD TO THE ACCOUNTS South Central Ambulance Service NHS Foundation Trust

OPERATIONAL AND FINANCIAL REVIEW

These accounts for the 12 months ended 31 March 2014 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 28 May 2014

Annual Report & Accounts 2013/14

201

STATEMENT OF COMPREHENSIVE INCOME Note

31 March 2014 £000

31 March 2013 £000

Operating income from continuing operations

162,410

144,403

Operating expenses of continuing operations

(158,881)

(140,923)

3,529

3,480

OPERATING SURPLUS / (DEFICIT) Finance costs Finance income

115

Finance expense - financial liabilities

(83)

(163)

Finance expense - unwinding of discount on provisions

(56)

(55)

PDC Dividends payable

(1,914)

(1,817)

NET FINANCE COSTS

(2,012)

(1,920)

1,517

1,560

Items that will not be reclassified subsequently to income and expenditure

2,377

TOTAL COMPREHENSIVE INCOME FOR THE YEAR

3,894

1,560

Surplus / (deficit) from continuing operations OTHER COMPREHENSIVE INCOME

There were no activities from discontinued operations The notes on pages 206 to 250 form part of these accounts

202

South Central Ambulance Service

STATEMENT OF FINANCIAL POSITION Note

31 March 2014 £000

31 March 2013 £000

Non-current assets Intangible assets

2,332

2,554

Property, plant and equipment

63,666

60,171

65,998

62,725

Total non-current assets Current assets 21

1,043

954

Trade and other receivables

9,044

7,087

Non-current assets for sale and assets in disposal groups

3,565

3,865

Cash and cash equivalents

8,329

8,301

21,981

20,207

Total current assets

OPERATIONAL AND FINANCIAL REVIEW

Inventories

Current liabilities Trade and other payables

(14,309)

(11,669)

Borrowings

(488)

(1,007)

Provisions

(2,129)

(2,903)

(16,296)

(15,579)

71,053

67,353

Total current liabilities Total assets less current liabilities Non-current liabilities Trade and other payables

(40)

Borrowings

(1,354)

(1,842)

Provisions

(2,495)

(2,201)

Total non-current liabilities

(3,889)

(4,083)

Total assets employed

67,164

63,270

57,874

9,535

6,465

(350)

105

(719)

67,164

63,270

Financed by Public dividend capital Revaluation reserve

Other reserves Income and expenditure reserve Total taxpayers’ and others’ equity

The financial statements on pages 202 to 205 were approved by the Board on 28 May 2014 and signed on its behalf by Will Hancock Chief Executive: Date: 28 May 2014

Annual Report & Accounts 2013/14

203

STATEMENT OF CHANGES IN TAXPAYERS EQUITY

Taxpayers’ Equity at 1 April 2013 Surplus / (deficit) for the year Transfers between reserves Revaluations - property, plant and equipment Other reserve movements Taxpayers' Equity at 31 March 2014

Taxpayers’ Equity at 1 April 2012 Surplus / (deficit) for the year Other reserve movements Taxpayers' Equity at 31 March 2013

Total £000

Public Dividend Capital £000

Revaluation Reserve £000

Other reserves* £000

Income and expenditure reserve £000

63,270

57,874

6,465

(350)

(719)

1,517

695

(695)

2,377

(2)

67,164

57,874

9,535

(350)

105

Total £000

Public Dividend Capital £000

Revaluation Reserve £000

Other reserves £000

Income and expenditure reserve £000

61,710

57,874

6,440

(350)

(2,254)

1,560

(25)

63,270

57,874

6,465

(350)

(719)

* Other reserves was a residual balance required in 2006 when the Trust was formed, from ambulance predecessor trust, to balance opening net assets with taxpayer’s equity.

204

South Central Ambulance Service

STATEMENT OF CASH FLOWS

31 March 2014 ÂŁ000

31 March 2013 ÂŁ000

Operating surplus / (deficit) from continuing operations

3,529

3,480

Depreciation and amortisation

7,699

6,823

Cash flows from operating activities

170

(Profit)/Loss on asset disposal

(23)

(45)

(1,954)

(581)

(89)

(21)

2,246

862

(70)

(536)

(179)

11,042

10,269

(Increase)/Decrease in Trade and Other Receivables (Increase)/Decrease in Inventories Increase/(Decrease) in Trade and Other Payables Increase/(Decrease) in Other Liabilities Increase/(Decrease) in Provisions NET CASH GENERATED FROM/(USED IN) OPERATIONS Cash flows from investing activities Interest received

115

(179)

(1,239)

(7,955)

(7,111)

(8,024)

(8,170)

(987)

(1,328)

Capital element of finance lease rental payments

(20)

(78)

Interest paid

(82)

(136)

(1)

(12)

PDC Dividend paid

(1,900)

(1,817)

Net cash generated from/(used in) financing activities

(2,990)

(3,371)

(1,272)

Cash and Cash equivalents at 1st April

8,301

9,573

Cash and Cash equivalents at year end

8,329

8,301

Purchase of intangible assets Purchase of Property, Plant and Equipment Sales of Property, Plant and Equipment Net cash generated from/(used in) investing activities Cash flows from financing activities Loans repaid to the Department of Health

Interest element of finance lease

Increase/(decrease) in cash and cash equivalents

Annual Report & Accounts 2013/14

205

OPERATIONAL AND FINANCIAL REVIEW

Net (gain)/loss on revaluation of assets

NOTES TO THE ACCOUNTS 1. ACCOUNTING POLICIES 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 2013/14 NHS Foundation Trust Annual Reporting Manual issued by Monitor. The accounting policies contained in that manual follow International Financial 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. 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. 206

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 has 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. 1.2 ACQUISITIONS AND DISCONTINUED OPERATIONS 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.

South Central Ambulance Service

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.

The NHS Pensions agency has provided information with regard to disclosure and calculation of ill health retirement liability.

Non current assets relating to land and buildings had a carrying value of £37.1m as at 31 March 2014 (2013 £34.6m).

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.

The Trust reviews all lease contracts to determine whether they are operating or finance leases.

1.3.3 CONSOLIDATION

Indexation has not been applied to any non-current assets (that is vehicles and equipment), as no material changes were reflected in any relevant price indices. The Trust’s land and buildings have been revalued as part of the Trust’s 5 yearly valuation exercise. The Trust has used an accredited valuer for this exercise who estimated asset values as at 31 March 2014. This is further explained in note 1.7. 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.

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 2015. 1.3.2 KEY SOURCES OF ESTIMATION UNCERTAINTY

South Central Ambulance Service NHS Foundation Trust is a corporate trustee to the SCAS NHS Charity. South Central Ambulance Service NHS Foundation Trust has considered the materiality of the current annual value of transactions and as a result has not consolidated the charitable fund results into the Trust accounts. 1.4 INCOME

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.

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.

These valuations are judgemental and future events (such as a change in economic conditions) could cause these valuations to change.

Where income is received for a specific activity that is to be delivered in the following year, that income is deferred.

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OPERATIONAL AND FINANCIAL REVIEW

1.3.1 CRITICAL JUDGEMENTS IN APPLYING ACCOUNTING POLICIES

NOTES TO THE ACCOUNTS Income from sale of noncurrent 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 Pension’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. 1.5 EMPLOYEE BENEFITS Short-term employee benefits Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees.

208

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.

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.

Retirement benefit costs

1.6 EXPENDITURE ON OTHER GOODS AND SERVICES

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.

South Central Ambulance Service

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. 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

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.

Annual Report & Accounts 2013/14

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. The Trust has undertaken a valuation exercise of land and buildings that it owns at 31 March 2014. This was undertaken by an accredited valuer, Bomford Estates Ltd, on a property by property basis. 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.

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OPERATIONAL AND FINANCIAL REVIEW

»» 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 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.

Gains and losses recognised in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Income. Subsequent expenditure

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.

210

Subsequent expenditure relating to an item of property, plant and equipment is recognised as an increase in the carrying amount of the asset when it is probable that additional future economic benefits or service potential deriving from the cost incurred to replace a component of such item will flow to the enterprise and the cost of the item can be determined reliably. Where a component of an asset is replaced, the cost of the replacement is capitalised if it meets the criteria for recognition above. The carrying amount of the part replaced is de-recognised. Other expenditure that does not generate additional future economic benefits or service potential, such as repairs and maintenance, is charged to the Statement of Comprehensive Income in the period in which it is incurred.

South Central Ambulance Service

1.8 INTANGIBLE ASSETS Recognition Intangible assets are nonmonetary assets without physical substance, which are capable of sale separately from the rest of the Trustâ&#x20AC;&#x2122;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 ÂŁ5,000. Software 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.

Internally-generated assets are recognised if, and only if, all of the following have been demonstrated:

Measurement The amount initially recognised for internallygenerated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internallygenerated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred.

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. Annual Report & Accounts 2013/14

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.

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OPERATIONAL AND FINANCIAL REVIEW

»» 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

Following initial recognition, intangible assets are carried at fair value by reference to an active market, or, where no active market exists, at amortised replacement cost (modern equivalent assets basis), indexed for relevant price increases, as a proxy for fair value. Internallydeveloped software is held at historic cost to reflect the opposing effects of increases in development costs and technological advances. 1.9 DEPRECIATION, AMORTISATION AND IMPAIRMENTS

NOTES TO THE ACCOUNTS 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 Donated non-current 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.

212

1.11 REVENUE GOVERNMENT AND OTHER GRANTS Government grants are grants from Government bodies other than income from primary care trusts or NHS trusts for the provision of services. Where a grant is used to fund revenue expenditure it is taken to the Statement of Comprehensive Income to match that expenditure. 1.12 NON-CURRENT ASSETS HELD FOR SALE 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. South Central Ambulance Service

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 governmentgranted 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 is adjusted. The asset is de-recognised when it is scrapped or demolished. 1.13 LEASES 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.

1.14 INVENTORIES

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.

Inventories are valued at the lower of cost and net realisable. This is considered to be a reasonable approximation to fair value due to the high turnover of stocks.

Operating leases 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.

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. 1.16 PROVISIONS The NHS Foundation Trust recognises where it has a present legal or constructive obligation as a result of a past event, for which it is probable that there will be a future outflow of cash or other resources: and a reliable estimate can be made of the amount. The amount recognised in the Statement of Financial Position is the best estimate of the resources required to settle the obligation.

Annual Report & Accounts 2013/14

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 1.8% in real terms. 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.

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OPERATIONAL AND FINANCIAL REVIEW

Finance leases

NOTES TO THE ACCOUNTS The measurement of a restructuring provision includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with ongoing activities of the entity. 1.17 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.

214

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 nonoccurrence 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.

South Central Ambulance Service

A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or nonoccurrence 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 INSTRUMENTS AND FINANCIAL ASSETS Recognition 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. Derecognition All financial assets are derecognised when the rights to receive cash flows from the assets have expired or the Trust has transferred substantially all of the risk and rewards of ownership. Financial liabilities are derecognised when the obligation is discharged, cancelled or expires.

Classification and measurement Financial assets are initially recognised at fair value. Financial assets and financial liabilities

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.

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.

Annual Report & Accounts 2013/14

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.

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OPERATIONAL AND FINANCIAL REVIEW

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 Trust’s financial assets are classified as loans and receivables.

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.

NOTES TO THE ACCOUNTS 1.21 FINANCIAL LIABILITIES

1.22 VALUE ADDED TAX

1.24 THIRD PARTY ASSETS

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 derecognised when the liability has been discharged, that is, the liability has been paid or has expired.

Most of the activities of the Trust are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the Trust has no beneficial interest in them. However they are disclosed as a separate note to the accounts in accordance with the requirements of HM Treasury’s FReM.

Loans from the Department of Health are recognised at historical cost. Otherwise, financial liabilities are initially recognised at fair value.

1.23 FOREIGN CURRENCIES

Other financial liabilities 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.

216

The Trust’s functional currency and presentational currency is sterling. Transactions denominated in a foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions. 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 Trust’s surplus/deficit in the period in which they arise.

South Central Ambulance Service

1.25 PUBLIC DIVIDEND CAPITAL (PDC) AND PDC DIVIDEND Public Dividend Capital (PDC) is a type of public sector equity finance based on the excess of assets over liabilities at the time of establishment of the predecessor NHS trust. HM Treasury has determined that PDC is not a financial instrument within the meaning of IAS 32. A charge, reflecting the cost of capital utilised by the NHS Foundation Trust is payable as public dividend capital dividend. The charge is calculated at the rate set by HM Treasury (currently 3.5%) on the average relevant net assets of the NHS Foundation Trust during the financial year.

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 »» IAS 27 Separate Financial Statements »» IAS 28 Investments in associates and joint ventures »» IAS 32 Financial Instruments; Presentation.

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.

Annual Report & Accounts 2013/14

217

OPERATIONAL AND FINANCIAL REVIEW

Relevant net assets are calculated as the value of all assets less the value of all liabilities, except for (i) donated assets (including lottery funded assets), (ii) average daily cash balances held with the Government Banking Services (GBS) and National Loans Fund (NLF) deposits, excluding cash balances held in GBS accounts that relate to a short term working capital facility and any PDC dividend balance receivable or payable. In accordance with the requirements laid down by the Department of Health (as the issuer of PDC), the dividend for the year is calculated on the actual average relevant net assets as set out in the preaudit version of the annual accounts. The dividend thus calculated is not revised should any adjustment to net assets occur as a result of the audit of the Annual Accounts.

NOTES TO THE ACCOUNTS 2 OPERATING SEGMENTS Each segment is reported separately in the monthly Board report. Emergency services include the 999 service, 111 call handling, Education and Training and the Hazardous Area Response Team (HART).

Non-emergency services include Patient Transport Service (PTS), Logistic Services, and Training income.

The Trust only reports contribution before overheads by service line reporting to the Trust Board at public Board meetings.

Direct costs include employee and non-employee costs (staff costs, drugs, medical equipment, vehicle costs etc). 2013/14

Income Direct Costs Contribution Operational Activities

Emergency Services

Non-Emergency Services

Total

£000’s

140,440

21,970

162,410

(108,676)

(19,179)

(127,855)

31,764

2,791

Total Overheads

34,555 (23,327)

Depreciation and amortisation

(7,699)

Total Costs Before Dividends and Interest

(31,026)

Operating Surplus

3,529 2012/13 Emergency Services

Non-Emergency Services

Total

£000’s

Income

123,426

20,932

144,358

Direct Costs

(94,263)

(18,513)

(112,776)

29,163

2,419

31,582

Contribution Operational Activities Total Overheads

(21,279)

Depreciation and amortisation

(6,823)

Total Costs Before Dividends and Interest Operating Surplus

(28,102) 3,480

Emergency services direct costs and overheads have been restated for 2012/13 to bring it into line with 2013/14 reporting.

218

South Central Ambulance Service

3 OPERATING INCOME FROM CONTINUING OPERATIONS 3.1 INCOME BY CLASSIFICATION

2012/13 £000

Total

A&E Income

121,593

117,238

111 Income

15,284

3,810

PTS Income

18,595

16,723

902

893

Education, training and research

2,104

1,849

Non-patient care services to other bodies

2,621

2,566

Other revenue

1,311

1,324

162,410

144,403

Income from activities

Other Income

OPERATIONAL AND FINANCIAL REVIEW

2013/14 £000

Other operating income

Other revenue includes £361k commercial training (£390k: 2012/13), £301k radio mast income (£286:k 2012/13) and £483k of reversal of impairments (nil: 2012/13) previously charged in the accounts. 3.2 PRIVATE PATIENT INCOME The Trust had no private patient income in 2013/14 (nil: 2012/13). 3.3 OPERATING LEASE INCOME The Trust had no operating lease income in 2013/14 (nil: 2012/13).

Annual Report & Accounts 2013/14

219

NOTES TO THE ACCOUNTS 3.4 OPERATING INCOME BY TYPE

2013/14 £000

2012/13 £000

2,130

1,044

150,022

129,120

2,860

6,240

100

307

336

Injury costs recovery

506

538

Other

452

1,286

6,036

5,739

162,410

144,403

NHS trusts Clinical Commissioning Groups Foundation trusts Local authorities Department of Health Non-NHS

Other operating income

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.

NOTE 3.5 INCOME GENERATION ACTIVITIES The Trust undertakes income generation activities. No income generating activity exceeded £1m (nil in 2012/13).

£133.2m of income received relates to commissioner requested services (£117m in 2012/13). All other income relates to non-commissioner related services.

220

South Central Ambulance Service

4 OPERATING EXPENSES

2012/13 £000

Employee Expenses - executive directors

794

669

Trust chair and non executive directors

101

99,829

91,183

282

223

2,920

3,221

903

989

3,645

4,015

Transport

24,010

20,839

Premises

5,540

5,081

(41)

Rentals under operating leases

4,801

4,357

Depreciation

6,637

6,212

Amortisation

1,062

611

Audit fee - statutory services

Audit fee - other assurance services

Non-audit fee - other non-audit services

Clinical negligence premiums

513

323

Legal Costs

264

Consultancy services

732

901

Training, courses and conferences

595

278

Insurance

1,295

1,143

Other contracted services *

2,985

131

653

1,132

603

158,881

140,923

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

Impairments Other

* Other contracted services includes £2,843k driven by new NHS 111 service provision in current year.

4.1 LIMITATIONS ON AUDITOR’S LIABILITY The Trust’s contract with its auditors for 2013/14, as set out in the engagement letter, limited the auditor’s liability to £1m (2012/13: £1m).

Annual Report & Accounts 2013/14

221

OPERATIONAL AND FINANCIAL REVIEW

2013/14 £000

NOTES TO THE ACCOUNTS 5.1 EMPLOYEE EXPENSES

2013/14 Total £000

2013/14 Permanently Employed £000

2013/14 Other £000

Salaries and wages

79,305

Social security costs

6,024

Employers contributions to NHS Pensions

9,930

Agency/contract staff

5,364

100,623

95,259

5,364

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

Employers contributions to NHS Pensions

8,153

Agency/contract staff

2,949

91,852

88,496

3,356

2013/14 Total Number

2013/14 Permanent Number

2013/14 Other Number

1,350

Administration and estates including emergency and 111 control staff

775

673

102

Healthcare assistants and other support staff

441

2,664

2,562

102

Total gross staff costs

5.2 AVERAGE NUMBER OF EMPLOYEES (WTE BASIS) Ambulance staff

Nursing, midwifery and health visiting staff Total average numbers

The increase in administration and estates is due to additional emergency and 111 control staff.

222

South Central Ambulance Service

5.2 AVERAGE NUMBER OF EMPLOYEES (WTE BASIS)

2012/13 Permanent Number

2012/13 Other Number

1,298

Administration and estates including emergency and 111 control staff

632

546

Healthcare assistants and other support staff

449

2,455

2,369

Ambulance staff

Nursing, midwifery and health visiting staff Total average numbers

5.3 REMUNERATION AND OTHER BENEFITS RECEIVED BY DIRECTORS

2013/14 £000

2012/13 £000

794

669

Total

5.4 EARLY RETIREMENTS DUE TO ILL HEALTH There were seven (2013: two) early retirements due to ill health in the reporting period with a value of £329k (2013: £89k)

5.5 ANALYSIS OF TERMINATION BENEFITS

2013/14 Number of compulsory redundancies Number

2013/14 Cost of compulsory redundancies £000

<£10,000

115

£10,001 - £25,000

213

£25,001 - £50,000

107

£50,001 - £100,000

359

£100,001 - £150,000

133

927

Exit package cost band (including any special payment element)

Total

There was 1 additional redundancy of £12k under the Mutually Agreed Redundancy Scheme.

Annual Report & Accounts 2013/14

223

OPERATIONAL AND FINANCIAL REVIEW

2012/13 Total Number

NOTES TO THE ACCOUNTS 5.5 ANALYSIS OF TERMINATION BENEFITS

2012/13 Number of compulsory redundancies Number

2012/13 Cost of compulsory redundancies £000

<£10,000

£10,001 - £25,000

197

£25,001 - £50,000

223

£50,001 - £100,000

141

631

Exit package cost band (including any special payment element)

Total

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.

224

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 “the period between formal valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows:

South Central Ambulance Service

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.

The scheme regulations were changed to allow contribution rates to be set by the Secretary of State for Health, with the consent of HM Treasury, and consideration of the advice of the Scheme Actuary and appropriate employee and employer representatives as appropriate. Employers pay contributions at 14% of pensionable pay. The next formal valuation to be used for funding purposes will be carried out as at 31 March 2012 and will be used to inform the contribution rates to be used from 1 April 2015. b) Accounting valuation

Actuarial assessments are undertaken in intervening years between formal valuations using updated membership data, accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2013 is based on the valuation data as at 31 March 2012, updated to the 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 Pension’s website. Copies can also be obtained from The Stationery Office.

c) Scheme provisions The NHS Pension Scheme provided defined benefits, which are summarised below. This list is an illustrative guide only, and is not intended to detail all the benefits provided by the Scheme or the specific conditions that must be met before these benefits can be obtained: »» The Scheme is a ‘final salary’ scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service.

A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period.

Annual Report & Accounts 2013/14

225

OPERATIONAL AND FINANCIAL REVIEW

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 sector pension provision in 2015.

NOTES TO THE ACCOUNTS »» 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

226

»» 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 AVCs run by the Scheme’s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers. The Pension Act 2008 introduced new duties on employers in providing access to a work place pension for all of its employees. The NHS Pension Scheme is not available to all employees and the Trust has provided access to a scheme for these employees which is operated by the National Employment Savings Trust (NEST). NEST is a defined contribution scheme where a minimum contribution is paid by the employer. South Central Ambulance Service NHS Foundation Trust currently contributes 1% of qualified earnings to the scheme.

South Central Ambulance Service

6.1 ANALYSIS OF OPERATING LEASE EXPENDITURE

Minimum lease payments

2013/14 Total £000

2012/13 Total £000

4,801

4,357

Land 2013/14 £000

Buildings 2013/14 £000

Other 2013/14 £000

- not later than one year;

2,479

1,326

1,153

- later than one year and not later than five years;

6,895

5,161

1,734

- later than five years.

12,755

Total

22,129

19,242

2,887

Total 2012/13 £000

Land 2012/13 £000

Buildings 2012/13 £000

Other 2012/13 £000

- not later than one year;

3,087

1,367

1,720

- later than one year and not later than five years;

6,998

4,627

2,371

- later than five years.

11,196

Total

21,281

17,190

4,091

Future minimum lease payments due:

6.2 THE LATE PAYMENT OF COMMERCIAL DEBTS (INTEREST AT ACT 1998) No interest payments were made by the Trust in the reporting period.

7 DISCONTINUED OPERATIONS The Trust has no discontinued operations.

Annual Report & Accounts 2013/14

8 CORPORATION TAX The Trust has determined that it has no corporation tax liability as it has no private income from nonoperational areas.

227

OPERATIONAL AND FINANCIAL REVIEW

Total 2013/14 £000

NOTES TO THE ACCOUNTS 9 FINANCE INCOME

2013/14 £000

2012/13 £000

115

2013/14 £000

2012/13 £000

136

Finance leases

Other Finance Costs

163

Interest on bank accounts

10 FINANCE COSTS Interest expense: Loans from the Department of Health

Total

11 IMPAIRMENT OF ASSETS

2013/14 £000 Net Impairments

2013/14 £000 Impairments

2013/14 £000 Reversals

Changes in market price

110

593

(483)

Total impairments charged to operating surplus

170

653

(483)

Impairments charged to operating surplus: Abandonment of assets in course of construction

There were no asset impairments in 2012/13.

228

South Central Ambulance Service

12.1 INTANGIBLE ASSETS 2013/14

Total

Valuation/Gross Cost at 1 April 2013 Additions - purchased

£000

Software licences (purchased) £000

Intangible Assets Under Construction £000

4,477

3,642

835

179

723

(62)

(162)

Valuation/Gross Cost at 31 March 2014

5,155

4,382

773

Amortisation at 1 April 2013

1,923

Provided during the year

1,062

Disposals

(162)

Amortisation at 31 March 2014

2,823

OPERATIONAL AND FINANCIAL REVIEW

661

Disposals

Reclassifications

Reclassifications relate to movements in year between assets in the course of construction within Property, Plant and Equipment and intangible assets - see note 13.1.

12.2 INTANGIBLE ASSETS FINANCING

Total £000

Software licences (purchased) £000

Intangible Assets Under Construction £000

2,332

1,559

773

NBV - Finance leases at 31 March 2014

NBV - Donated and government grant funded at 31 March 2014

2,332

1,559

773

Net book value NBV - Purchased at 31 March 2014

NBV total at 31 March 2014

Note. There is no revaluation reserve held for intangible assets.

Annual Report & Accounts 2013/14

229

NOTES TO THE ACCOUNTS 12.2 INTANGIBLE ASSETS 2012/13

Total £000

Software licences (purchased) £000

Intangible Assets Under Construction £000

Valuation/Gross Cost at 1 April 2012 as previously stated

2,917

Additions - purchased

1,264

429

835

296

Valuation/Gross cost at 31 March 2013

4,477

3,642

835

Amortisation at 1 April 2012

1,312

611

1,923

Reclassifications Disposals

Provided during the year Disposals Amortisation at 31 March 2014

12.2 INTANGIBLE ASSETS FINANCING

Total £000

Software licences (purchased) £000

Intangible Assets Under Construction £000

2,554

1,719

835

NBV - Finance leases at 31 March (2013 restated)

NBV - Donated and government grant funded at 31 March 2013 (restated)

2,554

1,719

835

Net book value NBV - Purchased at 31 March 2013 (restated)

NBV total at 31 March 2013 (restated)

Note. There is no revaluation reserve held for intangible assets.

230

South Central Ambulance Service

0 0 (203) 319 0 25 0

8,335

(353)

483

(661)

189

(2,257)

105,475

Additions - purchased

Impairments

Disposals

Valuation/Gross cost at 31 March 2014

Revaluations

Reclassifications

Reversal of impairments

Transfers by absorption

9,091

8,950

99,739

31,100

(209)

154

960

164

(90)

145

29,976

£000

Valuation/Gross cost at 1 April 2013

Buildings excluding dwellings

Land

Total

147

137

£000

Dwellings

13.1 PROPERTY, PLANT AND EQUIPMENT 2013/14

3,951

(3,386)

(60)

4,480

2,917

Assets under construction & payments on account £000

9,914

(93)

131

520

40,905

(1,764)

177

3,089

39,403

£000

9,356

Transport equipment

Plant and machinery

OPERATIONAL AND FINANCIAL REVIEW

Annual Report & Accounts 2013/14

231

9,040

(6)

1,113

105

7,828

£000

Information technology

1,327

(185)

344

(4)

1,172

£000

Furniture and fittings

232 0

0 0

39,568

6,637

(2,188)

Accumulated depreciation at 1 April 2013

Provided during the year

South Central Ambulance Service

NBV total at 31 March 2014

Donated

Finance Leased

Owned

Land

£000

8,225 0 866 9,091

£000

61,956

1,710

63,666

Total

41,809

Accumulated depreciation at 31 March 2014

13.2 PROPERTY, PLANT AND EQUIPMENT FINANCING

(2,208)

Disposals

£000

Revaluations

Land

Total

13.1 PROPERTY, PLANT AND EQUIPMENT 2013/14 (CONT’D)

27,882

844

27,038

£000

Buildings excluding dwellings

3,218

(209)

(2,169)

1,268

4,328

£000

Buildings excluding dwellings

147

£000

Dwellings

(19)

£000

Dwellings

3,951

Assets under construction & payments on account £000

3,050

£000

Plant and machinery

6,864

(93)

724

6,233

£000

Plant and machinery

16,329

£000

Transport equipment

24,576

(1,726)

3,575

22,727

£000

Transport equipment

2,630

£000

Information technology

6,410

(6)

957

5,459

£000

Information technology

586

£000

Furniture and fittings

741

(174)

108

807

£000

Furniture and fittings

NOTES TO THE ACCOUNTS

8,950

0 0 0 0 0 0

95,415

7,448

(296)

(2,828)

99,739

Impairments

Reversal of impairments

Disposals

Valuation/Gross cost at 31 March 2013

Revaluations

Reclassifications

Additions - purchased

8,950

£000

Valuation/Gross cost at 1 April 2012 - as previously stated

Land

Total

29,976

184

220

29,572

£000

Buildings excluding dwellings

137

£000

Dwellings

13.2 PROPERTY, PLANT AND EQUIPMENT 2012/13

2,917

(1,224)

2,623

1,518

Assets under construction & payments on account £000

9,356

(373)

224

936

8,569

£000

Plant and machinery

39,403

(1,603)

352

3,601

37,053

£000

Transport equipment

OPERATIONAL AND FINANCIAL REVIEW

Annual Report & Accounts 2013/14

233

7,828

(852)

164

8,448

£000

Information technology

1,172

1,168

£000

Furniture and fittings

234

39,568

Accumulated depreciation at 31 March 2013

South Central Ambulance Service

NBV total at 31 March 2013

Donated

Finance Leased

Owned

13.2 PROPERTY, PLANT AND EQUIPMENT FINANCING Land

£000

8,090 0 860 8,950

Total

£000

58,585

1,566

60,171

Revaluations

6,212

Provided during the year

36,164

Accumulated depreciation at 1 April 2012- as previously stated

(2,808)

£000

Disposals

Land

Total

13.2 PROPERTY, PLANT AND EQUIPMENT 2013/14 (CONT’D)

25,648

689

24,959

£000

Buildings excluding dwellings

4,328

1,150

3,178

£000

Buildings excluding dwellings

123

£000

Dwellings

£000

Dwellings

2,917

Assets under construction & payments on account £000

3,123

£000

Plant and machinery

6,233

(373)

598

6,008

£000

Plant and machinery

16,676

16,639

£000

Transport equipment

22,727

(1,583)

3,597

20,713

£000

Transport equipment

2,369

£000

Information technology

5,459

(852)

720

5,591

£000

Information technology

365

£000

Furniture and fittings

807

142

665

£000

Furniture and fittings

NOTES TO THE ACCOUNTS

14 INTANGIBLE ASSETS ACQUIRED BY GOVERNMENT GRANT The Trust had no Intangible assets acquired by government grant.

Min Life Years

Max Life Years

Min Life Years

Max Life Years

Property excluding dwellings

Dwellings

Plant & Machinery

Transport Equipment

Information Technology

Furniture & Fittings

OPERATIONAL AND FINANCIAL REVIEW

15.1 ECONOMIC LIFE OF INTANGIBLE ASSETS Intangible assets purchased Software

15.2 ECONOMIC LIFE OF PROPERTY, PLANT AND EQUIPMENT Tangible assets purchased

16 INVESTMENTS The Trust held no investments at 31 March 2014 (2013: nil). The Trust is corporate trustee of the SCAS Charity. The Trust decided not to consolidate on the grounds of materiality. The SCAS Charity had total assets of £612k as at 31 March 2014.

During 2014 the Charity received income of £154k and incurred expenditure of £68k. 17 INVESTMENTS IN ASSOCIATE OPERATIONS The Trust had no investments in associate or jointly controlled operations (2013 nil).

Annual Report & Accounts 2013/14

235

NOTES TO THE ACCOUNTS 18.1 NON-CURRENT ASSETS FOR SALE AND ASSETS IN DISPOSAL GROUPS - 2013/14

Total £000

Property, plant & equipment £000

NBV of non-current assets for sale and assets in disposal groups at 1 April 2013

3,865

Less Impairment of assets held for sale

(300)

NBV of non-current assets for sale and assets in disposal groups at 31 March 2014

3,565

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 for sites at Deanshanger, Battle, Banbury and Totton.

18.2 NON-CURRENT ASSETS FOR SALE AND ASSETS IN DISPOSAL GROUPS - 2012/13 NBV of non-current assets for sale and assets in disposal groups at 1 April 2012 Less Impairment of assets held for sale NBV of non-current assets for sale and assets in disposal groups at 31 March 2013

236

South Central Ambulance Service

Total £000

Property, plant & equipment £000

3,865

18.3 LIABILITIES IN DISPOSAL GROUPS The Trust held no liabilities in disposal groups as at 31 March 2014 (2013: nil). 19 OTHER ASSETS

OPERATIONAL AND FINANCIAL REVIEW

The Trust held no other assets as at 31 March 2014 (2013: nil). 20 OTHER FINANCIAL ASSETS The Trust held no other financial assets as at 31 March 2014 (2013: nil). 21.1 INVENTORIES 2013/14 £000

2012/13 £000

Consumables

861

845

Fuel

182

109

1,043

954

Carrying Value as at 31 March

21.2 INVENTORIES RECOGNISED IN EXPENSES There were no inventories recognised in expenses during the reported period.

Annual Report & Accounts 2013/14

237

NOTES TO THE ACCOUNTS 22 TRADE RECEIVABLES AND OTHER RECEIVABLES

31 March 2014 £000

31 March 2013 £000

1,965

1,028

Provision for impaired receivables

(556)

(500)

Prepayments (Non-PFI)

2,685

2,624

Accrued income

3,538

2,919

VAT receivable

582

343

Other receivables - Revenue

827

661

9,044

7,087

Current NHS Receivables - Revenue Receivables due from NHS charities – Revenue

Interest Receivable

TOTAL CURRENT TRADE AND OTHER RECEIVABLES

The Trust had no non-current trade or other receivables. The majority of trade receivables is due from Clinical Commissioning Groups, as commissioners for NHS patient care services. As Clinical Commissioning Groups are funded by Government to commission NHS patient care services, no credit scoring of them is considered necessary.

23.1 PROVISION FOR IMPAIRMENT OF RECEIVABLES 31 March 2014 £000

31 March 2013 £000

500

541

(41)

556

500

At 1 April (restated) Increase in provision Amounts utilised At 31 March

The provision relates to £344k Injury cost recovery (2013 - £342k), £128k trade receivables (2013 - £116k) and £84k overpaid salaries (2013 - £42k).

238

South Central Ambulance Service

23.2 ANALYSIS OF IMPAIRED RECEIVABLES

31 March 2014 Trade Receivables £000

31 March 2014 Other Receivables £000

31 March 31 March 2013 2013 Other Trade Receivables Receivables £000 £000

0 - 30 days

30-60 Days

60-90 days

90- 180 days (was "In three to six months")

344

342

over 180 days (was "Over six months")

212

158

Total

556

500

0 - 30 days

571

225

123

30-60 Days

169

127

60-90 days

107

Ageing of impaired receivables

90- 180 days (was "In three to six months") over 180 days (was "Over six months") Total

847

403

201

24 FINANCE LEASE RECEIVABLES The Trust had no finance lease receivables as at 31 March 2014 (2013 nil). 25 CASH AND CASH EQUIVALENTS At 1 April

2013/14 £000

8,301

9,573

(1,272)

8,329

8,301

Cash with the Government Banking Service

8,292

8,257

Cash and cash equivalents

8,329

8,301

Net change in year At 31 March Broken down into: Cash at commercial banks and in hand

The Trust held no third party assets as at 31 March 2014 (2013: nil). Annual Report & Accounts 2013/14

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OPERATIONAL AND FINANCIAL REVIEW

Ageing of non-impaired receivables past their due date

NOTES TO THE ACCOUNTS 26.1 TRADE AND OTHER PAYABLES

31 March 2014 Total £000

31 March 2013 Total £000

167

1,307

1,211

920

540

1,641

1,147

Social Security costs

975

973

Other taxes payable

863

907

Other payables

105

8,317

6,748

14,309

11,669

Current Receipts in advance NHS payables - revenue NHS payables - Early retirement costs payable within one year Amounts due to other related parties - revenue Other trade payables - capital Other trade payables - revenue

Accruals PDC dividend payable Total current trade and other payables Non-current Other payables Accruals Total non-current trade and other payables

Amounts due to related parties represents £1,307k outstanding pensions contributions as at 31 March 2014 (2013: £1,211k). There were no early retirement payments in the above.

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South Central Ambulance Service

26.2 BETTER PAYMENT PRACTICE CODE

March 2014 Number

March 2014 £000

March 2013 Number

March 2013 £000

Total Non-NHS Trade Invoices Paid in the Year

40,999

60,835

38,030

53,609

Total Non-NHS Trade Invoices Paid Within Target

36,330

57,268

33,426

50,155

Percentage of Non-NHS Trade Invoices Paid Within Target

88.6%

94.1%

87.9%

93.6%

Total NHS Trade Invoices Paid in the Year

556

2,771

1,021

1,969

Total NHS Trade Invoices Paid Within Target

502

2,708

885

1,840

90.3%

97.7%

86.7%

93.4%

Measure of compliance Non-NHS Payables

Percentage of NHS Trade Invoices Paid Within Target

The Better Payment Practice Code requires the Trust to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later.

27.1 BORROWINGS 31 March 2014 £000

31 March 2013 £000

488

987

488

1007

1,354

1842

Obligations under finance leases

Total non-current borrowings

1,354

1,842

Current Loans from Department of Health Obligations under finance leases Total current borrowings Non-current Loans from Department of Health

The Trust has two capital loans of £3,551,000 (payable over 10 years) taken out in 2008/09 and a further loan of £1,500,000 (payable over 5 years) taken out in 2009/10.

Annual Report & Accounts 2013/14

241

OPERATIONAL AND FINANCIAL REVIEW

NHS Payables

NOTES TO THE ACCOUNTS 27.2 PRUDENTIAL BORROWING LIMIT The prudential borrowing code requirements in section 41 of the NHS Act 2006 have been repealed with effect from 1 April 2013 by the Health and Social Care Act 2012. The financial statements are no longer required.

28 OTHER LIABILITIES The Trust had no other liabilities as at 31 March 2014 (2013: nil) 29 OTHER FINANCIAL LIABILITIES The Trust had no other financial liabilities as at 31 March 2014 (2013: nil)

30.1 PROVISIONS FOR LIABILITIES AND CHARGES

Current

Non-current

31 March 2014 £000

31 March 2013 £000

31 March 2014 £000

31 March 2013 £000

Pensions relating to other staff

153

143

2,115

1,912

Other legal claims

190

126

192

200

Restructurings

116

930

Other*

1,670

1,704

188

Total

2,129

2,903

2,495

2,201

242

South Central Ambulance Service

30.2 PROVISIONS FOR LIABILITIES AND CHARGES ANALYSIS

Change in the discount rate Arising during the year

Pensions other staff

Re-structurings

Other*

£000

Other legal claims £000

£000

5,104

2,055

326

930

1,793

166

1,579

153

116

1,225

(1,941)

(162)

(29)

(927)

(823)

(340)

(3)

(337)

4,624

2,268

382

116

1,858

2,129

153

190

116

1,670

908

586

192

130

- later than five years.

1,587

1,529

Total

4,624

2,268

382

116

1,858

Utilised during the year - cash Reversed unused Unwinding of discount At 31 March 2014 Expected timing of cashflows: - not later than one year; - later than one year and not later than five years;

* The provision for other includes £208k for agency related costs, £316k for lease car related costs, £290k staff related costs, £191k property dilapidations and £650k provision for credit notes.

Annual Report & Accounts 2013/14

243

OPERATIONAL AND FINANCIAL REVIEW

At 1 April 2013

Total

NOTES TO THE ACCOUNTS 30.3 CLINICAL NEGLIGENCE LIABILITIES

Total £000

Amount included in provisions of the NHSLA at 31 March 2014 in respect of clinical negligence liabilities of South Central Ambulance Service NHS Foundation Trust

5,189

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

31 CONTINGENT LIABILITIES/ASSETS

31 March 2014 £000

31 March 2013 £000

Other

(481)

(31)

Gross value of contingent liabilities

(481)

(31)

Value of contingent liabilities Equal pay

Amounts recoverable against liabilities

Net value of contingent liabilities*

(481)

(31)

Net value of contingent assets * Additional liability on legal claims and agency related issues at 100% probability.

32 REVALUATION RESERVE - 2013/14

31 March 2014 £000

31 March 2013 £000

Revaluation reserve at 1 April 2013

6,465

6,440

Revaluations

2,377

695

(2)

9,535

6,465

Transfers to other reserves * Asset disposals Revaluation reserve at 31 March 2014

* Adjustment for 2013/14 relates to the reversal of negative land revaluation reserves that arose during the Trust’s conversion to IFRS in 2009/10.

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33 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.

Note 33.1

Note 33.2

Payments to related party

Receipts from related party

Amounts owed to related party

£000

Amounts due from related party £000

2,098

2,737

303

1,739

Buckinghamshire Healthcare NHS Trust

1,852

263

NHS Oxfordshire CCG

24,691

373

NHS West Hampshire CCG

18,944

373

NHS Aylesbury Vale CCG

12,391

NHS Chiltern CCG

11,316

421

NHS Southampton CCG

9,992

159

NHS Milton Keynes CCG

8,999

233

Health Education England Oxford Health NHS Foundation Trust Berkshire Healthcare NHS Foundation Trust

NHS Fareham & Gosport CCG

7,726

NHS Portsmouth CCG

7,434

NHS South Eastern Hampshire CCG

6,876

NHS Slough CCG

5,965

144

NHS North Hampshire CCG

5,813

135

NHS South Reading CCG

5,277

135

NHS Windsor, Ascot & Maidenhead CCG

5,167

525

NHS Wokingham CCG

4,831

139

NHS Bracknell & Ascot CCG

4,652

109

NHS Newbury & District CCG

4,042

118

NHS North & West Reading CCG

3,541

114

During the period South Central Ambulance NHS Foundation Trust had charitable funds of £0.6m as at 31 March 2014 (2013 £0.5m) Annual Report & Accounts 2013/14

245

OPERATIONAL AND FINANCIAL REVIEW

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:

NOTES TO THE ACCOUNTS 34.1 CONTRACTUAL CAPITAL COMMITMENTS

31 March 2014 £000

31 March 2013 £000

Property, Plant and Equipment

148

152

Intangible assets

193

Total

341

237

31 March 2014 £000

31 March 2013 £000

- not later than one year;

Net lease liabilities

- not later than one year;

34.2 OTHER FINANCIAL COMMITMENTS The Trust has no other commitments under noncancellable contracts as at 31 March 2014 (2013: nil). 35 FINANCIAL LEASE OBLIGATIONS Gross lease liabilities of which liabilities are due

The finance leases shown, which referred to emergency operational vehicles, have now ceased and final payments have been made.

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South Central Ambulance Service

36 EVENTS AFTER THE REPORTING PERIOD

37 FINANCIAL INSTRUMENTS Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. Because of the continuing service provider relationship that the Foundation Trust has with clinical commissioning groups (CCG) and the way those CCGs are financed, the Foundation Trust is not exposed to the degree of financial risk faced by business entities.

Interest rate risk The Foundation Trust’s borrowings are from government. The borrowings are for 1-10 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The Foundation Trust therefore has low exposure to interest rate fluctuations. Credit risk Because the majority of the Foundation Trust’s income comes from contracts with other public sector bodies, the Foundation Trust has low exposure to credit risk. The maximum exposures as at 31 March 2014 are in receivables from customers, as disclosed in the trade and other receivables note. Liquidity risk

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.

Annual Report & Accounts 2013/14

The Foundation Trust’s operating costs are incurred under contracts with Clinical Commissioning Groups, which are financed from resources voted annually by Parliament. The Foundation Trust is not exposed to significant liquidity risks.

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OPERATIONAL AND FINANCIAL REVIEW

The Trust has been appointed as the successor body for NHS Direct which ceased providing services on 31 March 2014. The transaction has no impact on the Trust’s 2013/14 accounts. The Trust will be absorbing net assets from this service in 2014/15. Any new liabilities that arise in 2013/14 will be matched by equivalent income from the NHS Trust Development Authority (TDA) as per the signed agreement between the Trust and the TDA.

Also financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The Foundation Trust has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the Trust in undertaking its activities. The 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.

NOTES TO THE ACCOUNTS 37.1 FINANCIAL ASSETS BY CATEGORY

31 March 2014 £000

31 March 2013 £000

NHS Trade and other receivables excluding non financial assets (at 31 March 2014)

5,666

4,012

Cash and cash equivalents at bank and in hand (at 31 March 2014)

8,329

8,301

13,995

12,313

31 March 2014 £000

31 March 2013 £000

1,842

2,829

14,284

10,358

841

1,229

16,967

14,436

Assets as per SoFP

Total at 31 March 2014

37.2 FINANCIAL ASSETS BY CATEGORY Liabilities as per SoFP; Borrowings excluding Finance lease and PFI liabilities (at 31 March 2014) Obligations under finance leases (at 31 March 2014) Trade and other payables excluding non financial assets (at 31 March 2014) Provisions under contract (at 31 March 2014) Total at 31 March 2014

Trade and other payables have been restated for March 2013 to include pensions, National Insurance and income tax.

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South Central Ambulance Service

37.3 FAIR VALUES OF FINANCIAL ASSETS AT 31 MARCH 2014 The Trust has no non-current financial assets at 31 March 2014 (nil at 31 March 2013).

Book value £000

Fair value £000

191

Loans

1,354

Total

1,545

Provisions under contract

Current assets are assumed to have a fair value equal to net book value.

38 MATURITY OF FINANCIAL LIABILITIES

31 March 2014 £000

31 March 2013 £000

15,422

14,347

In more than one year but not more than two years

376

In more than two years but not more than five years

1,111

16,967

14,436

In one year or less

In more than five years Total

Annual Report & Accounts 2013/14

249

OPERATIONAL AND FINANCIAL REVIEW

37.4 FAIR VALUES OF FINANCIAL LIABILITIES AT 31 MARCH 2014

NOTES TO THE ACCOUNTS 39 LOSSES AND SPECIAL PAYMENTS

2013/14

2012/13

Total number of cases Number

Total value of cases

£000

Total number of cases Number

Loss incurred due to change in requirements

Overpayment of salaries

Bad Debts and abandoned claims

Damage to equipment

206

213

Total Losses

266

235

228

£000

LOSSES

SPECIAL PAYMENTS Extra statutory payments

250

South Central Ambulance Service

OPERATIONAL AND FINANCIAL REVIEW

Annual Report & Accounts 2013/14

251

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 190 to 250. These financial statements have been prepared under applicable law and the NHS Foundation Trust Annual Reporting Manual 2013/14. 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.

252

Respective responsibilities of the accounting officer and the auditor As described more fully in the Statement of Accounting Officer’s Responsibilities on page 169 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.

South Central Ambulance Service

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 nonfinancial 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 2014 and of its income and expenditure for year then ended; and

Opinion on other matters prescribed by the Audit Code for NHS Foundation Trusts In our opinion the information given in the Directorâ&#x20AC;&#x2122;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.

Annual Report & Accounts 2013/14

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 2014

253

OPERATIONAL AND FINANCIAL REVIEW

Have been prepared in accordance with the NHS Foundation Trust Annual Reporting Manual 2013/14.

GLOSSARY A and E AACP ACP ACS Agenda for change AMPDS ATP BASICS BMJ CAD CARS CBRN CCG CEO CF CFR CNST CPD CPI CPR CQC CQUIN CSD DH E and D ECP ECT EOC EoLC ePRF FFT Frem FT GBS GPS HALO HART HCP HOSC IAS

254

Accident and Emergency Ambulance Anticipatory Care Plan Anticipatory Care Plan Acute Coronary Syndrome National pay system implemented in 2004 for NHS staff Advanced Medical Priority Dispatch System Adenosine Triophosphate Testing British Association for Immediate Care British Medical Journal Computer aided dispatch system Clinical Audit Record System Chemical, Biological, Radiological, Nuclear Clinical Commissioning Group Chief Executive Officer Clinical Fellow Community First Responder Clinical Negligence Scheme for trusts Continuous Professional Development Clinical Performance Indicator Cardiopulmonary resuscitation Care Quality Commission Commissioning for Quality and Improvement Clinical Support Desk Department of Health Equality and Diversity Emergency Care Practitioner Emergency Call Taker Emergency Operations Centre End of Life Care Electronic Patient Report Form Friends and Family Test Financial Reporting Manual Foundation Trust Government Banking Service Global Positioning System Hospital Ambulance Liaison Officer Hazardous Area Response Team Health Care Provider Health Overview and Scrutiny Committee International Accounting Standards

IFRS JRCALC KPMG LD MINAP NBV NHSLA PALS PBL PCI PCT PCR PDC PERG PFI PRF PPCI PTS RAG RCN ROSC SCAS SCIE SHA SID SIRI SLA SOP STEIS STEMI TARN TUB uDNACPR UKcip

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 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

South Central Ambulance Service

OUR ANNUAL REPORT CAN BE PROVIDED IN DIFFERENT FORMATS AND LANGUAGES ON REQUEST PLEASE CALL 01869 365000

PRODUCED BY South Central Ambulance Service NHS Foundation Trust 7 - 8 Talisman Business Centre Talisman Road Bicester Oxfordshire OX26 6HR Tel 01869 365000 Fax 01869 322814 www.scas.nhs.uk Design > Ben Hennessy