Annual Report and Accounts - swast.nhs.uk · 3 | P a g e South Western Ambulance Service NHS...

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Annual Report and Accounts

1 April 2015 – 31 March 2016

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South Western Ambulance Service NHS Foundation Trust

Annual Report and Accounts

1 April 2015 – 31 March 2016

Presented to Parliament pursuant to Schedule 7, Paragraph 25 (4) (a) of

the National Health Service Act 2006

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©2016 South Western Ambulance Service NHS Foundation Trust

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Contents

A welcome message from our Chief Executive and Chairman………..…6

Performance Report………………………………………………………………...7

Overview of performance………………………………………………………….... ..7

About us………………………………………………………………………….………….….....8

Risks and uncertainties………………………………………………………………......9

Activities and achievements……..…………………………………………………..…12

Statement from the Chief Executive…………………………………………………...12

Going concern disclosure……………………………………………………………….12

Performance analysis………………………………………………………………….13

Performance against contract…………………………………………………………..13

Environmental matters…………………………………………………………………..40

Social, community and human rights issues………………………………………….40

Important events since year-end……………………………………………………….41

Overseas operations…………………………………………………………………….42

Accountability Report ………………………………………………………………...43

Directors‟ report………………………………………………………………………….43

Remuneration report…………………………………………………………………….53

Staff report…………………………………………………………………………….….79

The disclosures set out in the NHS Foundation Trust Code of Governance ……..96

Regulatory ratings………………………………………………………………………105

A statement of Accounting Officer‟s Responsibilities ………………………………107

An Annual Governance Statement ..………………………………………….………109

The Quality Report……..………………………………………………………..………118

Auditors Report including certificate.…………………………………..……..……….182

Foreword to accounts…………………………………………….…………….……….184

Four primary financial statements.………………………………………..……….….192

Notes to the accounts ..……………………………………….……………..…………196

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A welcome message from our Chief Executive and

Chairman

The 2015/16 financial year has seen a further significant increase in demand for the range of emergency and urgent care services we provide, around 5%. In real terms we handle an extra 270 extra incidents a day when compared with this time last year and an extra 470 incidents a day compared with 2011/12.

During the past year we have treated over a million patients through the variety of services we offer, and our sincere thanks go to our workforce for their sustained commitment to patients. In order to show our support for their wellbeing we launched a Staying Well Service – the first of its kind dedicated solely aimed at supporting our staff both professionally and personally.

The NHS as a whole continues to transform and diversify in order to meet public demand and expectations, and our organisation is no different. A good example of how we are responding to this evolving landscape is the roll-out of our electronic care system (ECS). By capturing all patient data electronically it can be safely stored and shared with other organisations as required in order to enhance the care we provide.

By fully utilising the skills of our clinicians and empowering them to treat patients in a setting most appropriate for their clinical need we continue to be the best performing ambulance service for non-conveyance rates. In fact we treat over 50% of patients without the need to take them to an Accident and Emergency Department.

We remain committed to delivering the highest standards of clinical care in conjunction with a number of partner organisations incorporating the public and private sectors to further strengthen our response as a health community. By working together and acting on the valuable feedback we receive from patients and their families, we can make their experience of the NHS as seamless as possible.

As we await the publication of the CQC report into the NHS 111 service we prepare for our wider inspection of our 999 and out of hours services provided in Dorset and Gloucestershire. We are committed to making whatever improvements are necessary to ensure we keep our patients safe and provide them with the best possible care.

Heather Strawbridge OBE Ken Wenman

Chairman Chief Executive

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Overview of Performance

About us South Western Ambulance Service NHS Foundation Trust (SWASFT) provides a range of emergency and urgent care services to the people of the South West of England. We work in a way that upholds the values and pledges of the NHS Constitution and are proud to embrace innovation and actively promote best practice. SWASFT was the first ambulance service to be authorised as an NHS Foundation Trust on 1 March 2011. Since acquiring our former neighbouring trust Great Western Ambulance Service (GWAS) in February 2013, our operating area now covers a fifth of England. Our geographical area encompasses Cornwall and the Isles of Scilly, Devon, Dorset, Somerset, Wiltshire, Gloucestershire and the former Avon area (Bristol, Bath, North and North East Somerset and South Gloucestershire). SWASFT is recognised as an efficient NHS organisation. We deliver the 999 ambulance service across the south west and also provide the following:

Service line Name of service provided

Geographical area(s) served

Urgent care Out of hours medical care

Dorset, Gloucestershire and Somerset (until 30

June 2015)

Urgent care NHS 111 Cornwall, Devon, Dorset and Somerset (until 30

June 2015)

N/A Patient Transport Services

Bristol, North Somerset, South Gloucestershire and the Isles of Scilly

N/A Hazardous Area Response Team

(HART)

The entire Trust – one based at Bristol and one

at Exeter

We operate from over 100 sites, including 96 ambulance stations, six air bases and three emergency clinical hubs. We also have clinicians based in the heart of communities at treatment centres and minor injury units (MIU). We have three operational divisions (with our headquarters in Exeter, Devon):

East division – Dorset and Somerset (including North Somerset);

North division – Gloucestershire, Wiltshire, Bristol, South Gloucestershire, Bath and North East Somerset;

West Division – Devon, Cornwall and the Isles of Scilly.

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Our mission statement is: To respond to patients’ emergency and urgent care needs quickly and safely to save lives, reduce anxiety, pain and suffering.

Our vision is: To be an organisation that is committed to delivering high quality services to patients and continue to develop ways of working to ensure patients receive the right care, in the right place at the right time. To deliver our ambitious plans we have produced a second Integrated Business Plan (IBP2) covering the 2014/15 to 2018/19 financial years. This overarching strategy sets out how we intend to deliver our plans. The Trust‟s Operational Plan for the forthcoming year further sets out that 2016/17 will be a year of significant change and uncertainty1. The Trust is operating in the context of wide scale NHS reforms that are, and this will continue to have a material impact on the future operating model. Our Board of Directors comprises;

a Non-Executive Chairman, Mrs Heather Strawbridge OBE

a Chief Executive, Mr Ken Wenman

six Non-Executive Directors

five Executive Directors. Three of the Executive Directors, including the Chief Executive, are male and three are female. The Non-Executive Directors are split as three female, including the Chairman, and four male. As an NHS Foundation Trust, we have a Council of Governors and a membership base drawn from the general public and our staff. Governors are either elected by public and staff members or appointed by partnership organisations. More details about the Board of Directors, Council of Governors and our members can be found in the staff report on pages 79 of this document. We employ 4511 staff (who are mainly clinical and operational) staff plus a number of GPs. The gender split of the workforce is 57.9% male and 42.1% female. Further information can be found in our „valuing staff‟ section on pages 80. We have a set of corporate objectives, along with a clear mission, vision, values and strategic goals, and it is these that underpin everything we do. For further information visit our website www.swast.nhs.uk

http://www.swast.nhs.uk/

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Risks and uncertainties We are committed to developing a responsible risk management culture that supports all staff to make sound judgments and decisions concerning risk identification and management. Risks are identified at all levels of the Trust and the function is led by our Head of Patient Safety and Risk, with a clear escalation process in place. Risks are scored on a 5x5 matrix, the first relating to the impact of the risk and the second to the likelihood of it occurring. A value of 1 represents low impact or likelihood and 25 represents the most significant impact or likelihood. Where the risk value exceeds 14, risks are included on the Corporate Risk Register ensuring the Board of Directors is aware and able to assure itself that appropriate actions are being taken to manage and mitigate or remove each risk. It is important to recognise that all organisations face risks all the time. The key issue is that all risks are properly assessed and addressed and, in particular, high-level risks where the impact and likelihood are elevated, receive robust management attention to reduce the risk. The Corporate Risk Register is reported at each meeting of the Board of Directors and Quality Committee. In addition it is presented monthly to the Directors‟ Group.

The Directors‟ Group and the Board of Directors appraise all risks regularly and will continue to do so to ensure that our plans are well thought through and sufficiently robust to enable us to respond to the rapidly changing environment. More information about risks to the Trust can be found in the Annual Governance Statement on page 109. We have identified the key external factors that are likely to affect our business. As a provider of emergency 999 and urgent care services, our development is affected by external changes within the health and social care environment, as well as by wider economic and demographic changes. These are presented within the following summary:

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Political Economic Social Technological Legislative Environmental

Reorganisation of the NHS delivery structure following the General Election in May 2015.

Public sector financial deficit.

The ageing population is expected to continue to grow with the number of people aged over 85 in this Country forecast to double in the next 20 years. This will significantly influence the way in which health services are delivered.

National programme for information technology introducing the electronic care system.

Health and Social Care Act 2012 – changes to commissioning and providing structures and requirements.

Volatility in fuel prices and requirement to reduce fuel usage.

Increased encouragement of competition for services amenable to choice.

Changes to funding priorities and commissioning structures as a result of NHS reforms and new health policies.

Ongoing challenge of delivering a range of emergency and urgent care services within an area that is largely rural, sparsely populated and with an annual influx of over 17 million visitors.

Growth in use of social media.

NHS constitution –including new rights for patients.

Tougher environmental and sustainability targets.

Development of outcome-focused contracts (increased focus on quality of services).

National funding settlement for the NHS.

Continuing increased demand for round the clock ambulance services.

Development of specialist centres for specific services (beyond historic highly specialised services).

A tougher and continually changing regulatory regime by regulators.

Environmental factors including weather and pandemics.

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High profile reviews of standards of care in health and social care system such as the Francis and Winterbourne View inquiries.

Quality, Innovation, Prevention, Productivity (QIPP) programmes at differing stages across the South West region.

Recognition of needs of vulnerable adults and those with specific health needs within health contracts (safe-guarding, mental health, dementia, bariatric patients).

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Activities and achievements During 2015/16 key activities and achievements for the Trust include:

Launching the Staying Well Service (SWS) for staff in December 2015 – this dedicated, confidential support service is for our workforce to access with any concerns, they have, stemming from either their work or personal life. The SWS is provided in addition to the existing mechanisms of help and support.

Holding a hugely successful paramedic conference in February 2016, in conjunction with the University of the West of England, which over 300 students attended. The „better paramedic‟ event encouraged students from all over the country to join a number clinicians, who are experts in their fields, to get „hands-on‟ with patients and learn more about the specialist equipment and vehicles on display. The event generated a great deal of positive feedback.

Awarding our staff for over 1800 years of service between them at three award ceremonies.

Reuniting staff with the people who saved their lives.

Delivering the Airways-2 research project trialling different methods to manage a patient‟s airway when they are in cardiac arrest.

Statement from the Chief Executive, Ken Wenman During the 2015/16 financial year, the Trust faced a substantial increase in demand for its services from the public. This upward trend of call volumes is consistent with what we have experienced in previous years, but the increase this year is more significant and not commensurate with our anticipated activity levels. This has made our stringent, national performance targets, as well as those agreed locally with our commissioners, more challenging to achieve. For a detailed breakdown of our performance (by service line) refer to pages 13-41 in the following Performance Analysis section.

Going concern disclosure After making enquiries, the directors have a reasonable expectation that South Western Ambulance Service NHS Foundation 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. Please refer to page 194 for further information.

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Performance Analysis Performance against contract During 2015/16, the Trust received a total number of 911,378 emergency and urgent incidents. This was an increase of 5.06% in the total number of incidents when compared with 867,505 emergency and urgent incidents across the same period and geographical area during the 2014/15 financial year.

Background For 2015/16, the Trust had a single contract to deliver A&E (emergency 999) services for the South West. The single contract was commissioned by all 12 Clinical Commissioning Groups. In addition to this contract in 2015/16, we had contracts to provide a range of urgent care services throughout the South West:

From 01 April to 30 June 2015, the Trust held three contracts – Somerset, Dorset and Gloucestershire, however this reduced to two from 1 July 2015 when the Somerset contract was transitioned to a new provider. The remaining two Out of Hours contracts in Dorset and Gloucestershire, both of which were block contracts, with the Gloucestershire contract incorporating an element of variance if activity levels are not as anticipated. These were monitored against National Quality Requirements, local Key Performance Indicators (KPIs) and against activity (patient contacts) compared with the same period in the previous financial year in Dorset and contracted activity levels in Gloucestershire;

During 2015/16 the Trust held four contracts to provide NHS 111 services in Cornwall and the Isles of Scilly (Kernow), Devon, Dorset and Somerset. The Somerset contract was delivered for the period 01 April to 30 June 2015, before transitioning to a new provider following a tendering exercise by Somerset CCG in 2014/15. All other contracts were provided for the whole year, and are provided on a block basis with Dorset and Kernow incorporating elements of variance if activity levels are not as anticipated.

During 2015/16 the Trust continued to deliver the contract for the Tiverton Urgent Care Centre on behalf of Northern, Eastern and Western Devon CCG (NEW Devon CCG).

A number of smaller urgent care service contracts, including a Single Point of Access (SPoA) to healthcare professionals in Dorset, dental call handling and triage, Out of Hours services to prisons in Dorset and GP practice telephone cover.

In 2015/16 the Trust delivered Patient Transport Services for Bristol, North Somerset and South Gloucestershire and on the Isles of Scilly.

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Quality and wider performance issues for Urgent Care Services and Patient Transport Services are scrutinised throughout the year in order to ensure that patient experiences are as positive as they can be. Performance against contract in 2015/16 for each of our core services and for PTS is summarised in the following table.

Activity Levels and Contract Values for 2015/16 and 2016/17

Service-currency/activity measure

Contracted 2015/16

Actual 2015/16

Contracted 2016/17

Emergency 999 ambulance service – incidents

896,065 911,378 931,378

Out of Hours services – patient contacts

There is no contracted activity level. Monitoring is undertaken against activity for the same period in the previous financial year.

Dorset: 89,499 Somerset: 13,171* Gloucestershire: 100,419

There is no contracted activity level. Monitoring is undertaken against activity for the same period in the previous financial year. The contract for Somerset Out of Hours services ended on 30 June 2015.

NHS 111 – calls received

Cornwall: 205,948 Devon: 394,296 Dorset: 253,222 Somerset: 44,892

Cornwall: 162,987 Devon: 392,376 Dorset: 247,305 Somerset: 40,401*

Cornwall 200,002 Devon 409,203 Dorset 270,683 The contract for Somerset NHS 111 service ended on 30 June 2015.

Patient Transport Service – patient seats / journeys

Isles of Scilly operated on a block contract basis for 2015/16.

Bristol, North Somerset and South Gloucestershire = 101,806.

Isles of Scilly operated on a block contract basis for 2015/16.

Bristol, North Somerset and South Gloucestershire: 105,317

Isles of Scilly will operate on a block contract basis until 30 September 2016.

The contract for Bristol, North Somerset and South Gloucestershire runs to 30 September 2016. The CCGs will be tendering for this service from 1 October 2016.

* The contracts for the provision of Out of Hours services and NHS 111 services in the county of Somerset ended on 30 June 2015.

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Emergency 999 Ambulance Services (A&E) Challenging national targets for call categories are set by the Department of Health and apply to every ambulance service in England. The relevant targets are set out below, along with the performance levels achieved in 2014/15 and 2015/16.

Category A8 (Red 1): Total number of category A Red 1 incidents that may be immediately life threatening and the most time critical should receive an emergency response within eight minutes irrespective of location in 75% of cases. Eight minutes is just 480 seconds;

Category A8 (Red 2): Total number of category A Red 2 incidents presenting conditions which may be life threatening but less time critical than Red 1 and should receive an emergency response within eight minutes irrespective of location in 75% of cases;

Category A19: Category A incidents presenting conditions, which may be immediately life threatening and should receive an ambulance response at the scene (an equipped vehicle able to transport a patient in a clinically safe manner if required) within 19 minutes irrespective of location in 95% of cases.

2015/16 was a very challenging year, with the Trust managing a high level of uncertainty. The Trust‟s early participation in the national Dispatch on Disposition pilot led to a change in the dispatch and operating model from February 2015 and whilst this has undoubtedly assisted the Trust in ensuring a more tailored response for patients with the additional triage time allowed and also improved hear and treat rates, performance against the Red 2 target was directly impacted. This „unintended consequence‟ was recognised locally with a contract variation for Red 2 performance, from 75% to 70% target, agreed with NHS Commissioners from 1 July 2015 to 31 March 2016. Trust Red 2 performance of 63.60% for 2015/16 was 6.40% below the revised target of 70%. A&E Activity Increase Historically ambulance services have experienced year-on-year growth in demand for their services. In recent years, this level of growth has been in the region of 4% and 5%. The A&E contract for 2015/16 incorporated an uplift of 3.29% compared to the actual incident numbers reported in 2014/15. During 2015/16 the Trust saw an increase of 5.06% on A&E incident volumes compared to 2014/15 which was 1.71% above the contracted incident volume for 2016/17. The cumulative effect of the 5.06% increase in the current year, on top of a 9.75% increase reported in the previous year has resulted in unprecedented pressure on operational resources across all areas of the Trust. The year-on-year increase in incident activity has created a more challenging environment to deliver our response time performance targets. In April 2014 the Trust reported weekly incident volumes in the region of 15,600 incidents. During

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Quarter 4 of 2015/16 incident activity increased consistently to over 18,000 incidents per week, which equates to 342 additional incidents every day on average.

Source of A&E Incident Increase Our calls come predominantly from the public and Healthcare Professionals (HCPs), though incidents transferred from the NHS 111 service are also significant. When comparing activity levels year-on-year, whilst there was growth in the number of incidents received from the public calling 999, this increase was in line with contracted volumes. The most significant proportionate increase was the number of calls transferred to 999 from the NHS 111 service - this was 18.27% higher than in 2014/15. We continue to work closely with NHS 111 service providers across the South West, including where SWASFT provide the NHS 111 services in the counties of Devon, Cornwall and Dorset to manage the flow of appropriate incidents between the two services.

Source of Incident 2014/15 2015/16 Variance

Public Incidents 599,648 617,638 +3.00%

NHS 111 Incidents 136,278 161,175 +18.27%

HCP Incidents 131,579 132,565 +0.75%

Total Incidents 867,505 911,378 +5.06%

Other Factors Influencing Performance In addition to the ongoing increase in demand, our ability to achieve red performance targets is affected by many other factors. SWASFT is the most rural ambulance service in England and this has direct consequences for our performance, as the target is measured across the whole operating area and makes no allowances for rurality. Other factors impacting on performance included localised peaks in activity and the impact of increased hospital handover delays creating pressure points in the system. The total operational resource time lost to handover delays in excess of 15 minutes in 2014/15 was 23,297 hours (average of 64 hours per day), this increased to 25,744 hours in 2015/16 (average of 70 hours per day). This represents a 10.5% increase in the time lost by an average of 6 hours per day compared to last year. The year-on-year increase in handover delays (and particularly increases seen during Quarter 4 of 2015/16) has impacted on performance and reduced the time ambulance resources have been available to respond to incidents across our region. Capacity challenges at acute hospitals impacts on their ability to accept ambulance patients in a timely manner, particularly at times when increases in activity levels are being experienced. The Trust works extremely closely with NHS Commissioners and colleagues in acute hospitals (including local action plans for each hospital) to help manage the flow of patients into the hospital to reduce the impact on ambulance resources where possible.

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Other areas impacting on the Trust‟s performance in 2015/16 include:

changes made to the national Ambulance Quality Indicators (AQIs) in January 2016;

implementation of a single Computer Aided Dispatch (CAD) system in February 2016.

‘Measures to Improve Performance’ Following the pressures and challenges to red performance, the Trust developed a „Measures to Improve Performance‟ (MIP) plan which was introduced during quarter 2 of 2015/16. The MIP was reviewed in October 2015 and updated to reflect the actions required to deliver performance improvements during quarters 3 and 4 of 2015/16. These actions were outlined in addition to those identified within the A&E Operating Plan for 2015/16. The MIP actions focus on the following areas:

abstraction management including the management of sickness;

rota‟s and relief;

staff training;

clinical hub;

demand management;

call cycles;

procedures and processes;

communications (internal and external); As part of the mitigation plans of the Trust, meetings were held with all 12 CCGs during quarter 1 of 2015/16, with a view to agreeing actions to help manage the demand. These demand management plans address:

the management of transfers from NHS 111 to the A&E service;

reviewing care home activity;

frequent callers as part of a trust wide CQUIN scheme;

hospital specific reductions relating to handover delays;

actions to improve the contribution of Community Responders;

identification of locations within the health community which may benefit from the introduction of a public access defibrillator.

Performance against national targets To try and more effectively manage the increased demand levels within the ambulance service, the Trust has been working closely with NHS Commissioners, NHS England and the Association of Ambulance Chief Executives (AACE) to develop more effective and appropriate methods of dispatching ambulance resources. This includes prioritising the dispatch of ambulance resources to the most acute patients (i.e. red 1 incidents). In February 2015 SWASFT was delighted to have been chosen, in partnership with London Ambulance Service, to pilot a new way for ambulance services to respond to 999 calls. The Dispatch on Disposition (DoD) pilot allows call-handlers a small

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amount of extra time to triage the patient over the telephone before dispatching an ambulance resource to respond. This additional triage time does not apply to those incidents which are identified as immediately life-threatening (i.e. Red 1 incidents) where an ambulance resource continues to be dispatched immediately. The limited extra assessment time ensures that call handlers are able to better deploy resources where they are most needed. The additional triage time also provides an opportunity to identify the most clinically appropriate response to meet the needs of patients. In some cases this may not be an ambulance response, and patients may be better served by an immediate referral to another service (e.g. local GP, pharmacy or a walk-in centre). During the pilot the Trust has seen an increase in „hear and treat‟ rates. This means that patients are treated with over the phone advice as opposed to an ambulance attendance. SWASFT continues to work with NHS England, the Association of Ambulance Chief Executives (AACE), the College of Paramedics and the London Ambulance Service, and strict oversight and monitoring of the results and impacts of these service changes, including patient safety. Red 2 data from February 2015 onwards is not completely comparable across England. In January 2015, the Secretary of State for Health announced the introduction of Dispatch on Disposition (DoD), allowing up to two additional minutes for triage (to identify the clinical situation and take appropriate action). This was based upon clinical advice that it would be likely to improve the overall outcomes for ambulance patients. For Red 1 calls, the clock start time is still the instant that the telephone call connects. However, from 10 February 2015, all other calls received by SWASFT and other ambulance services participating in the pilot use DoD. During October 2015, DoD was rolled out further to other ambulance services and the potential extra time was increased further for SWASFT.

Key Performance Indicator National Target

%

Actual Performance

2014/15 %

Actual Performance

2015/16 %

Category A8 Red 1 75 75.24 73.72

Category A8 Red 2 75 71.42 63.60

Category A19 95 93.62 89.44

Ambulance services across England have reported challenges to performance during 2015/16, with the national average for Red 1 performance of 73.50%, Red 2

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performance of 69.12% and A19 performance of 93.37%. National average performance for all three metrics was below national target levels for the period 1 April 2015 to 31 January 2016. In light of the challenges to performance during 2015/16, performance against the national metrics of Red 1, Red 2 and A19 have reduced compared to 2014/15. Whilst the „Measure to Improve Performance‟ have mitigated the impact of some of these challenges we have seen an increase in the utilisation of operational resources (due to a combination of increased demand and increases in the time lost to handover delays) and a subsequent reduction in performance against all three performance metrics compared to last year. We continue to look at opportunities to improve the efficiency of the operational model for service delivery, including reduction in the number of inappropriate responses by ambulance resources which are an important factor in managing the increasing incident volumes for the ambulance service.

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Ambulance Clinical Quality Indicators (ACQIs)

Ambulance trusts are required to publish all data in relation to Ambulance Quality Indicators (ACQIs) on a monthly basis, both locally (on the Trust‟s website) and nationally (by the Department of Health). ACQIs are used to understand the quality of care provided, focussing particularly on the outcome of care provided for patients, as well as the speed of response provided to patients. Ambulance service providers use ACQIs to stimulate continuous improvements in the care they provide for patients. ACQIs were created to provide a comprehensive and balanced view of care and should be used as a complete set rather than focussing only on a few specific indicators. As a complete set, ACQIs provide a much fuller picture of how ambulance services are performing. ACQIs are designed to be consistent with measures in other parts of the NHS, most notably those in hospital emergency departments. Our ACQIs are reported in the Quality Report on page 138.

Urgent Care Services – out of hours (OOH) quality requirements

National targets for out of hours services are set out by the Department of Health (DH) and are applicable to every out of hours service in England. These targets do not exist for in-hours GP services or other healthcare professional clinical services. There are 13 quality requirements that specifically relate to OOH services. However, not all of these targets are applicable to all of the services delivered by SWASFT. This is dependent upon the service that is commissioned in each area. For example, quality requirements 8 and 9 no longer apply to our OOH services in Dorset, as the call taking and triage functions transferred to NHS 111 (which we provide). The following table sets out all quality requirements for our OOH services (with performance stated for 2014/15 and 2015/16). These have been rated red, amber or green (RAG). A rating of red means that the requirement has not been met (89% or lower), amber means partially met (between 90% and 94% inclusive) and green means fully met (95% or above). A number of actions were implemented to meet the changing pattern of demand within the OOH services. These included enhancing the triage capacity of the service, both within the formal hub locations as well as piloting a remote triage concept, whereby a small number of local GPs were provided with the appropriate IT equipment to allow them to undertake telephone triage from home. A review of shift patterns and associate pay schedules is underway, recognising the impact of the change in activity on both treatment centre and home visit service requirements.

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Urgent Care Services – Out of Hours Quality Requirements

NQR Number

National Quality Requirement (NQR)

RAG Ratings for 2014/15 RAG Ratings for 2015/16

Do

rse

t

So

me

rse

t*

Glo

uc

es

ters

hir

e

Do

rse

t

So

me

rse

t*

Glo

uc

es

ters

hir

e

NQR1 Providers must report regularly to Primary Care Trusts on their compliance with the Quality Requirements.

Green Green Green Green Green Green

NQR2

Providers must send details of all OOH consultations to the practice where the patient is registered by 0800 the next working day.


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NQR3

Providers must have systems in place to support and encourage the regular exchange of information between all those who may be providing care to patients with predefined needs (including patients with terminal illness).


NQR4

Providers must regularly audit a random sample of patient contacts. The sample must be defined in such a way that it will provide sufficient data to review the clinical performance of each individual working within the service


NQR5 Providers must regularly audit a random sample of patients‟ service experience (e.g. 1% per quarter)


NQR6

Providers must operate a complaints procedure that is consistent with the principles of the NHS complaints procedure


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NQR7

Providers must demonstrate their ability to match their capacity to meet predictable fluctuations in demand for their contracted service


It should be noted that NQRs 8 and 9 for the Out-of-Hours service are no longer applicable. These elements of the service are now being delivered by the NHS 111 service, with appropriate calls being transferred to the Out-of-Hours service.

Definitive clinical assessment for all other calls started within 60 minutes

Target no longer applicable: Calls are now routed through the NHS 111 service.

NQR10 (walk-in patients)

All immediately life threatening conditions to be passed to the ambulance service within three minutes of face to face presentation

This quality standard is not applicable to this service as a separate clinical assessment is not carried out in between presentation and clinical

consultation at walk-in centres.

NQR10 (walk-in patients)

All definitive clinical assessment for urgent cases presenting at treatment location started within 20 minutes

n/a n/a n/a n/a n/a Red**

All definitive clinical assessment for children who are ill and have an urgent Out of Hours to start within 15 minutes

n/a n/a n/a n/a n/a Red**

All definitive clinical assessment for less urgent cases presenting at treatment location started within 60 minutes

n/a n/a n/a n/a n/a Amber**

NQR10d At the end of the assessment, the patient must be clear of the outcome


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NQR11

Providers must ensure that patients are treated by the clinician best equipped to meet their needs in the most appropriate location


NQR12 (presenti

ng at base)

Emergency consultation started within an hour

Red Green Green Green Green Red

Urgent consultations started within two hours

Amber Amber Green Amber Amber Amber

Less urgent consultations started within six hours.


NQR12 (home visit)

Emergency consultations started within one hour

Red Green Green Green Green Red

Urgent consultations started within two hours

Amber Amber Amber Amber Amber Red

Less urgent consultations started within six hours

Green Green Green Green Green Amber

NQR13

Patients unable to communicate effectively in English will be provided with an interpretation service within 15 minutes of initial contact. Providers must also make appropriate provision for patients with impaired hearing or impaired sight


* The contracts for the provision of Out of Hours services and NHS 111 services in the county of Somerset ended on 30 June 2015. **Walk in patients only form part of the contract for the Out of Hours service in Gloucestershire which commenced on 1 April 2015.

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Urgent Care Services – NHS 111 Quality Requirements

SWASFT delivered four of the NHS 111 services across the counties of Cornwall and the Isles of Scilly, Devon, Dorset and Somerset in 2015/16. The Somerset contract was delivered for the period 01 April to 30 June 2015, before transitioning to a new provider following a tendering exercise by Somerset CCG in 2014/15. All other contracts were provided for the whole of 2015/16. As with OOH services, national quality targets are set out by the DH for NHS 111 services and are applicable to every service in England. There are 12 quality requirements that specifically relate to the NHS 111 service. The main challenges for the service have been achieving the targets relating to the percentage of calls being answered within 60 seconds, as well as the percentage of abandoned calls. We have worked with commissioners to develop and deliver an improved trajectory for these areas.

The primary focus for Devon, Dorset and Cornwall 111 services during the reporting period relates to recruitment and retention, with further training and support, aiming to provide more staff at key times to respond to calls, and through these quality measures, a reduction in the turnover rate. Overall this plan has been successfully delivered, with the service provision seen over the Christmas and New Year period 2015-16 achieving above the predicted trajectory. During this time additional resilience was provided for other 111 services who had to invoke national contingency at this time. In March 2016, the CQC carried out an inspection of the NHS 111 services provided by the Trust. The formal report of this inspection, which was triggered by adverse media coverage, has not been published at the time that the Annual Report was produced. As a result of the allegations made, the Trust commissioned an independent review by PwC. The tables overleaf set out each of the quality requirements, with performance stated for each of the four services for 2015/16. These have also been „RAG‟ rated (see above for explanation).

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NQR Number


RAG Rating for 2014/15

RAG Rating for 2015/16

Cornwall Devon Dorset Somerset*

NQR8a No more than 0.1% of calls engaged.

Green Green Green Green Green

NQR8b No more than 5% of calls abandoned.

Red Amber Amber Green Red

NQR8c Calls to be answered within 60 seconds of the end of the introductory message.

Red Red Red Red Red

NQR9

All immediately life-threatening conditions to be passed to the ambulance service within three minutes.

Green Red Green Amber Green

NQR13

Patients unable to communicate effectively in English will be provided with an interpretation service within 15 minutes of initial contact. Providers must also make appropriate provision for patients with impaired hearing or impaired sight.

Green Green Green Green Green

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Urgent Care Services – NHS 111 Quality Requirements

NQR Number


RAG Rating for 2014/15 RAG Rating for 2015/16

Cornwall Devon Somerset Dorset Cornwall Devon Somerset* Dorset

NQR1

Providers must regularly report to NHS commissioners on their compliance with the Quality Requirements.

Green Green Green Green Green Green Green Green

NQR2

Providers must send details of all consultations (including appropriate clinical information) to the practice where the patient is registered by 08:00 hours the next working day.

Green Green Green Red Red Red Red Red

NQR3

Providers must have systems in place to support and encourage the regular exchange of information between all those who may be providing care to patients with predefined needs.


NQR4

Providers must regularly audit a random sample of patient contacts (audit should provide sufficient data to review the clinical performance of each individual working within the service).


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NQR Number




NQR5

Providers must regularly audit a random sample of patient experiences of the service (e.g. 1% per quarter).

Red Red Red Red Green Red Red Red

NQR6

Providers must operate a complaints procedure that is consistent with the principles of the NHS complaints procedure.


NQR7

Providers must demonstrate their ability to match their capacity to meet predictable fluctuations in demand for their contracted service.

Red Red Red Red Red Red Red Amber

NQR8a

No more than 0.1% of calls engaged.


No more than 5% of calls abandoned.

Amber Amber Amber Green Amber Amber Red Green

NQR8b Calls to be answered within 60 seconds of the end of the introductory message.

Red Red Red Red Red Red Red Red

NQR9a

All immediately life-threatening conditions to be passed to the ambulance service within three minutes.

Green Green Amber Amber Red Green Green Amber

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NQR Number




NQR9b Patient call-backs must be achieved within 10 minutes.

Red Red Red Red Red Red Red Red

NQR13

Patients unable to communicate effectively in English will be provided with an interpretation service within 15 minutes of initial contact. Providers must also make appropriate provision for patients with impaired hearing or impaired sight.


NQR14

Providers must demonstrate the online completion of the Information Governance Toolkit at Level 2 or above and that this is audited on an annual basis by Internal Auditors using the national framework.


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NQR Number




NQR15

Providers must demonstrate that they are complying with the Department of Health Information Governance SUI Guidance on reporting of Information Governance incidents appropriately.



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Urgent Care Services – Tiverton Urgent Care Centre SWASFT delivered services at the Tiverton Urgent Care Centre for the whole of 2015/16. The Trust is measured against two key targets under this contract, both measuring timeliness. The first is the national indicator of A&E Clinical Quality measuring the total time spent in A&E – the target is to treat 95% of patients within four hours. The second indicator is a local one relating to the triage of patients within 15 minutes and this also has a 95% target. The Trust consistently delivers strong performance against both indicators.

Key Performance Indicator National Target

%

Actual Performanc

e 2014/15 %

Actual Performance

2015/16 %

Percentage of cases completed within 4 hours

95 99.43 99.77

Patient Transport Service (PTS) Our patient transport services provide non-urgent journeys for patients who have a medical need, including attending outpatient appointments, admission to or discharge from hospital and transfers between hospitals. The Trust delivered in excess of 99,900 patient journeys in 2015/16 in Bristol, North Somerset and South Gloucestershire, as well as activity as part of a smaller contract for PTS on the Isles of Scilly. Feedback from patients continues to be overwhelmingly favourable and forms a valuable and crucial measure of how well our organisation performed. Our recent patient surveys include the Friends and Family Test, the outcome of which is that 92% of respondents would recommend PTS. During 2015/16, the Trust focussed on improving the timeliness of the service delivered to patients and invested in new ways of working to drive efficiencies and better utilise our available resources. This approach, together with a rigorous focus on value for money, ensures that resources are used wisely to deliver a high quality PTS service to our patients and commissioners. The tables overleaf set out performance for 2014/15 and 2015/16 against the locally agreed PTS targets.

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Key Performance Indicators – Bristol, North Somerset and South Gloucestershire

Locally agreed Target %

Actual Performance 2014/15 %


1a. Patients living up to 10 miles away from the treatment

centre (Band A) should not spend more than 60 minutes on

the vehicle on either an outward or return journey.

(Green >90%, Amber 80-90%, Red <80%)

90% 91.99% 92.05%

1b. Patients living over 10 miles and up to 35 miles away

from the treatment centre (Band B) should not spend more

than 90 minutes on the vehicle on either an outward or

return journey.

(Green >90%, Amber 80-90%, Red <80%)

90% 93.20% 95.64%

1c. Patients living over 35 miles away from the treatment

centre (Band C) should not spend more than 120 minutes

on the vehicle on either an outward or return journey.

(Green >90%, Amber 80-90%, Red <80%)

90% 97.50% 100%

2a. Patients should not arrive more than 45 minutes before

their booked arrival time.

(Green >90%, Amber 80-90%, Red <80%)

90% 87.64% 89.33%

2b. Patients should not arrive after their booked arrival time.

(Green >97%, Amber 87-97%, Red <87%) 97% 89.78% 90.62%

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3a. The Trust is to arrive to collect patients from the agreed

location within 45 minutes of the outward journey time.

(Green >90%, Amber 80-90%, Red <80%)

90% 87.76% 90.35%

3a. The Trust is to arrive to collect patients from the agreed

location within 75 minutes of the outward journey time.

(Green >90%, Amber 80-90%, Red <80%) 90% 94.95% 95.79%

3b. A summary of reasons and actions to be provided, for each month, for all cases where collection was outside of the KPI limits. This may include case by case analysis as deemed necessary.

Green Green Green

8c. Pick-up time to be confirmed by text, email or phone call

to the patient within a week of the appointment (phone call

being the preferred method).

(Assessed quarterly)

100% 100% 100%

9a. Patient satisfaction with the level of service received

from the provider. This is assessed through the annual

patient satisfaction survey.

(Green >85%, Amber 75-85%, Red <75%)

85% 97.80% 97.80%

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9b. NHS commissioners to be satisfied with the level of

service.

(Green = no issues or minor concerns resolved within 1

month)

(Amber = minor issues and not resolved within 1 month or

major issues resolved within 1 month)

(Red = major issues not resolved within 1 month)

Green Green Green

9f. Telephone answering.

(Green >95%, Amber 85-95%, Red <85%) 95% 95.12% 95.85%

10a. Agreed activity performance report received in correct format and on time within 10 working days of the start of the following month.

100% 100% 100%

10b. Activity and finance queries are acknowledged within 3 days of receipt and resolved within 28 days from the date of the query.

100% 100% 100%

12d. Compliance with the agreed Trust complaints

procedure – full response made in a timely manner agreed

with the complainant.

(Assessed quarterly)

100% 100% 100%

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12h. Nil Serious Untoward Incidents (SUIs). Any SUIs are to

be reported and action plans put in place, in line with NHS

Bristol standards and timeframes (reported immediately;

investigated within 24 hours and lessons learnt shared, then

closed within 60 working days of the incident).

(Green - No SUIs, Amber – SUIs reported but resolved within timeframe, Red SUIs reported but not resolved within timeframe)

100% 100% 100%

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Commissioning for Quality and Innovation (CQUIN) 2015/16 Lord Ara Darzi introduced the „High Quality Care for All‟ NHS reforms in 2008, which included a commitment to make a proportion of providers‟ income conditional on quality and innovation, through the NHS Commissioning for Quality and Innovation (CQUIN) payment framework. The tables that follow set out the Trust‟s CQUIN targets for each service for 2015/16. For emergency 999 (A&E) services, seven CQUINs were agreed with commissioners for 2015/16, representing 1.5% (£2.697 million) of our block contract. The Dorset Out of Hours contracts included local CQUIN schemes totalling 2.5% (£189,329) of the contract value, as presented below. CQUIN did not form part of the NHS 111 contracts, Gloucestershire Out of Hours contract or the Patient Transport Service contract. For 2015/16, the Trust achieved all of its CQUIN targets for emergency 999 (A&E) services and the Dorset Out of Hours service, and is therefore receiving the full contracted value for the CQUIN schemes.

Emergency 999 Ambulance Services (A&E) CQUIN 2015/16

CQUIN Target Description Indicator Name

Contracted Value £

Actual Value £

Promote evidence-based assessment and management of unwell children and young people for the six most common conditions when accessing 999 ambulance services

Paediatric Big 6

492,255 492,255

Explore the potential for Paramedics to practice enhanced wound care skills, traditionally practiced by Specialist Paramedics in Urgent and Emergency Care. This would enable the Paramedic to treat patients more effectively on-scene, potentially reducing the need for hospital admission. The CQUIN would also explore other clinical skills which may be included under the enhanced care umbrella.

Enhanced Skills

492,255 492,255

Improve the management of Frequent

Callers who present to the ambulance

service and across multiple patient facing

organisations.

Frequent

Callers 492,255 492,255

Develop a more consistent approach to transfers of care between urgent and emergency care providers. Improve understanding of patient safety concerns

Clinical Handovers

492,255 492,255

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Contracted Value £

Actual Value £

resulting from handovers in delay and subsequent delays in ambulance response to 999 calls. Identify opportunities to better meet HCP demand for A&E ambulance conveyance to hospital.

Review the provision of the new Alcohol Recovery Centre (ARC) in Bristol, to assess for a wide range of potential opportunities for the Trust to support initiatives aimed at mitigating the impact that alcohol has on the wider health economy. Determine how an Alcohol Recovery Unit (smaller scale support in same context as an ARC for town centres) could be developed and utilised.

Alcohol 242,756 242,756

Increase focus on Health Care Professional (HCP) calls in order to identify patients who may be more appropriately conveyed by PTS level resources operated by the private provider. The CQUIN will foster a closer working relationship between SWASFT, NEW Devon CCG, Torbay CCG and the private PTS provider.

Integrating Transport

242,756 242,756

Optimise use of Specialist Paramedics - Urgent and Emergency Care (SPUEC) Urgent Care Cars (UCC) to increase the number of people SWASFT see and treat, reduce conveyances to Treliske Emergency Department and SWASFTs overall conveyance rate to Treliske ED.

Increasing Utilisation of Specialist Paramedics

242,756 242,756

Total 2,697,288 2,697,288

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Dorset Out of Hours Service CQUIN 2015/16

Target Description Indicator Name Contracted

Value £

Actual Value £

The Out of hours service is recognised

as picking up requests for repeat

prescriptions from patients, that ideally

should have been managed during

working hours by their GP practice or

pharmacy. The CQUIN will enable

specific feedback to GP practices where

patients are using the UCS for repeat

prescriptions, working with Dorset CCG

to identify and resolve the potential

causes of the behaviour.

Repeat

Prescriptions 28,399 28,399

Sepsis can affect anyone at any time but

it does tend to strike more often people

at the extremes of life, the very young

and the very old. This CQUIN aims to

improve the recognition assessment and

management of patients with sepsis, by

utilising recognition tools for clinicians

and providing educational material.

Sepsis Screening

and management 37,866 37,866

A retrospective audit of prescribing to

assess appropriateness against national

guidance and provide feedback to the

prescriber to inform future prescribing

decisions.

In order to assess whether clinicians are

prescribing appropriately a retrospective

audit of clinical records would be

needed.

Antibiotic

Stewardship 28,399 28,399

The CQUIN focuses on increasing staff

support and engagement within the East

Clinical Hub and other resources.

Staff Support &

Engagement 94,665 94,665

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Commissioning for Quality and Innovation (CQUIN) 2016/17 For emergency 999 (A&E) services, four CQUINs have been agreed with our commissioners for 2016/17, representing 1.5% of the Trust‟s block contract.

Emergency 999 Ambulance Services (A&E) CQUIN 2016/17


Contracted Value £

Trust wide A key part of improving health and wellbeing for staff is giving them the opportunity to access schemes and initiatives that promote physical activity, provide them with mental health support and rapid access to physiotherapy where required. The role of board and clinical leadership in creating an environment where health and wellbeing of staff is actively promoted and encouraged.

Staff Health and Wellbeing

TBC

East and North Division Focusing on the management of older patients who have fallen and are at risk of further falls, the CQUIN will foster a closer working relationship between SWASFT and local community and primary care providers. This will support system wide objectives to reduce occurrence of falls and admissions as a result of falls.

Falls TBC

West Division The Trust is currently piloting a new model of service delivery within the NEW Devon CCG area. The overarching aim of this pilot is to establish whether the Trust can safely increase the proportion of Green 4 incidents that can be safely managed by a resource other than an emergency ambulance. This CQUIN aims to share the learning from the pilot to understand potential scalability across the Torbay Kernow CCG areas.

Transport TBC

Total £2,795,806

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Dorset Out of Hours CQUIN 2016/17 Dorset CCG has indicated that Dorset Out of Hours CQUIN schemes in 2016/17 will be developed to support the work of the Integrated Urgent Care Access and Advice Centre (IUCAAC). As a result the CCG has asked the Trust to continue with the 2015/16 CQUINs in Q1 of 2016/17, which represent 2.5% of the 2016/17 contract value, whilst the IUCAAC specification is agreed.

The core vision for the IUCAAC builds upon the work of NHS 111 in simplifying

access for patients. The aim is to deliver a single entry point to access fully integrated urgent care services which deliver high quality, clinical assessment, advice and treatment with clear accountability and leadership. Central to this is the development of an „Integrated Clinical Hub‟ offering patients who require it access to a wide range of clinicians, both experienced generalists and specialists.

Environmental Matters (the impact of our business on the environment) The nature of businesses provided by the trust, coupled with the extensive geographical area we cover, means that there is inevitably an impact on the environment. We acknowledge and take responsibility for the impact of our activities and operations on the local, regional and global environment and remain committed to reducing any adverse effects. Everyone in the organisation is encouraged and expected to take responsibility for environmental measures such as reducing energy consumption, fuel saving and waste reduction. We use environmental monitoring and reporting to quantify the environmental and social effects of our service delivery and work towards the goals set out in the NHS Sustainable Development Strategy. We have our own environmental policy and strategy and, in addition, have a dedicated Environmental Management Group (EMG) responsible for championing our green agenda and for reviewing and monitoring progress against our environmental objectives.

Social, community and human rights issues As the most rural ambulance service in the country SWASFT serves many isolated communities, which can be difficult to access quickly. Additionally, Cornwall is a peninsula, which presents its own unique challenges. The south west has the highest proportion of pensionable age people in the country and is home to some groups deemed „hard to reach‟ like the farming community for example. There are pockets of socio-economic deprivation across the region too, with many people residing in these areas suffering from long term conditions such as diabetes and COPD. All of these factors affect the way that the Trust delivers its services. The ongoing increase in activity has the most significant impact on service delivery. The number of calls from the public has doubled in the past 10 years and SWASFT needs to respond to this ongoing rise in demand. One way that we have responded

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and further assisted patients in more rural communities is by increasing the number of responders in operation. Responders are invaluable and highly regarded volunteers who have been trained to attend certain medical emergencies and deliver basic life support, oxygen therapy and defibrillation. We have 5229 individual responders across our operational area including 807 Community First Responders (CFRs), who are trained volunteers that provide support to their local communities by attending certain emergency calls (especially time critical ones like cardiac arrests) whilst an ambulance is on its way. CFRs provide an invaluable service, both to the ambulance service and local communities within which they work. Additionally, there are members of SWASFT staff who voluntarily respond to incidents whilst off-duty. The Trust is also provided with greatly valued support and assistance from colleagues working in other organisations including the RNLI, St John Ambulance CFRs, Fire Co-Responders and BASICS Doctors (members of the British Association for Immediate Care) who volunteer to attend emergencies, supporting ambulance clinicians and providing enhanced care for patients. The placement of defibrillators within communities for public access has also increased. There are now 1148 public access defibrillators supported by SWASFT, which can be accessed by anyone around the clock, and 1136 static site defibrillators. Defibrillator initiatives help improve cardiac arrest survival rates by being available at the time of need. SWASFT takes equality, diversity and human rights very seriously and is committed to promoting equality of opportunity in its employment practices and in its provision of care. Human rights issues are covered by our Single Equality Scheme, which aims to make „diversity, equal opportunities and human rights a reality‟. Through the implementation of this scheme, we aim to ensure that human rights are at the centre of our work and integral to all our functions, policies, strategies and procedures as a means of eliminating institutional and individual discrimination. In addition to the Single Equality Scheme, the new Equality, Diversity and Human Rights Strategy for 2016-2020 is currently being developed and will outline the Trust‟s commitment to advancing equality and celebrating diversity. See more in our Equality and Diversity section on page 82.

Important events since year-end Between 31 March 2016 and the publication of this document, SWASFT has continued its pilot of Dispatch on Disposition (DoD), the results of which have led to the implementation of the next stage of the programme. Further information about DoD can be found on page 144. The introduction of this new way of triaging and prioritising calls aims to improve the quality of ambulance responses provided to patients and address the ongoing, unprecedented demand for ambulance services nationwide. In March 2016, the CQC carried out an inspection of the NHS111 services provided by the Trust. The formal report of this inspection will be published in 2016/17.

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Overseas operations The Trust has no overseas operations.

Ken Wenman Chief Executive Officer 23 May 2016

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Directors’ Report There are thirteen Directors on the Trust Board of Directors. The Chief Executive of the Trust is Ken Wenman and he leads a team of five Executive Directors:

Jennie Kingston, Deputy Chief Executive/Executive Director of Finance

Jenny Winslade, Executive Director of Nursing and Governance

Emma Wood, Executive Director of HR and Organisational Development

Dr Andy Smith, Executive Medical Director

Francis Gillen, Executive Director of IM&T The Trust Non-Executive Chairman is Heather Strawbridge OBE. There are six independent Non-Executive Directors:

Dr Ian Reynolds

Paul Love

Baroness Watkins of Tavistock - and Vice-Chairman

Venessa James

Hugh Hood

Tony Fox – Senior Independent Director

In 2015/16 Robert Davies and Chris Kinsella also served as Non-Executive Directors.

None of the Directors or Governors has any company directorships or other significant interests held which may conflict with their management responsibilities. All Executive and Non-Executive Directors have an annual appraisal. The Chief Executive leads the appraisal arrangements for the Executive Directors and the Chairman leads on the Non-Executive Directors appraisals. The Senior Independent Director leads on the appraisal of the Chairman. The Committees review their effectiveness on an annual basis and last year made changes to how the Governance Committee and the Audit and Assurance Committee operated. In March 2016 the Trust Board of Directors updated their declaration of interests, and the Register of Interests that the Trust maintains is open to the public. This is available on the Trust website www.swast.nhs.uk or a copy can be obtained by contacting Marty McAuley, Trust Secretary, Trust HQ, Abbey Court, Eagle Way, Exeter, EX2 7HY or by calling 01392 261500. The Trust has not made any political donations in 2015/16.


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Profiles of the Board of Directors Heather Strawbridge OBE, Chair Heather has a wealth of experience and extensive understanding of large and complex organisations, particularly in the public sector. She has led organisations through significant change and has brought many successful partnerships together. During the time that Heather has been Chairman of SWASFT she has led the Board through the merger of Westcountry Ambulance Service and Dorset Ambulance Service to form SWASFT; has seen the organisation become one of the first Ambulance Trusts to achieve Foundation Trust status, and in 2013 led the Board through the acquisition of Great Western Ambulance Service NHS Trust. Heather has been involved in many regional and national organisations and continues to bring a national perspective to the Board. She is a Trustee of the NHS Confederation; Chair of the NHS Confederation Urgent and Emergency Care Forum and Chair of the HFMA Chair, NED and Lay Member Faculty. She is also a Non-Executive Director for Somerset Care Ltd (a care and training company). In 2016 she was awarded an OBE for services to health and care. Ken Wenman, Chief Executive Ken joined the NHS at age 21 years and has undertaken many senior roles within the Ambulance Service, including operational management and training. Ken is a State Registered Paramedic and was instrumental in establishing the Paramedic Register. He has a Masters in Management (Plymouth University). Ken leads the ambulance sector nationally on HR & Workforce and more recently has taken on the Chief Executive lead roles for IM&T and Operations for the national ambulance groups and is a member of the Board of the Association of Ambulances Chief Executives (AACE). He is the nominated Trust‟s (SWASFT) individual for the Care Quality Commission. Jennie Kingston, Deputy Chief Executive/Executive Director of Finance Jennie joined the NHS in 1990 as a graduate finance trainee and qualified as a Chartered Certified Accountant in 1993. Jennie has a BSc Hons (University of Birmingham) and she completed the Case Business School, London, Strategic Financial Leadership Course in 2008. Jennie recently graduated from the NHS South West Top Leaders Programme cohort and is the Chair of the National Ambulance Directors of Finance Group and member of the Board of the Association of Ambulances Chief Executives (AACE). Jennie was appointed to the Trust (SWASFT) in November 2008, which followed a period of secondment commencing in January 2008. Prior to commencing on a career in finance, Jennie served an eight year short service commission in the Royal Air force.

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Jennifer Winslade, Executive Director of Nursing and Governance Jenifer was appointed as NHS Devon, Plymouth and Torbay Director of Nursing in June 2010, having previously been the Executive Board Nurse for NHS Devon, covering quality and patient safety. Before 2007 Jennifer worked for East Devon Primary Care Trust as the Deputy Director of Nursing, combined with a lead role for children‟s services. Jennifer qualified as a nurse in 1991, initially working in acute and intensive care services in the UK before leaving to spend two years living and working in the USA. She then returned to the UK and trained as a district nurse and health visitor. Jennifer was appointed as the Trust‟s (SWASFT) Executive Director of Nursing and Governance in June 2014. Emma Wood, Executive Director of HR and Organisational Development Emma has 19 years‟ experience working in Human Resources. Her specialisms include Employee Relations and Engagement, Organisational Design and Development, Resourcing and Talent Development. Emma holds a BA in Psychology and Education and an MSC in Integrated Professional Practice from UWE. She is a Chartered Fellow of the Chartered Institute of Personnel and Development Her career started in the private sector with an IT software development company and she fulfilled managerial roles in the technology and food sector until she joined the Grafton Group, an international recruitment group, in 2002, as HR Account Manager and later Director of HR and MD for the recruitment outsourced and consultancy brand Grafton ESP whose client base featured clients CISCO, Microsoft and the Police Service. In 2009 Emma used her insights into Policing to move to Avon and Somerset Constabulary as Strategic Director of Human Resources. Emma led many regional collaborations joining neighbouring Forces together to improve interoperability and national projects, particularly in the specialism of resourcing. Emma was appointed to the Trust (SWASFT) as Executive Director of HR and Organisational Development in May 2014. Francis Gillen, Executive Director of IM&T Francis has 30 years‟ experience in IM&T. He is principally responsible for SWASFT‟s IM&T Strategy and also has a wider programme management involvement. His significant achievements include managing Airwave, CAD, Electronic Patient Records, III Telephony systems, NHS 111 Service programmes, along with major estates programmes including HART, ASOC and the new Bristol Ambulance Station. Francis is a qualified electrical engineer, has an ITIL Managers Certificate, is a Prince II Practitioner and has an MBA (Edinburgh Business School). Francis was appointed to the Trust‟s (SWASFT) role of Executive Director of IM&T in March 2013.

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Dr Andy Smith, Executive Medical Director Andy has been a GP in Devon since 1997 and has been actively involved in medical management. He has a Bachelor of Science Hons Microbiology (University of Bristol), Bachelor of Medicine & Surgery MB Ch.B. (University of Bristol), Post Graduate Diploma of the Royal College of Obstetricians and Gynaecologists, Diploma in Child Health. His interests have always included urgent and emergency care. He helped establish the „out of hours‟ GP service in his area. Prior to his appointment to the role of Executive Medical Director, Andy was the Associate Director of Primary Care Services for the Trust since April 2008. Andy was appointed to the role of the Trust‟s (SWASFT) Executive Medical Director on 1 February 2010 and is joint Board Champion for Clinical Quality and is the Trust‟s Caldicott Guardian. He is a member of the Royal College of General Practitioners, and responds to 999 calls as an ambulance Doctor. Non-Executive Directors Baroness Mary Watkins, Vice Chairman Mary has worked extensively in senior healthcare posts in both University and NHS settings. Her particular expertise is in the field of mental health and she has a wealth of experience of working in partnership with Social Services and the Voluntary sector. Mary is Board champion for governance and patient safety and has a keen interest in health economics. She has a Diploma in Nursing, General and Mental Health Diploma in Nursing, Masters in Nursing (Distinction), holds a Doctor of Philosophy (Science) from King‟s College London, and is a graduate of the Civil Service Top Management Programme. Mary was appointed a Life Peer in 2015; The Baroness Watkins of Tavistock. Mary was appointed to the Trust as a Non-Executive Director on 1 August 2006. Tony Fox, Non-Executive Director Tony has over 30 years senior leader experience of managing large and complex operations and has held numerous senior positions within Royal Mail. Tony is a member of the Royal Mail Letters Executive team and reports to the Managing Director of Royal Mail. Tony is also a Board Member for Opportunity Now. Tony brings to the Board of Directors a wealth of operational and strategic commercial experience with a track record of motivating and managing transformational change programmes and employee relations in a highly Unionised environment Tony was appointed to the Trust as Non-Executive Director in February 2013 and is the Senior Independent Director.

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Venessa James, Non-Executive Director Venessa has a vocational background in general nursing, social work and teaching. An experienced senior manager, she has held executive, board-level appointments in the private education sector and the NHS. Her specific areas of expertise include corporate governance and commissioning services for people with complex care needs, from which she brings a wealth of experience in partnership, collaborative and contractual working arrangements with NHS organisations, social services and the independent care sector. Venessa is Board champion for Social Care and the Duty of Candour, and she has a keen interest in applied health psychology research. She holds qualifications in business management and teaching, including the Masters-equivalent DTEFLA, and is currently studying for a Masters in Advanced Psychology at Plymouth University. She was appointed as a Non-Executive Director to the Trust (SWASFT) in June 2014. In January 2016 she became Chair of the Quality Committee. Paul Love, Non-Executive Director / Chairman of Audit and Assurance Committee Paul qualified as an accountant with the Audit Commission, and has 12 years‟ experience as a Finance Director within the housing and "welfare to work" sector. He currently supports Local Authorities on change management within social care. Paul has significant Board level experience within public service organisations and currently serves as a non-executive Director for the DCH group, a housing and regeneration organisation that operates in Devon and Cornwall. He was appointed as a Non-Executive Director of the Trust (SWASFT) in July 2015 and is Chairman of our Audit and Assurance Committee. Hugh Hood, Non-Executive Director Hugh is a qualified Human Resources practitioner who has extensive business experience in both the public and private sectors where he has been instrumental in defining and delivering substantial change programmes. Currently, Hugh is a BT Group Director and is part of BT Group‟s Human Resources leadership team with key input on BT‟s strategy for the future. He is also Chairman of BT Lancashire Services Ltd. He holds an MSc in Digital Systems Engineering and BSc in Physics from the University of Manchester, and a Post Graduate Certificate in Organisation Development from the University of Sussex. Hugh was appointed to the Trust as a non-Executive Director on 1 January 2010. Ian Reynolds, Non-Executive Director Dr Ian Reynolds has a healthcare, science and regulatory background in both public and private companies.

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Ian was previously Deputy Chairman of the Food Standards Agency, Chairman of the Meat Hygiene Service and Chairman of the Greyhound Regulatory Board and NED for Bedfordshire and Hertfordshire Strategic Health Authority. Ian is currently also Chairman of Chime, a social enterprise company. During Ian's executive career he was Chief Executive of Nottingham Health Authority and of Priory Hospitals. Achievements include acquisitions and company turnarounds in animal health pharmaceuticals, saving the Nottingham site of the raising of the Royal Standard where King Charles started the civil war for the nation and increasing standards in the Meat Hygiene Service to better protect the public. He was appointed to the Trust (SWASFT) as a non-Executive Director in July 2015.

Sickness and absence data Information pertaining to sickness and absence data can be found on pages 80-81 of the staff report.

Cost allocation and charges for information

South Western Ambulance Service NHS Foundation Trust has complied with HM Treasury‟s guidance on setting charges for information.

Better payment practice code The Trust has signed up to the better payment practice code. The Better Payment Practice Code requires the Trust to aim to pay all undisputed invoices by the due date or within 30 days of receipt of goods or a valid invoice, whichever is later. The Trust received 46,662 invoices and processed 45,026 in line with the code.

Interest paid under the Late Payment of Commercial Debts (Interest) Act 1998 The amount paid in interest for late payments during 2015/16 is £572.37.

Principles for remedy Further details about the „principles for remedy‟ can be found in the patient experience section on page 50.

Enhanced quality governance reporting An Annual Governance Statement has been developed to provide assurance on the strength of the Trust‟s systems of internal control. This includes an enhanced section on quality governance arrangements, outlining how assurance is provided to support the Board in making its quarterly submissions to Monitor against the conditions of the provider licence, and also supporting development and submission of the annual self-certification statements required by Monitor. The Statement was approved by the Trust‟s Audit and Assurance Committee at its meeting on 19 May 2016 and was endorsed by a Head of Internal Audit Opinion of significant assurance.

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The Trust Board of Directors reviews the Risk Register and Board Assurance Framework (BAF) at each meeting. This includes a quality assurance score, which rates the quality/robustness of the assurance/evidence provided for each area/indicator within the assurance framework. The Board of Directors scrutinises the Trust‟s Integrated Corporate Performance Report which includes all key performance indicators and targets with any trajectories set; and any areas which are off plan, together with mitigating actions. They also receive a Patient Safety and Experience report which presents key information around learning from patient feedback and incident and complaint investigation, including themes and trends identified and action taken as a result. An internal audit review in April 2016 confirmed that the Trusts new BAF and associated documents have been appropriately constructed. The changes made were referenced as representing a significant evolution of its design and use by the Board. The Directors Group also review any amber rated internal audit reports as part of the audit finalisation/approval process. The BAF cross references the relevant risk register associated with the achievement of their objectives and details the control assurances (internal and external) already in place. Gaps in control and/or assurance are identified and clear action plans to address weaknesses are set out. KPIs, Director responsibilities and Monitoring Forums are also included within the document. The purpose of the Audit Committee is to ensure that a Non-Executive committee of

the Board reviews and seeks assurance on the effectiveness of processes in place for

the management of arrangements for Governance, Risk Management, Clinical

Assurance, Internal Control, and Financial Reporting. The Committee ensures the

Trust and its External Auditor remain compliant with Monitor's Audit Code for NHS

Foundation Trusts and conditions of license. The Audit Committee is supported by

internal audit, external audit and a counter fraud service.

PricewaterhouseCoopers (PwC) were appointed Auditors of the Trust in 2012/13 and

this is the fourth audit they have undertaken. PwC attend every committee meeting to

report on progress and developments likely to affect the year-end audit and

accounts. In 2015/16 they have not provided any non-audit services. Each year the

Trust undertakes an evaluation of the work of the External Auditors based on their

performance, fees, level of support and challenge provided to the Trust and the

access to information that is made available. Based on this evaluation, the Audit

Committee makes a recommendation to the Council of Governors regarding the

annual reappointment of the External Auditor.

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The following are the critical judgements, apart from those involving estimations (see

below) that management has made in the process of applying the Trust‟s accounting

policies and which have the most significant effect on the amounts recognised in the

annual report and accounts.

Provisions – including workforce integration, NHS pension, workforce changes including MARS and dilapidations of two leased buildings.

Property, plant and equipment revaluation - The Trust has used the professional services of the Local District Valuer to value all Land and Buildings as at 31 March 2016.

Accruals - Accruals for services received not yet invoiced are estimated on the basis of past experience or the rostering system for overtime

Other critical judgements - The Trust reviews all lease contracts to determine whether they are operating or finance leases. The bad debt provision has been calculated based on a detailed review of each balance over 180 days. Income has been deferred where expenditure will take place during the year ended 31 March 2017.

During 2015/16 a review was undertaken of the key forums available to review and influence quality improvement and the following were introduced:

Quality Committee – the membership and focus were reviewed and a new agenda created, designed around the three pillars of quality

Quality Development Group, responsible for ensuring there is a robust programme in place to drive forward the Trust‟s quality improvement agenda. The Group also leads on planning for regulatory inspections

Quality Development Forum, responsible for driving the Quality Strategy within the Trust as the sub group to the Quality Committee. The role of the Forum includes: o Proactively highlighting areas of concern or poor practice and undertaking

focused reviews o Making recommendations for action to improve quality o Analysing and acting upon feedback from the external environment such as

national groups o Identifying and learning from areas of good practice o Learning from and acting upon staff and patient feedback o Exploring and influencing cultural change within the Trust

Action plans in place to improve service quality during 20151/6 include:

Measures to Improve Performance Plan (designed to address the impact of increased activity and work closely with commissioners to reduce demand)

Quality Development Plan (designed to address any risks to service quality and regulatory compliance)

We can report that there are no material inconsistencies between the following:

The Annual Governance Statement

The annual and quarterly statements submitted by the Board of Directors against the requirements of Monitor‟s Risk Assessment Framework

The Quality Report for 2014/15

The Annual Report for 2014/15, and

Reports arising from Care Quality Commission planned and responsive reviews of the Trust – there were no planned or response reviews during

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2014/15. The last planned review took place in February 2014, and the Trust remained compliant, with no recommendations for improvement

In Quarter 4, the Trust‟s NHS 111 services were inspected by the CQC following

allegations made in the national press by an ex-member of staff. The CQC had not

published its inspection report at the time of production of the annual report. The

Trust expects a number of areas that will require action by the Trust as well as areas

of commendation. The Trust responded to the allegations made by commissioning

an independent report which was conducted by PwC.

In Quarter four the Trust‟s governance rating was moved from green to - Under

Review – Requires Further Information.

The Trust is developing an action plan to respond to any recommendations that come

from the external reviews with the aim of ensuring that whilst patient safety remains

the Trust‟s priority; decisions are informed and appropriate resources are deployed to

achieve planned and sustainable outcomes on the NHS 111 service.

The Trust will have its full planned inspection on 6-10 June 2016.

Patient care activities

SWASFT uses its financial freedom as an NHS Foundation Trust to respond to the needs to patients, staff and the constant evolution of the healthcare sector, and continues to further develop its services based on the valued feedback of patients and their carers/families. This is generated predominantly through our patient experience function (refer to page 151 for further details) and our engagement team (see the following section). Our workforce is instrumental in driving forward service developments via initiatives like the Right Care2 project (refer to page 143), the staff suggestion scheme (available on the intranet) and by participating in research projects like Airways2 (refer to page 148). Refer to pages 7 and 13 for more information about the services that we provide and how we performed against agreed targets. During this reporting period (effective 1 April 2015-31 March 2016) we started to deliver the GP Out of Hours service across Gloucestershire. For further information about this refer to pages 13 and 146.

Patient Experience – Complaints Handling and Ombudsman referrals Comments, concerns and complaints are an invaluable source of information and provide us with a great deal of feedback about the experiences of our patients. The management of comments, concerns and complaints provides us with valuable learning opportunities and it is this feedback which we use to inform the future provision of our services.

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If we are not made aware of issues and concerns, we cannot take action and put them right. As an organisation, the Trust encourages patients and their families to get in touch when they have questions or concerns about their treatment, so we can pursue the matter and investigate as necessary. The Trust‟s Complaints Policy reflects the requirements of the 2009 Local Authority Social Services and National Health Service Complaints (England) Regulations. Each month, we monitor the patient feedback received and review any emerging themes. Lessons learned and actions taken to embed improvements are reported to the Board of Directors and commissioners through our Patient Experience and Safety report. Clinical development and Trust-wide learning is encouraged through the publication of clinical articles and in our Reflect newsletter. In addition, key learning is reflected in our statutory, mandatory and essential training programme. In 2015/16, SWASFT received a total of 1,517 comments, concerns and complaints. We also received 2,225 compliments. In addition, we received 1,005 general enquiries including issues such as lost property and signposting patients to other organisations. We have adopted three Ombudsman‟s Principles which are: Principles of Good Administration; Principles for Remedy; and Principles of Good Complaint Handling. This has resulted in the Trust operating a complaints service committed to:

getting it right;

being customer focused;

being open and accountable;

acting fairly and proportionately;

putting things right;

seeking continuous improvement. We provided recompense in accordance with, and appropriate to, these principles on five occasions in 2015/16. This action supports the wider health economy by preventing future and potentially costly claims because swift local action prevents litigation which is a huge cost to the taxpayer. We sent seven files to the Ombudsman‟s Office during 2015/2016 relating to comments, concerns and complaints received by the patient experience team. Of these files, three of these were not upheld by the Ombudsman and four are currently under review.

Stakeholder engagement

Partnership working In April 2015 the new tri-service officially launched in Hayle, Cornwall – this initiative is the first of its kind in the country- whereby a single responder works across all three services. He is based at the new Hayle tri-sce centre, working alongside on-call fire fighters, police officers and ambulance crews. The responder is employed by Cornwall Fire and Rescue Service and his role has been funded as part of a two-year government pilot aimed at strengthening collaboration between blue-light services.

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There are numerous benefits for those requiring assistance from emergency services, especially those in a relatively remote part of the UK.

Consultation and engagement with local groups and organisations

We were not required to undertake any statutory consultations during 2015/16, but carried out a series of activities to engage with key stakeholders, and have continued to place a great deal of emphasis on our Patient and Public Involvement (PPI) programme.

Patient and Public Involvement (PPI) and health checks During 2015/16, the Trust supported 197 patient and public involvement events. These were attended and staffed predominantly by volunteers from a variety of roles across the organisation including clinicians, managers, administrators, governors and community first responders. Examples of the types of events supported by the Trust include county shows, community fetes and fairs, school and college visits and public health awareness days. These events provide a fantastic opportunity to engage with the public and people who have accessed emergency and urgent care services provided by SWASFT. During these events visitors are informed about the services that the Trust provides and their views on a variety of topics related to these are sought. The events also provide an opportunity to deliver proactive health checks. A total of 1,200 members of the public had their blood pressure checked during the reporting period and a further 52 people received a free NHS Health Check, covering blood pressure, body mass index, blood glucose and cholesterol levels. The results are provided immediately and where necessary recommendations about further medical care, such as attending their own GP, are made. We have maintained our links with road safety partnerships across the area we serve and paramedics continue to give presentations to young people aged 19 to 24 under the „Learn to Live‟ initiative and „Drive to Arrive‟ programme. We have also engaged with Gloucestershire constabulary setting up an educational day warning youngsters of the dangers associated with and the consequences of anti-social behaviour and stabbing. Other achievements include;

providing public health messages to the public by working with our CCG partners and other health and care organisations;

establishing links with our local armed forces and supplying NHS health checks to serving royal marines;

joining forces with Avon & Somerset Constabulary‟s festive drink drive campaign, working with them at the roadside to deliver safety messages;

continued partnership working with colleagues from the police, street pastors and town centre managers – operating the mobile treatment centre (MTC) in densely populated locations allowing immediate access to healthcare, reducing unnecessary admissions to EDs and ensuring that patients get the right care, in the right place at the right time;

working with our Healthwatch partners and inviting them to headquarters to participate in meetings and view our systems of work;

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raising the profile of SWASFT‟s Bristol Bike Unit by ensuring that they have a presence at high profile events across the Trust area.

Below is a table showing a summary of the PPI activity during the reporting period:

Auditors The Trust‟s appointed external auditors are PricewaterhouseCoopers (PwC). The auditors carry out the statutory audit of the Trust‟s annual accounts. The cost of this audit service in 2014/15 was £0.058 million (2013/14: £0.056 million).

Statement as to disclosure to 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 required to make themselves aware of any relevant audit information and to establish that the auditors are aware of such information.

Income from the provision of goods and services The only income that the Trust has received has been for the provision of goods and services for the purpose of the Health Service in England. In line with the guidance this means that the Trust has greater income from the provision of goods and services than income for any other purposes. This means that there is no impact on the income from any other income.

Remuneration report Annual Statement on Remuneration Remuneration for the Trust‟s most senior managers (Executive Directors who are members of the Board of Directors) is determined by the Remuneration Committee, which is a statutory committee of the Board of Directors and is chaired by the Trust Chairman. It is a Non-Executive Director Committee, which as the Trust Chairman I have responsibility for chairing and is attended regularly by Ken Wenman, Chief Executive and Marty McAuley, Trust Secretary. The purpose of the Committee is to approve nomination, remuneration, and terms and conditions for executives and senior managers. The Committee also considers opportunities for development of the Executive Directors. In 2015/16 no external search consultancy was used for recruitment.

Total events

Blood pressure checks

Full NHS health checks

Governor Feedback Survey returns

Have Your Say leaflets

Response to running Red calls

197 1200 52 443 28 117

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The remuneration and expenses of the Chairman and Non-Executive Directors are determined by the Council of Governors. In 2015/16 there was no change to the terms and conditions of Non-Executive Directors. Their remuneration for the role remains the same as when we achieved Foundation Trust status in 2011. The Remuneration Committee met on four occasions in 2015/16. The Trust recognises the need to be competitive with remuneration packages for the Executive Directors reflecting the levels of skills and experience that the Trust needs to recruit and retain, the level of performance required from the Directors but also it is sensitive to the financial environment that we are operating in. Pay levels are informed by Executive salary surveys conducted by independent management consultants and NHS Providers and then thoroughly reviewed by the Remuneration Committee. Following guidance from the Secretary of State for Health, the Trust has noted the requirement to seek approval from the Chief Secretary to the Treasury for appointments above the Prime Minister‟s salary of £142,500. The Trust has not made any appointment beyond this level in 2015/16. The Trust does however provide its Chief Executive and Deputy Chief Executive a remuneration package that is higher than £142,500. This has been robustly reviewed by the Committee and based on the skills and experience required and the complexity of the Trust, the Committee is assured that the salary for both roles is necessary and justifiable. In 2015/16, the Committee undertook a thorough review of the role and remuneration of the Deputy Chief Executive/Executive Director of Finance. After careful consideration, the Committee awarded a pay increase. The salary for the Deputy Chief Executive/Executive Director of Finance was benchmarked and the performance of the post holder was assessed. As a result the pay increase for both parts of the role was awarded.

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Remuneration policy The remuneration package for Executive Directors is made up of:

Rationale

Salary

The Trust Strategy and business planning process sets the key business objectives of the Trust which are delivered by the Directors. This success measure is one of the ways in which the Directors performance is monitored.

All Executive Director remuneration is subject to satisfactory performance of duties in line with their employment.

There is no performance related pay so Directors receive 100% of their salary subject to the relevant deductions.

Salary is benchmarked and there are no automatic rises for Executive Directors.

Taxable benefits

Any taxable benefit is agreed by the Remuneration Committee.

This forms part of the recruitment and retention of Executive Directors by ensuring that the Trust remains competitive.

There is no maximum amount payable.

Pension

Standard pension arrangements are in place in 2015/16.

This forms part of the recruitment and retention of Executive Directors by ensuring that the Trust remains competitive.

There is no maximum amount payable.

Bonus There is no bonus scheme for anyone in South Western

Ambulance Service NHS Foundation Trust. The maximum that could be paid is £0.

The remuneration package for Non- Executive Directors is made up of:

Salary £13,000 per annum for all Non-Executive Directors

Salary £43,000 per annum for Non-Executive Chairman

Salary £2,500 per annum for the additional role of the Chair of Audit & Assurance Committee

Salary £2,500 per annum for the additional role of Senior Independent Director

There have been no new components of the remuneration package introduced in 2015/16. The Remuneration has agreed to a change to the Directors pension arrangements for 2016/17. This will be reported in the annual report next year. In 2015/16 there were no payments made to past senior managers. There are no provisions for the recovery of sums paid to directors nor have we withheld any payment to a Director in 2015/16.

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All Executive Directors are employees of the Trust and their contracts of employment are open ended. Termination and notice periods are six months with the exception of the Chief Executive which is 12 months. Non-Executive Directors are able to serve a maximum of six years. The Trust had no interim or fixed term contract Directors in 2015/16. The Trust‟s normal policies and procedures apply to the Directors including disciplinary and redundancy is in line with NHS terms for all staff. There is no compensation for early termination of contracts, other than the standard term of all staff which is payment in lieu of notice. Whilst the Trust does not consult with staff on remuneration for Directors, it is always mindful of the remuneration of staff when making decisions. When reviewing salary, the Committee considers what is happening to staff pay across the sector, the comparison to the median ratio of the workforce and ensuring that the Committee continues to be financially prudent.

The aggregate remuneration and other benefits receivable by Directors and Non-Executive Directors the financial year including pension related benefits totalled £1.043 million (to 31 March 2015; £0.972 million). Vacancies in 2014/15 were filled in 2015/16. Benefits are accruing under the NHS defined benefit pension scheme to 6 directors (2015: 6 directors). No benefits are accruing under any money purchase schemes. There were no other advances or guarantees existing with any of the Directors as at 31 March 2016 (2014/15 Nil). During the year to 31 March 2016, the highest paid Director for the Trust was the Chief Executive who was paid a salary between £0.170 million and £0.175 million (2015:0.170 million and £0.175 million) and benefits in kind of £0.004 million (2015: £0.004 million).

Annual report on remuneration Remuneration Committee Membership

Membership Attendance

Heather Strawbridge (Chair) 100% (4/4)

Professor Mary Watkins 100% (4/4)

Dr Ian Reynolds 100% (2/2)

Paul Love 100% (2/2)

Venessa James 100% (4/4)

Tony Fox 50% (2/4)

Hugh Hood 100% (4/4)

Robert Davies* 100% (2/2)

* Robert Davies‟ term of office ended on 31 May 2015.

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The Committee were also supported and advised by Ken Wenman, Chief Executive and Marty McAuley, Trust Secretary. Both are employees of the Trust and there were no external advisors utilised in 2015/16. In attendance Attendance

Ken Wenman 100% (4/4)

Marty McAuley 75% (3/4)

Expenses for 15/16

the total number of [governors /

directors] in office

the number of [governors /

directors] receiving expenses in the reporting period

and

the aggregate sum of expenses paid to

[governors / directors] in the reporting period.

Directors 14 12 £15,863.59

Governors 39 19 £6,724.69

Expenses for 14/15

the total number of [governors /

directors] in office

the number of [governors /

directors] receiving expenses in the reporting period

and

the aggregate sum of expenses paid to

[governors / directors] in the reporting period.

Directors 14 12 £20,232.11

Governors 34 21 £8,099.82

59 | P a g e

In 2015/16 (Information subject to audit)

Name and Title

Salary & Fees (bands of £5,000) £000

Taxable Benefits Rounded to the Nearest £100

Annual Performance-Related Bonuses (bands of £5,000) £000

Long-Term Performance-Related Bonuses (bands of £5,000) £000

Pension Related Benefit (bands of £2,500) £000

Total (bands of £5,000) £000

Mrs Heather Strawbridge (Chairman / Non-Executive Director) 40-45 0 0 0 0 40-45

Professor Mary Watkins (Non-Executive Director) 10-15 0 0 0 0 10-15

Mr Hugh Hood (Non-Executive Director) 10-15 0 0 0 0 10-15

Mr Robert Davies (Non-Executive Director) 0-5 0 0 0 0 0-5

Mr Tony Fox (Non-Executive Director) 15-20 0 0 0 0 15-20

Mrs Venessa James (Non-Executive Director) 10-15 0 0 0 0 10-15

Mr Paul Love (Non-Executive Director) 5-10 0 0 0 0 5-10

Mr Ian Reynolds (Non-Executive Director) 5-10 0 0 0 0 5-10

Mr Ken Wenman (Chief Executive) 170-175 4100 0 0 2.5-5.0 175-180

Mrs Jennie Kingston (Deputy Chief Executive and Executive Director of Finance) 140-145 3400 0 0 90-92.5 235-240

Dr Andy Smith (Executive Medical Director) 75-80 1400 0 0 0 75-80

Mr Francis Gillen (Executive Director of Information Management and Technology) 105-110 7900 0 0 7.5-10.0 125-130

Mrs Emma Wood (Executive Director of Human Resources and Workforce Development) 110-115 3900 0 0 25-27.5 135-140

Mrs Jennie Winslade (Executive Director of Nursing and Governance) 105-110 5200 0 0 0 110-115

Band of highest paid Director's Total

Remuneration (£'000) 170-175

Median Total Remuneration (£'000) 29

Ratio 5.9

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In 2014/15 (Information subject to audit)

Name and Title

Salary & Fees (bands of £5,000) £000

Taxable Benefits Rounded to the Nearest £100

Annual Performance-Related Bonuses (bands of £5,000) £000

Long-Term Performance-Related Bonuses (bands of £5,000) £000

Pension Related Benefit (bands of £2,500) £000

Total (bands of £5,000) £000

Mrs Heather Strawbridge (Chairman / Non-Executive Director) 40-45 0 0 0 0 40-45

Professor Mary Watkins (Non-Executive Director) 15-20 0 0 0 0 15-20

Mr Hugh Hood (Non-Executive Director) 10-15 0 0 0 0 10-15

Mr Robert Davies (Non-Executive Director) 15-20 0 0 0 0 15-20

Mr Tony Fox (Non-Executive Director) 10-15 0 0 0 0 10-15

Mr Kinsella (Non-Executive Director) 10-15 0 0 0 0 10-15

Mr Ken Wenman (Chief Executive) 170-175 4300 0 0 0 175-180

Mrs Jennie Kingston (Deputy Chief Executive and Executive Director of Finance) 125-130 3100 0 0 0 130-135

Dr Andy Smith (Executive Medical Director) 60-65 1600 0 0 17.5-20.0 80-85

Mr Francis Gillen (Executive Director of Information Management and Technology) 110-115 5000 0 0 32.5-35.0 145-150

Mrs Emma Wood (Executive Director of Human Resources and Workforce Development) 95-100 2900 0 0 17.5-20.0 115-120

Mrs Jennie Winslade (Executive Director of Nursing and Governance) 90-95 0 0 0 32.5-35.0 125-130

Band of highest paid Director's Total

Remuneration (£'000) 170-175

Median Total Remuneration (£'000) 30

Ratio 5.6 “On 16 March 2016, the Chancellor of the Exchequer announced a change in the Superannuation Contributions Adjusted for Past Experience (SCAPE) discount rate from

3.0% to 2.8%. This rate affects the calculation of CETV figures in this report. Due to the lead time required to perform calculations and prepare annual reports, the CETV

figures quoted in this report for members of the NHS Pension scheme are based on the previous discount rate and have not been recalculated.”

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As Non-Executive Directors do not receive pensionable remuneration, there will be no entries in respect of pension for non-executive members. Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation's workforce. The banded remuneration of the highest-paid director in South Western Ambulance Service NHS Foundation Trust in the financial year 2015-16 was £170-175k. This was 5.9 times the median remuneration of the workforce, which was £28,800. Total remuneration includes salary, non-consolidated performance-related pay, benefits in kind as well as severance payments. It does not include employer pension contributions, the cash equivalent transfer value of pensions or overtime as directors believe this reflects the median salary.

Name and Title

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£000 £000 £000 £000 £000 £000 £000

Mr Ken Wenman (Chief Executive) 0.0 to 2.5

2.5 to 5.0

80 to 85

240 to 245 1834 44 1790

Mrs Jennie Kingston (Deputy Chief Executive and Executive Director of Finance) 2.5 to 5.0

12.5-15.0

45 to 50

135 to 140 918 109 809

Dr Andy Smith (Executive Medical Director)

(0.0 to 2.5)

(0.0 to 2.5)

15 to 20

45 to 50 284 6 278

Mr Francis Gillen (Executive Director of Information Management and Technology) 0.0 to 2.5

2.5 to 5.0

10 to 15

40 to 45 256 21 235

Mrs Emma Wood (Executive Director of Human Resources and Workforce Development) 0.0 to 2.5 0 to 2.5 0 to 5 0 to 5 33 17 16

Mrs Jenny Winslade (Executive Director of Nursing and Governance) 0.0 to 2.5

(5.0 to 7.5)

30 to 35

90 to 95 518 (6) 525

62 | P a g e

*No members of our Trust Board are part of a stakeholder pension. This information is subject to

audit.

Ken Wenman Chief Executive

Pensions for the Year Ended 31 March 2015

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Mr Ken Wenman (Chief Executive)

0 to 2.5

0 to 2.5

75 to 80

230 to 235 1769 52 1716

0

Mrs Jennie Kingston (Deputy Chief Executive and Executive Director of Finance)

0 to 2.5

0 to 2.5

35 to 40

115 to 120 799 34 765

0

Dr Andy Smith (Executive Medical Director)

0 to 2.5

2.5 to 5

15 to 20

50 to 55 298 28 270

0

Mr Francis Gillen (Executive Director of Information Management and Technology)

0 to 2.5

5 to 7.5

10 to 15

35 to 40 232 44 188

0

Mrs Emma Wood (Executive Director of Human Resources and Workforce Development)

0 to 2.5

0 to 2.5 0 to 5 0 to 5 15 15 0

0

Mrs Jenny Winslade (Executive Director of Nursing and Governance)

0 to 2.5

5 to 7.5

30 to 35

95 to 100 519 45 474

0

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Council of Governors Structure and role As an NHS Foundation Trust, we have a Council of Governors. The Council forms a vital link between its members, staff, stakeholders and wider public, ensuring that their interests are represented.

Statutory roles and responsibilities of the Council of Governors

Appoint and, if appropriate, remove the Non-Executive Directors;

Decide the remuneration and allowances and other terms and conditions of office of the chair and the other Non-Executive Directors;

Approve (or not) any new appointment of a chief executive;

Appoint and, if appropriate, remove the NHS Foundation Trust‟s auditor;

Receive the NHS Foundation Trust‟s annual accounts, any report of the auditor on them, and the annual report at a general meeting of the Council of Governors;

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;

Approve „significant transactions‟;

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

Decide whether the Trust‟s non-NHS work would significantly interfere with its principal purpose, which is to provide goods and services for the health service in England, or performing its other services;

Approve amendments to the Trust‟s constitution.

Additional Powers In preparing the NHS Foundation Trust‟s forward plan, the Board of Directors must have regard to the views of the Council of Governors. The Council of Governors has a forward planning sub-group which receives regular presentations throughout the year on the Trust‟s objectives, priorities and strategic aims. This is also the forum through which views of the governors and members are fed back to the Board of Directors. The Council of Governors, in turn, has a duty to canvass the views of members and the public on the Trust‟s future plans. The Governors plan their own engagement activities to engage with the public as well as attend SWAST organised events. Through the Governors attendance at the Board and the Board‟s attendance at the Council of Governor meetings, both parties are able to exchange information about the Trust and its operations. Governors are also invited to attend formal committee meetings. As well as these formal opportunities there are also informal

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opportunities such as face to face meetings; public engagement activities and staff award ceremonies. In 2015/16 the Governors completed over 400 engagement surveys from members of the public, which they were able to inform the Board about. The Board in turn used this information when developing its forward plans. The develop an understanding of the views of governors and members about the NHS foundation trust, for example through attendance at meetings of the council of governors, direct face-to-face contact, surveys of members‟ opinions and consultations. The Council of Governors may require one or more of the directors to attend a governors‟ meeting to obtain information about performance of the Trust‟s functions or the directors‟ performance of their duties, and to help the Council of Governors to decide whether to propose a vote on the trust‟s or directors‟ performance.

Public, staff and appointed Governors

For the period 1 April 2015 to 31 March 2016, the Council was made up of 34 governors, with 19 being elected by public members, six by the staff members, one local authority appointed governor and the remaining eight being appointed by partner organisations.

Staff classes Name of staff class Number of

governors

Accident and Emergency (North Division) Staff Class 1

Accident and Emergency (East Division) Staff Class 1

Accident and Emergency (West Division) Staff Class 1

Urgent Care Services Staff Class 1

Volunteers Staff Class 1

Administration, Support and Other Services Staff Class 1

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Public Governors

Constituency

Area

Minimum Number of

members

Number of Governors

Bristol and Bath & North East Somerset

The electoral ward areas comprising the areas covered by Bristol City Council and Bath and North East Somerset Council, and, for the avoidance of doubt, any successor authority of Bristol City Council or Bath and North East Somerset Council.

320 2

Cornwall The electoral ward areas comprising the area covered by Cornwall Council and, for the avoidance of doubt, any successor authority of Cornwall Council.

272 2

Devon

The electoral ward areas comprising the area covered

by Devon County Council, East Devon District

Council, Exeter City Council, Mid Devon District

Council, North Devon District Council, South Hams

District Council, Teignbridge District Council, Torridge

District Council, West Devon Borough Council,

Plymouth City Council and Torbay Council and, for

the avoidance of doubt, any successor authority of

Devon County Council, East Devon District Council,

Exeter City Council, Mid Devon District Council, North

Devon District Council, South Hams District Council,

Teignbridge District Council, Torridge District Council,

West Devon Borough Council, Plymouth City Council

and Torbay Council.

580 4

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Dorset

The electoral ward areas comprising the area covered

by Christchurch Borough Council, Dorset County

Council, East Dorset District Council, North Dorset

District Council, Purbeck District Council, West Dorset

District Council, Weymouth and Portland Borough

Council, Borough of Poole Council and Bournemouth

Borough Council and, for the avoidance of doubt, any

successor authority of Christchurch Borough Council,

Dorset County Council, East Dorset District Council,

North Dorset District Council, Purbeck District

Council, West Dorset District Council, Weymouth and

Portland Borough Council, Borough of Poole Council

and Bournemouth Borough Council.

360 2

Gloucestershire and

South Gloucestershire

The electoral ward areas comprising the areas covered by Gloucestershire County Council and South Gloucestershire Council and, for the avoidance of doubt, any successor authority of Gloucestershire County Council of South Gloucestershire Council.

436

3

Isles of Scilly

The electoral areas comprising the areas covered by the parishes of the Council of the Isles of Scilly:

St Mary's;

Bryher;

St Martin's;

St Agnes; and

Tresco,

25 1

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Somerset and North Somerset

The electoral ward areas comprising the areas covered by Mendip District Council, Sedgemoor District Council, Somerset County Council, South Somerset District Council, Taunton Deane Borough Council, West Somerset District Council and North Somerset Council, Bath and North East Somerset Council, North Somerset District Council

375 3

Wiltshire and Swindon

The electoral ward areas comprising the areas covered by Wiltshire Council and Swindon Borough Council

336 2

Appointed Governors

Partner Representing Number of Governors

Local Authority

Cornwall Council, the Council of the Isles of Scilly, Devon County Council, East Devon District Council, Exeter City Council, Mid Devon District Council, North Devon District Council, South Hams District Council, Teignbridge District Council, Torridge District Council, West Devon Borough Council, Plymouth City Council, Torbay Council, Christchurch Borough Council, Dorset County Council, East Dorset District Council, North Dorset District Council, Purbeck District Council, West Dorset District Council, Weymouth and Portland Borough Council, Borough of Poole Council, Bournemouth Borough Council, Mendip District Council, Sedgemoor District Council, Somerset County Council, South Somerset District Council, Taunton Deane Borough Council, West Somerset District Council, Bristol County Council, Cheltenham Borough Council, Cotswold District Council, Forest of Dean District Council, Gloucester City Council, Gloucestershire County Council, South Gloucestershire Council, Stroud District Council, Tewkesbury Borough Council, Bath and North East Somerset Council, North Somerset District Council, Swindon Borough Council and Wiltshire Council

1

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Clinical Commissioning Groups

Bristol Clinical Commissioning Group, South Gloucestershire Clinical Commissioning Group, Gloucestershire Clinical Commissioning Group, Swindon Clinical Commissioning Group, Wiltshire Clinical Commissioning Group, Bath and North East Somerset Clinical Commissioning Group and North Somerset Clinical Commissioning Group

1

Clinical Commissioning Groups

Kernow Clinical Commissioning Group, Northern, Eastern and Western (NEW) Devon Clinical Commissioning Group, South Devon and Torbay Clinical Commissioning Group, Dorset Clinical Commissioning Group and Somerset Clinical Commissioning Group

2

Fire & Rescue Services

Avon Fire and Rescue Service, Devon and Somerset Fire and Rescue Service, Cornwall Fire and Rescue Authority, Dorset Fire and Rescue Service and Isles of Scilly Fire and Rescue Service, Gloucestershire Fire & Rescue Service, Wiltshire Fire & Rescue Services

1

Police Forces Avon and Somerset Constabulary, Dorset Police and Devon and Cornwall Constabulary, Gloucestershire Constabulary, Wiltshire Police

1

Air Ambulance Charities

Cornwall Air Ambulance Trust, Devon Air Ambulance Trust, Dorset and Somerset Air Ambulance, Great Western Air Ambulance Charity and Wiltshire Air Ambulance Charitable Trust

1

NHS Acute Trusts

Dorset County Hospital NHS Foundation Trust; Northern Devon Healthcare NHS Trust; Plymouth Hospitals NHS Trust, Poole Hospital NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust; Royal Devon and Exeter NHS Foundation Trust, the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, South Devon Healthcare NHS Foundation Trust, Taunton and Somerset NHS Foundation Trust, Weston Area Health NHS Trust and Yeovil District Hospital NHS Foundation Trust, Gloucestershire Hospitals NHS Foundation Trust, Salisbury Hospital NHS Foundation Trust, Weston Area Health NHS Trust, Royal United Hospital Bath NHS Trust, North Bristol NHS Trust, University Hospitals Bristol NHS Foundation Trust, Great Western Hospitals NHS Foundation Trust, Torbay and Southern Devon Health and Care NHS Trust

1

Mental Health Partnerships

Avon & Wiltshire Mental Health Partnership, 2gether NHS Foundation Trust, Cornwall Partnership NHS Foundation Trust, Devon Partnership NHS Trust, Dorset Healthcare NHS Foundation Trust and Somerset Partnership NHS Foundation Trust

1

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Governors

Meetings The Council of Governors met formally on 7 occasions during 2015-16, as well as other events and meetings. The following table details attendance at these meetings.

Governor Constituency Elected / Appointed

Commencement of Term of Office

Attendance in 2015/16

Actual / Possible

Rae Care Public - Bristol and Bath & North East Somerset

Uncontested 1 March 2014 6/7

Harriet Lupton Public - Bristol and Bath & North East Somerset

Left – vacancy following resignation


David Clare

Public – Cornwall

Left – replaced by Sylvia Hammond

Elected 1 March 2014 0/2

Sylvia Hammond Public Cornwall

Elected – next highest polling candidate

10 December 2015

1/1

William Thomas Public – Cornwall


Bob Deed Public – Devon


15 July 2014 6/7

Adrian Rutter Public – Devon Elected 1 March 2014 4/7

Paul Young Public – Devon Elected 1 March 2014 3/7

Phil Ford Public Devon


14 November 2014

5/7

Robert Day Public – Dorset Elected 1 March 2014 4/7

Jim Duffie Public – Dorset Elected 1 March 2014 6/7

Andrew Gravells

Public – Gloucestershire


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Craig Holmes Public – Gloucestershire


Paul Richardson

Public – Gloucestershire

Left – replaced by Jerry Pallister


Jerry Pallister Public – Gloucestershire


21 July 2015 ¾

Christopher Mills

Public - Isles of Scilly


Terry Beale Public – Somerset Elected 1 March 2014 4/7

Anthony Leak Public – Somerset Elected 1 March 2014 7/7

Ann Kesteven

Public – Somerset

Left – replaced by Jeff Liddiatt


9 July 2015 5/5

Jeff Liddiatt Public – Somerset


25 January 2016 1/1

Torquil David MacInnes Public – Wiltshire


Dee Nix Public – Wiltshire Uncontested 1 March 2014 6/7

David Shephard Staff - A&E (East)

Uncontested 17 Sep 2014 6/7

Alan Peak Staff - A&E (North) Elected 1 March 2014 6/7

Stephen Gough Staff - A&E (West)

Elected 16 February 2016 0/0

Neil Hunt

Staff - Admin, Support & Other Services


Steve Frost

Staff – Urgent Care Services (including NHS111)

Elected 10 October 2015 2/2

Mark Norbury Staff – Volunteers Uncontested 15 March 2014 4/7

Brian Mattock

Appointed – Local Authorities

Left – replaced by Doug Hellier-Laing

Appointed 14 Nov 2014 2/2

Doug Hellier-Laing

Appointed – Local Authorities

Appointed 18 November 2015

1/1

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Kay Haughton

Appointed - CCGs (North Division)

Left – vacancy to be filled following resignation

Appointed 1 March 2014 0/1

Steve Brown

Appointed - Fire Services

Left – replaced by Paul Walker


Paul Walker Appointed – Fire Services


Iain Tulley

Appointed - Mental Health Partnerships

Left – replaced by Steve Waite


Steve Waite Appointed – Mental Health Partnerships


Juliet Cross

Appointed - Acute Trusts



Assistant Chief Constable Sally Crook

Appointed - Police Forces



John Christensen

Appointed - Air Ambulance Charities


Lead Governor Governors are invited to nominate themselves for the posts of Lead and Deputy Lead Governor annually. Following election by their peers at the Annual General Meeting in September 2015, the Lead Governor is Adrian Rutter, Public Governor – Devon, and the Deputy Lead Governor is William Thomas, Public Governor – Cornwall. Their terms of office will run until the Annual General Meeting on 15 September 2016.

Register of Interests Governors have signed the Trust‟s Code of Conduct and are required to declare any interests which may compromise their objectivity in carrying out their duties. A Register of the Interests for all members of the Council of Governors is published on the Trust website at www.swast.nhs.uk or may be obtained by a request to the Trust


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Secretary, South Western Ambulance Service NHS Foundation Trust, Abbey Court, Eagle Way, Exeter, EX2 7HY.

Contacting Governors Members who wish to contact the Council of Governors may do so by contacting the Trust Secretary, South Western Ambulance Service NHS Foundation Trust, Abbey Court, Eagle Way, Exeter, EX2 7HY or via email at [email protected]. The Council of Governor meetings and workshops are regularly attended by members and non-members. Non-members include senior managers and Directors. The Chairman of the Trust chairs both the Board of Directors and the Council of Governors and therefore plays a significant role in ensuring effective and sound working relationships. To support the Chairman in this respect, we have developed a Policy of Engagement for the Council of Governors and the Board of Directors to ensure the smooth operation of both forums and the Trust‟s governance arrangements. Details of staff eligibility are detailed in our Constitution, which is available on the public website at www.swast.nhs.uk.

Sub Groups of Council of Governors The Council of Governors has a number of sub-groups which enable governors to contribute in the follow specific areas:

Remuneration and Recommendations Panel;

Audit and Planning;

Communications, Membership and Patient Experience. Over the past year, the work programme for CoG at its meetings included:

Receiving updates on the corporate committees of the trust;

Induction and training from the Trust Secretary and solicitor;

Appointing Non-Executive Directors;

Succession planning arrangements for Governors;

Engaging with the public through a range of events;

Contributing to the forward plan.

Remuneration and Recommendation Panel The Remuneration and Recommendation Panel is comprised of four Governors and the Chairman of the Council of Governors. The responsibilities of the Remuneration and Recommendation Panel include: To consider the remuneration, appointments, allowances and terms and conditions of the Chairman and Non-Executive Directors; To undertake the short listing and interview of any future Chairman or Non-Executive

mailto:[email protected]


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Directors; To assist the Council of Governors in these responsibilities the Panel shall:

i. Determine and agree with the Council of Governors, in liaison with the Board of Directors, the framework, (i.e. these terms of reference), for the remuneration, appointments, allowances and terms and conditions of the NHS Foundation Trust‟s Non-Executive Directors;

ii. In determining such a framework, take into account all factors which it deems necessary. The objective of such a framework shall be to ensure that the Chairman and Non-Executive Directors of the NHS Foundation Trust are provided with appropriate incentives to retain and recruit high quality individuals, encourage enhanced performance and that they are, in a fair and responsible manner, rewarded for their individual contributions to the success of the Trust;

iii. Review the ongoing appropriateness and relevance of the Remuneration and Recommendation Panel Terms of Reference;

iv. Recommend the design of, determine targets for, and set upper limits of any performance related pay schemes where operated by the NHS Foundation Trust and recommend the total annual payments made under such schemes. Any performance related pay scheme should be aligned with the interests of the NHS Foundation Trust, patients and taxpayers and ensures that targets are challenging and contribute to the overall benefit of the organisation. Full disclosure will be made for any performance related pay and bonuses agreed by the Council of Governors;

v. Ensure that contractual terms on termination, and any payments made, are fair to the individual, and the NHS Foundation Trust, aligned with the interests of the patients, that failure is not rewarded and that the duty to mitigate loss is fully recognised;

vi. Within the terms of the agreed framework and in consultation with the Chairman and/or Chief Executive as appropriate, determine the total individual remuneration package of the Chairman and each Non-Executive Director including bonuses, incentive payments and other awards;

vii. Recommend to the Council of Governors the policy for authorising claims for expenses from the Non-Executive Directors;

viii. Be exclusively responsible for establishing the selection criteria, short listing, appointing and setting the terms of reference for any remuneration consultants who advise the Panel, which should be at least every three years or when considering making large changes: and to obtain reliable, up-to-date information about remuneration in other NHS Foundation Trusts;

ix. Oversee any investigation of activities which are within its terms of reference, and at least once a year, review its own performance and terms of reference to ensure it is operating at maximum effectiveness and recommend any changes it considers necessary to the Council of Governors for approval.

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The following table shows members‟ attendance at Remuneration and Recommendation Panel Committee meetings for the 2015-16 financial year.

Name Position Attendance: Actual/Possible

Mrs Heather Strawbridge

Trust Chairman 2/2

Mr Adrian Rutter Public Governor - Cornwall 2/2

Mr Paul Young Public Governor - Devon 1/2

Mr John Christensen Appointed Governor – Air Ambulance Charities

2/2

Mr Alan Peak Staff Governor - A&E North Division 2/2

Mr Rae Care Public Governor Bristol and Bath & North East Somerset

2/2

In addition, the Chief Executive, Ken Wenman and Marty Mcauley, Trust Secretary, have been regular attendees to support and advise the panel.

Our Membership We welcome members from all walks of life and public membership is open to people aged 16 years or over who live within our operating area. We have a Membership Strategy which sets out how we continue to build a membership that is representative of its operational area, using the analysis of socio-economic demographics. The strategy defines our membership community and eligibility criteria, as well as defining differing levels of membership and the engagement opportunities offered at each level. At 31 March 2016, the main demographic imbalance within our membership was the under representation of men, who form 43 per cent of the membership as compared with 49 per cent of the total population within our operating area. In addition, there is an under-representation of members who classify themselves from a “white” ethnic background. They make up 87 per cent of the membership compared with 92 per cent of the total population. However, it should be noted that just fewer than nine per cent of the membership declined to provide their ethnic classification when they signed up to become a member. We are continuing to address previously identified demographic imbalances: which are an underrepresentation of public members under the age of 40 and members from the northern area of the region. We have also identified a further area of under-representation in the Volunteer Staff Class. We plan to address these representational issues through increased communication with volunteers and targeted recruitment exercises across the north of the region, with staff and governors attending local events. The Council of Governors has established a Communications and Membership Sub Group, which is charged with reviewing the effectiveness of the Membership

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Strategy and working with the Governance & Engagement Team to target demographic imbalances within the our membership. The Board of Directors monitors how representative the membership is, together with the level and effectiveness of membership engagement, through annual reporting and by individual directors attending membership events throughout the year. Our public membership at 31 March 2016, numbered 14,250 members which equates to 0.26% of the eligible population, meeting the target set out in the Membership Strategy. The following table provides a breakdown of our membership by constituency, and also provides details of the eligibility criteria for each constituency.

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Public Constituency

Membership 31.03.2016

Number of Governors Eligibility

Bristol and Bath & North East Somerset

1,224 2 Age 16 and above residing in the electoral ward areas comprising the areas covered by Bristol City Council and Bath and North East Somerset Council, and, for the avoidance of doubt, any successor authority of those listed above.

Cornwall 3,103 2 Age 16 and above residing in the electoral ward areas comprising the area covered by Cornwall Council and, for the avoidance of doubt, any successor authority of Cornwall Council

Devon 3,204 4

Age 16 and above residing in the electoral ward areas comprising the area covered by Devon County Council, East Devon District Council, Exeter City Council, Mid Devon District Council, North Devon District Council, South Hams District Council, Teignbridge District Council, Torridge District Council, West Devon Borough Council, Plymouth City Council and Torbay Council and, for the avoidance of doubt, any successor authority of those listed above. .

Dorset 1,585 2

Age 16 and above residing in the electoral ward areas comprising the area covered by Christchurch Borough Council, Dorset County Council, East Dorset District Council, North Dorset District Council, Purbeck District Council, West Dorset District Council, Weymouth and Portland Borough Council, Borough of Poole Council and Bournemouth Borough Council and, for the avoidance of doubt, any successor authority of those listed above.

Gloucestershire and South Gloucestershire

1,474 3

Age 16 and above and residing in the electoral ward areas comprising the areas covered by Gloucestershire County Council and South Gloucestershire Council, and, for the avoidance of doubt, any successor authority of Gloucestershire County Council or South Gloucestershire Council.

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Public Constituency


Number of Governors Eligibility

Isles of Scilly 73 1

Age 16 and above residing in the electoral areas comprising the areas of the Isles of Scilly – St Mary‟s, Bryher, St Martin‟s, St Agnes and Tresco and, for the avoidance of doubt, any successor authority of St Mary‟s, Bryher, St Martin‟s, St Agnes and Tresco

Somerset and North Somerset

2,554 3

Age 16 and above residing in the electoral ward areas comprising the areas covered by Mendip District Council, Sedgemoor District Council, Somerset County Council, South Somerset District Council, Taunton Deane Borough Council, West Somerset District Council and North Somerset Council, and, for the avoidance of doubt, any successor authorities of those listed above.

Wiltshire and Swindon

1,032 2

Age 16 and above residing in the electoral ward areas comprising the areas covered by Wiltshire Council and Swindon Borough Council, and, for the avoidance of doubt, any successor authority of Wiltshire Council or Swindon Borough Council.

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Our staff membership at 31 March 2016, numbered 4,914 members. The following table provides a breakdown of this membership by staff class and also provides details of the eligibility criteria for each class.

Staff Constituency


No of Governors

Eligibility

Accident & Emergency: East Division Staff Class

754 1

Those individuals who are employed by the Trust or a Designated Organisation in the eastern operating region of the Trust and who are accident and emergency clinical hub staff; accident and emergency clinical staff (other than senior managers); Hazardous Area Response Team staff; training staff; community support responders; patient transport service control staff and managers, patient transport service clinical staff, dedicated patient transport service support staff and managers.

Accident & Emergency: North Division Staff Class

1,474 1

Those individuals who are employed by the Trust or a Designated Organisation in the northern operating region of the Trust and who are accident and emergency clinical hub staff; accident and emergency clinical staff (other than senior managers); Hazardous Area Response Team staff; training staff; community support responders; patient transport service control staff and managers, patient transport service clinical staff, dedicated patient transport service support staff and managers.

Accident & Emergency: West Division Staff Class

1,176 1

Those individuals who are employed by the Trust or a Designated Organisation in the western operating region of the Trust and who are accident and emergency clinical hub staff; accident and emergency clinical staff (other than senior managers); Hazardous Area Response Team staff; training staff; community support responders; patient transport service control staff and managers, patient transport service clinical staff, dedicated patient transport service support staff and managers.

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Urgent Care Services Staff Class

697 1

Those individuals who are employed by the Trust or a Designated Organisation and who are Out of Hours service and NHS 111 clinical hub staff and managers, Out of Hours service and NHS 111 clinical staff including general practitioners and Registered Nurses, Out of Hours service and NHS 111 bank staff, and dedicated Out of Hours service and NHS 111 support staff.

Volunteers Staff Class

143 1 Those individuals who are either employed or engaged by a Designated Organisation and who are Volunteers trained to provide designated services on behalf of the Trust.

Administration, Support and Other Services Staff Class

670 1 All other individuals who are employed by the Trust or a Designated Organisation and who do not fall within the preceding five staff classes set out above.

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Details of staff eligibility are detailed in our Constitution, which is available on the public website at www.swast.nhs.uk. Our members receive communications and are invited to events including the Council of Governor Meetings and Annual Members‟ Meeting as well as PPI events. Members wishing to know more about membership, should contact us on 01392 261502 or via [email protected].

Signed:

Chief Executive and Accounting Officer Date: 23 May 2016


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Staff report

Staff data

An analysis of staff numbers can be found within the annual accounts on page 215 This data distinguishes between staff with a

permanent contract and those who are employed on a short term basis or through an agency.

The breakdown of staff by gender can be found on page 91. Sickness absence data is set out on page 80 and information about

disabled employees is available on page 92.

Average number of employees (WTE basis) Year ended 31 March 2016

Year ended 31 March 2015

Total

Permanently Employed

Other Total

Permanently Employed

Other

Number

Number

Number

Number

Number

Number

Medical and dental 54

5

49

78

7

71

Ambulance staff 2,685

2,638

47

2,556

2,503

53

Administration and estates 1,018

972

46

970

922

48

Healthcare assistants and other support staff 193

193

0

203

203

0

Nursing, midwifery and health visiting staff 67

67

0

67

67

0

Agency and contract staff 70

0

70

95

0

95

Bank staff 97

0

97

103

0

103

Total 4,184

3,875

309

4,072

3,702

370

This information is subject to audit.

The 2015/16 increase in administration and estates staff relates to the delivery of the Trust modernisation programmes.

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Staff Sickness Absence Year Ended 31 March 2016 Year Ended 31 March 2015

Number Number

Total Days Lost 47,292 50,677

Total staff years 3,922 3,739

Average working days lost 12.06 13.55

Valuing staff On 31 March 2016, we employed a workforce of 4511. The majority of our staff are frontline A&E staff covering the following roles:

critical care paramedics;

clinical hub staff;

clinical operational tutors;

clinical support officers;

clinical team leaders;

emergency care assistants (ECA);

Hazardous Area Response Team (HART) paramedics;

lead paramedics;

paramedics;

specialist paramedics;

technicians, advanced technicians and ambulance practitioners.

We also have access to 238 student paramedics, 636 bank staff, 239 sessional and eight employed GPs who support the delivery of the out of hours service, and over 5229 individual responders, who support delivery of the emergency 999 service.

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Sickness Absence The overall sickness absence rate for 2015/16 at March 2016 was 5.29%. Please refer to the table on page 80 for more detailed information. The Trust‟s target is to reduce sickness levels to 4%. Every 1% of sickness absence costs the organisation £869,000. The management of sickness remains a priority for the HR team. In order to achieve the 4% target, a detailed sickness action plan has been formulated and was presented to Directors during April 2015. The sickness action plan has had an immediate positive impact on the grip and focus of sickness management across the Trust to reduce sickness absence by 0.93% compared to February 2015. HR Business Partners now carry out monthly deep dives with Operations Managers to review the quality of all formal meetings required under the Trust‟s Sickness Absence policy. Where any meetings are outstanding, or the quality of the written correspondence is below the standards expected, the Operations Managers and HR Business Partners are providing formal feedback to ensure continuous improvement is maintained. One action remains outstanding from the sickness absence action plan, which is the development of the GRS reporting system that will allow enhanced reporting to enable HR Business Partners to run detailed reports at station level, as well as monitor employees‟ patterns of sickness absence as they arise. The reporting tool has a go live date of May 2016, and will greatly enhance the quality of data available. The HR Department's dedicated health and well-being lead has been involved in a number of initiatives to improve the health services available across the Trust. Of particular note are the Health and Well-being Forums that have been arranged, during which staff have been invited to provide feedback with regard to their health and well-being. This valuable information has enabled the HR department to introduce a new Staying Well Service (SWS) in conjunction with the Trust‟s Safeguarding department. The SWS launched on 1 December 2015, and provides a wealth of support to our workforce. A full time mental health practitioner is available to provide support across the entire trust area and has recently held local clinics to ensure all employees are aware of the service and the various avenues of support it offers. To date, there have been over 200 referrals which have primarily centred on mental health concerns and the treatment of musculoskeletal injuries. The new occupational health provider has continued to provide a good service, producing quality reports to demonstrate all service level agreements have been met. Individual case management is also monitored on an ongoing basis to ensure that staff are supported with appropriate management and, where necessary, referral to the trust‟s occupational health provider. Review of and changes to systems will result in more rigorous decision making to support reasonable adjustments to roles and/or suitable alternative options. This gives staff greater opportunity to return to their

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existing role after ill-health, or where appropriate, learn new skills to enable them to retain employment in an alternative capacity.

Consulting and engaging with staff Continually engaging with our staff remains a top priority and we have a number of mechanisms in place to share important information and, equally as important, encouraging feedback. There are several channels to provide information on matters of concern to them including, but not limited to, dedicated intranet pages, a weekly electronic information Bulletin, staff engagement events including HR road shows and clinics (delivered at a number of locations including stations and emergency departments), paid staff meetings, team briefings, one-to-one meetings, „career conversations‟, our „learn with SWASFT‟ website, video blogs from the Chief Executive, the opportunity to take part in surveys, clinical development sessions and marketing materials including posters, fliers and campaigns. By using a wide variety of methods such as those listed above, employees receive regular communication from the organisation in a „drip feed‟ capacity, so that there is always something for them to engage in, comment on and be involved with. This can most widely be noted in the Chief Executive‟s weekly information Bulletin, where their opinions are sought on a wide variety of matters – from the shaping of policies and procedures - to coming up with ideas via the Right Care initiative as part of an ongoing quality assurance process. In terms of involvement in the Trust‟s performance, regular operational meetings are held, whereby managers and officers spanning our entire area attend and cascade important messages and information locally. Performance data is published each week in the Bulletin and there are chat-rooms held on a series of topics where staff are encouraged to take part and give their feedback. There is a well-established staff suggestion scheme, which is popular with our workforce, whereby they put forward proposals and ideas to help improve performance and patient experience. There is also the Right Care initiative, which is an ongoing two-way communication channel.

Disabled Employees On 31 March 2016, SWASFT employed 112 staff who have declared a disability. Staff with a disability are covered by our approach to equality and diversity. Refer to page 83 for further information. Recruitment processes bear the two-tick symbol, which guarantees an interview to candidates who declare a disability and meet the essential criteria. When employees develop a disability whilst in employment, the Trust will seek alternative roles or duties where applicable to meet their needs and comply with occupational health advice and guidance. The Trust was recently revalidated as an employer committed to supporting this process.

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Equality and Diversity We are committed to ensuring full equality of access for patients who require our services. Additionally, we aim to provide an environment in which all staff are engaged, supported and developed throughout their employment, with none disadvantaged by virtue of any personal protected characteristic. To ensure the duties of the Equality Act 2010 and the requirements of the Public Sector Equality Duty (PSED) are met, we have adopted the NHS Equality Delivery System (EDS2) as a tool to enable analysis, review and assessment of performance against 18 evidence based outcomes. These outcomes are incorporated within four goals:

better health outcomes for all;

improved patient access and experience;

empowered, engaged and inclusive staff;

inclusive leadership.

A summary of the Trust‟s EDS2 grades is available on the Trust‟s website: http://www.swast.nhs.uk/What%20We%20Do/equality-and-diversity.htm In addition to EDS2, the Trust is also compliant with the requirements of the Workforce Race Equality Standard (WRES), with baseline data published on the webpage above. The findings from our EDS2 and WRES work programmes will form the basis of the new Equality, Diversity and Human Rights Strategy which is currently being developed; this will outline the Trust‟s plans to further embed this area within the organisation.

Occupational Health In December 2014, the Trust moved to a new Occupational Health Provider, Optima Health, the largest independent Occupational Health provider in the UK, with extensive experience of supporting NHS organisations. As part of this contract, Optima Health issue infection control advice, offer pre-employment health screening, rehabilitation advice following absence or injury and sickness absence management. Optima regularly liaise with the Trust‟s HR Department to ensure their service meets demand with additional performance reviews taking place monthly.

Health, Safety and Security The Health, Safety and Security department has three bases across SWASFT‟s operational area to assist the various departments and stations with their health and safety responsibilities. During the past year we continued to support staff and ensure that the Trust is compliant with health and safety legislation.

http://www.swast.nhs.uk/What%20We%20Do/equality-and-diversity.htm

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The health, safety and security agenda has been taken forward through an action plan, and key performance indicators are reported to the Board of Directors, Quality and Governance Committee and Health and Safety group. We have completed our third NHS Protect Self-Assessment Tool, looking at security issues within the Trust. During 2015/16, the department has continued to maintain significant achievements including:

provision of the Specsavers VDU Voucher (eye and eyesight testing) scheme for staff;

provision of fire warden training to staff in key locations;

identification and development of new health and safety policies, as well as a review of existing ones; and providing guidance to other departments on the development of new policies where required;

provision of advice and guidance to departments on specific health and safety matters, in order for the Trust to meet statutory requirements, legislation and best practice;

development and issue of online health and safety self-assessments accessible via the Trust‟s intranet;

provision of health and safety e-learning training courses to staff including fire, manual handling and patient moving and handling;

completion of 73 fire risk assessments, 72 health and safety workplace inspections and 72 site security inspections;

ongoing implementation and review of existing violence and aggression warning markers on patient addresses;

development of guidance notes and posters for staff on a variety of subjects.

During the 2015/16 financial year, the Health, Safety and Security Department received:

1,793 incident reports including 814 injury accidents (92 patient and 722 staff);

908 abuse related incident reports including 135 staff subjected to a physical assault;

71 security related incident reports. A total of 335 letters were sent to patients by the health, safety and security department following an incident where they had directed either violence or aggression towards ambulance staff. During 2015/16, 820 incident reports were received detailing staff who had been subjected to an injury or physical assault. This compares to 854 reports received during 2014/15 and represents a 4% decrease in reported incidents during 2015/16. Under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 2013, the Health, Safety and Security department reported 117 „over 7 day injuries‟ to the Health and Safety Executive during 2015/16, compared to 141 during 2014/15.

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Countering Fraud The Trust has a responsibility to ensure that public money is spent appropriately and, in relation to this, we have policies in place to counter fraud and corruption. These include detailed standing financial instructions, Counter Fraud policy and an Anti-Bribery policy. The Trust has a very strong working relationship with Audit South West who provides its Anti-Fraud Service. The nominated Local Counter Fraud Specialist and the Deputy Chief Executive/Executive Director of Finance implemented a work plan to meet the requirements of the NHS Protect Anti-Fraud strategy; inform and involve, prevent and deter and hold to account. There have been no significant fraud issues or threats in the year affecting the Trust. The main outstanding national threat continued to be „bank mandate fraud', whereby fraudsters attempt to manipulate purchasers, like the Trust, into making payments into incorrect bank account details. The Local Counter Fraud Specialist worked with the Trust to ensure they were prepared and had arrangements in place to reduce that risk. The Audit committee receives and approves the Counter Fraud Annual Work Plan and the annual report, monitors the adequacy of counter fraud arrangements and reports on progress to the Board of Directors.

NHS Staff Survey The annual NHS Staff Survey is a mandatory requirement as part of the Trust‟s registration with the CQC. It is designed to support and develop priority actions that deliver on the staff pledges contained within the NHS Constitution. These four pledges are:

Staff Pledge 1 – the NHS commits to provide all staff with clear roles and responsibilities and rewarding jobs for teams and individuals that make a difference to patients, their families and carers and communities;

Staff Pledge 2 – the NHS commits to provide all staff with personal development, access to appropriate training for their jobs and line management;

Staff Pledge 3 – the NHS commits to provide support and opportunities for staff to maintain their health, well-being and safety;

Staff Pledge 4 – the NHS commits to engage staff in decisions that affect them and the services they provide, individually, through representative organisations and through local partnership working arrangements. All staff will be empowered to put forward ways to deliver better and safer services for patients and their families.

We value the feedback and information provided by the annual independent NHS staff survey, which is undertaken on a national basis. It supports dialogue and engagement and provides a mechanism for identifying priority interventions to

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enhance staff health and well-being and organisational performance. Unlike the majority of other NHS Trusts, we survey the whole of our workforce each year, not just a percentage. This demonstrates our commitment to staff engagement which supports our ambition to become a model employer. We also have a staff suggestion scheme, which is used by staff across the organisation to suggest local improvements to patient care.

Approach to staff engagement and consultation Staff engagement refers to the extent to which a member of staff is committed to the organisations goals and values, how motivated they are to contribute to the organisations success and enhance their own sense of well-being. SWASFT takes staff engagement very seriously. It is fundamental to delivering high-quality clinical services and transformational change and is regarded as a valuable indicator of organisational health. A range of two-way feedback mechanisms, both formal and informal, are in place to encourage and enable the provision of information to and consultation with employees. The Trust faces significant challenges in developing its communications systems because of the 24/7 nature of the service against the context of a dynamic operating environment spanning a very wide geographical area. A selection of the tools and methods developed to communicate and encourage meaningful, two-way dialogue with staff includes:

Chief Executive‟s weekly bulletin and other newsletters;

corporate website and intranet;

email facilities which include 24/7 and remote access;

annual staff surveys;

electronic chat room sessions;

face-to-face paid for staff meetings

engagement Road shows across the Trusts localities and ED departments

union and executive director team meetings;

Local Consultation Committee, providing a union and management forum for each locality area designed to represent the staff within that locality. This in turn feeds into the Joint Negotiation and Consultative Committee (JNCC), which is our corporate committee for staff engagement and consultation. This ensures local input in corporate and strategic policy making;

focus groups;

Staff Suggestion Scheme;

staff Facebook page;

video blogs.

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Results from the NHS Staff Survey A total of 1,721 staff participated in the 2015 survey; this represents a response rate of 41%, which is above average for ambulance trusts in England.

2014 2015 SWASFT improvement/deterioration

SWASFT National Average

SWASFT National Average

Reduction of 1% when compared with last year‟s results.

Response Rate

42% 36% 41% 35%

Staff Engagement The overall indicator of staff engagement has been calculated using the questions that make up key findings 1, 4 and 7 respectively. These key findings relate to the following aspects of staff engagement:

Key Finding 1: Their willingness to recommend the Trust as a place to work or receive treatment;

Key Finding 4: The extent to which they feel motivated and engaged with their work.

Key Finding 7: Staff members‟ perceived ability to contribute to improvements at work;

The employment engagement score for SWASFT is 3.50, above (better than) average, when compared to other ambulance trusts in England, which is 3.39. The following table highlights the key findings for which the Trust compares most favourably with other ambulance trusts in England:

Key Findings SWASFT Score 2014

SWASFT Score 2015

Ambulance Average 2015

KF22 Percentage of staff experiencing physical violence from patients, relatives or the public in last 12 months

30% 28% 34%

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KF30 Fairness and effectiveness of procedures for reporting errors, near misses and incidents

3.31 3.48 3.28

KF6 Percentage of staff reporting good communication between senior management and staff

21% 23% 16%

KF21 Percentage of staff believing that the organisation provides equal opportunities for career progression or promotion

70% 76% 71%

KF5 Recognition and value of staff by managers and the organisation

New Question 3.11 2.96

The following table highlights the key findings for which the Trust compares least favourably with other ambulance trusts in England:

Bottom Key Findings SWASFT 2014 Score

SWASFT 2015 Score

Ambulance Average 2015

KF24 Percentage of staff / colleagues reporting most recent experience of violence

50% 49% 56%

KF27 Percentage of staff / colleagues reporting most recent experience of harassment, bullying or abuse

34% 28% 31%

KF15 Percentage of staff satisfied with the opportunities for flexible working patterns

New Question 31% 34%

KF16 Percentage of staff working extra hours

88% 87% 86%

KF2 Staff satisfaction with the quality of work and patient care they are able to deliver

New Question 3.78 3.79

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During the fieldwork period for the 2015 NHS Staff Survey, the Trust‟s HR department conducted station and emergency department visits to ensure that any queries or concerns regarding the survey were addressed. After the results are published, action plans are formed in each operational division, hub and support service to address the problem scores listed above in addition to their local themes. Progress on these action plans will be reported through the Quality committee. These action plans will be published on a dedicated intranet page and updated quarterly by the Head of Department/Operations and their respective HR Business Partner.

Next Steps

The HR team will be analysing the final results broken down by locality, which will be shared with management teams, and local action plans will be developed for the areas for improvement. It is essential to maintain focus in the areas where the Trust has seen significant improvement, and this will also be captured in local plans yet to be finalised.

Future priorities

Although the Trust response rate is higher than the average ambulance trust, improving the response rate for the staff survey remains a key priority for us. We are considering a range of methods for the 2016 survey to aid completion. In addition to the survey, the Trust will continue to promote participation in the Staff Friends and Family Test, to provide management with a rich source of data to highlight and address concerns much faster than traditional survey methods.

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Workforce Statistics A full breakdown of the workforce by protected characteristics is available on the Trust‟s website: http://www.swast.nhs.uk/What%20We%20Do/equality-and-diversity.htm The following WTE figure is different from that given in the annual accounts on page 79 because outlined below is the total number of people employed by the Trust on 31 March 2016 and the number given within the accounts is an average during the year.

2015/16 2014/15

Headcount WTE Headcount

%

WTE % Headcount WTE Headcount

%

WTE %

Age

16-25

26-35

36-45

46-55

56-65

66+

353

1104

1395

1155

472

32

323.72

1012.90

1221.18

1037.71

382.38

18.36

7.83

24.47

30.92

25.60

10.46

0.71

8.10

25.35

30.56

25.97

9.57

0.46

353

1035

1345

1123

401

28

332.16

951.73

1197.98

1011.27

330.25

16.75

8.65

24.78

31.20

26.33

8.60

0.44

8.24

24.15

31.39

26.21

9.36

0.65

http://www.swast.nhs.uk/What%20We%20Do/equality-and-diversity.htm

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Ethnicity

White

Mixed

Asian or Asian

British

Black or Black

British

Chinese

Other

Not Stated

4384

33

13

8

2

1

70

3905.21

28.57

9.22

7

1.25

1

44

97.18

0.73

0.29

0.18

0.04

0.02

1.55

97.72

0.72

0.23

0.18

0.03

0.03

1.10

4197

35

10

11

2

1

29

3764.88

31.82

6.37

10.50

1.25

1.00

24.32

98.04

0.83

0.17

0.27

0.03

0.03

0.63

97.95

0.82

0.23

0.26

0.05

0.02

0.68

Gender

Male

Female

Transgender

2418

2093

0

2290.79

1705.47

0

53.60

46.40

0

57.32

42.68

0

2349

1936

0

2223.50

1616.64

0

57.90

42.10

0

54.82

45.18

0

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Recorded

Disability

Yes

No

Not Declared

99

3696

716

88.34

3266.42

641.49

2.19

81.93

15.87

2.21

81.74

16.05

94

3421

770

81.75

3061.64

696.75

2.13

79.73

18.14

2.19

79.84

17.97

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Expenditure on consultancy

The Trust spent £707,000 on consultancy. Refer to note 4.1 of the accounts (page

214) for other professional fees.

Off-payroll engagements

The following tables show the Trust‟s off-payroll engagements for the 2015/16

financial year.

For all off-payroll engagements as of 31 Mar 2016, for more than

£220 per day and that last for longer than six months

2015/16

Number of

engagements

No. of existing engagements as of 31 Mar 2016 34

Of which:

Number that have existed for less than one year at the time of

reporting 17

Number that have existed for between one and two years at the

time of reporting 4

Number that have existed for between two and three years at the

time of reporting 1

Number that have existed for between three and four years at the

time of reporting 0

Number that have existed for four or more years at the time of

reporting 12

Confirmation:

Please confirm that all existing off-payroll engagements, outlined

above, have at some point been subject to a risk based assessment

as to whether assurance is required that the individual is paying the

right amount of tax and, where necessary, that assurance has been

sought.

Yes

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2015/16

Number of

engagements

For all new off-payroll engagements, or those that reached six

months in duration, between 01 Apr 2015 and 31 Mar 2016, for

more than £220 per day and that last for longer than six months

Number of new engagements, or those that reached six months in

duration between 01 Apr 2015 and 31 Mar 2016 0

Number of the above which include contractual clauses giving the

trust the right to request assurance in relation to income tax and

national insurance obligations

0

Number for whom assurance has been requested 0

Of which:

Number for whom assurance has been received 0

Number for whom assurance has not been received 0

Number that have been terminated as a result of assurance not

being received 0

2015/16

Number of

engagements

For any off-payroll engagements of board members, and/or

senior officials with significant financial responsibility, between

1 Apr 2015 and 31 Mar 2016

Number of off-payroll engagements of board members, and/or,

senior officials with significant financial responsibility, during the

financial year.

14 Number of individuals that have been deemed "board members

and/or senior officials with significant financial responsibility". This

figure should include both off-payroll and on-payroll engagements.

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The Trust follows the guidance issued by the Department of Health in 2012 relating to off-payroll engagements. The off-payroll payments for the Trust relate to self-employed doctors working for the urgent care service and one advisor to the Board.

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NHS Foundation Trust Code of Governance The NHS Foundation Trust Code of Governance (the Code of Governance) was first published in 2006 and was most recently updated in July 2014. The purpose of the Code of Governance is to assist NHS foundation trust boards in improving their governance practices by bringing together the best practice of public and private sector corporate governance. The code is issued as best practice advice, but imposes some disclosure requirements. South Western Ambulance Service NHS Foundation Trust has applied the principles of the NHS Foundation Trust Code of Governance on a comply or explain basis. The NHS Foundation Trust Code of Governance, most recently revised in July 2014, is based on the principles of the UK Corporate Governance Code issued in 2012. NHS foundation trusts are required to provide a specific set of disclosures in their annual report to meet the requirements of the Code of Governance. Schedule A to the Code of Governance specifies everything that is required within these disclosures. Schedule A is divided into six categories: 1) statutory requirements of the Code of Governance but do not require disclosures; 2) provisions which require a supporting explanation, even where the NHS foundation trust is compliant with the provision*; 3) provisions which require supporting information to be made publicly available, even where the NHS foundation trust is compliant with the provision; 4) provisions which require supporting information to be made to governors, even where the NHS foundation trust is compliant with the provision; 5) provisions which require supporting information to be made to members, even where the NHS foundation trust is compliant with the provision; and 6) other provisions where there are no special requirements as per 1-5 above and there is a “comply or explain” requirement. The disclosure should therefore contain an explanation in each case where the trust has departed from the Code of Governance, explaining the reasons for the departure and how the alternative arrangements continue to reflect the main principles of the Code of Governance. * Where the information is already contained within the annual report, a reference to its location is sufficient to avoid unnecessary duplication. The information in the paragraph and table below only covers items falling into category 2 and category 6 above. The requirements of parts 2 and 6 of schedule A to the Code of Governance are listed below. This table also includes requirements that are not part of the Code of Governance but are required by the FT ARM.

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Code of Governance Disclosure Statement – SWASFT

Relating to Code Ref

Summary of Requirement Annual Report Location, or Comply or Explain

Schedule A (2)

Board and Council of Governors

A.1.1 The schedule of matters reserved for the board of directors should include a clear statement detailing the roles and responsibilities of the council of governors. This statement should also describe how any disagreements between the council of governors and the board of directors will be resolved. The annual report should include this schedule of matters or a summary statement of how the board of directors and the council of governors operate, including a summary of the types of decisions to be taken by each of the boards and which are delegated to the executive management of the board of directors.

Comply – page 63 of the Annual Report

Board, Nomination Committee(s), Audit Committee, Remuneration Committee

A.1.2 The annual report should identify the chairperson, the deputy chairperson (where there is one), the chief executive, the senior independent director (see A.4.1) and the chairperson and members of the nominations, audit and remuneration11 committees. It should also set out the number of meetings of the board and those committees and individual attendance by directors.


Council of Governors

A.5.3 The annual report should identify the members of the council of governors, including a description of the constituency or organisation that they represent, whether they were elected or appointed, and the duration of their appointments. The annual report should also identify the nominated lead governor.


Board B.1.1 The board of directors should identify in the annual report each non-executive director it considers to be independent, with reasons where necessary.


Board B.1.4 The board of directors should include in its annual report a description of each director‟s skills, expertise and experience. Alongside this, in the annual report, the board should make a clear statement about its own balance, completeness and appropriateness to the requirements of the NHS foundation trust.


Nominations Committee(s)

B.2.10 A separate section of the annual report should describe the work of the nominations committee(s), including the process it has used in relation to board appointments.


Chair / Council of Governors

B.3.1 A chairperson‟s other significant commitments should be disclosed to the council of governors before appointment and included in the annual report. Changes to such commitments should be reported to the council of governors as they arise, and included in the next annual report.



B.5.6 Governors should canvass the opinion of the trust‟s members and the public, and for appointed governors the body they represent, on the NHS foundation trust‟s forward plan, including its objectives, priorities and strategy, and their views should be communicated to the board of directors. The annual report should contain a statement as to how this requirement has been undertaken and satisfied.


Board B.6.1 The board of directors should state in the annual report Comply – page 43 of the

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how performance evaluation of the board, its committees, and its directors, including the chairperson, has been conducted.

Annual Report

Board B.6.2 Where there has been external evaluation of the board and/or governance of the trust, the external facilitator should be identified in the annual report and a statement made as to whether they have any other connection to the trust.

Comply – no external evaluation in 2015/16 and therefore no disclosure made.

Board C.1.1 The directors should explain in the annual report their responsibility for preparing the annual report and accounts, and state that they consider the annual report and accounts, taken as a whole, are fair, balanced and understandable and provide the information necessary for patients, regulators and other stakeholders to assess the NHS foundation trust‟s performance, business model and strategy. Directors should also explain their approach to quality governance in the Annual Governance Statement (within the annual report).

Comply – page 109 of

the Annual Report

Board C.2.1 The annual report should contain a statement that the board has conducted a review of the effectiveness of its system of internal controls.


the Annual Report

Audit Committee / control environment

C.2.2 A trust should disclose in the annual report: (a) if it has an internal audit function, how the function is structured and what role it performs; or (b) if it does not have an internal audit function, that fact and the processes it employs for evaluating and continually improving the effectiveness of its risk management and internal control processes.


the Annual Report

Audit Committee / Council of Governors

C.3.5 If the council of governors does not accept the audit committee‟s recommendation on the appointment, reappointment or removal of an external auditor, the board of directors should include in the annual report a statement from the audit committee explaining the recommendation and should set out reasons why the council of governors has taken a different position.

Comply – page 49 of the

Annual Report

Audit Committee

C.3.9 A separate section of the annual report should describe the work of the audit committee in discharging its responsibilities. The report should include:

in relation to financial statements, operations and compliance, and how these issues were addressed;

effectiveness of the external audit process and the approach taken to the appointment or re-appointment of the external auditor, the value of external audit services and information on the length of tenure of the current audit firm and when a tender was last conducted; and

on-audit services, the value of the non-audit services provided and an explanation of how auditor objectivity and independence are safeguarded.


Annual Report

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Board / Remuneration Committee

D.1.3 Where an NHS foundation trust releases an executive director, for example to serve as a non-executive director elsewhere, the remuneration disclosures of the annual report should include a statement of whether or not the director will retain such earnings.

Comply. No Executives

released.

Board E.1.5 The board of directors should state in the annual report the steps they have taken to ensure that the members of the board, and in particular the non-executive directors, develop an understanding of the views of governors and members about the NHS foundation trust, for example through attendance at meetings of the council of governors, direct face-to-face contact, surveys of members‟ opinions and consultations.

Comply – page 61of the

Annual Report

Board / Membership

E.1.6 The board of directors should monitor how representative the NHS foundation trust's membership is and the level and effectiveness of member engagement and report on this in the annual report.


Annual Report

Membership E.1.4 Contact procedures for members who wish to communicate with governors and/or directors should be made clearly available to members on the NHS foundation trust's website and in the annual report.


Annual Report

Additional Requirements, FT Annual Reporting Manual 2015-16


n/a The annual report should include a statement about the number of meetings of the council of governors and individual attendance by governors and directors.

Page 69 of the Annual

Report

Board n/a The annual report should include a brief description of the length of appointments of the non-executive directors, and how they may be terminated

Page 43 and 62 of the

Annual Report

Nominations Committee(s)

n/a The disclosure in the annual report on the work of the nominations committee should include an explanation if neither an external search consultancy nor open advertising has been used in the appointment of a chair or non-executive director.


Report


n/a If, during the financial year, the Governors have exercised their power* under paragraph 10C** of schedule 7 of the NHS Act 2006, then information on this must be included in the annual report. This is required by paragraph 26(2) (aa) of schedule 7 to the NHS Act 2006, as amended by section 151 (8) of the Health and Social Care Act 2012. * Power to require one or more of the directors to attend a governors‟ meeting for the purpose of obtaining information about the foundation trust‟s performance of its functions or the directors‟ performance of their duties (and deciding whether to propose a vote on the foundation trust‟s or directors‟ performance). ** As inserted by section 151 (6) of the Health and Social Care Act 2012)


Report

Membership n/a The annual report should include:

joining different membership constituencies, including the boundaries for public membership;


Report

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number of members in each constituency; and

assessment of the membership and a description of any steps taken during the year to ensure a representative membership [see also E.1.6 above], including progress towards any recruitment targets for members.

Board / Council of Governors

n/a The annual report should disclose details of company directorships or other material interests in companies held by governors and/or directors where those companies or related parties are likely to do business, or are possibly seeking to do business, with the NHS foundation trust. As each NHS foundation trust must have registers of governors‟ and directors‟ interests which are available to the public, an alternative disclosure is for the annual report to simply state how members of the public can gain access to the registers instead of listing all the interests in the annual report. See also ARM paragraph 7.33 as directors‟ report requirement


Report

Schedule A (6) - Comply or Explain

Board A.1.4 The board should ensure that adequate systems and processes are maintained to measure and monitor the NHS foundation trust‟s effectiveness, efficiency and economy as well as the quality of its healthcare delivery

Comply

Board A.1.5 The board should ensure that relevant metrics, measures, milestones and accountabilities are developed and agreed so as to understand and assess progress and delivery of performance

Comply

Board A.1.6 The board should report on its approach to clinical governance.

Comply

Board A.1.7 The chief executive as the accounting officer should follow the procedure set out by Monitor for advising the board and the council and for recording and submitting objections to decisions.

Comply

Board A.1.8 The board should establish the constitution and standards of conduct for the NHS foundation trust and its staff in accordance with NHS values and accepted standards of behaviour in public life

Comply

Board A.1.9 The board should operate a code of conduct that builds on the values of the NHS foundation trust and reflect high standards of probity and responsibility.

Comply

Board A.1.10 The NHS foundation trust should arrange appropriate insurance to cover the risk of legal action against its directors.

Comply

Chair A.3.1 The chairperson should, on appointment by the council, meet the independence criteria set out in B.1.1. A chief executive should not go on to be the chairperson of the same NHS foundation trust.

Comply

Board A.4.1 In consultation with the council, the board should appoint one of the independent non-executive directors to be the senior independent director.

Comply

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Board A.4.2 The chairperson should hold meetings with the non-executive directors without the executives present.

Comply

Board A.4.3 Where directors have concerns that cannot be resolved about the running of the NHS foundation trust or a proposed action, they should ensure that their concerns are recorded in the board minutes.

Comply


A.5.1 The council of governors should meet sufficiently regularly to discharge its duties.

Comply


A.5.2 The council of governors should not be so large as to be unwieldy.

Comply


A.5.4 The roles and responsibilities of the council of governors should be set out in a written document.

Comply


A.5.5 The chairperson is responsible for leadership of both the board and the council but the governors also have a responsibility to make the arrangements work and should take the lead in inviting the chief executive to their meetings and inviting attendance by other executives and non-executives, as appropriate.

Comply


A.5.6 The council should establish a policy for engagement with the board of directors for those circumstances when they have concerns.

Comply Policy in place but to be reviewed in 2016/17


A.5.7 The council should ensure its interaction and relationship with the board of directors is appropriate and effective.

Comply


A.5.8 The council should only exercise its power to remove the chairperson or any non-executive directors after exhausting all means of engagement with the board.

Comply


A.5.9 The council should receive and consider other appropriate information required to enable it to discharge its duties.

Comply

Board B.1.2 At least half the board, excluding the chairperson, should comprise non-executive directors determined by the board to be independent.

Comply


B.1.3 No individual should hold, at the same time, positions of director and governor of any NHS foundation trust.

Comply

Nomination Committee(s)

B.2.1 The nominations committee or committees, with external advice as appropriate, are responsible for the identification and nomination of executive and non-executive directors.

Comply


B.2.2 Directors on the board of directors and governors on the council should meet the “fit and proper” persons test described in the provider licence.

Comply


B.2.3 The nominations committee(s) should regularly review the structure, size and composition of the board and make recommendations for changes where appropriate.

Comply


B.2.4 The chairperson or an independent non-executive director should chair the nominations committee(s).

Comply

Nomination Committee(s) / Council of Governors

B.2.5 The governors should agree with the nominations committee a clear process for the nomination of a new chairperson and non-executive directors.

Comply

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B.2.6 Where an NHS foundation trust has two nominations committees, the nominations committee responsible for the appointment of non-executive directors should consist of a majority of governors.

Comply


B.2.7 When considering the appointment of non-executive directors, the council should take into account the views of the board and the nominations committee on the qualifications, skills and experience required for each position.

Comply


B.2.8 The annual report should describe the process followed by the council in relation to appointments of the chairperson and non-executive directors.

Comply


B.2.9 An independent external adviser should not be a member of or have a vote on the nominations committee(s).

Comply

Board B.3.3 The board should not agree to a full-time executive director taking on more than one non-executive directorship of an NHS foundation trust or another organisation of comparable size and complexity.

Comply


B.5.1 The board and the council governors should be provided with high-quality information appropriate to their respective functions and relevant to the decisions they have to make.

Comply

Board B.5.2 The board and in particular non-executive directors, may reasonably wish to challenge assurances received from the executive management. They need not seek to appoint a relevant adviser for each and every subject area that comes before the board, although they should, wherever possible, ensure that they have sufficient information and understanding to enable challenge and to take decisions on an informed basis.

Comply

Board B.5.3 The board should ensure that directors, especially non-executive directors, have access to the independent professional advice, at the NHS foundation trust‟s expense, where they judge it necessary to discharge their responsibilities as directors.

Comply

Board / Committees

B.5.4 Committees should be provided with sufficient resources to undertake their duties.

Comply

Chair B.6.3 The senior independent director should lead the performance evaluation of the chairperson.

Comply

Chair B.6.4 The chairperson, with assistance of the board secretary, if applicable, should use the performance evaluations as the basis for determining individual and collective professional development programmes for non-executive directors relevant to their duties as board members.

Comply

Chair / Council of Governors

B.6.5 Led by the chairperson, the council should periodically assess their collective performance and they should regularly communicate to members and the public details on how they have discharged their responsibilities.

Comply


B.6.6 There should be a clear policy and a fair process, agreed and adopted by the council, for the removal from the council of any governor who consistently and

Comply

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unjustifiably fails to attend the meetings of the council or has an actual or potential conflict of interest which prevents the proper exercise of their duties.

Board / Remuneration Committee

B.8.1 The remuneration committee should not agree to an executive member of the board leaving the employment of an NHS foundation trust, except in accordance with the terms of their contract of employment, including but not limited to service of their full notice period and/or material reductions in their time commitment to the role, without the board first having completed and approved a full risk assessment.

Comply

Board C.1.2 The directors should report that the NHS foundation trust is a going concern with supporting assumptions or qualifications as necessary. See also ARM paragraph 7.17.

Comply

Board C.1.3 At least annually and in a timely manner, the board should set out clearly its financial, quality and operating objectives for the NHS foundation trust and disclose sufficient information, both quantitative and qualitative, of the NHS foundation trust‟s business and operation, including clinical outcome data, to allow members and governors to evaluate its performance.

Comply

Board C.1.4 a) The board of directors must notify Monitor and the council of governors without delay and should consider whether it is in the public‟s interest to bring to the public attention, any major new developments in the NHS foundation trust‟s sphere of activity which are not public knowledge, which it is able to disclose and which may lead by virtue of their effect on its assets and liabilities, or financial position or on the general course of its business, to a substantial change to the financial wellbeing, health care delivery performance or reputation and standing of the NHS foundation trust. b) The board of directors must notify Monitor and the council of governors without delay and should consider whether it is in the public interest to bring to public attention all relevant information which is not public knowledge concerning a material change in: • the NHS foundation trust‟s financial condition; • the performance of its business; and/or • the NHS foundation trust‟s expectations as to its performance which, if made public, would be likely to lead to a substantial change to the financial wellbeing, health care delivery performance or reputation and standing of the NHS foundation trust.

Comply

Board / Audit Committee

C.3.1 The board should establish an audit committee composed of at least three members who are all independent non-executive directors.

Comply

Council of Governors / Audit Committee

C.3.3 The council should take the lead in agreeing with the audit committee the criteria for appointing, re-appointing and removing external auditors.

Comply

Council of Governors / Audit

C.3.6 The NHS foundation trust should appoint an external auditor for a period of time which allows the auditor to develop a strong understanding of the finances,

Comply

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Committee operations and forward plans of the NHS foundation trust.


C.3.7 When the council ends an external auditor‟s appointment in disputed circumstances, the chairperson should write to Monitor informing it of the reasons behind the decision.

Comply

Audit Committee

C.3.8 The audit committee should review arrangements that allow staff of the NHS foundation trust and other individuals where relevant, to raise, in confidence, concerns about possible improprieties in matters of financial reporting and control, clinical quality, patient safety or other matters.

Comply

Remuneration Committee

D.1.1 Any performance-related elements of the remuneration of executive directors should be designed to align their interests with those of patients, service users and taxpayers and to give these directors keen incentives to perform at the highest levels.

Comply


D.1.2 Levels of remuneration for the chairperson and other non-executive directors should reflect the time commitment and responsibilities of their roles.

Comply


D.1.4 The remuneration committee should carefully consider what compensation commitments (including pension contributions and all other elements) their directors‟ terms of appointments would give rise to in the event of early termination.

Comply


D.2.2 The remuneration committee should have delegated responsibility for setting remuneration for all executive directors, including pension rights and any compensation payments.

Comply

Council of Governors / Remuneration Committee

D.2.3 The council should consult external professional advisers to market-test the remuneration levels of the chairperson and other non-executives at least once every three years and when they intend to make a material change to the remuneration of a non-executive.

Comply

Board E.1.2 The board should clarify in writing how the public interests of patients and the local community will be represented, including its approach for addressing the overlap and interface between governors and any local consultative forums.

Comply

Board E.1.3 The chairperson should ensure that the views of governors and members are communicated to the board as a whole.

Comply

Board E.2.1 The board should be clear as to the specific third party bodies in relation to which the NHS foundation trust has a duty to co-operate.

Comply

Board E.2.2 The board should ensure that effective mechanisms are in place to co-operate with relevant third party bodies and that collaborative and productive relationships are maintained with relevant stakeholders at appropriate levels of seniority in each.

Comply

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Regulatory Ratings As part of its regulatory regime, Monitor assigns risk ratings to each NHS Foundation Trust as an indicator of the risk of failure to comply with the conditions of its licence. The Trust did not achieve two of its key Access and Outcome Targets for all four quarters in 2015/16 due to a sustained period of unprecedented demand across the health community. As a result, the Board did not sign the required Governance statement in its quarterly submissions to Monitor for quarters 2, 3 and 4, in relation to confidence in ongoing compliance with performance targets. The Trust has continued to maintain a dialogue with Monitor about its plans to rectify its performance position; at the same time the Trust was awarded pilot status to run the Dispatch on Disposition trial. Alongside this pioneering work to develop improved and more appropriate response targets, the Trust developed both a Measures to Improve Performance plan (working with commissioners to tackle the increased demand, and to improve the Trust's responsiveness); and a Quality Development Plan (to reduce and minimise any risks to quality).

Financial Sustainability Risk Rating The Financial Sustainability Risk Rating states the risk facing a provider of key NHS services. There are five rating categories ranging from 1, which represents the most significant risk, to 4, representing no evident concerns. This rating system forms part of the Risk Assessment Framework.

Governance Risk Rating As part of the Risk Assessment Framework, Monitor assigns a green rating if there is no governance concern identified. Where a potential material cause for concern is identified, Monitor will replace a trust‟s green rating with a description of the issue and the steps (formal or informal) being taken to address it; or Monitor will assign a red rating if regulatory action is to be taken. Trusts are required to include forecast risk ratings within their forward plans. During 2015/16 we achieved our planned governance risk rating of green for the first two quarters. Following assessment of the quarter 3 return Monitor communicated that they had decided to change the Trust‟s governance rating from Green to „under review – requesting further information‟. This followed a period where the Trust failed to meet the Red 2 and A19 response time targets, the NHS England investigation report findings into a serious incident and staff allegations regarding the NHS 111 service. At the time of writing PricewaterhouseCoopers were undertaking an independent investigation, commissioned by the Trust. This follows a series of allegations made about the Trust‟s NHS 111 services published in the national media in February of this year. During 2015 we also achieved our planned continuity of services risk rating of 4 for three quarters. These scores have been determined through an assessment of key submissions to Monitor supported by assurance reports to the Board of Directors against the requirements of the Risk Assessment Framework. For the fourth and final quarter of 2014/15 (January to March 2015), we submitted a forecast governance risk rating of green and a continuity of services risk rating of 4 to Monitor.

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Our governance and continuity of services risk ratings for 2014/15 and 2015/16 are set out below:

2015/16 Operational Plan

Q1 Q2 Q3 Q4

Financial Sustainability Risk Rating

4 4 4 4 4*

Governance Risk Rating Green Green Green Under Review

Under Review

2014/15 Operational Plan

Q1 Q2 Q3 Q4

Financial Sustainability Risk Rating

4 4 4 4 4

Governance Risk Rating Green Green Green Green Green*

* The outcome of the Trust‟s monitoring return for quarter 4 of 2015/16 had not been confirmed by Monitor at the time of publication. Therefore the risk ratings presented here represent those submitted by the Trust for review.

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Statement of the Chief Executive’s Responsibilities as the Accounting Officer of South Western Ambulance Service NHS Foundation Trust

The NHS Act 2006 states that the chief executive is the Accounting Officer of the NHS Foundation Trust. The relevant responsibilities of the Accounting Officer, including their responsibility for the propriety and regularity of public finances for which they are answerable, and for the keeping of proper accounts, are set out in the NHS Foundation Trust Accounting Officer Memorandum issued by Monitor. Under the NHS Act 2006, Monitor has directed South Western Ambulance Service NHS Foundation Trust to prepare for each financial year a statement of accounts in the form and on the basis set out in the Accounts Direction. The accounts are prepared on an accruals basis and must give a true and fair view of the state of affairs of South Western Ambulance Service NHS Foundation Trust and of its income and expenditure, total recognised gains and losses and cash flows for the financial year. The directors consider the annual report and accounts, taken as a whole, is fair, balanced and understandable and provides the information necessary for patients, regulators and stakeholders to assess the NHS foundation trust‟s performance, business model and strategy. 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;

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 and to 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.

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To the best on my knowledge and belief, I have properly discharged the responsibilities set out in Monitor‟s NHS Foundation Trust Accounting Officer Memorandum. Signed:

Ken Wenman Chief Executive Date: 23 May 2016

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Annual Governance Statement

Scope of responsibility As Accounting Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the NHS foundation trust‟s policies, aims and objectives, whilst safeguarding the public funds and departmental assets for which I am personally responsible, in accordance with the responsibilities assigned to me. I am also responsible for ensuring that the NHS foundation trust is administered prudently and economically and that resources are applied efficiently and effectively. I also acknowledge my responsibilities as set out in the NHS Foundation Trust Accounting Officer Memorandum.

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 Western Ambulance Service NHS Foundation Trust, 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 South Western Ambulance Service NHS Foundation Trust NHS Foundation Trust for the year ended 31 March 2016 and up to the date of approval of the annual report and accounts. The Board has conducted a review of the effectiveness of its system of internal controls through the Internal Audit programme that it has in place throughout the year. The Audit and Assurance Committee also has a programme of deep dives around risk and performance in place to test the assurance.

Capacity to handle risk Risk Management is embedded across the organisation with each directorate and project owning their own risk registers. Risks that are scored 10 or 12 are transferred to the Directors Risk Register and Risks that score 15 or above are monitored on the Corporate Risk Register. Risk Management sits under the portfolio of the Executive Director of Nursing and Governance who chairs a monthly Risk Assurance Group made up of senior managers across the Trust. Oversight at a Committee level is provided by the Audit and Assurance Committee who on a quarterly basis receives the Risk Register. This enables them to look at the current risk profile and consider it against the Internal Audit Programme. The Risk Register and the Board Assurance Framework are received at every Board of Directors meeting. Each Board of Directors, Committee and Directors agenda also consider any new risks that have been identified.

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Risk Management is part of the induction process for staff where the Mandatory Workbook for all staff provides information to ensure that staff are knowledgeable on risk management. It covers staff responsibilities as well as how risk is identified, managed and reported. The Risk Assurance Group invites other teams and departments to join them to share learning across the organisation. The Board of Directors also has Risk Awareness sessions challenging themselves through the redesign of the Board Assurance Framework and Risk Register to ensure that they are fit for purpose and providing them with the right information. The Trust is a learning organisation and learns through its approach to risk management. Serious Incidents are well attended and seen as a valuable opportunity to improve practice and the governance publication Reflect offers opportunities for staff to share learning. The Trust also embraces its Duty of Candour, recognising where it needs to learn and improve. Members of the Board of Directors attend Serious Incident meetings. In addition the Directors and Board of Directors receive regular briefings on Serious Incidents.

The risk and control framework The Trust Board of Directors is committed to ensure that effective risk management is an integral part of its management approach, underpinning all activities. The Trust Risk Strategy was last approved in July 2014. It is currently under review and planned to be incorporated into a new Governance Strategy to further embed it in the culture of the Trust. The key aim of this strategy is to establish systems and processes to ensure that risk management becomes infused in the Trust‟s philosophy, practices and business planning processes ensuring a holistic approach. Risk oversight is through the Directors Group and Risk Assurance Group. Individual Directors will hold various forums and collate their own local risks and senior managers can feed risks into the Risk Assurance Group for consideration. The Risk Assurance Group will evaluate and check assurance on all Corporate and Director risk registers, ensuring consistency across the registers. This is then reported to the Directors Group. For additional scrutiny the Corporate and Directors Risk Register is also reported to the Audit & Assurance Committee and the Board of Directors receive the Corporate and Directors Risk Register and Board Assurance Framework at each meeting. Risk appetite is set at a Board level and reviewed depending upon the activity undertaken. Clinical and Operational risk appetite is low. The Risk Register and Board Assurance Framework is presented to each Board Meeting for the Board to have oversight of the key risks that the organisation is facing and how this affects our ability to achieve the strategic goals of the Trust.

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The Audit and Assurance Committee receive the Risk Register to inform their discussion and inform the commissioning of further Internal Audit and work.

Trust Quality Governance Arrangements The Trust has a Quality Development Group who has strategic oversight of the Trust approach to quality and ensures that it is embedded at all levels of the organisation. It is made up of members of the senior management team and all directorates are represented. The Trust also has a Quality Development Forum made up of clinicians and managers who undertake review of themes identified. The Forum is able to inform the Trust of front line experiences, learning and feedback and identify patient safety and experience concerns, recommending how this can be improved. The Quality Development Forum reports to the Quality Committee. The Quality Committee is accountable for overseeing the Quality arrangements of the Trust and its membership consists of Executive and Non-Executive Directors. It is chaired by a Non-Executive Director. The Board of Directors is continually focused on patient quality receiving assurance reports and updates at each of the meetings. Financial and quality performance information is available in the Integrated Corporate Performance Report (ICCP) which is always publically available; reinforcing a pledge by Directors in 2015 to give quality equal priority with performance. The Trust has a Quality Strategy and develops quality plans when appropriate. The Trust maintains a high profile nationally, with the Chairman, Chief Executive and Other Board Members holding membership of many national groups.

Care Quality Commission Registration The first full inspection of the Trust under the new regime is scheduled for 6 to 10 June 2016. However, due to the impact of adverse media coverage, the inspection of NHS 111 services was brought forward to 8 and 9 March 2016. The report into this inspection is awaited at the time of writing. The Trust maintains a positive relationship with the local CQC Inspector, and regular relationship meetings are held, with communication maintained by phone and email in between. The Trust has agreed a proactive communications protocol with the CQC providing information to them on certain levels of serious incidents, and any issues which might attract media attention. The Trust reports all serious and moderate patient safety incidents to the CQC via the National Reporting and Learning System, and provides the CQC with a copy of the 72 hour preliminary report prepared ahead of each serious incident investigation.

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The Quality Development Group monitors a work plan to address risks to quality and compliance and also oversees implementation of the Quality Development, and CQC communication plans. The Board of Directors and the Quality Committee receive regular reports to provide assurance. As part of the Internal Audit plan, an audit is undertaken each year of CQC compliance, and for 2015/16 the audit reviews compliance at a number of ambulance stations, as well as general readiness for an inspection. The Trust has an Information Assurance Steering Group chaired by the Executive Director of IM&T whose remit is to oversee data quality and information security arrangements for the Trust. Information security risks are reported to the Information Governance Group as the designated forum to consider issues arising from information governance and security incidents reported and trends that emerge from these. Any moderate or significant risks are escalated to the Risk Assurance Group and escalated to the Audit & Assurance Committee. During 2015/16, no information security incidents were classified as being serious. The Trust achieved compliance with level 2 of the NHS Information Governance Toolkit in 2015/16. The Board approved Caldicott Guardian is the Executive Medical Director. An Information Governance Group, chaired by the Senior Information Risk Owner (SIRO) and attended by Information Asset Owners, develops and monitors the information governance work programme. Our top major risks facing the Trust are the same as those risks that we see carrying forward. They are:

Maintaining and Improving quality

Staff Engagement

Increasing activity and demand on the service The Trust risk registers contain details of the controls that are in place to manage each risk, the action planned to manage the risk and an identified accountable director. These are reviewed and discussed at each meeting of the Board of Directors and Quality Committee, and monthly by the Directors Group with the accountable director being responsible for advising on the latest position for each risk. All risks are monitored through the Committee structure, via the risk register and Board Assurance Framework. The Risk Assurance Group, Audit and Assurance Committee, Quality Committee and Board of Directors are accountable for the oversight and assessing the outcomes of these risks. The pressure on the NHS is being faced across the sector. The Trust has worked with Commissioners, Monitor and NHS England to look at innovate was to contribute to

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managing the increase in activity and therefore the demand of the service, whilst coupling this with the robust governance arrangements that the Board of Directors ensure is in place. An example of this would be the Dispatch on Disposition pilot with NHS England. Whilst being part of the pilot had a knock on effect on Trust performance, it enabled us to be part of an initiative that would keep patients safe and able to access the right services for them whilst easing pressures on A&E departments. In 2015 the Trust maintained its green governance rating and a financial sustainability risk rating of 4 in quarters one and two. Like most ambulance providers we had failed to meet both the A8 Minute Response Time – Red 2 and A19 Minute Transportation Time targets. We had not achieved these targets for the last five quarters. Following the media coverage about NHS 111, in quarter four the Trust‟s governance rating was moved from green to - Under Review – Requires Further Information. The Trust is developing an action plan to respond to any recommendations that come from the external reviews with the aim of ensuring that whilst patient safety remains the Trust‟s priority; decisions are informed and appropriate resources are deployed to achieve planned and sustainable outcomes on the NHS 111 service. The Trust has an open and transparent relationship with Monitor, and we had shared throughout the period our issues and concerns around the performance. The Trust has also had two serious incidents, as well as some high profile media coverage regarding the Trust. Alongside the support from our Regulator, the Trust also commissioned an independent review to be completed by Price Waterhouse Coopers. The Trust continues to work with Monitor‟s relationship team to share the organisations view and steps taken across a range of matters, as well as any learning from external reviews such as our CQC inspection. The Trust has robust governance arrangements across the Board of Directors and the organisation and the Trust continues to prioritise patient safety. The Trust has worked with its commissioners throughout the year to review the unprecedented level of demand that we are experiencing and what solutions can be sought by the whole health economy. A joint action plan was developed with our commissioners. The Trust has continued to contribute to reducing the pressure on the rest of the community through initiatives such as Right Care 2 and our running of an Urgent Care centre in Tiverton. The Board of Directors, Audit and Assurance Committee, Quality Committee and Directors Group continue to monitor the level of demand and performance with the monthly publication of the ICPR. The Committees and Board of Directors continue to receive the Risk Register, Board Assurance Framework, Serious Incident reports and any concerns regarding patient

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safety. Committees work together to ensure that all are assured and cross refer issues as appropriate. The Trust‟s compliance with its corporate duties is reported through the Audit and Assurance Committee, Board of Directors and Council of Governors. The Trusts approach to risk is embedded across the whole organisation. The risk to service delivery and patient safety is managed locally through project and directorate risk registers and escalated through to the Board and Committee structure where appropriate. The Trust Serious Incident process is a positive example of its approach to Risk. Incidents are learned from to ensure that the practice of our staff is developed where possible and things are learned from to ensure that we continue to deliver a safe and effective service. Serious Incidents are well attended by the staff involved and are seen as an experiential learning opportunity. Cost improvement schemes have risk assessments carried out on them known as quality impact assessments so that decisions are not made in isolation but instead are part of a series of interdependent links that lead to the safe and effective responsive service that we run. The Trust values the input of others in looking at how their stakeholders can affect our approach to risk management. A large number of the Trust‟s risks are caused by pressures on the wider health system so these are regularly raised with our commissioners and acute partners. The Trust attends a quarterly meeting with our Commissioners who are sighted on key risks that affect our ability to deliver Trust services and we work together to provide solutions. We have the same open and transparent relationship with Monitor and regularly update them on issues and challenges facing the Trust. Alongside our regular reporting, our Commissioners are in attendance at our Quality Committee and Quality development Group meetings. Public Board meetings are attended by our Staff, Governors and Members of the Public. Nine of our 34 seats on the Council of Governors are held by appointed organisations that we work with closely. Last year the Governors completed over 400 Governor Engagement Surveys to help the Trust understand the public‟s priorities.

The foundation trust is fully compliant with the registration requirements of the Care Quality Commission. As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer‟s contributions and payments into the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations.

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Control measures are in place to ensure that all the organisation‟s obligations under equality, diversity and human rights legislation are complied with. 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.

Review of economy, efficiency and effectiveness of the use of resources The Trust works hard to ensure that its resources are used efficiently and effectively. Each year there is an Audit and Assurance Committee approved plan for how Internal Audit will be engaged in the year. The Trust ICPR contains all of the Trust performance information and is open to public review. All cost improvement schemes are assessed and delivered ensuring that they have a quality impact assessment done on them to understand the impact on the patient and the Trust Finance and Investment Committee oversees the accountability for cost improvement plans. We have always set appropriate cost improvement schemes and continue to return a surplus in a difficult financial climate.

Information governance The Trust is required to monitor and report information risks and data losses in a standard format specified by the regulator.

Summary of Personal Data Related Incidents in 2015/16

Category Breach Type Total

A Corruption or inability to recover electronic data 0

B Disclosed in Error 39

C Lost in Transit 22

D Lost or Stolen hardware 4

E* Lost or Stolen Paperwork 59

F Non-Secure Disposal 0

G Non-Secure Disposal Paperwork 3

H Uploaded to website in error 0

I Technical Security Failing (including hacking) 0

J Unauthorised Access/Disclosure 15

K Other 72 *Please note this usually relates to paperwork which can‟t be sourced, but is not confirmed lost or stolen.

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During 2015/16 there was one serious incident attracting a severity rating of 2 or more which required reporting at the national level. The Trust provided evidence to the ICO in respect of the breach and after careful consideration they decided no enforcement action was required. The Trust‟s Information Governance arrangements include dedicated management of risks to the information held by the Trust in order to reflect the specific requirements, defined through the Information Governance Toolkit and ISO 27001/2, for managing information security risks. 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. The Trust‟s Executive Director of Nursing and Governance oversees the Quality Account arrangements. Priorities are developed by the Trust and approved by the Executive Directors. One of these priorities is then selected by the Council of Governors for the Auditors to review. The Quality Strategy and clinical policies will inform the direction of the quality indicators and the Trust uses its learning from complaints and incidents when deciding priorities. The external auditors validate three indicators: Red1, Red 2 and A19 and provide limited assurance on one local indicator. In 2015/16 the local indicator was Paediatric Big 6. Data quality is reviewed throughout the year, through the Information Assurance Steering Group. Data quality is also reported to the Board of Directors for assurance and oversight. It is also provided as part of the ICPR. The Quality Account is presented to the Audit and Assurance Committee for assurance and recommendation to the Board of Directors once it is satisfied that it has met the requirements.

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 that have responsibility for the development and maintenance of the internal control framework. 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 quality committee, and a plan to address weaknesses and ensure continuous improvement of the system is in place.

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My review is also informed by: The Head of Internal Audit providing me with an opinion on the overall arrangements for gaining assurance through the Board Assurance Framework and on the controls reviewed as part of the internal audit work. The Head of Internal Audit Opinion confirms overall as significant assurance. The Executive Team provide assurance throughout the year in formal committee, Directors and Board Meetings and this is further confirmed by the external assurance that I receive and we report to the Board of Directors and Council of Governors. The Board of Directors, Audit and Assurance Committee and the Quality Committee receive assurance through their station visits, attendance at events, talking to staff and comparing this to the information that they receive in corporate meetings. The evolution and revision of the Risk Register and Board Assurance Framework has enabled the Board of Directors to change the way in which it receives and uses information ensuring that things stay fresh and approaches and assurance checking does not become complacent. Ongoing compliance with Monitor Code of Governance, License condition and the positive feedback from the Head of Internal Audit Opinion also informed opinion.

Conclusion

I certify that no significant internal control issues have been identified Signed

Ken Wenman Chief Executive Date: 23 May 2016

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Part 1: A Statement on Quality from the Chief Executive

Welcome to the Quality Account and Report 2015/16. As we enter a new financial year, I am pleased to have this opportunity to reflect on the quality of care and services we have delivered whilst looking forward to the developments and initiatives planned for 2016/17. It has been another challenging year for the NHS in general and the Trust specifically as we strive to continue to deliver high quality services in the face of ever increasing demands on our services and the financial climate within which we operate. However, I am proud to report that despite these challenges staff continue to deliver high quality patient care, whilst as an organisation we maintain our drive for quality and innovation for the benefit of our patients. As you will read, developments this year have included our management and treatment of unwell children for the six most common conditions leading to them accessing the 999 emergency service. We have also been working with our partners to manage those patients who access emergency healthcare on an abnormally high number of occasions to ensure that their needs are met, but not at the cost of our ability to care for others. I am particularly proud of our Right Care initiative which sees our clinicians working to ensure that patients receive the best possible care, in the right place, at the right time. This not only results in an improved patient experience, but has a positive impact on the rest of the healthcare economy across the South West as we now treat over 50% of patients in the comfort of their own home without the need to be taken to hospital. In previous years I have reported on the expansion of our urgent care services across the region with NHS111 and Out of Hours services being provided in a number of areas. This year, however, the Trust has had to take the difficult decision to move away from some of these services as it cannot deliver them as it would wish, without its commitment to quality being comprised. Throughout this busy year the Board of Directors and I have made time to meet and speak with our dedicated staff across the Trust. Their professionalism, commitment and willingness to go the extra mile for their patients is to be applauded. My thanks go out to them all. 2016/17 will see us continuing to focus on delivering high quality services for our patients. Initiatives will include improving outcomes from cardiac arrest, implementation of the Accessible Information Standard and learning from the way in which human factors can impact upon the way in which telephone calls are triaged. All of these initiatives will improve the experience of our patients and I look forward to reporting developments to you in future Quality Accounts. I confirm that, to the best of my knowledge, the information in this quality report is accurate and reflects a balanced view of the Trust, its achievements and future ambitions.

Ken Wenman Chief Executive

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Part 2: Priorities for Improvement and Statements of Assurance from the Board of Directors A Review of Quality Improvement Priorities made within the South Western Ambulance Service NHS Foundation Trust in 2015/16

Providing quality services to its patients remained the top priority for the Trust during 2015/16, with this priority being evidenced through its vision, values and strategic goals. The Trust‟s vision statement is „To be an organisation that is committed to delivering high quality services to patients and continues to develop ways of working to ensure patients receive the right care, in the right place at the right time.‟ This reflects the vision for emergency and urgent care set out by Sir Bruce Keogh: “for those people with urgent but non-life threatening needs we (the NHS) must provide highly responsive, effective and personalised services outside of hospital.” This vision is communicated and promoted through the following:

From Prevention to Intervention: summarises the Trust‟s ambition to support a safer, more efficient and sustainable urgent and emergency care system for the future. It recognises the integral part ambulance services can play in working alongside health partners to prevent disease and identify effective ways of influencing people‟s behaviours and lifestyles and in playing an increasingly significant role in urgent and emergency care provision.

Right Care, Right Place, Right Time: captures one of the Trust‟s key initiatives that focuses on ensuring patients receive the best possible care, in the most appropriate place and at the right time. This is alongside a drive to safely reduce the number of inappropriate A&E attendances at acute hospitals and deliver a wide range of developments to improve the appropriateness of the care delivered to patients.

1 Number, 1 Referral, 1 Outcome: captures the value added by the Trust as a provider of NHS 111 services that are integrated with GP Out-of-Hours and 999 services.

Local Service, Regional Resilience: recognises the dual role of the ambulance service in delivering a local service providing individual and personalised care to patients balanced with system wide coverage and capacity for resilience.

The values agreed by the Board of Directors demonstrate the emphasis that the Trust places on the individuality of patients and staff, and the commitment the Trust has to delivering high quality services. Values

Respect and dignity.

Commitment to quality of care.

Compassion.

Improving lives.

Working together for patients.

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The Trust‟s long term strategic goals and corporate objectives reflect its quality priorities. These include national priorities for ambulance trusts and local commitments agreed with the Clinical Commissioning Groups (responsible for commissioning services) and our Council of Governors. The corporate objectives are aligned to the strategic goals set out below and show the recurrence of quality throughout the strategic approach.

Strategic Goals Safe, Clinically Appropriate Responses: Delivering high quality and compassionate care to patients in the most clinically appropriate, safe and effective way. Right People, Right Skills, Right Values: Supporting and enabling greater local responsibility and accountability for decision making; building a workforce of competent, capable staff who are flexible and responsive to change and innovation. 24/7 Emergency and Urgent Care: Influencing local health and social care systems in managing demand pressures and developing new care models, leading emergency and urgent care systems and providing high quality services 24 hours a day, seven days a week. Creating Organisational Strength: Continuing to ensure the Trust is sustainable, maintaining and enhancing financial stability. In this way the Trust will be capable of continuous development and transformational change by strengthening resilience, capacity and capability. Performance and progress against these are all reported within the Trust‟s Integrated Corporate Performance Report, which is presented to the Board of Directors at each publicly held meeting and is available on our website.

Corporate Objectives 2016/17 Supporting staff: This objective focuses on embedding a robust culture of supporting

staff and changes the shape of training and support; Delivering performance: This objective focuses on the Trust‟s contractual and national

obligations in relation to key performance indicators and how the Trust intends to deliver these in the year ahead;

Clinical quality: This objective continues the focus of the Trust on delivering the basics to a high standard ensuring that a high quality safe and effective service is delivered to patients. It includes the Trust‟s approach to quality improvement, proposed CQUIN initiatives and the Trust‟s „sign up to safety‟ priorities;

No compromise: This objective addresses the change in financial risk appetite within the Trust in relation to securing new business and approaching new opportunities

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Quality Strategy The Trust is currently reviewing its Quality Strategy, with it being issued for consultation with staff and patients in early May 2016. The Strategy will continue to focus on the Darzi priorities of Patient Safety; Patient Experience; and Clinical Effectiveness.

It is intended that the Quality Strategy is built on the opinions and views of staff and our

members. The Strategy will describe the principles and framework for quality with the

vision and key performance indicators being built on what is important to staff and patients.

It will use „I-statements‟ to develop quality outcomes which provide robust safety measures. It will be underpinned by the principle that a better experience for staff and patients leads to improvement in safety.

Safety – Will it do me any harm

Effective – Will it do me

any good

Q Experience –

Will I be treated with Dignity and

Respect

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2015/16 Quality Priorities In 2015 the Trust published a Quality Account which illustrated its continuous quality improvement journey and set out its priorities for the year ahead. These priorities (listed under the three categories of patient safety, clinical effectiveness and patient experience) are restated below as they appeared at that time, along with an overview of the Trust‟s performance:

Patient Safety Priority 1 – Sign Up to Safety Sign up to Safety is a national campaign, launched by NHS England, designed to strengthen patient safety in the NHS and make it the „safest healthcare system in the world‟.2 By Signing up to Safety, we will align our patient safety improvement plans to the NHS-wide purpose, thereby strengthening our own activities. The campaign provides a robust structure on which we can pin our safety improvements, and this should help to make them clearer and more accessible to our service users.

Aims To develop and implement a clear and measurable programme of safety improvement across all of the Trust‟s services (A&E, Out of Hours, NHS111 and Patient Transport Services), which is underpinned by a published set of principles supporting the five Sign up to Safety pledges, which are:

1. Put Safety First Commit to reducing avoidable harm in the NHS by half and make public our goals and plans developed locally.

2. Continually Learn Make our own organisation more resilient to risks, by acting on the feedback from patients and by constantly measuring and monitoring how safe our services are.

3. Honesty Be transparent with people about our progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong.

4. Collaborate Take a leading role in supporting local collaborative learning, so that improvements are made across all of the local services that patients use.

5. Support Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and celebrate the progress.

Initiatives

Develop a clear set of aims or principles to support the five Sign up to Safety pledges.

2 www.england.nhs.uk/signuptosafety

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Engage and consult with patients, staff, governors, and other stakeholders, to seek their feedback on what they see as priorities for patient safety.

Develop and implement a short/medium/long term programme of safety improvement using the feedback provided.

Support the work of the three Patient Safety Collaboratives covering our operational area, including encouraging managers to undertake the Institute of Healthcare Improvement (IHI) Accelerated Patient Safety Programme.

Board Sponsor: Jenny Winslade, Executive Director of Nursing and Governance

Implementation Lead: Nicole Casey, Head of Governance

How will we know if we have achieved this priority? We will have a clear set of aims or principles supporting the five Sign up to Safety

pledges signed off by our Chief Executive Officer and published on the Trust website.

Through engagement with staff and governors, we will have received: o Responses from a minimum 3% of staff (n129/4285), and at least 50% of

governors (n13/26), to a new engagement survey on safety, to be used to develop the programme of safety improvement.

We will have a measurable short/medium/long term programme of safety improvement based around feedback provided from stakeholders and signed off by the Trust Quality and Governance Committee.

We will have improved the completion of actions (within agreed target deadlines) developed through learning from serious/moderate harm incidents from the baseline (at April 2015) to 70%. This will be reported to and monitored by the Directors‟ Group.

We will be able to demonstrate active involvement in the three Patient Safety Collaboratives covering our operational area, by ensuring a minimum of 3 Trust managers attend the Patient Safety Collaborative IHI training programme in 2015/16, and that at least one representative attends each meeting of the three Patient Safety Collaboratives

Implementation of the new programme will have commenced by quarter four of 2015/16. This will include development of a full plan for 2016/17.

Progress towards the Sign up to Safety campaign during 2015/16 will be reported by exception to the Quality and Governance Committee, including a deep dive into the first year‟s work at year end.

Did we achieve this priority? We partially achieved this priority:

We developed a clear set of principles supporting the five Sign up to Safety pledges and these will be published on our website.

We have commenced a programme of engagement with staff asking them what one thing would help to improvement the safety of their patients. Our aim is get a minimum 3% response from staff (n129)

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We are also engaging with our members and governors to ask them for their views on safety improvement. In May 2016 we contacted over 1,200 of our members and discussed the initiative with our governors in April. Our aim to receive a response from a minimum of 50% of governors.

We have improved the completion of actions developed through learning from serious/moderate harm incidents from the baseline 91% (at April 2015) to 91.5% at the end of March 2016.

We have been actively involved in the three Patient Safety Collaboratives covering our operational area, by putting 3 Trust managers through the Patient Safety Collaborative IHI training programme in October 2015, and attending meetings of the three Patient Safety Collaboratives, working with them on new initiatives including introduction of the National Early Warning Score to help improve the safety of patients involved in handover delays at emergency departments

Due to delays in the engagement process, we expect to have a draft safety improvement programme developed by the end of Quarter 1 2016/17. Implementation was intended to have started in Quarter 4 of 2015/16.

Clinical Effectiveness Priority 2 – Paediatric Big Six A recent study reported an increase of 28% in the admission rate for children under 15 years of age between 1999 and 2010 in England. In addition, a Kings Fund Review of the South of England in 2012 reported a 9% growth in general paediatric admissions over the previous four years. National data shows that the “big six” conditions accounted for 50% (2008/09) of all emergency and urgent care admissions. There is significant potential to better manage these conditions if there is the right distribution of services and a co-ordinated, systematic approach to the management, monitoring and recording of a patient‟s care, known as the care pathway. The South West Strategic Clinical Network has identified scope to both reduce avoidable admissions and improve treatment and outcomes in the South West in relation to children, young people and their families, according with the Trust‟s Right Care2 initiative.

Aims To promote the evidence-based assessment and management of unwell children and young people for the six most common conditions when accessing 999 ambulance services. The six conditions are:

Fever

Croup

Abdominal pain

Diarrhoea (with or without vomiting)

Asthma

Head injury

Initiatives

Development of an overarching Trust document covering the Guideline for Paediatric

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Big Six.

Integration of the overarching document into the Electronic Patient Clinical Record.

Partnership working with Acute Trusts to identify ways in which direct admissions or advice can be achieved.

Board Sponsor Executive Medical Director

Implementation Lead Clinical Development Officer (East)

How will we know if we have achieved this priority?

Trust clinicians will be supported by the latest evidenced best guidance with support from the region‟s providers, to reduce variation in the assessment and management of the six conditions and ensure patients are safe and have access to equitable care pathways.

The Big 6 Guideline will be published and uploaded to the intranet and electronic patient record.

75% of frontline clinicians (Specialist Paramedics, Operational Officers and Paramedics) will receive Big 6 training (excluding staff on secondment, maternity and long term sick leave).

Did we achieve this priority? Yes, we achieved this priority. A recent audit of 300 records relating to paediatric care has shown that there has been a reduction in conveyance of cases that presented as lower-risk when compared against the guidelines; all “Red Flag” cases were recognised as such and appropriately treated and conveyed. The audit also identified areas where the Trust will continue to work in collaboration with acute trusts in relation to advice lines and alternative pathways. The Big 6 guideline has been published in print format and sent to all clinicians in the Trust. It has been uploaded to the electronic patient clinical record (ePCR) server, and is also available on the Trust‟s intranet and internet sites. 88.52% of frontline clinicians (Specialist Paramedics, Operational Officers and Paramedics) have attended education events which contained Big 6 guidance (excluding staff on secondment, maternity and long term sick leave). The Trust has also recently targeted those who have not been able to attend the events, by ensuring the yearly one-to-one Learning and Development Review day contains the Big 6 guidance, which has accounted for another 0.98% of relevant staff. In addition, those who have not yet attended either of these opportunities have been sent an electronic package explaining the guideline and its origins, applications and extra links for personal learning. This has been acknowledged as received by a further 4.44% of relevant staff, giving a combined total of 93.94%. The Trust is able to evidence this achieved percentage of relevant training as the data is verified through the use of staff and training attendance records and then stored on the central Electronic Staff Record.

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Recognition and management of paediatric illnesses will continue to be a subject for education events for the next financial year.

Patient Experience Priority 3 – Frequent Callers Frequent callers are a small group of patients who access emergency healthcare on an abnormally high number of occasions. These patients, who often have specific social or healthcare needs, also have a significant impact on the ability of the NHS and emergency services to deliver a safe service to the wider community due to the level of resource required to deal with their requirements. Improved partnership working is required to ensure that frequent callers are treated in an equitable manner and that care plans are developed and delivered, which meet their individual needs in line with the Trust‟s Right Care2 initiative. This work will enable the Trust to manage demand from this small group by ensuring that resources are not used inappropriately and that their needs do not impact on the ability of the service to meet the requirements of other users.

Aim To improve the management of Frequent Callers who present to the ambulance service and a range of health and social care providers.

Initiatives Establish links with Frequent Caller Leads in external organisations including Acute

Trusts, Mental Health Trusts and NHS111 providers.

Review the top five Frequent Callers from private addresses, aged 18 years and over, for each CCG area. Establish the percentage which already has an individual action plan in place.

Work with partner organisations to develop individual action plans for any patients identified above where they are not already in place.

Board Sponsor Director of Operations

Implementation Lead Frequent Caller Lead

How will we know if we achieve this priority? We will have produced a list of the key contacts within relevant external organisations.

We will increase the percentage of frequent callers, identified during each quarter, who have an action plan in place at the end of the following quarter, compared to the quarter in which they were identified.

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Did we achieve this priority? Yes, we achieved this priority. During the year all A&E departments across the area were contacted, with their High Service User (HSU) Leads being identified and the Trust attending Frequent User meetings to discuss mutual HSU issues. Links were also made with all NHS111 services and Mental Health providers across the region. The details of all key contacts have been collated for ongoing reference and networking purposes. The Frequent Caller Team has proactively been contacting the wider Primary and Secondary Health Care teams, Social Care and Mental Health teams, to actively engage in the development of care plans where the patient is a 999 HSU. The Trust is also represented at multiagency meetings to progress initiatives in this area. The Top 5 most prolific Frequent Callers for each of the thirteen commissioning areas were identified on a quarterly basis throughout 2015/16, with this study covering 132 patients. The need for a care plan for all of these 132 patients was analysed. Where care plans were not found to be in place, relevant teams were contacted and the need for a Care Plan was discussed. It should be noted, however, that individual Care Plans are not always required to manage the patient‟s 999 demand, for example if 999 demand has ceased following the initial steps of the Frequent Caller process being undertaken. By proactively managing 999 HSUs the percentage treated via telephone triage and consultation, rather than by ambulance crews attending has increased considerably from a range of 0-40%, to a range of 13-92% over 2015/16. The Frequent Caller Team will continue to work proactively with the wider health and social care community to obtain individual care plans where required.

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Quality Priorities for Improvement 2016/17

The Trust is accountable to its patients and service users and the Quality Account provides an ideal mechanism for addressing this. As a Foundation Trust, SWASFT has a Council of Governors which is invaluable in representing the views of Governors, the Trust membership and the wider public, gained through engagement activities. The Trust liaised with its Council of Governors to obtain their opinion and input on the suggested priorities within this report and to encourage them to think about how they can engage with the Trust Membership and the wider public about these priorities. In developing the priorities for the forthcoming year, the Trust has taken into account feedback provided by stakeholders, including commissioners, on previous Quality Accounts. When setting the priorities for 2016/17 consideration has been given to Quality Account priorities from previous years, the learning from these and the benefits in focusing further on these areas. In previous years the Trust has focussed upon ROSC (the return of spontaneous circulation) as every month the Trust responds to around 200 patients who have suffered a cardiac arrest; and this year this focus continues with a quality priority that focuses upon improving outcomes from cardiac arrest. During 2015/16 the Implementation Leads for the agreed priorities were responsible for monitoring progress at the appropriate working groups, whilst the progress of the Trust‟s quality development programme was monitored through the Quality Committee. These governance arrangements will be continued during 2016/17. A review of the progress against these priorities will be included in next year‟s Quality Report and Account.

Clinical Effectiveness – Cardiac Arrest

Why a Priority? A cardiac arrest is considered the ultimate medical emergency, where outcomes are based largely on the correct treatment being delivered as quickly as possible, with clinicians delivering interventions that contribute to each part of the chain of survival. The ambulance service plays a crucial part in delivering these early interventions, influencing all of the links within the chain of survival. Evidence based resuscitation guidance is provided by the UK Resuscitation Council, which details the interventions which are likely to increase the chance of survival in a respiratory or cardiac arrest. It is well evidenced that adherence to the principles within the resuscitation guidelines increases the chance of a patient regaining a pulse (known as ROSC, Return of Spontaneous Circulation) and therefore survival to discharge (leaving hospital alive). Ambulance services are measured on the rate of ROSC and survival to discharge for all resuscitated cardiac arrest patients. The same clinical indicators are also reported for a sub-set known as the Utstein group, which includes only patients who should have the best chance of a positive outcome. Use of the Utstein group enables international

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comparison of performance between health systems. It should be noted that a range of factors outside of the ambulance services control affect survival to discharge, such as the quality of the care received within hospital. There is potential to improve outcomes from cardiac arrest if a more co-ordinated, systematic approach to the management is adopted.

Aim The aim of this Clinical Effectiveness Indicator is to improve adherence to the Resuscitation Council guidelines and therefore the quality of resuscitation by Trust clinicians. In addition we will promote the benefits of partnership working with local acute trusts, in order to improve outcomes in cardiac arrest.

Initiatives Use recognised quality improvement techniques such as Plan-Do-Study-Act (PDSA)

cycles, process maps, and feedback using annotated statistical process control (SPC) charts to understand the gaps in care, the barriers to improvement and how to address these.

Develop and implement resuscitation checklists to support clinicians when managing cardiac arrest.

Deliver a Resuscitation Council 2015 training update and practical ALS scenario to 90% of available Trust frontline clinical staff, in order to improve the quality of treatment provided. To embed sustainable improvement we will promote partnership working with acute trusts and Strategic Clinical Networks in order to reduce variation in patient outcomes. We may use operational modelling techniques to explore the potential implications of cardiac arrest centres in the South West.

Board Sponsor Executive Medical Director

Implementation Lead James Wenman, Clinical Development Manager


Trust clinicians will be supported by resuscitation checklists based on the updated resuscitation council guidance which will support adherence to evidence based guidance and team working in cardiac arrest.

90% of available frontline clinicians (Specialist Paramedics, Operational Officers, Paramedics, Advanced Technicians, Ambulance Practitioners and Emergency Care Assistants) will receive a cardiac arrest update and practical ALS assessment as part of their annual development day.1

The Trust will establish links with our stakeholders so that outcomes from cardiac arrest and the benefits of partnership working can be explored.

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Patient Engagement – Accessible Information Why a Priority? When people require transport to hospital or need urgent or emergency care, it is essential that they are able to communicate clearly with the staff who attend them so that the care provided is appropriate and safe. When care is provided in an emergency setting ambulance trusts are not always in a position to establish whether there are any individual communication needs which should be taken into account. There are existing mechanisms in place in the clinical hubs, such as: warnings on addresses for patients who have had laryngectomies and tracheostomies and may have difficulty communicating; Easy Read letters for frequent callers and contact with their learning disability or other teams to aid communication; communication is covered in the Pathways course; and hub staff are advised that if there are communication difficulties the call should be early exited and a response sent. A new Accessible Information Standard has been introduced which is designed for trusts to establish those communication needs at the first point of contact. In order to support implementation of the Standard and increase the chances of that information being available to emergency ambulance crews when they need it, it is important that patients know how to provide the information before they require our help. Encouraging patients to explain any individual communication needs when they call or when we attend them, will also support them when they need access to patient transport and out of hours care. Understanding better how our patients wish us to communicate with them will enable us to improve their access to and the quality of their experience of the services we provide.

Aims Improve the level of contact by those with communication difficulties in advance of their

treatment so that we able to provide them with a better and more accessible service, noting that we do not as yet have the capability to record this information for future contact

Increase engagement with groups supporting those with sensory loss to better understand their communication needs and help to develop bespoke communication tools

Initiatives Develop an education campaign to advise patients about the need to tell us (when they call or we attend them) if they have particular communication needs. This will include:

Adding a footnote to the following patient facing correspondence: complaint acknowledgements; proactive apology letters; Duty of Candour calls and letters; and patient survey forms.

Developing a video, advising patients what they need to tell us about their communication needs and when, for publication on the Trust website and dissemination to patient support groups.

Developing posters for display at treatment centres.

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Considering adaptation to ePCR to allow the recording of patient communication requirements.

Reviewing and developing a plan for improvement of the Trust‟s website to maximise the use of plain English and accessibility, asking Trust members to review the updated content.

Developing a programme of engagement with groups supporting patients with sensory loss to allow them to explain their particular communication needs, leading to future development of an Accessible Information Standard action plan.

Board Sponsor Executive Director of Nursing and Governance

Implementation Lead Nicole Casey, Head of Governance

How will we know we have achieved this priority?

Reports on notification of communication needs measured as a result of patient facing correspondence and the video and poster campaign, from a baseline set on 1 April 2016. This will be reported to us by staff in the hub or on scene.

Comment on the amended Trust website by a survey of Trust members

Development of an Accessible Information Standard action plan

Patient Experience – Human Factors

Why a priority? A thematic review of patient safety incidents identified human factors as a common theme amongst serious incidents. Human factors can influence how people behave and perform. In the context of the Trust, human factors are environmental, organisational and job factors, and individual characteristics which influence behaviour.

Aim The patient safety indicator will focus on undertaking a review of human factors influencing errors made during the telephone triage process to identify solutions to improve patient safety.

Initiatives

Undertaking research to agree the defined list of human factors from the models available which will be utilised to undertake the review.

Conducting a review of patient safety incidents to identify where telephone triage errors were identified as a concern.

Using the agreed human factors model, analyse the identified incidents to identify the human factors associated with the telephone triage errors.

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Undertaking a deep dive of the key human factors identified as part of the analysis and develop proposals for solutions to be considered by the Executive Director of Nursing and Governance to reduce the likelihood of error in telephone triaging.

Board Sponsor Jenny Winslade, Executive Director of Nursing and Governance

Implementation Lead Vanessa Williams, Head of Patient Safety and Risk


We will have an agreed human factors model to utilise in the organisation for patient safety research and future analysis of incidents, complaints, etc.

We will have identified key human factors influencing telephone triage errors.

We will have developed proposed solutions to address errors minimising the likelihood of recurrence of incidents relating to telephone triage.

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Statements of Assurance from the Board

Statutory Statement

This content is common to all healthcare providers which make Quality Accounts comparable between organisations and provides assurance that the Board has reviewed and engaged in cross-cutting initiatives which link strongly to quality improvement. 1. During 2015/16 the South Western Ambulance Service NHS Foundation Trust

provided and/or sub-contracted three relevant health services:

Emergency (999) Ambulance Service;

Urgent Care Service (NHS 111; GP Out-of-Hours and Tiverton Urgent Care Centre);

Non-Emergency Patient Transport Service. 1.1 The South Western Ambulance Service NHS Foundation Trust has reviewed all the

data available to them on the quality of care in three of these relevant health services. 1.2 The income generated by the relevant health services reviewed in 2015/16

represents 93.11 per cent of the total income generated from the provision of relevant health services by the South Western Ambulance Service NHS Foundation Trust for 2015/16.

2. During 2015/16, zero national clinical audits and zero national confidential enquiries

covered relevant health services that South Western Ambulance Service NHS Foundation Trust provides.

2.1 During 2015/16 South Western Ambulance Service NHS Foundation Trust

participated in 100 per cent national clinical audits and 100 per cent national confidential enquiries of the national clinical audits and national confidential enquiries which it was eligible to participate in.

2.2 The national clinical audits and national confidential enquiries that South Western Ambulance Service NHS Foundation Trust was eligible to participate in during 2015/16 are as follows:

None 2.3 The national clinical audits and national confidential enquiries that South Western

Ambulance Service NHS Foundation Trust participated in during 2015/16 are as follows:

None

2.4 The national clinical audits and national confidential enquiries that South Western Ambulance Service NHS Foundation Trust participated in, and for which data collection was completed during 2015/16, are listed below alongside the number 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:

None 0 Cases 0.00%

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2.5 The reports of no national clinical audits were reviewed by the provider in 2015/16 and South Western Ambulance Service NHS Foundation Trust intends to take the following actions to improve the quality of healthcare provided:

Undertake a programme of Quality Improvement activity across the organisation to facilitate the delivery of high quality care.

2.6 The reports of 7 local clinical audits were reviewed by the provider in 2015/16 and

South Western Ambulance Service NHS Foundation Trust intends to take the following actions to improve the quality of healthcare provided:

Continue to reinforce the importance of good quality record keeping which underpins clinical quality reporting.

Work to ensure that all clinical audits cover the whole Trust area to inform service delivery across the region.

Ensure that the outputs of clinical audit are used to inform the work of the Quality Improvement Paramedics.

Undertake Quality Improvement activity to improve the assessment and management of pain.

Work with the resuscitation clinical sub group to develop a programme of work to improve the proportion of patients who are resuscitated gaining a return of spontaneous circulation on arrival at hospital.

Undertake a programme of re-audit following quality improvement activity. 3. The number of patients receiving relevant health services provided or sub-

contracted by South Western Ambulance Service NHS Foundation Trust in 2015/16 that were recruited during that period to participate in research approved by a research ethics committee was 2,000.

4. A proportion of South Western Ambulance Service NHS Foundation Trust income in

2015/16 was conditional on achieving quality improvement and innovation goals agreed between South Western Ambulance Service NHS Foundation Trust 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 payment framework. Further details of the agreed goals for 2015/16 and for the following 12 month period are available electronically at www.swast.nhs.uk.

4.1 The monetary total available for the Commissioning for Quality and Innovation

payments, for all service lines, for 2015/16 was £2,961,958 and for 2014/15 was £2,927,940.

5. South Western Ambulance Service NHS Foundation Trust is required to register

with the Care Quality Commission and its current registration status is „registered without compliance conditions‟.

South Western Ambulance Service NHS Foundation Trust has the following conditions on registration:

None.


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5.1 The Care Quality Commission has not taken enforcement action against South Western Ambulance Service NHS Foundation Trust during 2015/16.

5.2 South Western Ambulance Service NHS Foundation Trust has not participated in any special reviews or investigations by the Care Quality Commission during the reporting period.

6. South Western Ambulance Service NHS Foundation Trust did not submit records

during 2015/16 to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published data.

7. South Western Ambulance Service NHS Foundation Trust Information Governance

Assessment Report overall score for 2015/16 was 71% and was graded green. 8. South Western Ambulance Service NHS Foundation Trust was not subject to the

Payment by Results clinical coding audit during the reporting period by the Audit Commission.

9. South Western Ambulance Service NHS Foundation Trust will be taking the

following action to improve data quality:

Continue to maintain and develop the existing data quality processes embedded within the Trust.

Hold regular meetings of the Information Assurance Group to continue to provide a focus on this area.

Ensure completion and return of the monthly Data Quality Service Line Reports and in particular strengthen reporting by its NHS111 services.

Continue to provide Data Quality Assurance Reports to the Board of Directors.

Where external assurance of data quality is required, commission an independent review from Audit Southwest, the Trust‟s internal audit provider.

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Key Performance Indicators

This section includes the mandatory indicators which the Trust is required to include in this report. Further performance information is shown in Part 3 of this report.

Category A Performance


Target 2015/16 2014/15 National Average 2015/16*

Highest Trust

2015/16*

Lowest Trust

2015/16*

Red 1 75% 73.72% 75.24% 73.50% 79.10% 67.84%

Red 2 75% 63.60% 71.42% 69.12% 75.95% 62.66%


Target 2015/16 2014/15

National Average 2015/16*

Highest Trust

2015/16*

Lowest Trust

2015/16*

19 Minute 95% 89.44% 93.62% 93.37% 97.34% 88.81%

*Highest/Lowest Trust reporting has been noted for each indicator independently, current information from YTD 2015/16 reported at the end of January 2016. Category A performance by Clinical Commissioning Group can be found at Appendix 1. For clarification, Category A incidents are those involving patients with a presenting condition which may be immediately life threatening and who should receive an emergency response within 8 minutes irrespective of location, in 75% of cases. Red 1 calls are those requiring the most time critical response and cover cardiac arrest patients who are not breathing and do not have a pulse and other severe conditions such as airway obstruction. Red 2 calls are those which are serious but less immediately time critical and cover conditions such as stroke and fits. In addition, Category A patients should receive an ambulance response at the scene within 19 minutes in 95% of cases. A19 performance is based on the combination of both Red 1 and Red 2 categories of call. The Trust is assessed against the delivery of the Red 1, Red 2 and A19 performance targets quarterly by Monitor. The Trust met the Red 1 performance target in Quarters 1, 2 and 3 of 2015/16, but the other two targets were breached. In Quarter 4 all three performance targets were breached. Details of the breaches have been reported within the Annual Governance Statement, which forms part of the Annual Report and includes assurance of the action taken to improve the position. The South Western Ambulance Service NHS Foundation Trust considers that this data is as described for the following reasons:

The Trust has robust data quality processes in place to ensure the reporting of performance information is both accurate and timely.

Information is collated in accordance with the guidance for the Ambulance Quality Indicators.

This information is reported to the Board of Directors monthly in the Integrated Corporate Performance Report.

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The South Western Ambulance Service NHS Foundation Trust is taking the following actions to improve Red performance percentages, and so the quality of its services, by:

The development and implementation of a „Measures to Improve Performance‟ plan during Quarter 2 of 2015/16, which was updated during Quarter 3 and 4 of 2015/16. This is a comprehensive plan developed by the Operations directorate, in conjunction with all directorates across the Trust, to identify the key actions and developments required to improve Red performance.

The Trust is currently a pilot organisation for the Ambulance Response Review which is looking at the way in which ambulances are monitored in terms of response times. Details of this review can be found in Part 3 of this report.

Ambulance Clinical Quality Indicators (ACQIs) ACQIs are designed to reflect best practice in the delivery of care for specific conditions and to stimulate continuous improvement in care. They were initially introduced in 2010/11, and since this time ambulance trusts have been working nationally to agree and improve the comparability of the datasets reported. Whilst there are currently no national performance targets for ACQIs, local thresholds have been agreed with the Trust‟s commissioners and these are shown in the table below. In addition the data from the indicators is used to reduce any variation in performance across Trusts (where clinically appropriate) and drive continuous improvement in patient outcomes over time. Further ACQI information is contained in Part 3 of this report and details of all ACQIs are contained in the Trust‟s monthly Integrated Corporate Performance Report presented to the Trust Board of Directors and available on the Trust‟s website.

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) Outcome from Acute ST Elevation Myocardial Infarction (STEMI) - % of patients suffering a STEMI and who receive an appropriate care bundle.

90% 83.7% 89.1% 78.3% 87.4% 65.4%

Outcome from Stroke for Ambulance Patients - % of suspected stroke patients (assessed face to face) who receive an appropriate care bundle.

97% 96.93% 97.5% 97.6% 99.6% 96.1%

*Highest/Lowest Trust reporting has been noted for each indicator independently.

Data for these indicators is not currently available for information after November 2015. The longer timeframe for the production of this clinical data is due to the manual nature of the collection process and the delays experienced in collecting some of the data from third party sources.

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The South Western Ambulance Service NHS Foundation Trust considers that this data is as described for the following reasons:

The Trust has robust data quality processes in place to ensure the reporting of performance information is both accurate and timely.

Information is collated in accordance with the technical guidance for the ACQIs and this work is subject to internal audit on an annual basis.

The South Western Ambulance Service NHS Foundation Trust is taking the following actions to improve these percentages, and so the quality of its services, by:

Undertaking a programme of quality improvement activity across all regions, supported by Quality Improvement Paramedics.

Staff Survey

One of the key findings in the 2015 national staff survey relates to staff recommending the Trust as a place to work or receive treatment. Staff were asked to rate their answer on a five point scale from “1” strongly disagree to “5” strongly agree. Staff responses were then converted into scores. The table below shows the Trust‟s performance compared to last year, together with the performance of other Ambulance Trusts.

Staff Survey Indicator

Performance 2015

Performance 2014

National Ambulance

Average 2015

Highest Ambulance Trust 2015

Lowest Ambulance Trust 2015

Staff recommendation of the Trust as a place to work or receive treatment.

3.45 3.28 3.33 3.52 n/a

Percentage of staff experiencing harassment, bullying or abuse from staff in the last 12 months

24% 25% 30% 15% n/a

Percentage of staff believing that the Trust provides equal opportunities for career progression or promotion

76% 70% 71% 76% n/a

The 2015 survey demonstrated significant improvement in the three indicators above, with the Trust consistently performing better than the National Ambulance Average. For the final indicator regarding equal opportunities to career progression, the Trust was the leading Ambulance Trust, further demonstrating the positive impact the new My Career Conversation process has had on staff perception of how appraisals and staff development are managed. South Western Ambulance Service NHS Foundation Trust is taking the following actions to improve staff engagement, and so the quality of its services, by:

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Reviewing the results of the 2015 staff survey with each of the locality managers to develop suitable targeted action plans for their individual areas aimed at improving response rates and performance across the Trust.

Ensuring that staff have the opportunity to give feedback on this point through ongoing implementation of the Friends and Family Test for staff throughout 2016/17.

Holding roadshows at Emergency Departments and major ambulance stations during May and October 2016 – with members of Human Resources, Learning & Development, Executive Directors and operational colleagues in attendance.

National Reporting and Learning System

All Trusts are required to provide confidential and anonymised reports of patient safety incidents to the National Reporting and Learning System (NRLS). This information is analysed to identify common risks to patients and opportunities to improve patient safety. These incidents are identified through the Trust‟s incident reporting processes, and of the 9,884 incidents reported during the 2015/16 year, 4,158 have been identified as relating to patient safety. The National Patient Safety Agency recognised that organisations that report more incidents usually have a better and more effective safety culture, stating „you can‟t learn if you don‟t know what the problems are‟.

Indicator

2015/16 2014/15 National Average

Highest Trust*

Lowest Trust*

1 Oct to 31 Mar

01 Apr to 30 Sep

01 Oct to 31 Mar

01 Apr to 30 Sep

1 April to 30 Sept 2015

Total Incidents Reported to NRLS

1211** 632** 1,252 234 509 945 263

Number of Incidents Reported as Severe Harm

28** 17** 27 5 6.64 18 0

Number of Incidents Reported as Death

0** 3** 2 1 3.27 10 1

*Highest/Lowest Trust reporting has been noted for each indicator independently. **This information is sourced from the Trust‟s incident reporting system based on the criteria used in NRLS reports. All other information in this table is published by the NRLS based on the data they received and collated from the Trust during their reporting periods. Information is published in arrears, and therefore the most recent information available from the NRLS relates to the period 1 April to 30 September 2015. However, it should be noted that not all Ambulance Trusts have reported data for all six months, with the number of months reported ranging from 1 through to 6. It should be noted that the figures for reported incidents throughout the year, as set out in the text above, and those reported to NRLS will not correlate as the incidents are reported upon completion of the investigation and closure of the incident. Those incidents uploaded to NRLS in the first half of the financial year are therefore likely to be incidents that were reported during the previous financial year. A significant number of the incidents reported during 2015/16 remain under investigation and are therefore yet to be reported to NRLS.

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During the year a new process was implemented to ensure more timely „cleansing‟ of incidents, removing personal identifiable details, to enable swifter upload to NRLS. South Western Ambulance Service NHS Foundation Trust considers that this data is as described for the following reasons:

The Trust has a good culture for reporting adverse incidents.

Information is provided to the NRLS electronically through the upload of data taken from the Trust‟s adverse incident reporting system.

The Trust has taken the following actions to improve this number, and so the quality of its services, by:

o Continuing to encourage the reporting of adverse incidents by all members of staff so learning can occur at all levels of the Trust.

o Reviewing the mechanisms for learning from adverse incidents to ensure this is done quickly and effectively, and disseminated to staff so they have continued confidence in the reporting system.

o Reviewing the mapping of coding of patient safety incidents with the NRLS to ensure reporting is consistent with national requirements.

Duty of Candour On 1 April 2013, the contractual Duty of Candour was introduced for all NHS Trusts to report to patients or their next of kin where it is identified that moderate or serious harm has resulted from care provided by the Trust. This duty became regulatory on 27 November 2014 and was included within the Health and Social Care Act 2008 (Regulated Activities) as Regulation 20. The Trust has developed a process for the management of these incidents which has been agreed with commissioners. The Trust supports an open culture and has introduced a „Proactive Apology Process‟ which involves apologising to patients when the level of service that has been provided to them is below the standard that the Trust would expect. This process, which applies to incidents rated as being negligible or low, complements the Trust‟s approach to the Duty of Candour.

Care Quality Commission (CQC) The Trust maintains its registration with the CQC with no conditions. The Trust is proactive in ensuring compliance with CQC regulations through the maintenance of a centralised evidence system and an annual assessment of compliance across all service lines by way of an internal audit review. A “green” rated internal audit outcome was achieved for 2014/15 with the Trust robustly evidencing compliance against all three of the outcomes reviewed. The annual review for 2015/16 focused upon staff understanding of the Trust‟s approach to quality and, at the time of drafting this report, the outcome of the review is awaited. In March 2016, the CQC carried out an inspection of the NHS111 services provided by the Trust. The formal report of this inspection, which was triggered by adverse media coverage, has not been published as yet. However, initial feedback included praise for the call centre staff, in particular the way in which they treated patients with compassion and

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reduced anxiety levels. The strong resilience provided through the integration of the two clinical hubs was also commended as was safeguarding. Some areas for improvement were also highlighted including staffing levels and staff engagement as well as overarching systems and processes and the way in which learning from complaints and incidents was disseminated. All of the areas highlighted are being addressed by the Trust. The Trust will be undergoing its first comprehensive CQC inspection of all service lines in June 2016 and preparation is underway to ensure that it maintains its unconditional registration. A key element of this work has been assessing the Trust and its services against the CQC five domains of safe, effective, caring, responsive and well-led. An initial assessment is set out in the following table:

SAFE EFFECTIVE CARING RESPONSIVE WELL LED

Emergency and Urgent

Care

Requires Improvement

Good Good Good Good

Emergency Operations

Centre Good Good Good Good Good

Patient Transport

Service Good Good Good Good Good

Resilience

Good Good Good Good Good

OVERALL

Good Good Good Good Good

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Part 3: Quality Overview 2015/16

Additional Quality Achievements and Performance of Trust against selected metrics

This section provides an overview of other performance metrics for the Trust. The indicators and information contained within this section of the report have been selected to describe the Trust‟s continuous quality improvement journey. They build on the indicators reported in the previous Quality Reports and where possible historical and national benchmarked information has been provided to help contextualise the Trust‟s performance.

Right Care Over the past decade, the Trust has been improving the pathways and care options available to our clinicians. Ambulance services are now a key provider of urgent as well as emergency care, and our workforce, pathways and clinical support have adapted to this challenge. Many of the patients that call 999 for an ambulance can be managed safely and effectively over the phone, without sending an emergency ambulance. Where we do need to send an ambulance, over half of our patients can be managed by ambulance clinicians in their own home. In 2010, we developed the Right Care, Right Place, Right Time initiative, a five year commissioner funded agreement that committed to us reducing unnecessary admissions to Emergency Departments (EDs) by 10%. Thanks to the enthusiasm of our clinicians, the programme exceeded expectations, with the proportion of 999 calls managed without ED attendance increasing from 50.84% in 2010/11 to 57.45% in 2013/14. SWASFT has consistently achieved the highest non-conveyance rate of any UK ambulance Trust. We also have the highest rate of admission for patients we do convey to EDs, demonstrating appropriate clinical decision-making. The Right Care2 programme was launched in 2014/15 to build on this initial success to ensure that even more patients are able to be safely managed within the community. During 2015-16 the initiative has assisted in reducing the impact of ambulance activity increases on the EDs at acute hospitals across the South West. Whilst overall ambulance incident volumes increased by 5.06% in the same period, the number of incidents resulting in a conveyance to an ED only increased by 1.87% compared to 2014/15. If the proportion of patients conveyed to an ED had remained at the same level as 2014-15, a further 12,313 more patients would have been taken to EDs in 2015-16. Our clinicians are at the heart of the Right Care2 programme, and have the greatest level of clinical autonomy of any UK ambulance service. We continued to promote a dedicated feedback system amongst staff and EDs to seek information on blocks to providing the right care. Over 2,850 items of feedback were received during 2015-16, with the Trust working closely with CCGs and providers to resolve the issues. Time and time again, the feedback has proved vital in improving access to existing pathways and creating further opportunities.

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Ambulance Response Review /Dispatch on Disposition In February 2015 the Trust was delighted to have been chosen in partnership with London Ambulance Service, to pilot a new way for ambulance services to respond to 999 calls. The Dispatch on Disposition (DoD) pilot allowed call-handlers a small amount of extra time to triage the patient over the telephone before an ambulance resource was dispatched to respond. This additional triage time did not apply to those incidents which were identified as immediately life-threatening (i.e. Red 1 incidents) where an ambulance resource would continue to be dispatched immediately. The limited extra assessment time was to ensure that call handlers were able to better deploy resources where they were most needed. This time also provided an opportunity to identify the most clinically appropriate response to meet the needs of the patient. In some cases this may not be an ambulance response, and patients may be better served by an immediate referral to another service (e.g. local GP, pharmacy or walk-in centre). The Trust worked with NHS England, the Association of Ambulance Chief Executives (AACE), the College of Paramedics and London Ambulance Service during the pilot period with strict oversight and monitoring of the results and impacts of these service changes, including patient safety. The DoD pilot was also subject to rigorous and independent external evaluation, the findings of which will be published in due course. During the pilot period (10 February 2015 to 18 April 2016) the Trust was required to monitor against metrics for Red 1, Red 2 and A19 performance. In agreement with NHS England changes were made to the clock start to allow additional telephone triage time before an ambulance resource was dispatched, in all calls except Red1 which remained at the time of call-connect. This additional time was incrementally adjusted up to five minutes during the pilot; however this has been reduced to four minutes in anticipation of the Clinical Coding trial. The DoD pilot this was expected to improve Red 1 and Red 2 performance, resource allocation and Hear & Treat rates. This expected positive effect for Red 1 and Red 2 has been difficult to demonstrate due to an unexpected increase in demand on the service. However, the vehicle allocation and Hear & Treat have shown improvement under the DoD pilot. The pilot was effective in demonstrating its intended aims and a further four Trusts were recruited into the pilot to further demonstrate the benefits, with the remaining Ambulance Trusts acting as controls. The Trust has been instrumental in driving the agenda and the need to review the time-driven targets which do not directly reflect patient outcomes. The success of the pilot has led to Phase2 to further enhance the aims of Ambulance Response Programme (ARP), with a Clinical Code Trial being developed from October 2015 to respond to patient needs with the correct resources first time, and reduce the time to treatment for the most serious conditions. The Trust and Yorkshire Ambulance Service were selected to participate in this trial, providing a once in a decade opportunity to influence ambulance performance measures. Implementation began in January 2016 with a go live date of April 2016. The Trial will report to the Secretary of State for Health in Autumn 2016.

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Electronic Patient Clinical Record One of the Trust‟s quality priorities for 2014/15 was the electronic Patient Clinical Record (ePCR) and development work continued throughout 2015/16 with the Trust continuing to roll out the (ePCR) product to the counties of Devon, Cornwall, Somerset and Dorset, with ten acute trusts now live and over 60% of Trust staff trained and successfully utilising the system. Rather than purchase an off the shelf product, the ePCR has been designed by Trust staff with a bespoke configuration to support and document a structured patient assessment and to enhance clinical decision making to ensure that the patient receives the Right Care. This has added a level of complexity to the project, but has enabled the Trust to work with the developers to create a comprehensive system which focuses on the development of effective assessment and care planning to enhance the patient experience and ensure that the patient is directed to the right service for definitive care. The system uses a combination of assessment tools, structured data fields and free text options, to arrive at a final disposition and treatment plan. This is then viewed within Clinical Work Stations in the Acute Trust or via email functionality within community service providers. The Trust has been successful in linking the product‟s development into system wide projects. The West of England Academic Health Science Network has seen the benefit the ePCR can bring to the wider health economy and has been working with the Trust to create automated calculation of the National Early Warning Score (NEWS). The introduction of NEWS, a structured triage tool used across health and social care, as a means of quickly identifying the severity of illness and tracking any serious deterioration, has been particularly successful and demonstrates how the ePCR can be used across health boundaries to support the wider health economy in delivering high quality care. The Trust is now engaged and leading further national developments to create opportunities for systems integration. This will enable electronic systems across health and social care to communicate and for clinicians across organisations to share essential need to know information. During 2016-17 the Trust will finalise the ePCR roll out within the North Division and work to enhance its capabilities and further support high quality care.

Urgent Care Service The Urgent Care Services, both GP Out of Hours and NHS 111, are monitored through the assessment against national quality requirements. These quality requirements cover a number of different areas (including the auditing of calls and patient experiences). This information is reported in the Integrated Corporate Performance Report, presented to the Board of Directors at each meeting, and available on the Trust‟s website. In addition to the NHS111 and GP Out of Hours, the Trust operates a number of smaller urgent care service contracts, including a Single Point of Access (SPoA) to healthcare professionals in Dorset, dental call handling and triage, Out of Hours services to prisons in Dorset and GP practice telephone cover. Within all of these contracts, the Trust continues to achieve well against the contractual performance requirements.

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GP Out of Hours Service During the first quarter of 2015/16 the Trust delivered GP Out of Hours Services across Dorset, Somerset and Gloucester. From 1 July 2015, the Somerset Out of Hours service moved to a new provider as identified through the procurement exercise undertaken by the Clinical Commissioning Group. Appendix 2 of this report shows the achievement of the national quality requirements. These requirements are set by the Department of Health and are applicable to every Out of Hours service in England. As can be seen, the two services have performed differently during 2015/16, reflecting that the Dorset contract is a well-established service with a history of good performance whereas the Gloucestershire contract is new, commencing on 1 April 2015. Overall Dorset continued to deliver well against performance and quality requirements whereas in Gloucestershire, the overall performance has been more volatile with overall delivery at a level below that seen in Dorset. The Trust continues to focus on actions which contribute to deliver an improving position against the contractual performance requirements, some of these including a full review of the shift patterns and staffing structure; enabling remote access to allow GPs to undertake telephone triage at peak periods from home; and enhancing existing standard operating procedures to improve patient flow between emergency departments, minor injury units and the Out of Hours led primary care centres (co-located with these other departments).

NHS111 As with the Out of Hours service, the Trust commenced the year delivering NHS111 services to Devon, Dorset, Cornwall and Somerset. However, on 1 July 2015 the Somerset service transitioned to a new provider. Following the decision of the Trust to service notice on the Devon and Cornwall NHS111 contracts with effect from 31 March 2016, agreement was reached that additional investments would be provided by the Clinical Commissioning Groups to ensure an improving position of service delivery for the remainder of 2015/16. As a result of this an extended period of recruitment commenced in July for all contracts, the outcome of which was a steady increase in clinical staff numbers and call answering, with a reciprocal improvement in the performance and quality of the service provided. In December 2015, Devon Clinical Commissioning Group commenced a procurement exercise to secure the next provider for its NHS111 and GP Out of Hours services. Whilst the Trust developed an initial partnership to explore the options to bid for these services, in February a decision was made to not progress this and therefore it awaits instruction from the Clinical Commissioning Group as to who the successful bidder is. Once this award has been made the Trust will work with this new provider to ensure a smooth transition for staff and patients. Appendix 3 sets outs activity for each of the NHS111 contracts during 2015/16, together with performance against national quality requirements. As with Out of Hours services,

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national quality targets are set out by the Department of Health for NHS111 services and are applicable to every service in England. Tiverton Urgent Care Centre The Trust took over the management of the Urgent Care Centre in Tiverton in July 2014. The primary measure within the operating contract is the 4 hour waiting time standard, which is the same target for Acute Trust Emergency Departments. As can be seen from the table below, performance is excellent and patient report receiving an excellent service.

Indicator Target 2015/16 8 July 2014 – 31 March 2015

Percentage of cases completed within 4 hours

95% 99.77% 99.43%

Ambulance Clinical Quality Indicators The following tables show Trust performance for further ACQIs.

Indicator

Lo

ca

l

Pe

rfo

rma

nce

Th

res

ho

ld

Ye

ar

to d

ate

20

15

/16

(Ap

r to

No

v)

20

14

/15

Nati

on

al

Ave

rag

e (

Ap

r to

No

v 2

015

)

Hig

hes

t T

rust

Pe

rfo

rma

nce

(Ap

r to

No

v 1

5)*

Lo

we

st

Tru

st

Pe

rfo

rma

nce

(Ap

r to

No

v 1

5)*

Return of spontaneous circulation (ROSC) at time of arrival at hospital (Overall)

24.00% 25.36% 25.0% 27.8% 32.9% 24.0%

Percentage of Face Arm Speech Test (FAST) positive stroke patients (assessed face to face) potentially eligible for stroke thrombolysis, who arrive at a hyperacute stroke centre within 60 minutes of call

57.00% 45.64% 45.1% 51.5% 57.3% 42.2%


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Indicator

Lo

ca

l

Pe

rfo

rma

nce

Th

res

ho

ld

Ye

ar

to d

ate

20

15

/16 (

Ap

r 1

5

to F

eb

20

16

)

20

14

/15

Nati

on

al

Ave

rag

e

(Ap

r 1

5 t

o F

eb

16

)

Hig

hes

t T

rus

t

Pe

rfo

rma

nce

(Ap

r 1

5 t

o F

eb

16

)

Lo

we

st

Tru

st

Pe

rfo

rma

nce

(Ap

r 1

5 t

o F

eb

16

)

Calls closed with telephone advice 7.50% 11.4% 8.3% 9.5% 15.1% 5.6%

Incidents managed without the need for transport to A&E

52.00%

52.4% 52.3%

38.3% 51.5% 29.8%


Research Activity Disseminating work at External Conferences During 2015/16 the Research and Audit team showcased their work to a national audience through attendance at several key conferences. Posters were displayed at the National College of Paramedics Conference, and our Lead Research Paramedic delivered an update of her work which was sponsored by the college. At the 999 EMS Research Forum the team won prizes for „Best Poster‟, and also the top award of highest quality research, which attracts a prize to speak at an international conference, this year in New Zealand. Additionally, the team presented at the South West Emergency Academic Conference in March.

Research Showcase The Research and Audit Team also hosted the Trust‟s annual Research Showcase in Exeter in March 2016. The aim of the event was to showcase some of the research currently being undertaken both within and outside of the Trust, and to promote engagement with staff and students, highlighting some of the ways in which they can become involved in, and develop, a research career. The event brought together a multi-disciplinary group including a wide range of staff grades, students from University partners, and representatives from the research community and Higher Education Institutions (HEIs). The speakers presented on a range of projects, including both recently completed and ongoing studies, including:

AIRWAYS-2 – This ongoing study, which the Trust is sponsoring, is the largest trial of airway management in the world, and is comparing intubation with a supraglottic airway device for managing the airway in patients experiencing an out of hospital cardiac arrest.

The Peninsula Public Involvement Group described their experiences as a user led advisory group participating in research, and the value of involving patients and service users.

PARAMEDIC-2 – a key study in out of hospital cardiac arrest, examining whether

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adrenaline has a beneficial effect in this patient group.

The event was shared with a global audience through social media. Over 300 „tweets‟ during the event resulted in over 349,200 twitter impressions.

Patient Safety

Incident Reporting As reported previously, the Trust has a central reporting system for adverse incidents, including near misses, as well as Moderate Harm Incidents (MIs) and Serious Incidents (SIs).

All three core service lines for the Trust: A&E, Patient Transport Service (PTS) and Urgent Care Service (UCS), are covered in the patient safety measures reported within this section, including the table below which sets out the categories and numbers of patient safety incidents managed by the Trust.

Other Patient Safety Measures 2015/16 2014/15

Adverse Incidents 4,077 1,450

Moderate Harm Incidents 40 48

Serious Incidents 41 56

It would appear that the number of adverse incidents reported has increased significantly during 2015/16. However, this apparent increase is due to changes in internal coding guidance rather than an actual increase.

It should also be noted that the figures for Moderate Harm and Serious Incidents are for those incidents confirmed as meeting the necessary criteria within the reporting timeframe; however, the incident could have been reported outside the 2015/16 timeframe of this document.

Working groups within the Trust receive reports on incidents relating to their remit. During the year the Trust established a Quality Development Forum which replaced the Experiential Learning Forum. The role of the Quality Development Forum is to drive the Quality Strategy within the Trust and to lead on service and quality improvement as the sub group to the Quality Committee. The group‟s key duties include:

Proactively highlighting areas of concern or poor practice and undertaking focusedreviews, informed by other forums such as the Quality Committee and ClinicalEffectiveness Group, to develop and influence Trust-wide quality improvements;

Approving updates to the Trust‟s Quality Strategy, and supporting its implementation;

Making recommendations for action to improve quality, ensuring those actions areimplemented and disseminated throughout the organisation;

Referring and receiving recommendations for change to policy to appropriate Director;

Referring and receiving recommendations for change to the Trust annual trainingprogramme, via the Clinical Effectiveness Group;

Analysing and acting upon feedback from the external environment such as national groups.

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The first theme reviewed by the Quality Development Forum during the year was „Emotional Resilience‟. The outcome of this review included the recommendation to develop an accredited Emotional Resilience course for staff. Future themes for review have been identified as Clinical Care and Human Factors, with the latter being a quality priority for 2016/17.

Serious Incidents A fundamental part of the Trust‟s risk management system is appropriately managing SIs to ensure lessons are learned. SI's are identified through a systematic review of both adverse incidents and patient feedback. All incidents that are believed to potentially meet the nationally set criteria for a SI are passed to the clinically qualified Patient Safety Manager for preliminary review, before being circulated to the dedicated Serious and Moderate Harm decision making group. It is important to note that the proportion of SIs as a percentage of patient contact activity remains very low. In addition, the Trust has seen a decrease in SIs reported in 2015/16. Analysis of the 2015/16 SIs has identified that there is an equal split between those identified for the East and West divisions for the A&E service line, however the North division has seen double that seen for other divisions. In addition, the majority of SIs which related to the Trust‟s A&E Clinical Hubs took place within the East division. SI investigations are considered within Serious Incident Review Meetings which are designed to identify organisational learning. These meetings are chaired by a Clinical Director or Deputy Director. All staff involved in the incident are invited to attend as this provides the best opportunity for the Trust to identify learning. Learning can either be at a local, Trust wide or at times national level, for example referring learning to NHS Pathways to help them improve the national Pathways system. A Serious Incident Action Plan is maintained to monitor progress against actions identified. Learning from SIs is shared via the Trust‟s publication „Reflect‟ which is widely publicised within the Trust‟s newsletter and available to all staff on the intranet. The Trust produces a bi-monthly Patient Safety and Experience Report presented to the Board of Directors which summarises themes and learning arising from SIs. One example of a trend identified during the year is the impact of Human Factors on patient safety incidents. This has led to Human Factors being been identified as one of the Trust‟s Quality Priorities for 2016/17 and will be the subject of a review overseen by the Trust‟s Quality Development Forum. Other areas of learning have included actions associated with demand, delays in the provision of back up resources, telephone triage, confirmation bias, incomplete patient clinical records, communications and the moving and handling of patients.

Central Alert System The Central Alert System (CAS) is an electronic web-based system developed by the Department of Health, the National Patient Safety Agency (NPSA), NHS Estates and the Medicines and Healthcare products Regulatory Agency (MHRA). This aims to improve the systems in NHS Trusts for assuring that safety alerts have been received and implemented. During 2015/16 the Trust acknowledged almost 100% of CAS notifications within 48 hours except one. The number of notifications received is set out in the table below.

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Other Patient Safety Measures 2015/16 2014/15

Central Alert System (CAS) Received 120 157

Patient Experience

Patient experience and patient engagement provide the best source of information to understand whether the services delivered by the Trust meet the expectations of the patient, including assessing whether a quality service is provided.

The following table shows some of the Trust‟s existing methods and quantitative information on service user experience.

Patient Experience Measures 2015/16 2014/15

Complaints, Concerns and Comments3 1,519 1,268

Patient, Advice and Liaison Service (PALS) – Lost Property, signposting to other services etc.

1,005 857

Health Service Ombudsman complaints upheld 2 in part 2

Compliments 2,225 2,055

Learning from Incidents and Complaints

A review of root causes identified following investigations into serious and moderate harm incidents and moderate complaints completed during 2015/16 has identified the most common causes being:

clinical care e.g. misinterpretation of clinical signs; poor record completion; and alack of capacity assessment;

access and waiting e.g. delayed call backs and limited resources due to high levelsof demand;

communication e.g. failure to probe on questioning and poor communication withcontrol following RTCs; and

infrastructure such as IT process errors or a Hub system error.

3 When noting the number of comments, concerns and complaints received it is important to consider

that the Trust proactively invites feedback from patients and their representatives.

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The area of Clinical Care is the most commonly identified root cause; however, it is important to recognise that this category also includes the care afforded by telephone triage. These incidents are often difficult to definitively categorise and may also appear in the communication category under a failure to probe or similar. A high number of complaints are multifaceted in nature which in turn leads to multiple root causes being identified.

Examples of learning from each of the identified root cause themes are set out below:

Clinical Care

There have been no overriding themes identified by the Patient Experience and Patient Safety teams. Clinical Care has been identified as a topic to be reviewed by the Quality Development Forum in 2016/17. In terms of concerns relating to clinical care issues during face to face assessments, learning points included:

Confirmation bias when a clinician allows other factors to cloud their assessment anddiagnosis of a patient – for instance if a patient is nervous about travelling to hospitalthey may tailor their answers to convince you they are feeling better than they are.Confirmation bias can lead to clinicians making inadequate treatment plans for theirpatients. An article regarding confirmation bias will be included within a future editionof the Trust‟s Reflect publication.

Incomplete Patient Clinical Records (PCR), for example recording of less than twocomplete sets of observations and the lack of a systematic assessment using the„Medical model‟. This has led to poor decision making with regards to non-conveyance and safety netting. The individuals concerned have received furthertraining from the Trust‟s Learning and Development Team or GP Lead.

The Trust has also noted an ongoing theme in relation to spinal care. This washighlighted previously as a trend and the Medical Directorate revisited the guideline.Whilst initially the reporting figures reduced, it has become evident that cases havestill been occurring. There appears to be a discrepancy in understanding andapplication of the spinal guidelines which is resulting in staff not treating patients withpotential spinal injuries appropriately. In order to address this immediately an articlereinforcing the guidelines is to be placed in the Trust‟s weekly bulletin and a specialedition of Reflect will be produced.

In previous years, sepsis has been a quality priority for the Trust. 2015/16 saw a small but increasing number of sepsis cases. This is high profile nationally and learning continues to be embedded. The main themes and learning in terms of actions taken include:

Sepsis remaining under discussion at the Trust‟s Quality Development Forum.

The Trust has contributed to the JRCALC guidance regarding Sepsis management;

„Sepsis Assessment and Management (SAM)‟ leaflets have been produced and putonto vehicles – these leaflets are written for the lay person to understand, so membersof public know what to look out for;

The e-PCR is to be modified to alert the crew if they are about to leave a patient athome who has signs of symptoms;

As reported previously, Paediatric „Big6‟ guidelines were issued in August 2015,covering the six main causes of paediatric illness and symptoms to look out for; and

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The development and implementation of a training programme for staff working withinour 111 services took place in 2015/16 which incorporated sepsis red flags, meningitis,septicaemia in children and the unwell child.

Human Factors

Human factors can influence how people behave and perform. Human factors are environmental, organisational and job factors, and individual characteristics which influence behaviour.

In this reporting period, learning in respect of behaviours has resulted in remedial training on clinical guidelines and supervised shifts; as well as reflective practice.

The human factors that influence those behaviours will be part of a bigger piece of work which will be undertaken by the Patient Safety team and overseen by the Trust‟s Quality Development Forum. The Trust has met with an expert in Human Factors investigations methodology and will be liaising with the Academic Health Science Network regarding moving this area of work forward.

Telephone triage inherently is subject to issues of Human Factors and potential error given the nature of the system. As has been stated previously, one of the Trust‟s Quality Priorities for 2016/17 is to undertake a review of patient safety incidents where telephone triage errors were identified as a concern and analyse these using an agreed human factors model with a view to developing proposals for improvement.

Access and Waiting

Of the remedial actions relating to access and waiting, a small number of actions relate to dispatching errors. There was no identified relationship between each of the cases and individual learning actions for the staff involved were put into place.

During 2015/16 demand and resourcing continued to be an issue. The Trust continues to face two acute challenges; demand for services which is growing by more than 6% per year; and challenges in resourcing to meet that demand. The Trust aims to deliver the very best service it can to its patients within these constraints, despite that a number of complaints and incidents have identified demand and the availability of resources as a root cause. In order to address this issue, the Trust has developed a Quality Improvement Plan and holds twice weekly performance briefings attended by representatives from all key functions. It has been agreed that the Trust and Commissioners will work collaboratively to understand where they can best concentrate resources in order to provide the greatest improvement and to focus on the external factors which impact demand.

Learning points within the Clinical Hubs and 111 Call Centres have resulted in a review of the Standing Operating Procedure in respect of “Resource Movements Across Localities” in order to ensure that resources are best utilised across the Trust, and the repeat caller processes have been highlighted to staff within the UCS service line in order to ensure that this process is better understood in the management of patients.

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Communication The area of communication skills has been identified as a theme by the Trust‟s Quality Development Forum in relation to complaints and adverse incidents and this has subsequently been linked to the emotional resilience of staff. It is anticipated that the Trust‟s new Peer Support Network will assist in this area and in addition the Trust is considering the development of an accredited Emotional Resilience course. Individual action that has taken place as a result of complaints regarding the attitude of staff includes attendance at a Customer Care course.

Compliments The Trust receives telephone calls, letters and emails of thanks from many patients every week. Wherever possible this gratitude is passed directly onto the members of staff who attended the patient or service user. 2,225 compliments were received during 2015/16; an increase of 8% on 2014/15. The Trust continues to use „wordles‟ – a visual representation of the key words included in the compliments received. These are shared on the Trust‟s intranet so that all staff can see the type of positive feedback that the Trust receives about the work that they do. The picture below is a year-end summary of the compliments received for 2015/16 - the larger the word/phrase the more frequently it was used.

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Patient Engagement

During 2015/16 the Trust continued to develop its patient engagement activities, ensuring that its services are responsive to individual needs; are focused on patients and the local community; and supporting its ongoing commitment to improving the quality of care provided.

The Patient Engagement Team source patient stories for use at the start of each meeting of the Board of Directors and of the Council of Governors. Previously these stories were written testimonies read out by a member of the forum; however, this year the Trust enhanced this project and has begun to invite patients into the Board meeting to share their stories in person. This activity has been a positive experience not only for the meeting members, but also for the patients involved.

Patient Opinion

Patients and their relatives and carers can post details of their experience on the “Patient Opinion” website, with these posts being available to anybody visiting the site. The Trust responds to every comment about its service. Where the feedback is negative or indicates service failure, the individual who provided the comments is invited to contact the Trust directly with further details so that the concerns can be addressed by the Patient Experience Team. Where the post is positive and the incident in question can be identified, the posting is passed directly to the member(s) of staff involved. If there is insufficient detail the Patient Engagement Team will respond requesting additional information in order to be able to convey the positive feedback.

During the year 141 stories relating to the Trust have been posted on Patient Opinion. This is a decrease of 48% compared to last year. The decrease is likely to be due to the cessation of advertising of the site; as the Trust chose not to renew its subscription to the Patient Opinion site due to funding requirements.

Patient Experience Surveys

The Trust audits a random sample of 1% of patient contacts every month for its NHS111 contracts and separately for the GP Out of Hours contracts, with care being taken to ensure that the survey is not sent to anyone whom it would not be appropriate to contact, for example a sensitive case that may related to a safeguarding concern.

A paper questionnaire is sent out to respondents, which also contains a link to the online survey. The survey includes a series of questions under the following headings:

Friends and Family Test

Getting through

After the call

Satisfaction

Use of 111/Out of Hours telephone service and satisfaction with the NHS

Caller/patient information

The Trust provides a monthly report to its Commissioners on the number of calls taken; and the forms returned within that period, with a detailed report being submitted every six months.

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During the year 1,329 people responded to the survey in respect of their NHS111 experience; equating to a response rate of 23%. These responses highlighted that further consideration needs to be given to communication about the service to manage patient expectations, whilst the issue of clinician availability was also raised.

Some of the comments provided by survey respondents have raised issues about triage; the perception that questioning is too long and unhelpful, with respondents indicating that the questioning has „fuelled‟ feelings of anxiety. A small number of survey respondents have stated that the attitude from the call taker was less than favourable.

Many positive comments relate to patients feeling grateful for the service; with respondents citing how the staff they spoke to or were attended by were helpful and caring.

491 responses were received from the GP Out of Hours surveys during the year, equating to a response rate of 25%. Feedback suggests that patients are satisfied with the service received, with them being likely to recommend the service and to use it again. Respondents cited high levels of satisfaction with the service, confirming that they were given good information regarding their care options and treatment.

Learning Disability

During 2015/16 the Patient Engagement Team has continued to work with the patient reference group, called SWAG (South Western Ambulance Group), which was established in September 2014.

The Trust has successfully completed the first annual work plan for SWAG and has now developed a new plan for the coming year. The Group is preparing to welcome and interview the Trust‟s Chief Executive early in 2016/17. They have compiled a detailed list of questions and are very much looking forward to this opportunity.

During the first year of SWAG the group;

looked at the Trust filming and photography equipment and spoke extensively aboutconsent; including consent to be filmed/photographed and for images to be used bythe service and consent regarding treatment and travel;

reviewed easy read materials and supported the creation of a new leaflet designed toprovide patients with details to contact the Trust with a complaint or a compliment;

considered reasons to contact the Trust for medical help and the consequences ofmisusing the service.

The Trust is currently establishing relationships with groups that support patients with Learning Disabilities in Gloucester and South Devon. It is hoped this engagement will provide the Trust with more in depth feedback from this patient group with a view to improving services for them.

Friends and Family Test for Patients

The FFT is a single question survey which asks patients whether they would recommend the NHS service they have received to friends and family who need similar treatment or care.

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The Trust offers the FFT to patients who receive „See and Treat‟ care across the 999 and Urgent Care service lines; this means care delivered to patients when they are seen by a Trust clinician and the patient is not conveyed to any receiving facility. The FFT is also offered to patients that access the Patient Transport Service (PTS).

Response rates to the FFT are poor. A review of response rates across all ambulance services identifies that this is an issue across the country. In addition, it is difficult to directly compare data as each Trust is using a different response method and so it can‟t be used as a reliable bench mark.

Despite the low response rate, the Trust continues to receive largely positive feedback to the FFT. However, this in itself provides a challenge for service development based on these responses as the only consistent theme offered in the feedback is that of praise and gratitude.

The FFT results for 2015/16 are set out below –

Public and Patient Involvement

During 2015/16 the Trust attended 197 patient and public involvement events such as county shows, community fetes, school and college visits and public health awareness days. These events were staffed predominantly by volunteers drawn from clinicians, managers, administrators, governors and community first responders.

These events provide a fantastic opportunity to engage with existing patients and potential service users. They also provide an opportunity to deliver proactive health checks. A total of 1,200 members of the public had their blood pressure checked during 2015/16 and a further 52 people received a free NHS Health Check, covering blood pressure, body mass index, blood glucose and cholesterol levels. The results were provided immediately and where necessary recommendations about further medical care, such as attending their own GP, were made.

We have continued to improve our links with our Road Safety Partnerships across the area and worked with Gloucestershire Constabulary to deliver an educational day warning youngsters of the dangers and consequences of antisocial behaviour such as knife crime. Other achievements include;

Providing public health messages to the public by working with our CCG partnersand other health and care organisations;

Establishing links with our local armed forces and supplying NHS health checks toserving Royal Marines;

Joining forces with Avon & Somerset Constabulary‟s Festive Drink Drive Campaign;

Continued partnership working with colleagues from the police, street pastors andtown centre managers – operating the mobile treatment centre in densely populatedlocations;

Recommend? April May June July Aug Sept Oct Nov Dec Jan Feb March

Would 86% 88% 89% 92% 84% 94% 89% 86% 94% 88% 86% 91%

Would not 5% 7% 5% 8% 11% 4% 8% 5% 6% 7% 11% 9%

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Working with our Healthwatch partners and inviting them to Trust HQ to meet usand view our systems of work; and

Raising the profile of the Trust‟s Bristol Bike Unit by ensuring that they have apresence at high profile events across the Trust area.

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Assurance Statements – Verbatim

Clinical Commissioning Groups (CCGs)

NHS Gloucestershire CCG is pleased to provide a combined commentary on South Western Ambulance Service NHS Foundation Trust (SWASFT) Quality Account on behalf of all Clinical Commissioning Groups across the South West in relation to 999 services. South Central and West Commissioning Support Unit (SCWCSU) have put routine processes in place with SWASFT to agree, monitor and review the quality of services throughout the year covering the key quality domains of safety, effectiveness and experience of care.

SWASFT is a responsive, dynamic and innovative organisation, and has continued to work hard to develop excellent working relationships with commissioners. SWASFT provides 111, Out of Hours and 999 services however this commentary is based on knowledge of SWASFT as a provider of 999 services.

SWASFT fulfils an important contribution to the health and wellbeing of the population within CCG localities through the services it provides and is committed to providing safe, high quality clinically effective patient care. The achievements noted in the quality account reflect this.

Quality Accounts are produced to help the general public understand how their local health services are performing and are written with that in mind. SWASFT has produced an easy to understand and comprehensive report. The document outlines SWASFT‟s approach to delivering quality care and quality improvements within its service in an open and transparent way in terms of patient safety, patient experience and clinical effectiveness.

Commissioners have reviewed the Quality Account and can confirm that the information presented appears to be accurate and demonstrates a successful organisation and a high level of commitment to quality. This is to be commended. It contains the undertakings of the organisation with regards to the quality ambitions, challenges and achievements from 2015/16 and defines the future direction for 2016/17.

The main body of this letter will pertain to the quality aspect and although performance will be commented on it will be in a very broad sense.

NHS Gloucestershire CCG has taken all the comments received from the commissioners and has combined them into the response below.

General Comments

It has been a challenging year for SWASFT in terms of growth and number of incidents. Red 1 and Red 2 performance targets have not been met, however it is recognised that Dispatch on Disposition and the Ambulance Response Programme along with the new Ambulance Quality Indicators (Jan 2016) are all factors that have impacted on this and the steps taken in conjunction with SCWCSU and the commissioners could improve performance moving forward. It should be noted that Commissioners are fully supportive of the Trust‟s actions to improve this.

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The Commissioners welcome local support of the “Urgent Care commissioning agenda” and engagement to deliver the “RightCare 2” programme and the improvements this delivers to those patients who do not require conveyance to the Emergency department. The report highlights the work the trust has done to support a culture to deliver a safe service. The work done on “Sign up To Safety” in the main has achieved its objectives. SWASFT‟s attendance at “Patient Safety Collaborative” is to be commended. However one CCG commented that a narrative and plan would be welcomed for 2016/17 due to the previous year‟s partial success with regards to this element. It was noted that the report highlighted the Trust‟s continued focus on paediatric illness management, focusing on the “Big Six”. The Commissioners recognise the work achieved by SWASFT in addressing this patient groups‟ clinical needs in an alternative method rather than an attendance at an Emergency Department. Whilst committing to this it is recognised that SWASFT is still prioritising Child Sepsis identification. A number of Commissioners expressed that they felt they would like a closer working relationship for this Patient Group. It is felt the work done by the Commissioners and the work done by SWASFT would be complimentary. More audit data on this patient group would be welcome. SWASFT has shown that they are committed to seeking feedback from the users of its service and engages with those with learning disabilities through the “patient reference group” and continually contributes to public events. The Commissioners also credit the work achieved by SWASFT in managing “Frequent Callers” whilst always ensuring they are managed in a safe and effective manner, and it is noted that SWASFT also achieved their targets in this area. It is recognised that more work could be achieved in this area, despite the success of last year. The “Reflect” newsletter to share learning from Serious Incidents is commended as well as the offer to patients to tell their stories at Board meetings. More detail around the implementation of “Duty of Candour” within SWASFT would be welcome. Staff welfare remains an important issue for Commissioners and greater detail regarding the support being offered to staff in a highly pressured environment would be appreciated. It is recognised that the work done in this area will improve the patient experience; however it was felt that the support of those on Long Term Sick could have been elaborated upon. The commissioners wished to commend the Trust for being the leading ambulance Trust for the final indicator regarding equal opportunities to career progression.

Looking Forward The Commissioners broadly support the priorities of:

Clinical Effectiveness- Cardiac Arrest

Patient Engagement- Accessible Information

Patient Experience – Human Factors

A little narrative around the above choices would be welcome. Especially surrounding the choice of “accessible information” and the difference between that and business as usual?

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Overall the Commissioners are happy to commend this Quality Account and SWASFT for its continued focus on the quality of care. They look forward to continuing to work in partnership with SWASFT during 2016/17 and developing further relationships to help deliver their vision.

Healthwatch

Healthwatch Bath & North East Somerset

Thank you for sharing the draft Quality Account with us. I met with our Quality lead on Friday and we were really interested to read about all the fantastic work that the Trust is undertaking.

We had one concern, which had been picked out within the Quality Account itself already; regarding the breaches in achievement of Red 1, Red 2 and A19 performance across the Trust, particularly during quarter four. We noted with interest that an action plan has been put together to try to address this issue, but felt that it would have been useful to have the outline of the action plan detailed within the Quality Account for reference. We also note that there are some pilot projects and work being planned and/or built on during 2016-17 which aim to address this performance and look forward to hearing more about the outcomes of those next year.

Healthwatch Bristol & Somerset

Healthwatch Bristol and Healthwatch Somerset volunteers met with Martyn Callow, External Relationships Manager for SWASFT, on Wednesday 4 May 2016 to review and make comment on SWASFT‟s Quality Review and Quality Account.

Volunteers agreed that reviewing the SWASFT quality review and account was enhanced by the attendance and involvement of Martyn. Volunteers also said that they look forward to working more closely with SWASFT in the future for the benefit of patients, carers and service users.

Volunteers made the following comments that they would like to see applied to the final document after the closure of the consultation process:

the glossary of terms and acronyms should be moved to the front of the documentfor ease and accessibility of reading;

the “…if you would like to request this document in another format…” notice needsto be in a larger font (we suggest at least font size 16) and moved from the back ofthe document to the front of the document. We recommend you check the colourcontrast of the document with RNIB;

the final document must be written in an easy read or simple language format thatavoids the use of jargon.

Volunteers agreed that they accept the findings of last year‟s quality actions and look forward to seeing similar levels of achievement and improvement at next year‟s review. Volunteers did have concerns that, whilst there was reference to service users and patients with learning disabilities and people who have lived experience of poor mental

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health, there was no mention of service users and patients from the other nine protected characteristics or equality groups. They recommended that:

each of the nine protected characteristics need to be specifically referred to in theQuality Account if these groups‟ needs are to be effectively met. Equality needs tobe interwoven into quality at all levels of the organisation. Volunteers recommendthat this could be overcome if the nine protected characteristics were referred to inKen Wenmen‟s introductory quality statement.

Volunteers made the following comments about SWASFT‟s Quality Priorities:

volunteers were glad to see that last year‟s quality priorities will be ongoing,alongside the new priorities which were agreed upon through consultation betweenstaff, stakeholders and governors. They thought that the Quality Account evidencedgood improvements in regards to the Sign Up to Safety scheme and the FrequentCallers scheme;

volunteers also wanted to commend SWASFT for the evidence they provided inrelation to training staff for the above two new schemes, which demonstrates anactive learning culture and drive for improvement at SWASFT;

volunteers agreed that SWASFT‟s Quality Priorities for Improvement for the year2016/2017 were both valuable and ambitious enough to drive change. It wasagreed that cardiac arrest is a sensible thing to prioritise in terms of saving lives. Itis also valuable to promote equality by prioritising Accessible Information (pleasesee the Healthwatch Information Sheet called Accessible Information Standard,which explains that all NHS providers must provide accessible information for allpatients by law from July 2016.) Volunteers also commended the Human Factorspriority, which promotes looking at both patients and staff as individuals with variedneeds and histories – an approach that echoes Healthwatch‟ s ethos ofpersonalisation.

In terms of SWASFT‟s quality improvement, volunteers made the following comments:

volunteers were pleased to see SWASFT‟s performance league tables included inthe Quality Account. We suggest that Appendix 1 on page 38 is cross referencedwith page 16 to improve ease of reading.

Healthwatch Bristol and Healthwatch Somerset, as well as Healthwatch SouthGloucestershire who did not have a volunteer available to attend the QualityAccount discussion, have received mixed feedback about ambulance responsetimes – some of which has been very positive and some has been very negative;

SWASFT have failed to meet all three targets for Red 1, Red 2 and 19 Minute. Theirperformance re. response times in 2015/16 is lower than in 2014/15. The 19 minuteresponse time performance for 2015/16 is particularly low at 89.44% and not muchhigher than the nation‟s lowest ambulance trust (who provided ambulances within19 minutes for 88.81% of Category A patients.) We would like to see this improvenext year;

volunteers also commented that it would have been easier to review the 2016/2017Quality Account if they had been provided with a copy of the 2015/2016 QualityAccount, so hope this will be provided next year.

In terms of final comments, volunteers recommend that SWASFT:

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includes information about the annual updating of staff training and understandingto next year‟s account as supporting evidence that 2016/2017 priorities have beenmet when we review next year‟s account;

ensures response times improve this year;

encourages and signposts patients, service users and carers, particularly thoseunder the Human Factors scheme and the Frequent Callers scheme, to share theirexperiences of using SWASFT with local Healthwatch. This will enable Healthwatchto capture patients‟ opinions and signpost service users onto further support in thecommunity. It will also enable Healthwatch volunteers to hear more communityopinions about SWASFT‟s service quality, which we will feed into our consultationregarding next year‟s account.

Healthwatch Cornwall

Healthwatch Cornwall (HC) has read with interest the Quality Account from the South West Ambulance Service NHS Foundation Trust and notes the successful implementation of education around the Paediatric Big Six, the collaborative working arrangements regarding and proactive management of frequent callers, and the commitment to Sign Up to Safety. It is reassuring to see that a priority for this coming year is a deep dive analysis of human factors involved in patient safety incidents, especially considering some high profile coverage of these last year. The open culture of reporting and the Proactive Apology Process introduced by the Trust is welcomed.

During the year 2015-16 HC worked closely with NHS Kernow as part of the Systems Resilience Group. SWASFT also attended these meetings and HC was impressed with the level of information, commitment and willingness to change the current system to alleviate the high current demand on the emergency department. The recent pilot of “hear and treat” rather than “see and treat” shows how SWASFT are supporting system partners in providing care in the right place at the right time. One patient rated the iPad system used by SWASFT when exchanging information with the receiving hospital and wondered why it could not be used more widely for communicating patient information.

The feedback received about the ambulance service was mostly positive and shows that people in Cornwall value highly the service they receive and regard it as timely, professional, caring and safe. This year we have received a little feedback showing patients were not happy about waiting times for an ambulance.

The feedback that has been received in regards to the 111 service that SWASFT runs was limited last year, but was an equal mixture of positive and negative comments. Frustrations were more around the interface between 111 and Out of Hours doctors and the time taken for a doctor to call back or be found than about the 111 system itself. HC looks forward to seeing the outcome of the CQC inspection of the NHS 111 services provided by the Trust, along with the coming comprehensive inspection of all service lines in June 2016.

Healthwatch Dorset

In the past year, Healthwatch Dorset has received feedback about the Trust‟s services from patients, relatives, carers and professionals. Just over half the comments we

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received are positive, especially in relation to the professionalism, care and compassion shown from first responders, paramedics and ambulance staff to patients in urgent and emergency situations.

However, as per our comments for the year 2014/15 we still receive feedback that, on occasion, the telephone support via NHS 111 has caused some concerns with patients being provided with seemingly incorrect advice (especially around issues such as asthma), having to call back repeatedly for advice and having to wait long hours for call backs. There were also a few incidents reported to us where patients were waiting a long time for ambulances, in one instance a call being made at 7.30p.m. for an elderly patient who had fallen and injured themselves, but the ambulance not arriving until 3.00a.m.

The comments we have received appear to reflect the comments the Trust already receives through the Patient Experience Surveys (page 32).

In our comments last year, we advised “We welcome the fact that the Trust “Patient Experience Priority 3 – Frequent Callers” will be looking at how to manage this group of patients better” … We hope that this Priority will help to support this vulnerable group moving forward”. It is good to note that the Trust‟s Frequent Caller Team has made a considerable impact and will continue to “work proactively with the wider health and social care community to obtain individual care plans where required”.

We welcome the priority “Patient Engagement – Accessible Information” and the aim to “improve the level of contact by those with communication difficulties in advance of their treatment so that we are able to provide them with a better and more accessible service, noting that we do not as yet have the capability to record this information for future contact”. We also welcome the development of an Accessible Information Standard action plan.

Given recent concerns about NHS 111, we also welcome the priority “Patient Experience – Human Factors” and the initiatives to identify where telephone triage errors were identified as a concern, to analyse the identified incidents to identify the human factors associated with the telephone triage errors and to develop proposals for solutions to reduce the likelihood of error in telephone triaging.

In our comments last year we acknowledged that the Friends and Family Test was relatively new to the Trust and all its service areas and we looked forward to seeing further results. We note that the response rate was low but mainly providing positive feedback.

Concerns about the NHS 111 service were raised in national media earlier in 2016 and the Care Quality Commission carried out a “snap” inspection. The public‟s confidence in the service was damaged and it will be crucially important that, if failings are identified, the Trust acts decisively to rectify them and to restore that confidence.

We look forward to continuing to work with the Trust to ensure that people's feedback on the Trust's services, both good and bad, is welcomed, listened to, learned from and drives forward improvements.

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Healthwatch Gloucestershire

Healthwatch Gloucestershire is pleased to provide feedback on the SWAST performance and relationships over the year.

HWG and SWAST have developed an effective relationship in which it has been possible to have regular meetings with members of the SWAST Board and wider leadership team.

Throughout the year all feedback from the public about SWAST services in the Northern Division has been discussed and acted upon when appropriate. In addition, SWAST has shown a willingness to participate in HWG‟s community engagement events. This has been particularly helpful in explaining some of the challenges associated with providing services in more rural areas. When issues have been escalated to SWAST over the year, they have investigated them and provided full reports to us. Almost a third of the feedback HWG received on emergency services last year was positive.

Healthwatch Isles of Scilly

We are pleased to have the opportunity to comment on this Quality Account, although we can only do so based on a relatively small amount of community feedback and our knowledge of local SWAST services. It is therefore difficult to draw any link between the priorities and progress reviewed here and our knowledge of service provision. However, we are pleased to note that there is an emphasis on patient experience and how feedback through a number of channels has been used to improve provision and set future priorities.

SWAST provides emergency services and routine ambulance transport in the islands, plus a volunteer co-responder service on the off islands. The urgent care and GP out of hours service are provided separately. We understand that staff are fully engaged with the local multi-disciplinary team and joint working arrangements.

We ran a general community survey last year and asked people to comment on their experience of emergency services. The local ambulance and co-responders service both received majority ratings of excellent or good; alongside majority ratings of excellent for emergency air transfer. These results reflect the high regard in which health emergency services are held locally, and indicates that people have confidence in these services.

Healthwatch North Somerset

Healthwatch North Somerset is pleased to have the opportunity to comment on the draft South West Ambulance Service NHS Trust Quality Account for 2016.

The reporting on the previous year priorities is clearly set out and we acknowledge the achievements. We are disappointed that Priority 1 – Sign up to Safety was not fully achieved and seek reassurance that there will be a continued focus towards attaining this priority.

We welcome the focus of the priorities for 2016/2017 on Cardiac Arrest, Accessible Information and Human Factors. There is an acknowledgement of Human Factors on patient safety incidents in the Patient Safety section of the report and a prioritised focus on

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this concerning issue is welcomed. An explanation of why there has been a rise in Serious Incidents would be of benefit. We acknowledge the statements about learning points in relation to lapses in Clinical Care and seek assurance that robust processes are in place to ensure high standards.

It is noted that Category A Performance targets have not been achieved and have reduced in comparison with the previous year. Of considerable concern, the Category A performance data shows poorer performance in North Somerset than in comparison with many other CCG areas. However, we acknowledge the impact of an increase in demand and the steps being taken to address this including the Ambulance Response Review, the Right Care, Right Place, Right time initiative and the Electronic Patient Record.

The Staff Survey indicators of experience of harassment, bullying or abuse is of concern, despite a reduction on the previous year, it remains high. Although steps have been taken to respond to the problem there is no clear indication about how it is being adequately addressed.

We commend the Trust for including Patient Stories at the Board and Governors meetings, putting the patient experience at the heart of the governing bodies. We also commend the Trust for the high percentage of positive feedback received from patients and for developing levels of Public and Patient Involvement.

This response was completed with the support of Healthwatch North Somerset Volunteers.

Healthwatch Plymouth

Healthwatch Plymouth has read the Quality Account with interest and notes the progress made around Patient Sign up to Safety, the Paediatric Big Six and the steps to improve the management of Frequent Callers not only by the Trust, but by other health and social care providers by working towards improved partnership. Healthwatch Plymouth is also encouraged that the Trust recognises that further work is required around Patient Sign up to Safety to ensure that full implementation and development of the initiatives are achieved.

Priorities for the forthcoming year are welcomed especially around better outcomes for cardiac arrest patients and the analysis of human factors that affect patient safety. Healthwatch Plymouth also acknowledges the Trust‟s open culture of reporting around incidents of moderate or serious harm and welcomes the introduction of a Proactive Apology Process for patients who do are not provided with the expected level of service.

Healthwatch Plymouth looks forward to further developing its relationship with the Trust over the next 12 months and beyond.

Healthwatch Torbay

Healthwatch Torbay Rate and Review interactive web-site collects user experience across all Torbay's NHS and social care services. Perhaps, not surprisingly, very few comments received in this way relate to SWASFT directly as on the whole the public are unaware of the Trust's considerable knowledge and experience which is used to keep them safe. The

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comments see SWASFT as a conveyance mechanism to another service, with concerns relating to speed of response. We are, therefore, unable to reflect on the impact of the 2015/16 clinical priorities in any depth. It is with this in mind that we were pleased to note that the Trust has continued with its extensive programme of public engagement events alongside its patient engagement programme. Our shared events are opportunities to improve our insight and to add to our knowledge of the service.

We did receive a number of reviews of the 111 service. Most rated it highly but within this there were a few comments about the questioning algorithm length and relevance. Comments tended to perceive 111 and Devon Doctors as a single service.

We were very pleased to read that the Quality Priorities for 2016/17 included Accessible Information with its emphasis on improving knowledge of communication needs, including people with sensory loss and with learning disability. Healthwatch Torbay works alongside these communities and hard to reach groups to ensure their knowledge is used to improve the quality of health and care services.

Our role includes signposting for service users when they have a comment or complaint. The Account explains clearly how the Trust collects this type of information and how issues are examined to improve the quality of the service. The recent Healthwatch engagement event at the Trust headquarters was appreciated as an opportunity to learn more about innovative practice. This helps us to play our part in promoting the image of a modern and responsive ambulance service.

The Quality Account is, as last year, readable and in plain English. Care has been taken to ensure that the terms used are explained and can be understood by the general public. Thank you again for maintaining this standard.

Healthwatch Wiltshire

This statement is provided on behalf of Healthwatch Wiltshire. The role of Healthwatch is to promote the voice of patients and the wider public in respect to health and social care services and we welcome the opportunity to comment.

As a local Healthwatch we know that finding easily accessible, good quality information is a major issue for local people. Therefore, we welcome the Trust‟s prioritisation of accessible information for patients particularly in the area of sensory loss. We are pleased to see that Trust members will be invited to review improvements to the Trust‟s website and would suggest also engaging with local Healthwatch in each of the areas served by the Trust.

We are concerned to see that overall, the Trust has missed targets for Red 1, Red 2 and A19 performance with all three targets down on 2014/15 figures. We are reassured to see however, that targets for Red 1 performance were met in Q1, Q2 and Q3. We acknowledge that these results may in part be owing to the rurality of certain areas of the patch. We welcome the introduction of the „Measures to improve performance‟ plan that seeks to identify the key actions and developments required to improve red performance. As the Trust covers such a wide area, it would be useful to see a breakdown of performance times for each CCG locality.

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We are pleased to see that the Trust‟s Staff Survey has demonstrated significant improvements in all three indicators in particular, the recommendation of the Trust as a place to work or receive treatment. In addition, we note the positive work that has been carried out to engage with the public and in particular those who have a learning disability. We are concerned however, about the low response rate for the Friends and Family test.

The introduction of a „proactive apology process‟ for patients is welcomed as we know from our own work that patients and relatives appreciate an acknowledgement if care has not always met their expectations.

We note the new priorities set by the Trust. Healthwatch Wiltshire will engage with patients, carers, and the wider community and will feedback to the Trust to help in their monitoring of these priorities going forward.

Local Health Overview and Scrutiny Committees

Dorset Health Overview and Scrutiny Committee

The Chairman of Dorset Health Scrutiny Committee, on behalf of the Committee, welcomes the invitation to comment on the Quality Review and Quality Account 2015/16 for the South Western Ambulance Service NHS Foundation Trust, and would like to submit the following comments:

The Dorset Health Scrutiny Committee is pleased to note that two out of three key priorities for 2015/16 were achieved (Paediatric Big Six and Frequent Callers) and hope that the third priority (Sign up to Safety) will be achieved shortly. With regard to engagement with staff to contribute to the improvement of patient safety, one observation would be that the target of a minimum response rate of 3% seems somewhat low, and the Committee would hope that a higher response rate than this will actually be reached.

The Committee notes the priorities identified for 2016/17 and supports those proposed (Cardiac Arrest, Accessible Information and Human Factors). The priority to increase the accessibility of information is of particular interest in the context of reducing health inequalities, something which the Committee is tasked to promote.

With regard to the reporting of key performance indicators for 2015/16, the Committee recognises the challenges faced by the Trust in relation to the Category A targets and hopes that the improvement plan is successful in identifying key actions and driving development forwards. It was disappointing to find that data was not yet available in the draft Account for some indicators, but the Committee welcomes the commitment to learning from staff feedback and from patient incidents.

The Committee also welcomes the increase in compliments and the way in which these are passed on to staff, but was concerned to find that complaints, concerns and comments had also increased (by over 19%). Analysis of causes and themes for these will hopefully enable measures to be taken to reverse this trend over the next year. Related to this, the patient experience surveys seem to indicate higher levels of appreciation for the GP Out of Hours Service than the NHS 111 Service. Given the recent concerns regarding the NHS

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111 Service discussed by the Dorset Health Scrutiny Committee in March 2016, further consideration of this may be helpful. Over the past year, members of the Dorset Health Scrutiny Committee have continued to engage in a positive relationship with the South Western Ambulance Service NHS Foundation Trust and would like to express their thanks for the Trust‟s commitment to this.

Gloucestershire Health Overview & Scrutiny Committee On behalf of the Gloucestershire Health and Care Overview and Scrutiny Committee I welcome the opportunity to comment on the South Western Ambulance Service NHS Foundation Trust (GHNHSFT) Quality Review and Quality Account 2015/16. The committee notes the good work undertaken by the Trust with regard to See and Treat and Hear and Treat. In particular that this means that the Trust performs above the national average for not transporting patients to A & E. However, Gloucestershire elected members do continue to have concerns regarding the ability of the Trust to meet response targets in the rural areas of the county. Committee members are aware that these targets are measured at Trust level but the committee does receive this information broken down by district area. Members welcome the proactive work undertaken by the Trust with regard to Community First Responders and Defibrillators. The committee is particularly pleased that there is now a joint working arrangement with the Gloucestershire Fire and Rescue Service (GFRS) with regard to first responding; and members will be interested to see how this develops. From 1 April 2015 the Trust became the provider of the Out of Hours Service in Gloucestershire. During the committee‟s six month review of this service it was clear that this had been a challenging time and the service was not meeting its targets. The committee is undertaking a 12 month review in May 2016 and will be looking for improvement. The committee has welcomed the Trust‟s involvement in the Dispatch on Disposition (Ambulance Performance Review) pilot. Whilst the committee may be concerned with regard to response times in the rural areas it is also clear that the health outcome for the patient should be the priority. The committee is clear that safeguarding is everyone‟s responsibility. The committee is aware that the Trust takes this matter seriously so it would have been good to see this issue reflected within this report. Having said this, it is good to see that the Trust places the patient at the centre of care. The Trust is due to be inspected by the Care Quality Commission (CQC) in June 2016. The committee will be interested to note the outcome of this inspection. Elected members are aware that the Trust faces the same workforce challenges as the wider NHS. The committee is aware that the Trust, in conjunction with Gloucestershire Clinical Commissioning Group (GCCG), is working hard to address this issue in Gloucestershire.

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I would like to thank the Trust for its willingness to engage with the committee and in particular its positive response to members many questions.

Isles of Scilly Health Overview and Scrutiny Committee

We welcome the opportunity to comment on the SWASFT Quality Review and Quality Account 2015/16. The priorities for this year and the year ahead are well described and cover clinical and operational effectiveness as well as patient engagement, communication and learning.

The Committee has had constructive discussion with SWASFT with regard to the particular challenges of service delivery on the Isles of Scilly, especially with regard to communications and paramedic cover. The Committee is keen to continue with effective dialogue and work with SWASFT to ensure a safe, sustainable service on the islands for urgent and emergency care. We have local feedback commending the professionalism, commitment and honesty of paramedics and controllers who come to their aid. This is very reassuring. NHS111 is largely superseded by an effective GP out-of-hours service, another reflection of the unique circumstances of the islands.

The Committee are fully supportive of supporting staff and highlighting transparency, as this is key to driving improvements. The report mentions the effectiveness of telephone triage operations and the links to effective and appropriate clinical responses. However, intimately linked to these is the recognition of human factors and that these represent a significant area where the Trust can develop. We are pleased to see this translated into a future priority. Staff survey results show that a quarter of staff have experienced harassment, bullying or abuse from staff in the last 12 months. While this is below the national average, there are concerns that friction within the Trust may impact on effective team working and consequently on safe and sustainable service delivery. This is where staff support, transparency, learning and emotional resilience can be of benefit. The inclusion of supporting staff within the Corporate Objectives 2016/17 is welcomed. Further progress with the Sign up to Safety campaign and engagement with the South West Patient Safety Collaborative is encouraged.

The Committee commends SWASFT for its actions to improve Red performance targets and involvement in the Ambulance Response Review. We appreciate the increased demand in 2015/16 and hope for positive outcomes from evaluation and subsequent implementation. The support for frontline clinicians regarding the paediatric Big 6 is welcomed as is the extension to education events in the coming year.

The work with frequent callers indicates that SWASFT is actively involved with wider health and social care requirements of patents, with ancillary benefits for SWASFT operational effectiveness. Such work is to be encouraged under current requirements to develop health and social care integration.

North Somerset Health Overview and Scrutiny Panel

The Panel remains concerned by the Trust‟s performance against some of the prescribed key indicators, with performance against the Category A measures failing to meet target

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and worsening by comparison with last year (both across the Trust‟s area as a whole and within the North Somerset catchment).

Nevertheless, the Panel acknowledges the significant impact of increasing demand (up by 17% in 2015/16) and is encouraged by the promise shown by the Trust‟s spearheading of the Ambulance Response Programme (demand management) trial and other initiatives including the implementation of ECPR (electronic records system), the establishment of the Research and Audit Team, recent successful recruitment campaigns, and community engagement work such as with the Night Time Economy Team in North Somerset. The Panel hopes that these initiatives will begin to make a sustainable difference going forward.

The Panel acknowledges the Trust‟s achievement (or partial achievement) all of its 2015/16 priorities and welcomes the focus of the 3 2016/16 priorities on Cardiac Arrest, Accessible Information and Human Factors. In respect to the Accessible Information priority, Members commented on the importance of clearly referencing the mother tongue of patients.

South Gloucestershire Health Scrutiny Committee

The Committee has not invited SWASFT to a meeting during 2015/16, but has been aware of the ongoing issues with Red 1, Red 2 and A19 performance at the North Bristol Trust (NBT) Southmead Hospital via its discussions around the performance of the Emergency Department.

In March 2015 the Ambulance Joint Health Scrutiny Committee was advised that handover times at Southmead Hospital had improved significantly, however this is not reflected in the red performance percentages for South Gloucestershire in 2014/15 and 2015/16. Whilst it is acknowledged that there has been a significant increase in the demand for ambulance services, the Committee is also aware of the extensive patient / system flow work at NBT and questions why this has not led to improved Red 1, Red 2 and A19 performance.

The Committee is pleased to report that SWASFT has accepted an invitation to attend a meeting in June 2016 to provide an update on its performance and answer members‟ questions. The Committee is particularly looking forward to hearing about the actions being taken to improve red performance percentages and so the quality of services, particularly the development and implementation of a „Measures to Improve Performance‟ plan during Q2 of 2015/16, which was updated during Q3 and Q4 of 2015/16.

The Committee is also looking forward to hearing about the „Ambulance Response Review Dispatch on Disposition‟ pilot, looking at ways in which ambulances are monitored in terms of response times, and the phase 2 trial to influence ambulance performance measures, which is due to report to the Secretary of State for Health in the autumn 2016.

Torbay Health Overview and Scrutiny Committee

South Western Ambulance Service NHS Foundation Trust‟s Quality Account for 2015/2016 has been considered by Torbay Council‟s Overview and Scrutiny Board. A representative of the Trust attended the meeting and the clarity with which it was explained

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how the Trust had met its priorities for 2015/2016 and what its priorities are for the forthcoming year was appreciated.

It was pleasing to note the wider initiatives being undertaken by the Trust to find alternative pathways for patients, improve patient experience and engage with the communities it serves. The joined up working with other trusts and agencies was evident and it is hoped that this work continues to ensure that the reducing levels of public spending can continue to provide better outcomes for patients and service users.

The Board commends South Western Ambulance Service NHS Foundation Trust for its openness and transparency of its operations and hopes that the Trust will continue to work closely with the Board and Torbay Council as a whole.

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Statement of Directors’ Responsibilities in respect of the Quality Report

The Directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations to prepare Quality Accounts for each financial year.

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.

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 NHSFoundation Trust Annual Reporting Manual 2015/16 and supporting guidance;

the content of the Quality Report is not inconsistent with internal and external sourcesof information including:

o board minutes and papers for the period April 2015 to 19 May 2016o papers relating to Quality reported to the Board over the period April 2015 to 19

May 2016o feedback from the commissioners dated 10 May 2016o feedback from governors dated 9 July 2015 and 21 April 2016o feedback from Local Healthwatch organisations dated 4, 8, 9, 10, 12, 13 and 16

May 2016o feedback from Overview and Scrutiny Committees dated 5, 10 and 12 May 2016o the local patient survey (monthly and six monthly NHS111 and GP Out of Hours)o the latest national staff survey dated 22 March 2016o the Head of Internal Audit‟s annual opinion over the trust‟s control environment

dated 10 May 2016

the Quality Report presents a balanced picture of the NHS Foundation Trust‟sperformance over the period covered;

the performance information reported in the Quality Report is reliable and accurate;

there are proper internal controls over the collection and reporting of the measures ofperformance included in the Quality Report, and these controls are subject to review toconfirm that they are working effectively in practice;

the data underpinning the measures of performance reported in the Quality Report isrobust and reliable, conforms to specified data quality standards and prescribeddefinitions, is subject to appropriate scrutiny and review; and

the Quality Report has been prepared in accordance with Monitor‟s annual reportingguidance (which incorporates the Quality Accounts regulations) (published atwww.monitor.gov.uk/ annualreportingmanual) as well as the standards to support dataquality for the preparation of the Quality Report (available at www.monitor.gov.uk/annualreportingmanual).

http://www.monitor.gov.uk/%20annualreportingmanual)

http://www.monitor.gov.uk/%20annualreportingmanual).

http://www.monitor.gov.uk/%20annualreportingmanual).

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The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the Quality Report.

By order of the board

Chairman

Date 23 May 2016

Chief Executive

Date 23 May 2016

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Appendix 1 Category A Performance by Clinical Commissioning Group.

Red 1 Performance Red 2 Performance A19 Performance

Clinical Commissioning Group

No of Incidents*

2015/16 2014/15* No of

Incidents* 2015/16 2014/15*

No of Incidents*

2015/16 2014/15*

Kernow 1,848 71.97% 74.83% 32,831 57.63% 69.20% 34,537 82.50% 90.74%

South Devon & Torbay

1,018 78.88% 83.23% 18,176 68.36% 75.99% 19,182 93.32% 96.21%

NEW Devon 2,940 80.00% 79.49% 49,332 68.38% 75.61% 51,988 90.47% 93.69%

Somerset 1,650 74.67% 72.98% 27,728 60.97% 70.92% 29,284 86.15% 92.82%

Dorset 2,856 82.42% 84.07% 46,687 65.59% 73.70% 49,111 91.23% 95.77%

North Somerset 741 67.21% 70.34% 12,951 60.30% 68.56% 13,677 87.62% 93.25%

Bath & NE Somerset

570 72.11% 74.75% 9,559 65.01% 72.22% 10,123 90.08% 93.73%

Bristol 1,919 72.95% 76.63% 30,942 66.72% 74.29% 32,575 94.64% 97.11%

South Gloucestershire

711 62.87% 65.35% 13,810 55.18% 63.64% 14,495 91.58% 94.58%

Gloucestershire 2,045 64.40% 67.07% 34,067 62.47% 66.44% 36,109 88.79% 91.53%

Wiltshire 1,288 61.26% 65.86% 24,679 55.54% 62.28% 25,952 84.89% 88.71%

Swindon 807 78.81% 81.88% 12,614 75.40% 79.03% 13,420 95.74% 96.99%

Trust 18,423 73.72% 75.24% 314,056 63.60% 71.42% 331,156 89.44% 93.62%

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Appendix 2

GP Out of Hours Quality Requirements

Quality Requirement Target Dorset Somerset

(Apr 15 – Jun 15) Gloucester

QR1 - Providers must report regularly to NHS Commissioners on their compliance with the Quality Requirements

Compliance Compliant Compliant Compliant

QR2 - Percentage of Out-of-Hours consultation details sent to the practice where the patient is registered by 08:00 the next working day

95.00% 97.46% 97.13% 99.94%

QR3 - Providers must have systems in place to support and encourage the regular exchange of information between all those who may be providing care to patients with predefined needs


QR4 - Providers must regularly audit a random sample of patient contacts (audit should provide sufficient data to review the clinical performance of each individual working within the service)


QR5 - Providers must regularly audit a random sample of patients‟ experiences of the service


QR6 - Providers must operate a complaints procedure that is consistent with the principles of the NHS complaints procedure


QR7 - Providers must demonstrate their ability to match their capacity to meet predictable fluctuations in demand for their contracted service


QR10a - All immediately life threatening conditions (walk in patients) to be passed to the ambulance service within 3 minutes of face to face presentation

95.00% n/a n/a n/a

QR10b - Definitive Clinical Assessment for Urgent adult cases presenting at treatment location to start within 20 minutes - not applicable to this service as a separate clinical assessment is not carried out between presentation and clinical consultation at walk-in-centres

95.00% n/a n/a 72.19%

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Quality Requirement Target Dorset Somerset

(Apr 15 – Jun 15) Gloucester

QR10b - Definitive Clinical Assessment for Urgent Child cases presenting at treatment location to start within 20 minutes - not applicable to this service as a separate clinical assessment is not carried out between presentation and clinical consultation at walk-in-centres

95.00% n/a n/a 38.98%

QR10b - Definitive Clinical Assessment for Less Urgent cases presenting at treatment location to start within 60 minutes - not applicable to this service as a separate clinical assessment is not carried out between presentation and clinical consultation at walk- in-centres

95.00% n/a n/a 94.94%

QR10d - At the end of an assessment, the patient must be clear of the outcome


QR11 - Providers must ensure that patients are treated by the clinician best equipped to meet their needs in the most appropriate location


QR12 – Emergency Consultations (presenting at base) started within 1 hour

95.00% 0 cases 0 cases 75.86%

QR12 - Urgent Consultations (presenting at base) started within 2 hours

95.00% 90.50% 94.22% 93.26%

QR12 - Less Urgent Consultations (presenting at base) started within 6 hours

95.00% 97.41% 97.44% 98.40%

QR12 - Emergency Consultations (home visits) started within 1 hour

95.00% 0 cases 0 cases 68.09%

QR12 - Urgent Consultations (home visits) started within 2 hours

95.00% 93.16% 91.31% 86.36%

QR12 - Less Urgent Consultations (home visits) started within 6 hours

95.00% 96.31% 96.92% 91.24%

QR13 - Patients unable to communicate effectively in English will be provided with an interpretation service within 15 minutes of initial contact. Providers must also make appropriate provision for patients with impaired hearing or impaired sight


179

Appendix 3

NHS111 Quality Requirements

Quality Requirement Target Dorset Devon Somerset

(Apr 15 – Jun 15)

Cornwall and IoS

Activity (Total calls offered) n/a 247,305 392,376 40,401 162,987

QR1 - Providers must report regularly to NHS Commissioners on their compliance with the Quality Requirements

Compliance Compliant Compliant Compliant Compliant

QR2 - Providers must send details of all consultations (including appropriate clinical information) to the practice where the patient is registered by 0800 the next working day.

95.00% 84.52% 88.50% 88.42% 85.96%

QR3 - Providers must have systems in place to support and encourage the regular exchange of information between all those who may be providing care to patients with predefined needs


QR4 - Providers must regularly audit a random sample of patient contacts (audit should provide sufficient data to review the clinical performance of each individual working within the service)


QR5 - Providers must regularly audit a random sample of patients‟ experiences of the service

1.00% 0.53% 0.83% 0.96% 1.03%

QR6 - Providers must operate a complaints procedure that is consistent with the principles of the NHS complaints procedure


QR7 - Providers must demonstrate their ability to match their capacity to meet predictable fluctuations in demand for their contracted service

Compliance Partially

Compliant

Non-

Compliant

Non-

Compliant

Non-

Compliant

QR8a - No more than 5% of calls abandoned before being answered 5.00% 3.48% 8.64% 12.47% 8.81%

QR8b - Calls to be answered within 60 seconds of the end of the introductory message

95.00% 84.94% 68.19% 62.74% 68.63%

180

QR9a - All immediately life threatening conditions to be passed to the ambulance service within 3 minutes

95.00% 94.38% 95.63% 95.24% 89.62%

QR9b - Patient callbacks must be achieved within 10 minutes 95.00% 19.54% 49.70% 20.06% 25.22%

Quality Requirement Target Dorset Devon Somerset

(Apr 15 – Jun 15)

Cornwall and IoS

Activity (Total calls offered) n/a 247,305 392,376 40,401 162,987

QR13 - Patients unable to communicate effectively in English will be provided with an interpretation service within 15 minutes of initial contact. Providers must also make appropriate provision for patients with impaired hearing or impaired sight

100.00% 100.00% 100.00% 100.00% 100.00%

QR14 - Providers must demonstrate the online completion of the annual assessment of the Information Governance Toolkit at level 2 or above and that this is audited on an annual basis by Internal Auditors using the national framework


QR15 - Providers must demonstrate that they are complying with the Department of Health Information Governance SUI Guidance on reporting of Information Governance incidents appropriately.


Independent Auditors’ Limited Assurance Report to the Council of Governors of South Western Ambulance Service NHS Foundation Trust on the Annual Quality Report We have been engaged by the Council of Governors of South Western Ambulance Service NHS Foundation Trust to perform an independent assurance engagement in respect of South Western Ambulance Service NHS Foundation Trust’s Quality Report for the year ended 31 March 2016 (the ‘Quality Report’) and specified performance indicators contained therein. Scope and subject matter The indicators for the year ended 31 March 2016 subject to limited assurance (the “specified indicators”) marked with the symbol in the Quality Report, consist of the following national priority indicators as mandated by Monitor:

Specified Indicators Specified indicators criteria (exact page number where criteria can be found)

Category A Call- Emergency response within 8 Minutes

Criteria for the indicators can be found in the Annual Report on page 15 on which we are giving our limited assurance opinion.

Category A Call- Ambulance vehicle arrives within 19 Minutes

Respective responsibilities of the Directors and auditors The Directors are responsible for the content and the preparation of the Quality Report in accordance with the specified indicators criteria referred to on pages of the Quality Report as listed above (the "Criteria"). The Directors are also responsible for the conformity of their Criteria with the assessment criteria set out in the NHS Foundation Trust Annual Reporting Manual (“FT ARM”) and the “Detailed requirements for quality reports 2015/16” issued by the Independent Regulator of NHS Foundation Trusts (“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 does not incorporate the matters required to be reported on as specified in Annex 2 to Chapter 7 of the FT ARM and the “Detailed requirements for quality reports 2015/16”;

• The Quality Report is not consistent in all material respects with the sources specified below; and

• The specified indicators have not been prepared in all material respects in accordance with the Criteria set out in the FT ARM and the “2015/16 Detailed guidance for external assurance on quality reports”.

We read the Quality Report and consider whether it addresses the content requirements of the FT ARM and the “Detailed requirements for quality reports 2015/16; 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 the following documents: • Board minutes for the financial year, April 2015 and up to the date of signing this limited assurance

report (the period); • Papers relating to quality report reported to the Board over the period April 2015 to the date of

signing this limited assurance report; • Feedback from NHS Gloucestershire CCG on behalf of South West Clinical Commissioning Groups

dated 10 May 2016; • Feedback from Governors dated 9 July 2015 and 21 April 2016;

• Feedback from Local Healthwatch organisations: Bristol and Somerset dated 4 May 2016; Dorset 4 May 2016; Torbay dated 4 May 2016; Plymouth dated 13 May 2016, North Somerset dated 13 May 2016; Gloucestershire dated 13 May 2016; and Wiltshire 9 May 2016;

• Feedback from Overview and Scrutiny Committee: Torbay dated 12 May 2016; Gloucestershire dated 10 May 2016; Dorset dated 5 May 2016; South Gloucestershire Health Scrutiny Committee dated 16 May 2016; and Isles of Scilly dated 12 May 2016;

• The local patient survey results for both GP OOH Urgent Care dated April 2015 to September 2015 and NHS 111 dated April 2015 to September 2015;

• The national staff survey dated 22 March 2016; and • The Head of Internal Audit’s annual opinion over the Trust’s control environment dated 10 May

2016.

We consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with those documents (collectively, the “documents”). Our responsibilities do not extend to any other information. Our Independence and Quality Control We applied the Institute of Chartered Accountants in England and Wales (ICAEW) Code of Ethics, which includes independence and other requirements founded on fundamental principles of integrity, objectivity, professional competence and due care, confidentiality and professional behaviour. We apply International Standard on Quality Control (UK & Ireland) 1 and accordingly maintain a comprehensive system of quality control including documented policies and procedures regarding compliance with ethical requirements, professional standards and applicable legal and regulatory requirements. Use and distribution of the report This report, including the conclusion, has been prepared solely for the Council of Governors of South Western Ambulance Service NHS Foundation Trust as a body, to assist the Council of Governors in reporting South Western Ambulance Service NHS Foundation Trust’s quality agenda, performance and activities. We permit the disclosure of this report within the Annual Report for the year ended 31 March 2016, to enable the Council of Governors to demonstrate they have discharged their governance responsibilities by commissioning an independent assurance report in connection with the 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 Western Ambulance Service NHS Foundation Trust for our work or this report save where terms are expressly agreed and with our prior consent in writing. 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 (Revised)’). Our limited assurance procedures included:

• reviewing the content of the Quality Report against the requirements of the FT ARM and “Detailed requirements for quality reports 2015/16”;

• reviewing the Quality Report for consistency against the documents specified above; • obtaining an understanding of the design and operation of the controls in place in relation to the

collation and reporting of the specified indicators, including controls over third party information (if applicable) and performing walkthroughs to confirm our understanding;

• based on our understanding, assessing the risks that the performance against the specified indicators may be materially misstated and determining the nature, timing and extent of further procedures;

• making enquiries of relevant management, personnel and, where relevant, third parties; • considering significant judgements made by the NHS Foundation Trust in preparation of the

specified indicators; • performing limited testing, on a selective basis of evidence supporting the reported performance

indicators, and assessing the related disclosures; and

• reading the documents. A limited assurance engagement is less 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. 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 assessment criteria set out in the FT ARM the “Detailed requirements for quality reports 2015/16 and the criteria referred to above. The nature, form and content required of Quality Reports are determined by Monitor. This may result in the omission of information relevant to other users, for example for the purpose of comparing the results of different NHS Foundation Trusts. In addition, the scope of our assurance work has not included governance over quality or non-mandated indicators in the Quality Report, which have been determined locally by South Western Ambulance Service NHS Foundation Trust. Conclusion Based on the results of our procedures, nothing has come to our attention that causes us to believe that for the year ended 31 March 2016:

• The Quality Report does not incorporate the matters required to be reported on as specified in Annex 2 to Chapter 7 of the FT ARM and the “Detailed requirements for quality reports 2015/16”;

• The Quality Report is not consistent in all material respects with the documents specified above; and

• the specified indicators have not been prepared in all material respects in accordance with the Criteria set out in the FT ARM and the “Detailed guidance for external assurance on quality reports 2015/16”.

PricewaterhouseCoopers LLP Chartered Accountants Princess Court 23 Princess Street Plymouth PL1 2EX 25 May 2016

The maintenance and integrity of the South Western Ambulance Service NHS Foundation Trust’s website is the responsibility of the directors; the work carried out by the assurance providers does not involve consideration of these matters and, accordingly, the assurance providers accept no responsibility for any changes that may have occurred to the reported performance indicators or criteria since they were initially presented on the website.

Independent auditors’ report to the Council of Governors of South Western Ambulance Service NHS Foundation Trust

Report on the financial statements

Our opinion

In our opinion, South Western Ambulance Service NHS Foundation Trust‟s financial statements (the “financial statements”):

give a true and fair view of the state of the Trust‟s affairs as at 31 March 2016 and of its income and expenditure and cash flows for the year then ended 31 March 2016; and

have been properly prepared in accordance with the NHS Foundation Trust Annual Reporting Manual 2015/16.

What we have audited

The financial statements comprise:

the Statement of Financial Position as at 31 March 2016;

the Statement of Comprehensive Income for the year then ended;

the Statement of Cashflows for the year then ended;

the Statement of Changes in Taxpayer‟s Equity for the year then ended; and

the notes to the financial statements, which include a summary of significant accounting policies and other explanatory information.

The financial reporting framework that has been applied in the preparation of the financial statements is the NHS Foundation Trust Annual Reporting Manual 2015/16 issued by the Independent Regulator of NHS Foundation Trusts (“Monitor”).

Our audit approach

Context

Our 2016 audit was planned and executed having regard to the fact that the Trust‟s operations and financial stability were largely unchanged in nature from the previous year. In light of this, our approach to the audit in terms of scoping and areas of focus was largely unchanged, albeit we focussed on the economy, efficiency and effectiveness audit procedures in light of the allegations into the NHS 111 service and potential governance concerns raised by the CQC and NHS Improvement.

Overview

Overall materiality: £4,607,000 which represents 2% of total revenue.

In establishing our overall approach we assessed the risks of material misstatement and applied our professional judgement to determine the extent of testing required over each balance in the financial statements.

Risk of fraud in revenue and expenditure recognition

Revaluations of land and buildings

Risk of management override of controls

The scope of our audit and our areas of focus

We conducted our audit in accordance with the National Health Service Act 2006, the Code of Audit Practice and relevant guidance issued by the National Audit Office on behalf of the Comptroller and Auditor General (the “Code”) and, International Standards on Auditing (UK and Ireland) (“ISAs (UK & Ireland)”).

We designed our audit by determining materiality and assessing the risks of material misstatement in the financial statements. In particular, we looked at where the directors made subjective judgements, for example in respect of significant accounting estimates that involved making assumptions and considering future events that are inherently uncertain. As in all of our audits, we also addressed the risk of management override of internal controls, including evaluating whether there was evidence of bias by the directors that represented a risk of material misstatement due to fraud.

The risks of material misstatement that had the greatest effect on our audit, including the allocation of our resources and effort, are identified as “areas of focus” in the table below. We have also set out how we tailored our audit to address these specific areas in order to provide an opinion on the financial statements as a whole, and any comments we make on the results of our procedures should be read in this context. This is not a complete list of all risks identified by our audit.

Area of focus How our audit addressed the area of focus

Risk of fraud in income and expenditure recognition

See note 1 to the financial statements for the directors’

disclosures of the related accounting policies, judgements

and estimates relating to the recognition of revenue and

expenditure and notes 2 to 5 for further information.

The Trust receives the majority of its income from local

commissioners for the services it provides. The majority of

contracts are block contracts which are an agreed amount

paid for the year. Within these contracts there are complex

terms, including variable performance measures which are

dependent on the delivery of activity. In addition and in

line with other Trusts, non-contractual income is received

during the year, for example winter pressure funding.

The Trust delivered a small surplus this year and with

existing contracts changing and going out to tender, we

considered there to be an increased risk that income may

be deferred to 2016/17 and expenditure recognised in

2015/16 to improve the future financial position.

We therefore determined the risks to be:

inappropriate deferral of revenue from 2015/16 to

2016/17 in order to support future expenditure;

early recognition of expenditure in 2015/16 in order

to decrease expenditure in 2016/17 when funding

may be more restricted; and

accruals and provisions are overstated – particularly

the „workforce provision‟, which the Trust established

a number of years ago and which is separately

disclosed in the financial statements.

Revenue and expenditure

We evaluated and tested that the accounting policy for income

and expenditure recognition was consistent with the

requirements of the NHS Annual Reporting Manual.

We tested the significant contracts and agreed income

recognised back to the contract value. In addition, we have

determined that these significant contract arrangements were

not complex. We identified contract variations and agreed

these to variable income recognised/ penalties incurred.

We tested a sample of revenue transactions recognised after

the year end to supporting schedules/ invoices, to check that

the amount of revenue recorded was accurately and

appropriately recognised in the appropriate financial year.

Intra- NHS balances

We examined intra-NHS confirmations received by the Trust

(through Monitors „agreement of balances‟ exercise) of income

and expenditure transactions that had occurred during the

year and year end balances. We tested unresolved differences

by agreeing to correspondence between the parties, which we

found to support the balances recognised by the Trust.

Manipulation through journal entries

Our journals work was carried out using a risk based

approach. We used data analysis techniques to identify the

journals that had unusual account combinations. For example

credits to revenue which do not debit debtors or cash. Where

unusual journals were identified, we traced them back to

supporting documentation to verify our understanding of the

journal.

Management estimates

We selected a number of accruals and provisions recorded in

the financial statements, traced them to supporting

documentation, such as invoices to determine whether the

expenditure was recognised in the correct period.

On the workforce integration provision we read legal advice

received from the Trust‟s lawyers and correspondence

received during the year to assess if this continued to be a

valid potential liability. We substantively tested and

confirmed that the valuation of the provision in the financial

statements was fairly stated and that the provision should

continue to be recognised in the current year.

We did not identify any transactions that were indicative of fraud in the recognition of income or expenditure.

Area of focus How our audit addressed the area of focus

Revaluations of land and buildings

See note 1 to the financial statements for the directors’

disclosures of the related accounting policies, judgements

and estimates and note 9 for further information.

Property, plant and equipment (PPE), totalling £85 million,

represents the largest balance in the Trust‟s statement of

financial position. The value of land is £15.7 million and of

buildings is £32 million. All PPE assets are measured initially

at cost with land and buildings being subsequently measured

at fair value based on periodic valuations. The valuations are

carried out by professionally qualified valuers in accordance

with the Royal Institute of Chartered Surveyors (RICS)

Appraisal and Valuation Manual, and performed with

sufficient regularity to ensure that the carrying value is not

materially different from fair value at the reporting date.

We focused on this area because the value of the properties

and the related movements in their fair values recognised in

the financial statements are material. Additionally, the value

of properties included within the financial statements is

dependent upon the reliability of the valuations obtained by

the Trust, which are themselves dependent on:

the accuracy of the underlying data provided to the

valuer by the Directors and used in the valuation;

assumptions made by the Directors, including the

location of a “modern equivalent asset”; and

the selection and application of the valuation

methodology applied by the valuer, including

assumptions relating to build costs and the

estimated useful life of the buildings.

We confirmed that the valuer engaged by the Trust to perform

the valuations had professional qualifications and was a

member of the RICS.

We obtained and read the relevant sections of the full

valuation performed by the Trust‟s valuer. Using our own

valuations expertise, we determined that the methodology and

assumptions applied by the valuer were consistent with

market practice in the valuation of Trust‟s buildings. We

determined that the assumptions made by the Trust and the

approach then taken together formed an acceptable basis for

valuation.

We tested the data provided by the Trust to the external valuer

by:

checking and finding that the portfolio of properties

included in the valuation was consistent with the Trust‟s

fixed asset register, which we had audited; and

agreeing gross the internal area used by the valuer to

floor plans for the properties valued.

We agreed that the values provided to the Trust by the valuer

had been correctly included in the accounts and that the

valuation movements were accounted for correctly.

We physically verified a sample of assets to confirm existence and in doing so assessed whether there was any indication of physical obsolescence which would indicate potential impairment. No issues were identified.

How we tailored the audit scope

We tailored the scope of our audit to ensure that we performed enough work to be able to give an opinion on the financial statements as a whole, taking into account the structure of the Trust, the accounting processes and controls, and the environment in which the Trust operates.

The Trust comprises one single entity with books and records all retained at the head office in Exeter. We performed our audit at the head office in Exeter.

Materiality

The scope of our audit was influenced by our application of materiality. We set certain quantitative thresholds for materiality. These, together with qualitative considerations, helped us to determine the scope of our audit and the nature, timing and extent of our audit procedures and to evaluate the effect of misstatements, both individually and on the financial statements as a whole.

Based on our professional judgement, we determined materiality for the financial statements as a whole as follows:

Overall materiality £4,607,000 (2015: £4,588,000).

How we determined it 2% of revenue

Rationale for benchmark applied

Consistent with last year, we have applied this benchmark, a generally accepted auditing practice, in the absence of indicators that an alternative benchmark would be appropriate.

We agreed with the Audit Committee that we would report to them misstatements identified during our audit above £230,000 (2015: £229,400) as well as misstatements below that amount that, in our view, warranted reporting for qualitative reasons.

Other reporting in accordance with the Code

Opinions on other matters prescribed by the Code

In our opinion:

the information given in the Strategic Report and the Directors‟ Report for the financial year 2015/16 for which the financial statements are prepared is consistent with the financial statements;

the part of the Remuneration Report to be audited has been properly prepared in accordance with the NHS Foundation Trust Annual Reporting Manual 2015/16; and

the part of the Staff Report to be audited has been properly prepared in accordance with the NHS Foundation Trust Annual Reporting Manual 2015/16.

Other matters on which we are required to report by exception

We are required to report to you if, in our opinion:

information in the Annual Report is:

materially inconsistent with the information in the audited financial statements; or

apparently materially incorrect based on, or materially inconsistent with, our knowledge of the Trust acquired in the course of performing our audit; or

otherwise misleading.

We have no exceptions to report.

the statement given by the directors on page 47, in accordance with provision C.1.1 of the NHS Foundation Trust Code of Governance, that they consider the Annual Report taken as a whole to be fair, balanced and understandable and provides the information necessary for members to assess the Trust‟s performance, business model and strategy is materially inconsistent with our knowledge of the trust acquired in the course of performing our audit.


the section of the Annual Report on page 96, as required by provision C.3.9 of the NHS Foundation Trust Code of Governance, describing the work of the Audit Committee does not appropriately address matters communicated by us to the Audit Committee.


the Annual Governance Statement does not meet the disclosure requirements set out in the NHS Foundation Trust Annual Reporting Manual 2015/16 or is misleading or inconsistent with information of which we are aware from our audit. We have not considered whether the Annual Governance Statement addresses all risks and controls or that risks are satisfactorily addressed by internal controls.


We are also required to report to you if:

we have referred a matter to Monitor under paragraph 6 of Schedule 10 to the NHS Act 2006 because we had reason to believe that the Trust, or a director or officer of the Trust, was about to make, or had made, a decision which involved or would involve the incurring of expenditure that was unlawful, or was about to take, or had taken a course of action which, if followed to its conclusion, would be unlawful and likely to cause a loss or deficiency; or


we have issued a report in the public interest under paragraph 3 of Schedule 10 to the NHS Act 2006.


Arrangements for securing economy, efficiency and effectiveness in the use of resources

Under the Code we are required to report to you if we are not satisfied that the Trust has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2016.

The Trust was put under review by NHS Improvement in March 2016 following potential governance concerns about the Trust‟s NHS 111 service, as explained in the Annual Governance Statement. The Trust is waiting on the final CQC report and is in the process of agreeing an action plan. Consequently we have been unable to conclude on whether the Trust has secured proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes on the NHS 111 service.

Except for the NHS 111 service, we have been able to satisfy ourselves that the Trust has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the financial period.

Responsibilities for the financial statements and the audit

Our responsibilities and those of the directors

As explained more fully in the Directors‟ Responsibilities Statement, the directors are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view in accordance with the NHS Foundation Trust Annual Reporting Manual 2015/16.

Our responsibility is to audit and express an opinion on the financial statements in accordance with the National Health Service Act 2006, the Code, and ISAs (UK & Ireland). Those standards require us to comply with the Auditing Practices Board‟s Ethical Standards for Auditors.

This report, including the opinions, has been prepared for and only for the Council of Governors of South Western Ambulance Service NHS Foundation Trust as a body in accordance with paragraph 24 of Schedule 7 of the National Health Service Act 2006 and for no other purpose. We do not, in giving these opinions, accept or assume responsibility for any other purpose or to any other person to whom this report is shown or into whose hands it may come save where expressly agreed by our prior consent in writing.

What an audit of financial statements involves

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. 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 directors; and

the overall presentation of the financial statements.

We primarily focus our work in these areas by assessing the directors‟ judgements against available evidence, forming our own judgements, and evaluating the disclosures in the financial statements.

We test and examine information, using sampling and other auditing techniques, to the extent we consider necessary to provide a reasonable basis for us to draw conclusions. We obtain audit evidence through testing the effectiveness of controls, substantive procedures or a combination of both. In addition, we read all the financial and non-financial information in the Annual Report to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report.

Responsibilities for securing economy, efficiency and effectiveness in the use of resources

Our responsibilities and those of the Trustees

The Trust is responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources. We are required under paragraph 1(d) of Schedule 10 to the NHS Act 2006 to satisfy ourselves that the Trust has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources and to report to you where we have not been able to satisfy ourselves that it has done so. We are not required to consider, nor have we considered,

whether all aspects of the Trust‟s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively.

We have undertaken our work in accordance with the Code, having regard to the criterion determined by the Comptroller and Auditor General as to whether the Trust has proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people.

We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary.

Certificate

We certify that we have completed the audit of the financial statements in accordance with the requirements of Chapter 5 of Part 2 to the National Health Service Act 2006 and the Code.

Heather Ancient (Senior Statutory Auditor) for and on behalf of PricewaterhouseCoopers LLP Chartered Accountants and Statutory Auditors Plymouth May 2016

(a) The maintenance and integrity of the South Western Ambulance Service NHS Foundation Trust website is the responsibility of the directors; the work carried out by the auditors does not involve consideration of these matters and, accordingly, the auditors accept no responsibility for any changes that may have occurred to the financial statements since they were initially presented on the website.

(b) Legislation in the United Kingdom governing the preparation and dissemination of financial statements may differ from legislation in other jurisdictions

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Annual Accounts

Accounts for the Year Ended 31 March 2016

Foreword to the accounts

These accounts are prepared in accordance with paragraphs 24 and 25 of Schedule 7 to the NHS Act 2006 and are presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006.

Signed:

Ken Wenman Chief Executive and Accounting Officer Date: 23 May 2016

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Summary of financial performance

Key highlights of SWASFT‟S financial performance for 2015/16 are as follows:

income of £232.2million, this is above plan and includes additional incomeassociated with NHS 111, events, training and salary recharges;

a surplus of £0.191million, this was lower than the plan of £0.6million due tothe application of A&E fines. These fines have been reinvested;

earnings Before Interest, Tax, Depreciation and Amortisation (EBITDA) of£13.6million representing 5.9% of income compared to a plan of 6.3%;

a year-end cash balance of £28.8million (2015: £34.1million);

net current assets of £10.7million (2015: £10.4million). The increase reflectsthe surplus;

delivered a Continuity of Service risk rating of 4 (as set by Monitor) (where 4is the best and 1 is the worst).

2015/16 was a challenging year for SWASFT as set out below:

A&E Service line activity is broadly in line with contract. However activity is5.06% above last year.

non-delivery of the A&E constitutional standards;

ongoing challenges with recruiting appropriate numbers of paramedics.However, SWASFT has had a successful year recruiting to establishment;

rollout of the trust‟s strategic programmes including the computer aideddispatch system, ARP and electronic care system project;

tender activity in relation to urgent care with the loss of Somerset OOH andNHS 111 from 30 June 2015.

Analysis of Income

SWASFT recognised income of £232.2million in 2015/16. This has increased by 1.2% from £229.4million in 2014/15. The following table provides a summary of the key movements.

Income movements 2014/15 to 2015/16

£'m

Income 2014/15 229.4

Additional A&E income 4.8

Reduction in OOH income (0.7)

Additional NHS 111 income 0.7

Reduction in local Winter Pressure funding (2.2)

Other income movements 0.2

Total income 2015/16 232.2

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Total income 2015/16

The Trust‟s principal source of income is from local NHS commissioning contracts for the provision of A&E Services. This income totalled £182.0 million (2015: £177.2 million) which represented 78.4% of the Trust‟s 2015/16 turnover (2015: 77.2%). The table below provides a summary of the key movements.

Trust income 205/16 and 2014/15

2015/16 2014/15

£'m % £'m %

A&E income 182.0 78.4% 177.2 77.2%

PTS income 4.0 1.7% 3.9 1.7%

UCS income 25.6 11.0% 24.5 10.7%

Other income 20.6 8.9% 23.8 10.4%

232.2 100.0% 229.4 100.0%

The A&E income increased due to the additional activity funding agreed at the start of 2015/16.

The PTS income increased during 2015/16 due to in year activity increases.

The UCS income increased due to the new Gloucester OOH contract and increase in NHS 111 income offset by loss of Somerset OOH and NHS 111 contracts.

Other income decreased this was due to Electronic Care Summary non-recurring income for 2014/15 offset by expenditure for Electronic Care Summary during 2014/15.

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Analysis of expenditure

The operating expenditure for 2015/16 was £230.0 million. This has increased by 1.1% from £227.6 million in 2014/15. The following table provides a summary of the key movements.

Operating expenditure in 2015/16 and 2014/15

2015/116 2014/15

£'m % £'m %

Staff Costs 168.6 73.3% 164.2 72.1%

Supply and Services 8.6 3.7% 9.1 4.0%

Establishment 5.0 2.2% 4.7 2.1%

Transport 19.1 8.3% 17.5 7.7%

Premises 9.7 4.2% 11.7 5.1%

Depreciation 10.8 4.7% 10.2 4.5%

Impairment 0.6 0.3% 2.0 0.9%

Other 7.6 3.3% 8.2 3.6%

230.0 100% 227.6 100.0%

These movements reflect:

the additional staff costs associated with the improved paramedic recruitment;

the reduction in staff costs for Somerset OOH and NHS 111 from 30 June2015;

the use of external third parties arising from vacancies (included in thetransport section) to support the frontline operations of A&E;

the transactions relating to the electronic care system project in 2014/15which was matched by other income;

impairments include the impairment of the new Bristol ambulance station in2015/16 and the impairment of St Leonards in 2014/15.

it should be noted that the Trust charitable accounts of £0.3 million are notconsolidated.

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Cost improvement strategy

The delivery of internal efficiencies is vital to the ability of the trust to deliver its Business Plan. SWASFT has a strong track record of delivering recurrent efficiencies that underpin its financial plan. The delivery of the cost improvement programme is one of the most significant factors in delivering the Trust financial position and maintaining the ability to reinvest surpluses and maintain the financial health of the organisation. During 2015/16, despite facing a number of challenges the trust delivered a recurrent cost improvement programme of £7.9 million through the implementation of recurrent schemes. The 2016/17 cost improvement plan is £6.0million. The cost improvement plan has been fully identified on a recurrent basis and extracted from budgets, however there remains a risk to delivery of schemes. The plan includes schemes such A&E modernisation, review of non-pay, urgent care service modernisation and a fuel reduction action plan. The continued delivery of cost improvements is critical to the on-going financial health of the Trust.

Financing and investment

Capital Investment

The Trust continues to manage its capital spend in line with the Trust‟s Fleet, Information Communication and Technology and Estate enabling strategies. The total investment in capital for the year to 31 March 2016 was £10.7million (2015: £14.3million). Details of key elements of spend during the year is detailed below.

Capital programme 2015/16 and 2014/15

2015/16 2014/15

£'m % £'m %

Fleet 8.1 75.7% 6.1 43%

Information Communication and Technology 0.7 6.5% 3.2 22%

Estates 0.9 8.4% 3.7 26%

Hazardous Area Response Team Estate 0.0 0.0% 0.9 6%

Other including Medical Devices 1.0 9.4% 0.4 3%

10.7 100% 14.3 100%

The main movements in capital expenditure include:

the timings of the fleet replacement programme;

the ICT costs in 2014/15 included the new computer aided dispatch system inthe clinical hub;

the estate costs in 2014/15 relate to the new ambulance station in Bristol;

medical device replacement in 2015/16 relates to the vital signs equipment.

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Financing and Investment

From January 2015 the Trust has in place an overdraft facility of £5 million which was renewed in January 2016. The Trust had no requirement to access either facility during 2015/16, maintaining healthy cash balances throughout the year. The Trust continues to forecast its cash requirements on a rolling 12-month basis and has no plans to use the facility over the period.

Better Payment Practice Code

The Trust has an excellent record delivering against requirements set out by the Better Payment Practice Code.

Although not a financial target, the Trust monitors compliance to ensure that suppliers are paid within 30 days. The table below provides a summary of the number and value of the invoices paid within this target.

Better Payment Practice Code Performance

2015/16 2014/15

Number £'m Number £'m

Total Non-NHS trade invoices paid in year 45,317 66.0 46,352 63.5

Total Non-NHS trade invoices paid within target 43,730 61.2 44,720 60.6

Percentage of Non-NHS trade invoices paid within target 96% 93% 96% 95%

Total NHS trade invoices paid in year 1,345 3.2 1,130 2.8

Total NHS trade invoices paid within target 1,296 3.0 1,096 2.8

Percentage of NHS trade invoices paid within target 96% 94% 97% 97%

During 2015/16 the trust‟s Better Payment Practice performance fell below 95% for value of invoices paid within 30 days. This reflected process changes with the use of purchase orders and queries relating to capital invoices in August 2015.

Public Dividend Capital

The trust is required to pay a dividend to the Department of Health based on 3.5% of average relevant net assets. During 2015/16, the trust recognised a dividend payable of £1.9 million within the Statement of Comprehensive Income based on average relevant net assets of £54.8 million.

Monitor’s Financial Sustainability Risk Rating

During August 2015 Monitor published an updated Risk Assessment Framework (RAF) that sets out Monitor‟s approach to overseeing the sector under new rules. The RAF explains how Monitor will assess individual NHS Foundation Trusts‟ compliance with two specific aspects of their work

the Governance Risk Rating;

the Financial Sustainability Risk Rating (FSRR).

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Monitor will regularly consider the planned and actual financial performance and will use a FSRR to assess financial risk. The FSRR incorporates the previous measure which was the continuity of services risk rating with two additional measures. The metric focuses on financial elements only and comprises of four metrics as follows:

capital servicing capacity: the degree to which the organisation‟sgenerated income covers its financing obligations;

liquidity: days of operating costs held in cash or cash-equivalent forms,including wholly committed lines of credit available for drawdown;

income and expenditure (I&E) margin: the degree to which theorganisation is operating at a surplus/deficit;

variance from plan in relation to I&E margin: variance between afoundation trust‟s planned I&E margin in its annual forward plan and itsactual I&E margin within the year.

The Trust has an overall risk rating of four (where 4 is the best and 1 is the worst) This means that the Trust is considered by Monitor, the independent regulator of NHS Foundation Trusts, to be low risk in financial terms. This is evidence of the strong financial discipline and cost control embedded across the Trust.

Financial Outlook

The sound financial performance of SWASFT in 2015/16 secures a strong starting point for 2016/17. The trust has an approved Financial Plan for 2016/17 and an Integrated Business Plan for the period 2014/15 to 2018/19 including financials. We have a history of achieving our key financial targets and financial plans. The Directors of the trust have confidence in our future plans to ensure ongoing success as demonstrated by:

negotiation of the A&E contract;

signed contracts in place for all other services;

approved financial plans for 2016/17 including identified cost improvementplan;

the Trust cash flow forecast.

General Economic Climate

The Trust has been delivering services against the backdrop of the ongoing financial challenges and this is expected to continue over the medium term.

Other Developments

the trust continues to operate in competitive markets under the Governmentpolicy of Any Willing Provider;

as part of the A&E contract the Right Care2 service development investmentis profiled within our financial plan for 2016/17;

the Trust has a number of service developments continuing into 2016/17, themost significant of which are the rollout of the electronic care system project,

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the north clinical hub and the rationalisation of A&E clinical hubs with the provision a single triage and telephony system;

any investments are assessed using our finance strategy, ensuring that thereis minimal impact on the current levels of service delivery or the trust‟sunderlying financial stability.

Planning

As a foundation trust, the organisation has a rigorous process to review its financial position and projections including the identification of the risks to which it is likely to be exposed. This process includes the reconciliation between the financial plan and the operational plan of the organisation. The Trust has developed a Mitigation Escalatory Action Plan (MEAP) to allow the Trust to manage these risks should they materialise. Refer to page 9 for more information about risk management.

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STATEMENT OF COMPREHENSIVE INCOME FOR THE YEAR ENDED 3 31 MARCH 2016

Year ended

31 March

2016

Year ended

31 March

2015

Note £000 £000

Operating income from patient care activities 3.1 223,277 219,773

Other operating income 3.1 8,934 9,666

Total operating income from continuing operations 232,211 229,439

Operating expenses from continuing operations 4.1 (230,013

) (227,572

)

Operating surplus 2,198 1,867

Finance costs:

Finance income 7 84 95

Finance costs - interest expense 8 (115) (124)Finance costs - unwinding of discount on provisions 18 (59) (52)

PDC Dividends payable (1,917) (1,627)

Net finance costs (2,007) (1,708)

Surplus for the year 191 159

Other comprehensive income / (expense)

Impairments 9.1 (57) (262)

Revaluations 9.1 2,186 1,605

Total comprehensive income for the year 2,320 1,502

The notes on pages 196 - 243 form part of these accounts.

196

STATEMENT OF FINANCIAL POSITION AS AT 31 MARCH 2016

31 March

2016

31 March

2015 Note £000 £000

Non-current assets Property, plant and equipment 9.1 84,841 83,371 Trade and other receivables 12 17 397

Total non-current assets 84,858 83,768

Current assets Inventories 11 2,136 2,207 Trade and other receivables 12 6,864 4,974 Cash and cash equivalents 20 28,767 34,066

Total current assets 37,767 41,247

Current liabilities Trade and other payables 13.1 (18,577) (22,672) Borrowings 15 (468) (497)Provisions 18 (7,571) (7,266)Other liabilities 14 (477) (398)

Total current liabilities (27,093) (30,833)

Total assets less current liabilities 95,532 94,182

Non-current liabilities Trade and other payables 13.1 0 (228) Borrowings 15 (2,369) (2,822) Provisions 18 (3,926) (4,215)

Total non-current liabilities (6,295) (7,265)

Total assets employed 89,237 86,917

Financed by taxpayers' equity: Public Dividend Capital 43,025 43,025 Revaluation reserve 19 9,899 8,121 Income and expenditure reserve 36,313 35,771

Total Taxpayers' Equity 89,237 86,917

The accounts of pages 184-193 were approved by the Board on 19 May 2016 and signed on its behalf by

Signed:

Ken Wenman Chief Executive and Accounting Officer

197

STATEMENT OF CHANGES IN TAXPAYERS’ EQUITY FOR THE YEAR ENDED 31 MARCH 2016

Note

Public dividend

capital (PDC)

Revaluation reserve

Income and expenditure

reserve

Total Taxpayers'

Equity

£000 £000 £000 £000 Changes in taxpayers’ equity Balance at 1 April 2015 43,025 8,121 35,771 86,917 Surplus for the year 0 0 191 191 Transfers between reserves 0 (351) 351 0

Impairments 9.1 & 9.2 0 (57) 0 (57)

Revaluations - property, plant and equipment 9.1 & 9.2 0 2,186 0 2,186

Asset disposals 0 0 0 0 Public Dividend Capital received 0 0 0 0

Taxpayers' Equity at 31 March 2016 43,025 9,899 36,313 89,237

STATEMENT OF CHANGES IN TAXPAYERS’ EQUITY FOR THE YEAR ENDED 31 MARCH 2015

Public dividend

capital (PDC)

Revaluation reserve

Income and expenditure

reserve

Total Taxpayers'

Equity

£000 £000 £000 £000 Changes in taxpayers’ equity Balance at 1 April 2014 42,455 7,115 35,275 84,845 Surplus for the year 0 0 159 159 Transfers by absorption: transfers between reserves 0 (336) 336 0 Impairments 0 (262) 0 (262) Revaluations 0 1,605 0 1,605 Asset disposals 0 (1) 1 0 Public Dividend Capital received 570 0 0 570

Taxpayers' Equity at 31 March 2015 43,025 8,121 35,771 86,917

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STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31 MARCH 2016

Note

Year ended

31 March

2016

Year ended

31 March

2015 £000 £000

Cash flows from operating activities Operating surplus from continuing operations 2,198 1,867

Operating surplus 2,198 1,867 Non cash income and (expense) Depreciation 4.1 10,821 10,150 Impairments 4.1 585 1,974 Reversals of impairments 3.1 (186) (341)(Gain) on disposal 3.1 & 4.1 (135) (164)(Increase)/decrease in trade and other receivables 12.1 (1,601) 1,091 Decrease/(increase) in Inventories 11.1 71 (171) Decrease/(increase) in trade and other payables 13.1 (2,035) 2,584 Increase in other liabilities 14 79 257 (Decrease) in Provisions 18 (43) (399)

Net cash generated from operations 9,754 16,848

Cash flows from investing activities Interest received 7 84 95 Purchase of property, plant and equipment 9.1 & 13.1 (12,963) (14,303)

Sales of Property, Plant and Equipment 3.1, 4.1, 9.1

& 9.2 249 2,659

Net cash used in investing activities (12,630) (11,549)

Cash flows from financing activities Public dividend capital received 0 570 Loans received 15 0 111 Loans repaid to the Department of Health 15 (428) (428)Loans repaid 15 (58) (71)Capital element of finance lease rental payments 0 (18)Interest paid (54) (67)Interest element of finance lease (57) (57)PDC Dividend paid (1,826) (1,722)

Net cash used from financing activities (2,423) (1,682)

Net (decrease)/increase in cash and cash equivalents (5,299) 3,617 Cash and cash equivalents at the start of the year 34,066 30,449

Cash and cash equivalents at end of the year 28,767 34,066

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NOTES TO THE ACCOUNTS

1.

1.1

1.2

1.3

1.4

1.5

Accounting Policies

Accounting Policies

Monitor is responsible for issuing an accounts direction to NHS foundation trusts under the NHS Act 2006. Monitor has directed that the financial statements of NHS foundation trusts shall meet the accounting requirements of the NHS Foundation Trust Annual Reporting Manual (FT ARM) which shall be agreed with the Secretary of State. Consequently, the following financial statements have been prepared in accordance with the FT ARM 2015/16 issued by Monitor. The accounting policies contained in that manual follow IFRS and HM 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.

Accounting convention

These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment.

Going Concern

After making enquiries, the 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.

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.

Critical accounting judgements and key sources of estimation uncertainty

In the application of the 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.

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1.5.1 Critical judgements in applying accounting policies

The following are the critical judgements, apart from those involving estimations (see below) that management has made in the process of applying the Trust‟s accounting policies and which have the most significant effect on the amounts recognised in the annual report and accounts.

Provisions

The provision calculated for the outcome of outstanding workforce integration issues has been based on management best estimate and legal advice received.

Information provided by the NHS Litigation Authority has been used to determine provisions required for potential employer liability claims and disclosure of Clinical Negligence liability.

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

Provisions for pensions are estimated by using the interim life tables available from the National Statistics web site.

The 2015/16 accounts include provisions for workforce changes including the Mutually Agreed Resignation Scheme (MARS).

The Trust has made a provision for the potential dilapidation costs for two leased buildings where notice has been given on the leases.

Property, plant and equipment revaluation

The Trust has used the professional services of the Local District Valuer to value all Land and Buildings as at 31 March 2016. Indexation has not been applied to any non-current assets (i.e. vehicles and equipment). The key assumptions for the valuation are set out in note 1.9.

Accruals

Accruals for services received not yet invoiced are estimated on the basis of past experience.

Within the holiday accrual the NIC is estimated at the standard rate and that all employees are in the pension scheme.

Overtime accrual is estimated on the previous month and adjusted for any known movements within the rostering system.

Other critical judgements

201

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

The bad debt provision has been calculated based on a detailed review of each balance over 180 days.

Income has been deferred where expenditure will take place during the year ended 31 March 2017.

1.5.2 Key sources of estimation uncertainty The following are the key assumptions concerning the future and other key sources of estimation uncertainty at the end of the reporting period that have a significant risk of causing a material adjustment to the carrying amounts of assets and liabilities within the next financial year.

A discount rate of 1.37% (2015: 1.3%) has been used to calculate the Injury Benefit provision of £4.037 million (2015: £4.320 million).

Non-current asset lives have been reassessed by the District Valuer at 31 March 2016.

1.6 Income

Income in respect of services provided is recognised when and to the extent that performance occurs and is measured at the fair value of the consideration receivable. The main source of income for the Trust is contracts with commissioners in respect of healthcare services.

Where income is received for a specific activity that is to be delivered in the following year, such income is deferred. This is a combination of NHS and non NHS income which is not material in 2015/16.

Income from the sale of non-current assets is recognised only when all material conditions of sale have been met and is measured as the sums due under the sale contract.

The 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.

1.7 Expenditure on 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.

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The cost of annual leave entitlement earned but not taken by employees at the end of the period is recognised in the annual report and accounts to the extent that employees are permitted to carry forward leave into the following period.

Pension costs

Past and present employees are covered by the provisions of the NHS Pension Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. It is not possible for the Trust to identify its share of the underlying scheme liabilities. Therefore, the scheme is accounted for as a defined contribution scheme.

Employers pension cost contributions are charged to operating expenses as and when they become due.

Additional pension liabilities arising from early retirements are not funded by the scheme except where the retirement is due to ill-health. The full amount of the liability for the additional costs is charged to the operating expenses at the time the Trust commits itself to the retirement, regardless of the method of payment.

1.8 Expenditure on goods and services

Expenditure on goods and services is recognised when and to the extent that they have been received, and is measured at the fair value of those goods and services. Expenditure is recognised in operating expenses except where it results in the creation of a non-current asset such as property, plant and equipment.

1.9 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 potentialwill be supplied to, the 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 at least £5,000; or

Collectively, a number of items have a cost of at least £5,000 andindividually have a cost of more than £250, where the assets arefunctionally interdependent, they had broadly simultaneous purchasedates, are anticipated to have simultaneous disposal dates and are undersingle managerial control; or

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Items form part of the initial equipping and setting-up cost of a newbuilding or ambulance station, irrespective of their individual or collectivecost.

Where a large asset, for example a building, includes a number of components with significantly different asset lives e.g. plant and equipment, then these components are treated as separate assets and depreciated over their own useful economic lives.

Valuation

All property, plant and equipment is 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. With the exception of land and buildings, depreciated historic costs are considered to reflect 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 subsequent accumulated depreciation and impairment losses. 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.

All other assets are measured subsequently at fair value. Valuations are carried out by professionally qualified valuers in accordance with the Royal Institute of Chartered Surveyors (RICS) Appraisal and Valuation Manual. The latest full revaluation of the Trusts specialised buildings was undertaken as at 31 March 2016.

The Treasury has decided that the NHS should value its property assets in line with the Royal Institution of Chartered Surveyors (RICS) Red Book standards. This means that specialised property, for which market value cannot be readily determined, should be valued at depreciated replacement cost (DRC) on a modern equivalent asset basis.

In accordance with the Treasury accounting manual, valuations are now carried out on the basis of modern equivalent asset replacement cost for specialised operational property and existing use value for non-specialised operational property. The value of land for existing use purposes is assessed at existing use value.

Alternative open market value figures are only used for operational assets scheduled for imminent closure and subsequent disposal.

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Specialised buildings – depreciated replacement cost

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. Assets in the course of construction are initially valued at cost and are subsequently valued by professional valuers when construction is completed if there is evidence that the construction cost is not a good approximation of fair value. For 2015/16 this includes St James Bristol, which has been assessed and this impairment is not material.

Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are revalued and depreciation commences when they are brought into use.

Until 31 March 2009, fixtures and equipment were carried at replacement cost, as assessed by indexation and depreciation of historic cost. From 1 April 2009 indexation has ceased. The carrying value of existing assets at that date will be written off over their remaining useful lives and new fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from fair value.

Non-property assets

For non-property assets the depreciated historical cost basis has been adopted as a proxy fair value in respect of assets which have short lives or low values. Where appropriate, assets assessed to be either high value or long life have been revalued to their current depreciated replacement cost using estimations of current market value.

Revaluation gains and losses

Revaluation gains and losses are recognised in the revaluation reserve, except where, and to the extent that they reverse a revaluation decrease that has previously been recognised in operating expenses, in which case, they are recognised in operating income.

Revaluation losses are charged to the revaluation reserve to the extent that there is an available balance for the asset concerned and are thereafter charged to operating expenses.

Gains and losses recognised in the revaluation reserve are reported in the Statement of Comprehensive Income as an item of 'other comprehensive income'.

Subsequent expenditure

205

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 costs 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.

1.10 Depreciation

Assets in the course of construction are not depreciated until the asset is brought into use or reverts to the Trust, respectively.

Otherwise, depreciation is charged to write off the costs or valuation of property and plant and equipment, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service delivery benefits. The estimated useful life of an asset is the period over which the Trust expects to obtain economic benefits or service potential from the asset. This is specific to the Trust and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over their estimated useful lives.

Freehold land is considered to have an infinite life and is not depreciated.

Impairments

In accordance with the Foundation Trust Annual Reporting Manual, impairments that are due to a loss of economic benefits or service potential in the asset are charged to operating expenses. A compensating transfer is made from the revaluation reserve to the income and expenditure reserve of an amount equal to the lower of (i) the impairment charged to the operating expenses; and (ii) the balance in the revaluation reserve attributable to that asset before the impairment.

An impairment arising from a loss of economic benefit or service potential is reversed when and to the extent that, the circumstances that gave rise to the loss is reversed. Reversals are recognised in operating income to the extent that the asset is restored to the carrying amount it would have had if the impairment had never been recognised. Any remaining reversal is recognised in the revaluation reserve. Where, at the time of the original impairment, a transfer was made from the revaluation reserve to the income and

206

expenditure reserve, an amount is transferred back to the revaluation reserve when the impairment reversal is recognised.

Other impairments are treated as revaluation losses. Reversals of 'other impairments' are treated as revaluation gains.

1.11 Donated assets

Donated plant and equipment assets are capitalised at their fair value on receipt. The donation is credited to income at the same time, unless the donor imposes a condition that the future economic benefits embodied in the donation are to be consumed in a manner specified by the donor, in which case, the donation is deferred within liabilities and is carried forward to future financial years to the extent that the condition has not yet been met.

The donated assets are subsequently accounted for in the same manner as other items of property, plant and equipment.

1.12 Software

Software which is integral to the operation of hardware e.g. an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software which is not integral to the operation of hardware e.g. application software, is charged to software in the Statement of Comprehensive Income.

1.13 Useful Economic lives of property, plant and equipment

Useful economic lives reflect the total life of an asset and not the remaining life of an asset. The range of useful economic lives are shown in the table below:

Min life

Max life

Years Years Land 0 0 Buildings, excluding dwellings 6 72 Plant & machinery 1 15 Transport equipment 1 12 Information technology 4 5 Furniture & fittings 5 10

Finance-leased assets (including land) are depreciated over the shorter of the useful economic life or the lease term, unless the FT expects to acquire the asset at the end of the lease term in which case the assets are depreciated in the same manner as owned assets above.

1.14 Leases

207

Finance leases

Where substantially all the risks and rewards of ownership of a leased asset are borne by the Trust, the asset is recorded as property, plant and equipment and a corresponding liability is recorded. The value at which both are recognised is the lower of the fair value of the asset or the present value of the minimum lease payments, discounted using the interest rate implicit in the lease.

The asset and liability are recognised at the commencement of the lease. Thereafter the asset is accounted for as an item of property, plant and equipment.

The annual rental is split between the repayment of the liability and the finance cost so as to achieve a constant rate of finance over the life of the lease. The annual finance cost is charged to Finance Costs in the Statement of Comprehensive Income. The lease liability, is de-recognised when the liability is discharged, cancelled or expires.

Operating leases

Other leases are recognised as operating leases and the rentals are charged to operating expenses on a straight-line basis over the term of the lease. Operating lease incentives received are added to the lease rentals and charged to operating expenses over the life of the lease.

Leases of land and buildings

Where a lease is for land and buildings, the land and building components are separated from the building component and the classification for each is assessed separately.

The Trust as lessor

Rental income from operating leases is recognised on a straight-line basis over the term of the lease. Initial direct costs incurred in negotiating and arranging an operating lease are added to the carrying amount of the leased asset and recognised on a straight-line basis over the lease term.

1.15 Inventories

Inventories are valued at the lower of cost and net realisable value using the first-in first-out cost formula with the exception of fleet parts which are valued using the weighted average cost formula. This is considered to be a reasonable approximation to fair value due to the high turnover of stocks.

A review is made where necessary for obsolete, slow moving and defective stocks and written off where considered appropriate.

1.16 Cash and cash equivalents

208

Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than twenty four hours. Cash equivalents are investments that mature in three 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.

In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand.

1.17 Provisions

Provisions are recognised when the Trust has a present legal or constructive obligation as a result of a past event and it is probable that the Trust will be required to settle the obligation and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where the effect of the time value of money is significant, the estimated risk-adjusted cash flows are discounted using the discount rates published and mandated by HM Treasury.

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.

1.18 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 trust is disclosed within Note 18 but is not recognised in the Trust's accounts.

1.19 Non-clinical risk pooling

The Trust participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the Trust pays an annual contribution to the NHS Litigation Authority and in return, receives assistance with the costs of claims arising. The annual membership contributions and any excesses payable in respect of particular claims are charged to operating expenses when the liability arises.

1.20 Contingencies

Contingent liabilities are not recognised, but are disclosed in Note 21, unless the probability of a transfer of economic benefit is remote.

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A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence of one or more uncertain future events not wholly within the control of the Trust, or a present obligation arising from past events but for which it is not probable that a transfer of economic benefits will arise or for which the amount of the obligation cannot be measured with sufficient reliability.

Where the time value of money is material, contingencies are disclosed at their present value.

1.21 Financial instruments and financial liabilities

Recognition

Financial assets and financial liabilities which arise from contracts for the purchase or sale of non-financial items (such as goods and services), which are entered into in accordance with the Trust's normal purchase, sale or usage requirements, are recognised when, and to the extent which, performance occurs i.e. when receipt or delivery of the goods or services is made.

De-recognition

All financial assets are de-recognised when the rights to receive cash flows from the assets have expired or the Trust has transferred substantially all of the risks and rewards of ownership.

Financial liabilities are de-recognised when the obligation is discharged, cancelled or expires.

Classification and measurement

Financial assets are classified as loans and receivables.

Financial liabilities are classified as other 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. They are included within current assets.

The Trust's loans and receivables comprise: cash and cash equivalents, NHS Receivables, accrued income and other receivables.

Loans and receivables are recognised initially at fair value, net of transactions costs, and are measured subsequently at amortised cost, using the effective interest method. The effective interest rate method is the rate that discounts exactly estimated future cash receipts through the expected life of the

210

financial asset or, when appropriate, a shorter period, to the net carrying amount of the financial asset.

Interest on loans and receivables is calculated using the effective interest method and credited to the Statement of Comprehensive Income.

Impairment of financial assets

At the Statement of Financial Position date, 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, and only if, there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset.

For financial assets carried at amortised costs, 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 the Statement of Comprehensive Income and the carrying amount of the asset is reduced directly.

1.22 Other financial liabilities All other financial liabilities are recognised initially at fair value, net of transaction costs incurred and measured subsequently at amortised cost using the effective interest method. The effective interest rate is the rate that discounts exactly estimated future cash payments through the expected life of the financial liability or, when appropriate, a shorter period, to the net carrying amount of the financial liability.

They are included in current liabilities except for amounts payable more than 12 months after the Statement of Financial Position date, which are classified as long-term liabilities.

Interest on financial liabilities carried at amortised cost is calculated using the effective interest method and charged to Finance Costs. Interest on financial liabilities taken out to finance property, plant and equipment is not capitalised as part of the cost of those assets.

1.23 Value Added Tax

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

1.24 Corporation Tax

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The trust is a Health Service Body within the meaning of s986 Corporation Taxes Act 2010. Accordingly is not liable to corporation tax. The trust is also exempt from tax on chargeable gains under S271(3) Taxation of Chargeable Gains Act 1992.

There is, however, a power for HM Treasury to submit an order to Parliament which will dis-apply the corporation tax exemption in relation to particular activities of a NHS foundation trust (s987 Corporation Taxes Act 2010). Accordingly, the trust is potentially within the scope of corporation tax in respect of activities to be specified in the order which are not related to, or ancillary to, the provision of healthcare, and where the profits there from exceed £50,000 per annum. Until the order is approved by Parliament, the trust has no corporation tax liability.

1.25 Foreign exchange

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.

When the Trust has assets or liabilities denominated in a foreign currency at the Statement of Financial Position date:

monetary items are translated at the spot exchange rate on 31 March2016;

non-monetary assets and liabilities measured at historical cost aretranslated using the spot exchange rate at the date of the transactionand

at the date the fair value was determined.

Exchange gains or losses on monetary items are recognised in income or expense in the period in which they arise.

Exchange gains or losses on non-monetary assets and liabilities are recognised in the same manner as other gains and losses on these items.

1.26 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 a 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 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 Trust during the financial year. Relevant net assets are calculated as the value of all assets less the value of all liabilities, except for (i) donated assets, (ii) average daily cash balances held with the Government Banking Services (GBS) and National Loans Fund (NLF) deposits, excluding cash balances

212

held in GBS accounts that relate to a short-term working capital facility, and (iii) PDC dividend balance receivable or payable. In accordance with therequirements laid down by the Department of Health (as the issuer of PDC),the dividend for the year is calculated on the average relevant net assets asset out in the 'pre audit' version of the annual accounts. The dividend thuscalculated is not revised should any adjustment to the net assets occur as aresult of the audit of the annual accounts.

1.27 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).

However the losses and special payments note is compiled directly from the losses and compensations register which reports on an accruals basis with the exception of provisions for future losses.

1.28 Accounting standards that have been issued but have not yet been adopted

At the date of authorisation of these annual report and accounts, the following Standards and Interpretations which have not been applied in these annual report and accounts were in issue but not yet adopted. None of them are expected to impact upon the Trust's annual report and accounts.

Standards applicable from 2016/17 IFRS 11 (Amendment) acquisition of an interest in a joint operation IAS 16 (Amendment) and IAS 38 (Amendment) Depreciation and amortisation IAS 16 (Amendment) and IAS 41 (Amendment) Bearer plants IAS 27 (Amendment) Equity method in separate financial statements IFRS 10 (Amendment) and IAS 28 (Amendment) Sale or contribution of

assets IFRS 10 (Amendment) and IAS 28 (Amendment) Investment entities applying the consolidation exception IAS 1 (Amendment) disclosure initiative

Standards applicable from 2017/18 IFRS 15 Revenue from contracts with customers

Standards applicable from 2018/19

213

IFRS 9 Financial Instruments

2. Operating Segments

The Trust has assessed that the chief operating decision maker is the Boardof Directors.

The Board receives a detailed Integrated Corporate Performance Report(ICPR) on a monthly basis; this includes segmental analysis of the Trust'sservice lines. This analysis is also received by the Finance and InvestmentCommittee (FIC), a sub-committee of the Board of Directors.

The Accident and Emergency Ambulance (A&E) service line accounts for78.4% (2015:77.2%) of total income received by the Trust during the yearended 31 March 2016. Urgent Care Services (UCS) including Out of Hoursand NHS 111 accounts for 11.0% (2015:10.7%) of the total income receivedby the Trust during the same year.

31 March

2016 31 March

2015 £000 £000

A&E income 182,016 177,170 PTS income 3,955 3,887 UCS income 25,637 24,479 Other income 20,603 23,903

Total income 232,211 229,439

Operating expenses (230,013) (227,572)

Operating surplus 2,198 1,867

Other income includes HART, hosting of the Ambulance Radio Programme (ARP) team, Winter Pressures, Road Traffic Collision (RTC), ECS Project, Medical Transport Service (MTS) and Training Income.

Emergency Ambulance Service (A&E)

The Trust provides an emergency response to 999 Category Red and Green injuries and illnesses, which are likely to require treatment and immediate transport to a hospital or other facility. Provision is provided across the entire Trust area being the South West region.

Urgent Care Service (UCS)

214

The Trust provides a range of non-emergency responses to people who require, or perceive the need for, urgent (but not emergency) advice, care, diagnosis or treatment. The Out of Hours service is delivered across Dorset and Gloucestershire and includes other additional activities. The NHS 111 service is provided for Cornwall, Devon and Dorset.

The contracts for OOH and NHS 111 for Somerset terminated on 30 June 2015.

Patient Transport Service (PTS)

The Trust provides ambulance non-emergency medical patient transport services, such as to and from outpatient appointments. The Trust now only provides services in the Bath, North Somerset and South Gloucestershire (BNSSG) and the Isle of Scilly.

The Board in approving the Finance Strategy periodically undertakes a review to evaluate contracts against the investment/ disinvestment criteria and the commercial principles. This is particularly pertinent for UCS and PTS contacts which are competitively tendered.

3. Operating Income

3.1 Operating income (by classification)

Year ended

31 March

2016

Year ended

31 March

2015 £000 £000

Income from activities Income from Commissioner Requested Services A&E income 182,016 177,170 PTS income 3,955 3,887 Income from non-Commissioner Requested Services Other income 37,306 38,715 Private patient income 0 1

Total income from activities 223,277 219,773

Other income

The other income from non-Commissioner requested Services of £37.306 million (2015: £38.715 million) can be further broken down as follows:

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Year ended

31 March

2016

Year ended

31 March

2015

£'000 £'000

Out of Hours (OOH) 17,738 17,472 NHS 111 7,899 7,007 Hazardous Area Response Team (HART) 6,573 6,574 Other 5,096 7,662

Total Other Income 37,306 38,715

Other income includes winter pressure income £2.0 million (2015: £4.3 million)

Year ended

31 March

2016

Year ended

31 March

2015

£'000 £'000

Out of Hours (OOH) 17,738 17,472 NHS 111 7,899 7,007 Hazardous Area Response Team (HART) 6,573 6,574 Other 5,096 7,662

Total Other Income 37,306 38,715

Other operating income

Research and development 722 257 Education and training 2,150 1,405 Other 4,447 6,662 Profit on disposal of property, plant and equipment 154 240 Reversal of impairments of property, plant and equipment 186 341 Rental revenue from operating leases 28 140 Income in respect of staff costs 1,247 621

Total other operating income 8,934 9,666

Total operating income 232,211 229,439

Included in other income £4.447 million (2015: £6.662 million) is £2.5 million Ambulance Radio Programme (ARP) for hosting the team (2015: £2.4 million) and Electronic Care System Record (ECS) project income £0.7 million (2015: £3.3 million).

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3.2 Income from patient care activities

Year ended

31 March

2016

Year ended

31 March

2015 £000 £000

NHS Foundation trusts 519 549 NHS trusts 67 65 Clinical Commissioning Groups and NHS England 221,851 218,245 Local Authorities 17 17 Non-NHS:

Private patients 0 1 Injury costs recovery 652 684 Other 171 212

223,277 219,773

3.3 Operating lease income

The 2015/16 Operating lease income relates to the Chippenham aerial site and associated telecommunication companies. The 2014/15 Operating lease income included previous year‟s invoices for aerial sites.

Operating lease income

Year ended

31 March

2016

Year ended

31 March

2015 £000 £000

Rents recognised as income in the year 28 140

Total 28 140

Future minimum lease payments receivable

Year ended

31 March

2016

Year ended

31 March

2015 £000 £000

Not later than one year 28 28 Later than one year and not later than five

years 80 106 Later than five years 53 78

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Total 161 212

3.4 Income from the sale of goods

Income is wholly from the supply of services, there is no income from the sale of goods.

3.5 Income generation activities

The Trust undertakes income generation activities with an aim of reinvesting any profit in patient care. No income generation activities exceeded £1 million.

4. Operating Expenses from continuing operations

4.1 Operating Expenses from continuing operations

4.1. Operating Expenses from continuing operations

Year ended 31

March 2016

Year ended

31 March

2015 £000 £000

Services from NHS Foundation Trusts 4 16 Services from CCGs and NHS England 11 0 Purchase of healthcare from non NHS bodies 208 0 Employee Expenses - Executive directors 906 832 Employee Expenses - Non-executive directors 137 140 Employee Expenses – Staff 167,595 163,252 Drug costs 948 753 Supplies and services - clinical (excluding drug costs) 5,761 5,919 Supplies and services - general 1,937 2,476 Establishment 5,021 4,685 Transport 19,100 17,534 Premises 9,725 11,681 Increase/(decrease) in provision for impairment of receivables 38 (26) Change in provision discount rate and increase in other provisions (106) 550Inventories write down 165 161 Rentals under operating leases 2,831 2,382 Depreciation on property, plant and equipment 10,821 10,150 Impairments of property, plant and equipment 585 1,974 Audit fees payable to the external auditor:- audit services- statutory audit 47 58 other auditor remuneration (external auditor only) 29 18 Clinical negligence 43 200

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Loss on disposal of property, plant and equipment 19 76 Legal fees 170 232 Other professional fees 706 755 Internal Audit Fees 121 129 Training, courses and conferences 1,487 1,809 Redundancy 341 (64) Early retirements 54 13 Insurance 168 160 Other services, e.g. external payroll 238 227 Losses, ex gratia and special payments 98 108 Other 805 1,372

230,013 227,572

4.2 Other auditor remuneration

Year ended

31 March

2016

Year ended

31 March

2015 £000 £000

Other auditor remuneration paid to the external auditor: 1. Audit of accounts of any associate of the trust 0 0 2. Audit-related assurance services 12 0 3. Taxation compliance services 17 0 4. All taxation advisory services not falling withinitem 3 above 0 0 5. Internal audit services 0 0 6. All assurance services not falling within items1 to 5 0 0 7. Corporate finance transaction services notfalling within items 1 to 6 above 0 0 8. Other non-audit services not falling withinitems 2 to 7 above 0 18

Total 29 18

4.3 Limitation on auditor’s liability

The Trust's contract with its auditors, as set out in the engagement letter signed 9 December 2015, states that the liability of PwC, its members, partners and staff (whether in contract, negligence or otherwise) shall in no circumstances exceed £1 million in aggregate in respect of all services (2015: £1 million).

4.4 Arrangements containing an operating lease

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The Trust leases property, vehicles and equipment under operating leases. Lease terms vary from less than one year to seventy six years remaining, which relates to land at Torpoint.

Year ended

31 March

2016

Year ended

31 March

2015 £000 £000

Minimum lease payments 2,831 2,382

Future minimum lease payments due Year ended 31 March 2016

£000 £000 £000 £000 £000

Land Buildings Plant and

machinery Other Total

Not later than one year 34 1,449 23 450 1,956 Later than one year and not later than five years 134 2,413 3 318 2,868 Later than five years 1,950 3,310 0 0 5,260

Total 2,118 7,172 26 768 10,084

Year ended 31 March 2015 £000 £000 £000 £000 £000

Land Buildings Plant and

machinery Other Total

Not later than one year 33 1,179 22 341 1,575 Later than one year and not later than five years 133 2,692 9 230 3,064 Later than five years 1,974 4,652 0 0 6,626

Total 2,140 8,523 31 571 11,265

220

5. Employee costs and numbers

5.1 Employee benefits

5.1 Employee benefits Year ended 31 March 2016 Year ended 31 March 2015 Total Permanentl

y Employed Other Total Permanentl

y Employed Other

£000 £000 £000 £000 £000 £000

Salaries and wages 138,310 127,534 10,776 134,016 123,839 10,177 Social Security Costs 9,207 8,925 282 8,848 8,569 279 Employer contributions to NHS Pension scheme 16,891 16,203 688 16,185 15,480 705 Agency/contract staff 4,093 0 4,093 5,035 0 5,035

Total 168,501 152,662 15,839 164,084 147,888 16,196

5.2 Remuneration and other benefits received by Directors

The aggregate remuneration and other benefits receivable by Directors and Non-Executive Directors the financial year including pension related benefits totalled £1.043 million (to 31 March 2015; £0.972 million). Vacancies in 2014/15 were filled in 2015/16. Benefits are accruing under the NHS defined benefit pension scheme to 6 directors (2015: 6 directors). No benefits are accruing under any money purchase schemes. There were no other advances or guarantees existing with any of the Directors as at 31 March 2016 (2014/15 Nil). During the year to 31 March 2016, the highest paid Director for the Trust was the Chief Executive who was paid a salary between £0.170 million and £0.175 million (2015:0.170 million and £0.175 million) and benefits in kind of £0.004 million (2015: £0.004 million).

5.3 Retirements due to ill-health

During the year to 31 March 2016 there were 6 early retirements from the Trust agreed on the grounds of ill-health (31 March 2015: 14 early retirements). The estimated additional pension liabilities of this ill-health retirements will be £0.257

221

million (31 March 2015: £1.069 million). The cost of these ill-health retirements will be borne by the NHS Business Services Authority - Pensions Division.

5.4 Exit packages for staff leaving during the year ending March 2016

Thirty seven staff (£0.367 million) left the Trust during the year ending 31 March 2016 (2015: £0.321 million); they received an exit package when they left the Trust. The majority of exit packages related to the relocation of NHS 111 services.

5.5 Exit Packages


Exit package cost band (including any special payment

element)

Number of compulsory redundancie

s

Cost of compulsory redundancie

s

Number of other

departures agreed

Cost of other

departures agreed

Total number of exit

packages

Total cost of

exit package

s

Number £000s Number £000s Number £000s Less than £10,000 24 45 4 18 28 63 £10,001-£25,000 2 32 2 37 4 69 £25,001-£50,000 1 44 3 98 4 142 £50,001-£100,000 1 93 0 0 1 93 £100,001 - £150,000 0 0 0 0 0 0 £150,001 - £200,000 0 0 0 0 0 0 >£200,000 0 0 0 0 0 0

Total 28 214 9 153 37 367


Exit package cost band (including any special payment element)

Number of compulsory redundancie

s

Cost of compulsory

redundancies

Number of other

departures agreed

Cost of other

departures agreed

Total number of exit

packages

Total cost of

exit packages

Number £000s Number £000s Number £000s

Less than £10,000 0 0 7 46 7 46

222

£10,001-£25,000 2 40 3 48 5 88 £25,001-£50,000 0 0 2 51 2 51 £50,001-£100,000 0 0 0 0 0 0 £100,001 - £150,000 0 0 1 136 1 136 £150,001 - £200,000 0 0 0 0 0 0 >£200,000 0 0 0 0 0 0

Total 2 40 13 281 15 321

223

Redundancy and other departure costs have been paid in accordance with the provisions of the NHS Scheme. Where the Trust has agreed early retirements, the additional costs are met by the Trust and not by the NHS pension scheme. Ill-health retirement costs are met by the NHS pension scheme and are not included in the table.

Termination benefits are recognised at the earlier of:

when the Trust can no longer withdraw the offer of those benefits; and

when the Trust recognises costs for restructuring that is within thescope of IAS37 and involves the payment of termination benefits.

There were nine (2015: thirteen) other departures agreed for the year ended 31 March 2016, eight (2015: nine) were Mutually Agreed Resignation Scheme (MARS) and one (2015: four) was a Compromise agreement.

This disclosure reports the number and value of exit packages taken by staff leaving in the year. Note: The expense associated with these departures may have been recognised in part or in full in a previous year.

5.6 All Off Payroll Engagements

Year ended 31 March

2016

Year ended 31 March

2016 Number of

Engagements Number of

Engagements Number that have existed for less than one year at the time of reporting 17 4 Number that have existed for between one and two years at the time of reporting 4 0 Number that have existed for between two and three years at the time of reporting 1 2 Number that have existed for four or more years at the time of reporting 12 18

Total 34 24

6. Pension Costs

Past and present employees are covered by the provisions of the two NHS Pensions Scheme. Details of the benefits payable and rules of the Schemes can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. Both are unfunded, defined benefit schemes that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. They are not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, each scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS Body of participating in each scheme is taken as equal to the contributions payable to that scheme for the accounting period.

224

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 Financial Reporting Manual requires that "the period between formal valuations shall be four years, with approximate assessments in intervening years". An outline of these follows:

a) Accounting valuation

A Valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary's Department) as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data for the current reporting period and are accepted as providing suitably robust figures for financial reporting purposes. The valuation of scheme liability as at 31 March 2016, is based on valuation data as at 31 March 2015, updated to 31 March 2016 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant Financial Reporting Manual 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. These accounts can be viewed on the NHS Pensions website and are published annually. Copies can also be obtained from The Stationery Office.

b) 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 payable by employees and employers.

The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2012.

The Scheme Regulations allow for the level of 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 deemed appropriate.

c) National Employment Savings Trust (NEST)

There are a small number of staff who are not entitled to join the NHS Pension scheme, for example:

those already in receipt of an NHS pension

those who work full time at another Trust

225

employees who are absent from work due to sickness, maternity leave etc.when the statutory duty to automatically enrol applies.

The National Employment Savings Trust (NEST) has been set up specifically to help employers to comply with the Pensions Act 2008. Those employees in the categories above are automatically enrolled in the NEST scheme. NEST Corporation is the Trustee body that has overall responsibility for running NEST; it is a non-departmental public body that operates at arm's length from government and is accountable to Parliament through the Department of Work and Pensions (DWP).

In 2015/16 employee contributions to NEST were 1.0% of pensionable pay and employer contributions were also 1.0% of pensionable pay.

NEST levies a contribution charge of 1.8% and an annual management charge of 0.3% which is paid for from the employee contributions. There are no separate employer charges levied by NEST and the Trust is not required to enter into a contract to utilise NEST qualifying pension schemes.

7. Finance income

Year ended

31 March

2016

Year ended

31 March

2015 £000 £000

Interest on bank accounts 84 95

Total 84 95

8. Finance costs – interest expense

Year ended

31 March

2016

Year ended

31 March

2015 £000 £000

Loans from the Department of Health 57 67 Finance leases 57 57 Interest on late payment of commercial debt 1 0

Total 115 124

226

9. Property, plant and equipment9.1 Property, plant and equipment

For the year ended 31 March 2016

Land Buildings excluding dwellings

Assets under

construction

Plant and machinery

Transport equipment

Information technology

Furniture and

fittings

Total

£000 £000 £000 £000 £000 £000 £000 £000

Cost or valuation at 1 April 2015 15,692 28,000 5,238 7,469 66,626 6,944 882 130,851 Additions purchased 0 422 785 574 7,972 739 183 10,675 Impairments charged to the revaluation reserve (12) (45) 0 0 0 0 0 (57) Reclassifications 0 3,152 (5,097) 174 0 1,771 0 0 Revaluation (32) 573 0 0 0 0 0 541 Disposals 0 0 0 0 (8,129) (1,548) (68) (9,745)

At 31 March 2016 15,648 32,102 926 8,217 66,469 7,906 997 132,265

Accumulated depreciation at 1 April 2015 0 0 0 5,617 37,813 3,512 538 47,480 Provided during year 0 1,246 0 502 7,909 1,086 78 10,821 Impairments 163 422 0 0 0 0 0 585 Reversal of impairments (15) (171) 0 0 0 0 0 (186) Revaluation (148) (1,497) 0 0 0 0 0 (1,645) Disposals 0 0 0 0 (8,015) (1,548) (68) (9,631)

Accumulated depreciation at 31 March 2016 0 0 0 6,119 37,707 3,050 548 47,424

Net book value Owned 15,648 31,817 926 2,098 28,711 4,856 449 84,505 Finance leased 0 285 0 0 0 0 0 285 Donated 0 0 0 0 51 0 0 51

Total at 31 March 2016 15,648 32,102 926 2,098 28,762 4,856 449 84,841

227


For the year ended 31 March 2015

Land Buildings excluding dwellings

Assets under

construction

Plant and machinery

Transport equipment

Information technology

Furniture and

fittings

Total

£000 £000 £000 £000 £000 £000 £000 £000

Cost or valuation at 1 April 2014 16,159 26,418 5,613 7,171 67,263 9,986 615 133,225

Additions purchased 0 1,095 5,236 305 5,964 1,460 272 14,332

Impairments (2) (260) 0 0 0 0 0 (262)

Reversal of impairments 0 0 0 0 0 0 0 0

Reclassifications 390 3,053 (5,611) 0 1,896 272 0 0

Revaluation 345 (1,506) 0 (7) (2,866) 0 0 (4,034)

Disposals (1,200) (800) 0 0 (5,631) (4,774) (5) (12,410)

At 31 March 2015 15,692 28,000 5,238 7,469 66,626 6,944 882 130,851

Accumulated depreciation at 1 April 2014 0 0 0 5,131 38,417 7,192 511 51,251

Provided during year 0 1,133 0 493 7,398 1,094 32 10,150

Impairments 20 1,954 0 0 0 0 0 1,974

Reversal of impairments (211) (130) 0 0 0 0 0 (341)

Reclassifications 0 0 0 0 0 0 0 0

Revaluations 191 (2,957) 0 (7) (2,866) 0 0 (5,639)

Disposals 0 0 0 0 (5,136) (4,774) (5) (9,915)

Accumulated depreciation at 31 March 2015 0 0 0 5,617 37,813 3,512 538 47,480

Net book value

Owned 15,692 27,722 5,238 1,852 28,729 3,432 344 83,009

Finance leased 0 278 0 0 0 0 0 278

Donated 0 0 0 0 84 0 0 84

Total at 31 March 2015 15,692 28,000 5,238 1,852 28,813 3,432 344 83,371

228


The Trust's land and buildings were revalued by the District Valuer at 31 March 2016. Non specialised operational property was valued at Market Value assuming existing use. Specialised operational property was valued at Depreciated Replacement Cost.

Any improvements made to properties during the later months of the year were considered when assessing the value at 31 March 2016. Where the improvements were of a significant value, they were individually assessed by the District Valuer. The District Valuer advised that the impairment on these improvements was 10% and this impairment was applied across all other property improvements.

The remaining lives of all properties were also reviewed by the District Valuer at 31 March 2016.

No other classes of non-current assets were revalued during the year.

9.4 Impairment of assets

Year ended 31

March 2016

Year ended 31 March

2015 £000 £000

Net impairments charged to operating surplus / deficit resulting from: Changes in market price 399 1,633

Total net impairments charged to operating surplus / deficit 399 1,633

Impairments charged to the revaluation reserve 57 262

Total net impairments 456 1,895

The Gross carrying amount of fully depreciated assets still in use at 31 March 2016 was £18.111 million (2015: £18.701 million).

10. Contractual capital commitmentsAs at 31 March 2016

As at 31 March 2015

£000 £000

Property, plant and equipment 5,568 7,023

5,568 7,023

229

11. Inventories

11.1 Inventories

31 March 2016

31 March 2015

£000 £000

Drugs 187 214 Consumables 1,122 1,122 Energy 234 206 Other 593 665

Total 2,136 2,207

11.2 Inventories movement

Year ended 31

March 2016

Year ended 31 March

2015 £000 £000

Carrying Value at 1 April 2,207 2,036 Additions 9,033 8,998 Inventories recognised in expenses (8,939) (8,666) Write-down of inventories recognised as expenses (165) (161)

Carrying Value at 31 March 2,136 2,207

230

12. Trade and other receivables

12.1 Trade and other receivables

Current Non-

current Current Non-

current 31

March 2016

31 March 2016

31 March

2015 31 March

2015 £000 £000 £000 £000

NHS receivables 1,904 0 1,161 0 Other receivables with related parties 7 0 2 0 Provision for impaired receivables (97) 0 (62) 0 Prepayments 2,996 17 2,210 397 Accrued income 95 0 149 0 PDC receivable 8 0 99 0 VAT receivable 473 0 94 0 Other receivables 1,478 0 1,321 0

Total 6,864 17 4,974 397

The majority of trade receivables are due from Clinical Commissioning Groups, as commissioners for NHS patient care services. As Care Commissioning Groups are funded by Government to commission NHS patient care services, there is no need to carry out credit checks.

12.2 Provision for impairment of receivables

31 March 2016

31 March 2015

£000 £000

Balance at 1 April 2015 (62) (283)(Decrease) in provision (119) (37)Amounts utilised 3 195 Unused amounts reversed 81 63

Balance at 31 March 2016 (97) (62)

Majority of the provision relates to the recovery of overpaid salaries.

231

12.3 Receivables past their due date

31 March 2016

31 March 2015

£000

£000

Ageing of impaired receivables 0-30 days

0

0 30-60 days

0

0

60-90 days

0

0 90-180 days (was "In three to six months")

9

2

180-360 days (was "Over six months")

88

60

Total

97

62

Ageing of non-impaired receivables past their due date

0-30 days

934

492 30-60 days

294

198

60-90 days

53

63 90-180 days (was "In three to six months")

23

78

180-360 days (was "Over six months")

94

61

Total

1,398

892

13. Trade and other payables

13.1 Trade and other payables

Current

Non-current

Current

Non-current

31 March

2016

31 March 2016

31 March

2015

31 March 2015

£000

£000

£000

£000

NHS payables 193

0

272

0 Amounts due to other related parties - revenue 38

0

26

0

Other trade payables - capital 708

0

2,996

0 Other trade payables - revenue 5,412

0

5,604

0

Social Security costs 1,599

0

1,511

0 Other taxes payable 1,314

0

1,421

0

Other payables 59

0

80

0 Accruals 9,254

0

10,762

228

Total 18,577

0

22,672

228

232

13.2 Better Payment Practice Code – measure of compliance

31 March 2016 31 March 2015

Number £000 Number £000

Total Non-NHS trade invoices paid in the year 45,317 66,004 46,352 63,481 Total Non NHS trade invoices paid within target 43,730 61,167 44,720 60,591

Percentage of Non-NHS trade invoices paid within target 96% 93% 96% 95%

Total NHS trade invoices paid in the year 1,345 3,240 1,130 2,847 Total NHS trade invoices paid within target 1,296 3,038 1,095 2,766

Percentage of NHS trade invoices paid within target 96% 94% 97% 97%

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

The Trust has paid £0.001 million, this is included in the financial costs during the year in relation to claims under this legislation (2015: £nil). £nil million compensation has been paid during the year to cover debt recovery costs under this legislation (2015: £0.000).

14. Other liabilities

14. Other liabilities Current Non-

current Current Non-

current 31

March 2016

31 March 2016

31 March

2015 31 March

2015 £000 £000 £000 £000

Deferred income 477 0 398 0

Total 477 0 398 0

233

15. Borrowings

15. Borrowings Current

Non-current

Current

Non-current

31 March 2016

31 March 2016

31 March 2015

31 March 2015

£000

£000

£000

£000

Loans from Department of Health 428

1,718

428

2,146

Other loans 29

42

59

72

Obligations under finance leases 11

609

10

604

Total 468

2,369

497

2,822

A loan was taken out by Great Western Ambulance Service NHS Trust (GWAS) and was transferred as part of the acquisition. This loan with the Department of Health, was a Working Capital loan (£4.500 million) taken out in 2010 at an interest rate of 2.3% due to expire 2021. The Trust has an agreed £5.0 million Overdraft Facility in place which has not been utilised during the year.

16. Finance lease obligations

Finance lease liabilities relate to four leasehold premises with lease periods ranging from 55 to 74 years.

Amounts payable under finance leases:

Buildings and vehicles

Gross lease liabilities

Net lease liabilities

Gross lease liabilities

Net lease liabilities

31 March 2016

31 March

2016

31 March

2015

31 March

2015

£000 £000

£000

£000

Not later than one year; 26 11

26

10 Later than one year and not later than five years; 104 42

104

41

After five years 1,418 567

1,443

563 Less future finance charges (928) 0

(959)

0

Present value of minimum lease payments 620 620

614

614

Included in: Current borrowings

11

10

Non-current borrowings

609

604

620

614

234

17. Finance lease commitments

The Trust has no new finance lease commitments as at 31 March 2016 (2015:£nil). The obligation Note 17 lays out the existing financial lease details.

18. Provisions

Current Non-current

Current Non-current

31 March 2016

31 March 2016

31 March 2015

31 March 2015

£000 £000 £000 £000

Pensions relating to other staff 253 3,784 253 4,067 Other legal claims 220 0 353 0 Workforce Integration 5,628 0 5,628 0 Redundancy 290 0 352 0 Other 1,180 142 680 148

Total 7,571 3,926 7,266 4,215

235

Pensions

relating to other

staff

Other legal claim

s

Workforce

Integration

Redundancy

Other

Total

£000

£000

£000

£000

£000

£000

At 1 April 2015 4,320 353 5,628 352 828 11,481

Change in the discount rate

(34) 0 0 0 0 (34)

Arising during the year

152 164 0 355 652 1,323

Utilised during the year - accruals

0 0 0 0 0 0

Utilised during the year - cash

(237) (127) 0 (342) (19) (725)

Reversed unused

(223)

(170) 0 (75) (139)

(607)

Unwinding of discount

59

0 0 0 0

59

At 31 March 2016 4,037

220

5,628

290

1,322

11,497

Expected

timing of cash flows:

Not later than one year 253

220

5,628

290

1,180

7,571

Later than one year and not later than five years 1,011

0

0

0

33

1,044

Later than five years 2,773

0

0

0

109

2,882

Total 4,037 220

5,628

290 1,322

11,497

The provisions represent a material amount in the financial accounts and a more detail breakdown is listed below: Provision for "Pensions relating to other staff" represents injury benefit pension payable to staff who retired through injury and is payable for the remainder of their lives. The provision has been calculated using current life expectancy tables and a discount factor of 1.37% (2015: 1.3%).

236

The provision for other legal claims includes information provided by the NHS Litigation Authority and estimated legal costs arising from ongoing employment tribunal cases. A provision has been made for the potential outcome of outstanding workforce integration issues. This provision has been maintained at the same level as per the 2014/15 accounts following Board consideration and legal advice. This is expected to be resolved during 2016/17. An estimated redundancy provision is included as the Trust continues to review its organisational structure. This figure includes £0.268 million for Mutually Agreed Resignation Schemes (MARS). Other provisions includes provision for non-guaranteed overtime, alignment of payments, long term sick and dilapidations for two lease sites due to termination of the leases. Included with the provisions of the NHS Litigation Authority at 31 March 2016 is £26.312 million (2015: £17.776 million) in respect of clinical negligence liabilities of the Trust.

19. Revaluation reserve

31 March 2016

31 March 2015

£000

£000

Property, plant and

equipment

Property, plant and

equipment

At 1 April

8,121

7,115 Impairments

(57)

(262)

Revaluations

2,186

1,605 Transfers to other reserves

(351)

(336)

Asset disposals

0

(1)

At 31 March

9,899

8,121

237

20. Cash and cash equivalents

31 March 2016

31 March 2015

£000

£000

Balance at 1 April

34,066

30,449 Net change in year

(5,299)

3,617

Balance at 31 March

28,767

34,066

Represented by:

£000

£000 Cash at commercial banks and in hand

6

6

Cash with the Government Banking Service

28,761

34,056 Other current investments

0

4

Cash and cash equivalents as in statement of financial position and statement of cash flows

28,767

34,066

21. Contingencies

The Trust is currently managing a number of employment cases and no provision has been made against those which it has been advised are unlikely to succeed. In normal circumstances, a worst case assessment of the outcome of such cases would be disclosed as a contingent liability but the Trust has decided to refrain from doing so in this instance because it considers such disclosure would seriously prejudice its position. (31 March 2015, £nil).

238

22. Related party transactions

During the year, there were no material transactions relating to the Trust and members of the Trust Board, senior managers, or parties related to any of them.

Key management includes Directors, both executive and non-executive. The compensation paid or payable in aggregate to key management for employment services is shown in note 5.1. None of the key management personnel received an advance from the Trust. The Trust has not entered into guarantees of any kind on behalf of key management personnel. There were no amounts owing to key management personnel at the beginning or end of the financial year.

The Department of Health is regarded as a related party. During the year the Trust has had a

significant number of material transactions with the Department and with other entities for which the Department is regarded as the parent Department. These entities are listed below:

Income Income Receivables Receivables

31 March 2016

31 March 2015

31 March 2016

31 March 2015

£000

£000

£000

£000

Bath And North East Somerset CCG

6,157

6,049

25

23 Bristol CCG

17,272

16,933

139

61

Kernow CCG

24,934

24,592

82

72 Department of Health

3,144

2,655

418

1

NEW Devon CCG

34,707

32,545

447

529 Dorset CCG

35,371

34,310

5

26

Gloucestershire CCG

29,748

26,429

221

110 North Somerset CCG

7,826

7,869

58

78

Gloucester Hospitals NHS Foundation Trust

0

0

0

0

239

Somerset CCG

21,713

25,967

52

201 South Gloucestershire CCG

8,275

8,207

94

0

Swindon CCG

6,546

6,395

106

41 South Devon and Torbay CCG

12,562

12,186

23

0

Wiltshire CCG

16,444

16,396

63

65 Other NHS organisations

4,064

5,909

198

318

228,763

226,442

1,931

1,525

Expenditure Expenditure Payables Payables

31 March 2016

31 March 2015

31 March 2016

31 March 2015

£000

£000

£000

£000

Dorset Health Care NHS Foundation Trust

63

62

0

0

Dorset CCG

0

211

0

54 Great Western Hospitals NHS

Foundation Trust

3

164

0

1 NHS Litigation Authority

1,334

1,112

0

0

Portsmouth Hospitals NHS Trust

0

525

54

45 Plymouth Hospitals NHS Trust

221

236

58

4

Avon And Wiltshire Mental Health Partnership NHS Trust

0

0

0

0

Yorkshire Ambulance Service NHS Trust

62

0

0

0

South Devon Healthcare NHS Foundation Trust

0

176

0

326

Gloucestershire Hospitals NHSFT

72

0

0

0 Oxford Health NHS FT

44

30

3

4

240

Torbay & South Devon NHS FT

157

0

469

0 UHB NHS FT

56

39

4

3

West Midlands Ambulance Service NHS FT

76

34

48

18

East Midlands Ambulance Service NHS Trust

68

14

0

4

East of England NHS Trust

69

14

13

9 Gloucestershire Care Service NHS

Trust

83

36

0

36 Other NHS organisations

940

603

335

497

3,248

3,256

984

1,001

22. Related party transactions (cont.) The Trust has entered into the following contracts for 2016/17:-

Lead Commissioner

Contract Type

Comments

NHS Gloucestershire CCG A&E ambulance services

Comparable with the value of the 2015/16 contract

NHS Dorset CCG Out of Hours


NHS Gloucestershire CCG Out of Hours


NHS Dorset CCG 111


NHS NEW Devon CCG 111

Contract expires 30/09/2016

NHS Kernow CCG 111


NHS South Gloucestershire CCG Patient Transport Services

Contract expires 30/09/2016

241

Charitable Funds

As at 31 March 2016 South Western Ambulance Service NHS Foundation Trust had charitable funds of £0.309 million (2015: £0.212 million). The Trust acts as Corporate Trustee to the South Western Ambulance Service Foundation Trust Fund Charity (Registered charity number: 1049230). Previously HM Treasury has granted dispensation to the application of IAS 27 (Revised) by NHS Foundation Trusts in relation to the consolidation of NHS Charitable funds. From 2013/14 the Treasury dispensation is no longer available and therefore NHS Foundation Trusts are required to consolidate any material NHS charitable funds determined to be subsidiaries. The Audit Committee has agreed that the level of charitable funds is below materiality and therefore consolidation is not required. The management of the Charitable Funds is the responsibility of the Charitable Funds Committee and its terms of reference state that the committee is made up from the Executives and Non-Executives of the Trust. The Trust Chairman, Chief Executive and Deputy Chief Executive/Executive Director of Finance have served as members of the Charitable Funds Committee during the year. An additional Non-Executive Director has become a member of the Charitable Funds Committee from March 2016.

The Trust has also had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with the HM Revenue and Customs.

242

23. Intra-Government and other balances Current receivables

Non-current receivables

Current payables

Non-current payables

£000

£000 £000

£000

Balances with other central government bodies

475

0

5,223

0 Balances with local authorities

6

0

26

0

Balances with NHS Trusts and FTs

85

0

717

0 Balances with Public Corporations and Trading Funds

1,846

17

32

0

Intra government balances

2,412

17

5,998

0 Balances with bodies external to government

4,452

0

12,580

0

At 31 March 2016

6,864

17

18,578

0

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23. Intra-Government and other balances

Current receivables

Non-current receivables

Current payables

Non-current payables

£000 £000 £000 £000

Balances with other central government bodies 475 0 5,223 0 Balances with local authorities 6 0 26 0 Balances with NHS Trusts and FTs 85 0 717 0 Balances with Public Corporations and Trading Funds 1,846 17 32 0

Intra government balances 2,412 17 5,998 0 Balances with bodies external to government 4,452 0 12,580 0

At 31 March 2016 6,864 17 18,578 0

24. Financial Instruments

24.1 Financial assets by category

Loans and receivables

£000

Trade and other receivables excluding non-financial assets 3,293 Other Financial Assets 0

Cash and cash equivalents 28,767

Total at 31 March 2016 32,060

Trade and other receivables excluding non-financial assets 1,757 Other Financial Assets 0 Cash and cash equivalents 34,066


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24.2 Financial liabilities by category

24.2 Financial liabilities by category Other financial liabilities

£000 Borrowings excluding finance lease and PFI liabilities

2,217

Obligations under finance leases 620 Trade and other payables excluding non-financial liabilities

15,704

Provisions under contract 7,442


Borrowings excluding finance lease and PFI liabilities

2,705

Obligations under finance leases

614

Trade and other payables excluding non-financial liabilities

16,846

Provisions under contract

7,160

Total at 31 March 2015

27,325

The book value of financial liabilities detailed above is equal to the fair value of the financial assets. This is due to the short term nature of the liabilities.

25. Financial risk management

Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the year in creating or changing the risks a body faces in undertaking its activities. Due to the continuing service provider relationship that the Trust has with primary care trusts and the way those primary care trusts are financed, the Trust is not exposed to the degree of financial risk faced by business entities. Financial instruments also 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 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 Trust‟s treasury management operations are carried out by the finance department, within parameters defined formally within the Trust‟s standing

245

financial instructions and policies agreed by the Board of Directors. Trust treasury activity is subject to review by the Trust‟s internal auditors.

Currency risk

The Trust is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The Trust has no overseas operations. The Trust therefore has low exposure to currency rate fluctuations.

Interest rate risk

The Trust's borrowings comprise of an interest free loan and finance leases so the Trust is not considered to be exposed to interest rate risk.

Credit risk

As the majority of the Trust‟s income comes from contracts with other public sector bodies, the Trust has low exposure to credit risk. The maximum exposures as at 31 March 2016 are in receivables from customers, as disclosed in the trade and other receivables note. The Trust procurement process is robust and the Trust restricts prepayments to suppliers.

Liquidity risk

The Trust‟s operating costs are incurred under contracts with Clinical Commissioning Groups (CCGs), which are financed from resources voted annually by Parliament. The Trust funds its capital expenditure from funds obtained within its prudential borrowing limit. The Trust is not, therefore, exposed to significant liquidity risks. The Trust invests surplus funds in line with its Treasury Management policy. The Trust produces a twelve month rolling cash flow to manage liquidity risk.

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26. Losses and Special Payments

There were 753 (2015: 671) cases of losses and special payments totalling £0.263 million (2015: £0.244 million) paid during the year ended 31 March 2016.

Number of

Cases

Value of

Cases

Number of

Cases

Value of

Cases

2015/16 2015/1

6 2014/15 2014/1

5 £'000 £000

Losses Salary Overpayments 339 111 223 36 Bad Debt 25 7 31 2 Other 367 93 395 127

Total Losses 731 211 649 165

Special payments Personal Injury with advice 22 52 22 79 Special Severance Payments 0 0 0 0

Total Special Payments 22 52 22 79

Total Losses and Special Payments 753 263 671 244

Other losses include insurance excess payments for vehicles and damage to property.

© South Western Ambulance Service NHS Foundation Trust 2015

If you would like a copy of this report in another format including braille, audio tape, total communications, large print, another language or any other format, please contact:

Email: [email protected] Telephone: 01392 261649 Fax: 01392 261510

Post: Communications and Engagement Department, South Western Ambulance Service NHS Foundation Trust, Abbey Court,

Eagle Way, Exeter, Devon, EX2 7HY

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