De livering foryou - Scottish Ambulance Service report... · Serv ice exce ede d its tar ge to re...

Deliveringfor youScottish Ambulance ServiceAnnual Report and Accounts 2008/2009

The patients featured in this annual reporttell their own stories about the quality ofcare they received through the Service’sEmergency Response Team and fromstaff of the Patient Transport Service.In the course of the last year, despiteincreasing demands on resources,response times to both life threateningand urgent calls, improved. In March theService exceeded its target to respondto 75% of life-threatening calls withineight minutes. Clinical capability hasbeen improved through the introductionof a Medical Directorate which hasintroduced new ways of clinical working,and strengthened clinical governance,driving better patient outcomes. Sicknessabsence has been reduced througha number of initiatives, including theprovision of additional support suchas fast-track physiotherapy. Against thispicture of improved performance, theService has continued to deliver a strongfinancial performance.

The staff of the Scottish AmbulanceService are key to delivering the highquality clinical care expected by patients.Their professionalism and motivationis recognised, and much appreciated,by the Board. It is further recognisedthat despite the increasing demand madeon the Service through alcohol misuse,Service staff continue to provide clinicalcare to all patients with high levelsof professionalism.

The strong focus on improvingperformance, strengthening governanceand driving innovation to deliver thegoals set out in the Scottish government’sstrategy for a healthier Scotland hasbeen underpinned by making time tolisten. The Service has just undertakenits biggest-ever consultation exercise,asking patients and their carers, staff,key stakeholders, colleagues and partnersacross the NHS, and other emergencyservices, about the direction of theScottish Ambulance Service in the nextthree to five years. This has promptedsome challenging questions about thefuture of the Service and generated somelively debates about the right path to takein order to provide even better care forpeople across Scotland.

The Scottish Ambulance Service has risento the challenges it has faced in the last12 months. It is developing an increasinglycollaborative working style, which putsit in a stronger position than ever to meetthe needs of the tens of thousands ofpeople it cares for every year.

We are extremely proud of the dedication,professionalism and enthusiasm seenacross the Service and are extremelyconfident that these qualities, combinedwith clinical excellence, rigorous governanceand patient focus will pave the way foran even stronger performance in thecoming year.

Annual Report and Accounts 08/0902 Annual Report and Accounts 08/09 03

David GarbuttChairman

“The staff of theScottish AmbulanceService are key todelivering the highquality clinical careexpected by patients.”

Pauline HowieChief Executive

//Chairman and ChiefExecutive statement for2008/09 annual reportEvery day of the year,the Scottish AmbulanceService continues tomeet the clinical needsof patients and carersacross Scotland

Elizabeth& JohnMallinson

Elizabeth collapsed in herhome. She was in a lot ofpain. John called anambulance. The ambulancecrew members whoattended Elizabethdiagnosed the problem andalleviated her symptoms.They rushed herto Edinburgh RoyalInfirmary where sheunderwent complexsurgery and has nowrecovered.

“I feel it is down to theskill and dedication of theambulance crew that mywife was sufficiently stableon arrival at RIE that surgerycould be undertaken with anyconfidence of success, andcannot thank and commendthe crew members involvedtoo highly… my wife, whois nearly 80, is still with meto share a few more yearstogether after 52 yearsof marriage.”

Annual Report and Accounts 08/09 05Annual Report and Accounts 08/0904

Sound GovernanceThe Scottish Ambulance Service isunderpinned by sound clinical, staffand financial governance arrangements.These ensure safe and effective clinicalcare for our patients, fair and effectivemanagement and development of allstaff and sound financial managementof the Service.

Staff governanceThe Scottish Ambulance Service takespride in the way that it continues tomanage staff fairly and effectively andmake improvements in line with theStaff Governance Standard.

This included the continuation and highuptake of the of fast track physiotherapyfor all staff who require it as well as theconfidential employee counselling service.An Anti Bullying and Harassment campaignwas successfully launched, supportedby posters, cards, training for managersas well as Confidential Advisers. Theresults of the staff survey have been fedinto the action plan for the coming year.

Self assessment exercises for staffgovernance were carried out with localDivisions which fed into the nationalself assessment process carried out inDecember 2008. Final documentationwas submitted to the Scottish Governmentin line with prescribed timescalesin April 2009.

Patient safety and clinical governanceClinical Governance means makingsure that systems and processes arein place for ensuring patient safety whilstmaintaining and improving the qualityof treatment and care we provide andthat this is encouraged and supportedin everything we do.

A wide range of areas are coveredsuch as the provision of patient centredcare, clinical performance, trainingand development, clinical policiesand procedures, clinical audit andthe management of clinical risk.

National audits were conducted to reviewa wide range of clinical activities includingthe management of asthma, acute coronarysyndromes, pain management and the airwing activity. The Service also prepared forthe second review by NHS QIS against theNational Standards for Clinical Governanceand Risk Management which is scheduledfor August 2009.

Overall, in 2008/09, there has beenan improvement in clinical performanceand effectiveness for example the numberof patients treated at home has risenand increasing the numbers of paramedicadvisors in the EMDCs.

The Scottish Ambulance Service deliversaccident and emergency care to patientsthe length and breadth of the country.

Accident and emergency care is deliveredby specially trained paramedics andambulance technicians who, last year,responded to almost 600,000 incidentsacross Scotland.

999 calls are handled by one of threeEmergency Medical Dispatch Centres(EMDCs) and ambulance crews aredispatched from stations and deploymentpoints situated near to areas where the

fastest response can be provided whichcould be in the form of a double crewedambulance, motorbikes, all-terrainvehicles and even mountain bikesto reach patients as quickly as possible.

Crews provide life saving emergencymedical care. Having assessed themedical needs of the patient, theymay take patients to hospital, treatthem at the scene or refer them toan appropriate clinic.

Annual Report and Accounts 08/0900 Annual Report and Accounts 08/09 00Annual Report and Accounts 08/0906 Annual Report and Accounts 08/09 07

Last year, the Patient TransportService (PTS), undertook 1.6 millionjourneys across Scotland.

PTS provision is prioritised accordingto clinical need. The service is providedby specially trained ambulance careassistants who are increasingly providingthis service to patients with more complexneeds for example palliative care.

The service is provided by speciallytrained ambulance care assistants.

The Patient Transport Service operates601 vehicles.

Patient TransportServices

The air ambulance service is deliveredby four purpose built aircraft, twohelicopters and two fixed wing aircraft.

The air ambulance service is the onlyintegrated, publicly funded air ambulanceservice in the UK.

Air wing

//Overview of our yearThis section of the reportprovides an overviewof how we performedin 2008/09

//Our servicesThe Scottish Ambulance Service isa Special Health Board. We operatefrom 178 locations across five Divisionscovering the whole of Scotland, thelargest geographic area of any ambulanceservice in the UK.

The Scottish Ambulance Servicecontinues to deliver for patients acrossScotland – saving lives by respondingto life threatening emergency calls,increasingly preventing unnecessaryhospital admissions by treating

or referring people at the scene and,by taking patients requiring clinical careduring transport to hospital in timefor their appointment.

Accident andemergency care

This is being supported by the co-locationof our Emergency Medical Dispatch Centreswith NHS 24, implementation of a numberof clinical advisor posts to support clinicaldecision making, advanced technologyin the form of the electronic care recordand clinical database.

The New Ways of Clinical Working grouphas also made inroads into reviewingand improving new and innovativeways of treating patients. This has beenunderpinned by the approval of a newMedical Directorate structure and byparticipation in the National PatientSafety Programme.

Healthcare Acquired Infection (HAI)continues to be of national importance.Reducing the risk of HAI to both patientsand staff continues to be a priority for theService with the Infection Control teamworking towards achieving the objectivesof an annual rolling programme over2008/9. These actions have been furthersupported by the appointment of anInfection Control Advisor in May 2008.

Financial governanceThe Scottish Ambulance Service deliveredanother balanced budget for the yearending March 2009.

The Service ensures that both financialprocesses and controls are in place andis working effectively though a system ofinternal audit reviews. The Corporate RiskRegister is used as a basis for developingthe internal audit plan. The ScottishAmbulance Service commissioned 20Internal Audit Reports during the yearto 31 March 2008. Action plans havebeen developed to ensure that allrecommendations are implemented.

The Service also met its financial targetsfor the year and exceeded the 2% cashreleasing efficiency savings target for theyear. These efficiencies have been investedin front line services for the public.

Overview of our year

>06/07

Annie Clark from Ayrshire

>10/11


AnnieClark

Annie has been receivingtreatment for breast cancerat the Beatson Hospitaland Ayr Hospital. ThePatient Transport Servicehas taken Annie to andfrom her appointments.

“The service givento me by the ScottishAmbulance Servicehas been first-class.”

Annual Report and Accounts 08/0910 Annual Report and Accounts 08/09 11 Annual Report and Accounts 08/0912 Annual Report and Accounts 08/09 13

\\How we performedThis section of the reportcovers how we performedin 2008/09 against ourHEAT targets

Target H1:Save more lives

Performance Indicator

Maintain rates of survivalof cardiac arrest on arrivalat hospital within bandof reasonableness

Target for 2008/09

17% to 21% full year

Performance in 2008/09

20%

A key performance measure for SAS is the return of spontaneous circulation (ROSC) for cardiac arrest patients on arrival athospital. The service set a target range of 17-21% for 2008/09 and achieved 20%. International evidence suggests a target rangeof 12-20% is realistic, so the Service has performed extremely strongly.

Saving more lives

The Scottish Ambulance Service is committed to operating within our allocated budget. The Service has a track record of meetingits financial targets in recent years and, accordingly, financial planning and monitoring is rigorous. Once again, the Serviceoperated within our revenue and capital resource limits for this financial year. Key risks are identified and assessed annually andthen on an ongoing basis, arrangements are put in place to mitigate or reduce these risks. In addition, contingency plans are put inplace to deal with them if they arise.

The Service has achieved this financial balance in a challenging environment which has included significant pressures from: risingfuel costs, inflationary costs of parts and equipment and additional overtime worked to provide 24/7 cover in some areas. This isagainst a backdrop of the 4.6% increase in emergency demand in 2008/09, as well as a 16% increase in air ambulance demand in2008/09 compared to the previous year.

The Service met and exceeded this target and was able to use the cash releasing savings to invest in additional frontline staff.The additional savings were able to be carried over to the coming financial year.

Meeting financial targets

Sickness absence rates reduced from 5.8% in 2007/08 to 5.3% in 2008/09. In 2009/10, sickness absence has remainedconsistently below 5% due to the continued focus on identifying the drivers of absence and responding to these quickly. TheService has invested in additional Personnel support for managers through the appointment of a dedicated resource to focus onabsence management, initially piloted in the West of Scotland.

The roll out of workforce planning teams and the availability of station based management information through the intranet aredriving the streamlining of processes for reporting and recording sickness absence.

Reducing sickness absence

Improving response timesTarget E1:Meet financial targets


Operate within the revenueand capital resource limits;meet the cash requirement

Target for 2008/09

Meet targets


25K revenue underspend

8K capital underspend

Cash requirement of £196mwas under achieved by £12k

Target A1:Improve response time to Lifethreatening calls

Target A2:Improve response timeto serious but not lifethreatening calls

Target A3:Improve response timein Island Board


Improve Response time toCategory A (Life Threateningemergency incidents (mainland)– from 62% within target time(8 mins) in 2007/08 to 75%by March 2009

Improve Response time toCat B emergency incidents(serious but not life threatening(Mainlaind) – from 91.4%within target time in 2007/08to 95.00%

Improve Response time to allemergency incidents (IslandNHS Board areas) – targettime is 50% in 2008/09

Target for 2008/09

75%

95%

50%


70.7% (77.4% in March 2009)

94.4%

50.5%

Target E2:Meet cash efficiency


To generate 2% cash releasingefficiency savings per annum

Target for 2008/09

2% (£3,668,000)


2.93%

Target E4:Utilisation of CommunityHealth Index (CHI)


Number of patient transportregistrations where CHInumber is used

Target for 2008/09

75%


79.4%

Target E3:Reduce sickness absence


Reduce the % of hours lostfrom current 5.6% in 2006/07to 5% in 2009/10

Target for 2008/09

5% full year


5.3%

This target reflects the percentage of Patient Transport journeys where the Community Healthcare Index number is recorded andthe Service exceeded the targets of 75%.

Target E5:Implementation of Knowledgeand Skills Framework


Number of available staffcovered by AfC with KSFpersonal development plans

Target for 2008/09

100% by May 2009


98%

The Service implemented the e-KSF system on 2008/09. It reached 98% of all eligible staff, resulting in a Personal DevelopmentPlan in place for them by May 2009. Role profiles have been developed and training delivered to managers and staff as part of theroll out, including e-learning packages.

Clinical GovernanceCommitteeThe Clinical Governance Committeecurrently comprises four Non-ExecutiveDirectors: Mrs Christine Humphries(Chair), Mr Andrew Richmond, MsSuzanne Dawson and Mr David Garbutt.Mr David Nelson is the Public/PatientRepresentative. Until Mr Garbutt’sappointment on 29 November 2008,Mr Alan Lawton was a Non-Executivemember. The Committee meetsapproximately four times per year tomonitor standards of care and measurethe effectiveness of pre-hospital treatment.

Audit CommitteeThe Audit Committee comprises fourNon-Executive Directors: Mr Douglas Marr(Chair); Mr Andrew Richmond; Mr DavidAlexander; and Ms Theresa Houston.Mr Alan Lawton was a Non-Executivemember until 28 November 2008. Mr DAlexander took up his position on the AuditCommittee on 1 December 2008 as didMs T Houston. The Audit Committee meetsfour times per year to consider the variousreports from both internal and externalauditors to assess the risks which mayarise in the Service.

Staff GovernanceThe Staff Governance comprises threeNon-Executive Directors: Mr AlanBickerstaff (Employee Director and Chair);Mrs Christine Humphries; Mr DouglasMarr; and the Chairman, Mr WilliamBrackenridge. The Committee meetsfour times per year to ensure effectivemonitoring of staff governance withinthe organisation.

Remuneration CommitteeThe Remuneration Committee comprisesthe Chairman and three Non-ExecutiveDirectors: Mr Douglas Marr; Ms SuzanneDawson; and Mr David Alexander joinedthe Committee on 1 December 2008.The Committee is chaired by the Chairman,Mr William Brackenridge. It meets atleast three times per year to considerthe evaluation of performance and payawards for Executive Directors.

The committees have an important role inensuring consistency of policy and equityof treatment of staff across the local NHSsystem, including remuneration issues,where these are not already covered byexisting arrangements at national level.


Over 4,000 highlyskilled staff respondto around 600,000Accident andEmergency callseach year.

\\Our Committee andMembership 2008/09

//Vital statistics

Scotland 8.3

CAT A AverageResponse Time (mins)

7.2

Argyll and ClydeAyrshire and ArranBordersDumfries and GallowayFifeForth ValleyGrampianGreater GlasgowHighlandLanarkshireLothianOrkneyShetlandTaysideWestern Isles

6.77.29.08.27.07.76.87.08.57.16.9----

7.68.39.79.07.98.87.68.79.18.08.511.314.28.39.7

584,108 599,052 + 2.6%Total A&E IncidentsVariance08/0907/08

All EmergencyResponse Time (mins)

3,274 3,797 +16%Air MissionsVariance08/0907/08

1,607,590 1,567,499 -2.5%PTS JourneysVariance08/0907/08

How we performed

>12/13Committee & membership

>16/17

Balance sheets

>18/19

2009£000

2008£000

Fixed assetsIntangible fixed assets 1,356 1,657

Tangible fixed assets 84,644 66,127

Total Fixed Assets 86,000 67,784

Debtors falling due after more than one year 3,511 5,594

Current assetsStocks 0 0

Debtors 9,570 11,402

Investments 0 0

Derivative financial instruments 0 0

Cash at bank and in hand 60 60

9,630 11,462

Current liabilitiesCreditors due within one year (17,353) (14,461)

Net current assets/(liabilities) (7,723) (2,999)

Total assets less current liabilities 81,788 70,379

Creditors due after more than 1 year (1,713) (470)

Provisions for liabilities and charges (5,206) (6,544)

(6,919) (7,014)

74,869 63,365

Financed by:General Fund 61,268 58,041

Revaluation Reserve 13,597 5,324

Donated Asset Reserve 4 0

74,869 63,365


\\Operating cost statementFor the year ended 31March 2009

//Balance sheetFor the year ended 31March 2009

2009£000

2008£000

Clinical services costsHospital and Community 182,094 204,724

Less: Hospital and Community Income 4,549 6,992

177,545 197,732

Family Health 0 0

Less: Family Health Income 0 0

Total Clinical Services Costs 177,545 197,732

Administration Costs 2,176 2,176

Less: Administration Income 241 157

1,935 2,559

Other Non Clinical Services 1,443 2,556

Less: Other Operating Income 1,350 867

93 1,689

Net Operating Costs 179,573 201,980

Summary of revenue resource outturnNet Operating Costs (per above) 179,573 201,980

Capital Grants (to)/from Other Bodies 0 0

Profit/(Loss) on disposal of fixed assets 340 (472)

Annually Managed Expenditure (Write Downs) (285) (12,858)

FHS Non Discretionary Allocation 0 0

Other Allocations 0 0

Net Resource Outturn 179,628 188,650

Revenue Resource Limit 179,666 188,675

Saving/(excess) against Revenue Resource Limit 38 25

Sophie &Helen Smith

Helen went into labourand was being takento the Royal AlexandraHospital by ambulancewhen it became clear thather baby was not goingto wait. The ambulancecrew decided to pull offthe road to a safe locationwhere baby Sophie couldbe delivered, beforecontinuing the journeyto hospital. Both Helenand Sophie are doing well.

“I wasn’t expecting togive birth in the ambulance,but the crew were reallycalm and looked after mereally well. I’m extremelygrateful for the care bothSophie and I were given.”


Equality and DiversityThe SAS took part in an equality anddiversity benchmarking exercise betweenOctober 2008 and February 2009conducted by the equalities support team,part of Health Scotland’s Equalities andPlanning Directorate. The aim of theexercise was to develop a national pictureof the status of equality and diversitydelivered in NHSScotland to date.A final report [The Big Picture: A reviewof progress on equality in the NHSin Scotland] included outcomes fromthe information gathering exercise andcontained suggestions for changesand improvements on all strandsof equality and diversity.

The Service is currently developing anaction plan in order to prioritise workto be taken forward. More details areavailable by writing to the Equality andDiversity Manager, National Headquarters,Tipperlin Road, Edinburgh.

Hand HygieneCompliance MonitoringThe Scottish Ambulance Service hasbeen part of NHS Scotland’s NationalHand Hygiene Campaign since it startedin 2007. In that time the national handhygiene audits which form part of theCampaign have shown a significantimprovement in hand hygiene complianceacross the Service. This has beenachieved by raising awareness throughpromotional materials, newsletters,staff training, a zero tolerance approachto non-compliance and providing staff withindividual alcohol hand rub dispensers.The most recent national audit resultsshowed an average compliance with handhygiene of 95% with the last few auditsshowing a consistent improvement.

Over and above the national bi-monthlyaudits the Hand Hygiene Coordinatorcompletes monthly local hand hygieneaudits across the service.

National bi-monthly audit results arepublished in NHS Scotland ‘NationalHand Hygiene Campaign Audit Reports’.

Annual PatientExperience Survey2008 was the sixth consecutive yearthe Scottish Ambulance Service hasconducted research into qualitative andquantitative patient experience, continuingour determination to routinely seek theviews of our users and thereby improveservices to patients requiring emergencyand patient transport pre hospital care.As before, this research was carried outindependently by Market Research UKand the results were very positive.

With regards Accident and EmergencyPatients overall satisfaction was 97%and 93% were satisfied with the timetaken to reach patients. PTS patientshad an overall satisfaction rate of 97%and 94% were satisfied with arrival timeat hospital for their appointment. In depthqualitative interviews were also carriedout with patients who lived in remoteand rural areas, under 16s and thosewho had experienced the Inter hospitaltransport. These results have been fedinto various programmes of work acrossthe organisation.

Copies of the survey can be obtainedby writing to the Corporate AffairsManager, National Headquarters,Tipperlin Road, Edinburgh.

Health and Safety AuditIn January the Service commissioned theBritish Safety Council to conduct a Servicewide Health and Safety Audit using their5 star audit process. Following completionof the audit process the Service wereawarded a 3 star result with an audit scoreof 83.2%, a healthy improvement overthe previous audit.

The audit report is being used to shapethe Services Health and Safety plansfor the future.

The next planned audit will be in 2012when it is expected that a four starresult will be achieved. More detailscan be obtained [email protected]

Informationgovernance reviewsThe Service conducts quarterly selfassessments which are provided to NHSQIS through completion of an “online toolkit”managed by the Information ServicesDivision of NHS National Services Scotland.

In addition, the Service has been involvedin a number of internal and external reviewsand all have shown that current informationgovernance arrangements are fit for purpose.

Further information is available fromwww.isdscotland.org orwww.nhshealthquality.org

Patient focuspublic involvementThe Scottish Ambulance Service is formallyassessed on its PFPI activity by the ScottishHealth Council on a quarterly basis. Thesesubmissions include evidence relating toactions identified as important to patientsin the previous year. These actions areprogressed via the PFPI steering groupand a full annual self assessment whichis approved and commented on by theScottish Health Council is available onthe Scottish Ambulance Service website.

Areas of praise in our self assessmentincluded First Responder Schemes,developments in complaints feedbackand a survey of PTS patients.

Areas for improvement included developingmore lines of communications to patientswho wish to be involved in the Service andbuilding on links with Patient Public Forums.

Full details of the assessment by theScottish Health Council are availableon www.scottishambulance.com

Internal auditThe Scottish Ambulance Servicecommissioned 20 Internal Audit Reportsduring the year to 31 March 2008. Actionplans have been developed to ensure thatall recommendations are implemented.

For further information contact:Director of Finance on 0131 446 7000.


\\Top10 Category A incidents

%of All Cat A% of Top 10 TotalCount of IncidentsTop 10 Cat A incidents

//Our Staff

\\Accident and Emergency Journey

//Audit and inspection

Chest PainBreathing ProblemsUnconscious/Fainting (near)ConvulsionsTraffic/Transport AccidentsFallsCardiac/Resp ArrestHaemorrhage/LacerationsAssault/Sexual AssaultOverdose/Poisoning

3077725422252391447213372108606005598336402940

20.2%16.7%16.6%9.5%8.8%7.1%3.9%3.9%2.4%1.9%

22.2%18.3%18.2%10.4%9.6%7.8%4.3%4.3%2.6%2.1%

% of All Emergencies% of Top 10 TotalCount of IncidentsTop 10 Emergency IncidentsTransfer/InterfacilityFallsUnconscious/Fainting (near)Breathing ProblemsChest PainConvulsionsOverdose/PoisoningAssault/Sexual AssaultTraffic/Transport AccidentsHaemorrhage/Lacerations

102388495513839930973309042189921590180481445112290

23.5%11.4%8.8%7.1%7.1%5.0%5.0%4.1%3.3%2.8%

30.1%14.6%11.3%9.1%9.1%6.4%6.3%5.3%4.2%3.6%

Variance07/0808/09A&E Journeys – Type of CallEmergencyUrgentPlanned

435,907152,10111,044

4.6%-2.5%-1.7%

41680315606911236

Number of EmployeesStaff CategoryParamedicTechnicianPTS (ACA’s, Drivers, PTS Amb Assts)EMDCAdmin & ClericalManagersAncillary & MaintenanceAmbulance auxiliariesTotal number of staff overall

1321100910842342241867924

4161

Audit & inspections

>24/25

Capital investments

>26/27

The Scottish Ambulance Serviceis committed to delivering high quality,safe, effective, patient focused careand to using the views and experiencesof the people who use its serviceas part of a process of continuousquality improvement.

The Scottish Ambulance Service seeksto learn from feedback given by patientsand use this information to make positiveimprovements to the Service. It recognisesthe importance in understanding that theway in which the Service responds and actsto the complaints is a marker of its attitudeto and engagements with patients, carersand their families. The Service has put inplace measures to improve its currentcomplaint handling process in 2008/09.

• Ensuring that complaints aremore patient/consumer focused:a complainants questionnaire waspiloted in March 2009. This workwill be progressed in 2009/2010.

• Considering staff training needs andhelp them develop the knowledgeand skills required: the Service hasdeveloped a training pack to assistits Divisions and has started todeliver training.

• Learning from complaints by sharinginformation throughout the organisation:a quarterly report is presented to boththe Senior Management Team Meetingand the Clinical Governance CommitteeMeeting.

• Use complaints/audit findingsto facilitate service improvements:senior Managers are provided withthe necessary information fromcomplaints to enable them to takeforward any actions that couldbenefit the Service as a whole.

• Closer working with Clinical Governance:serious clinical complaints were reviewedby the Medical Director for the Serviceand the necessary remedial action.In 2009/2010 the newly appointed Headof Clinical Governance will play developthe mechanisms for ensuring clinicalcomplaints are effectively managed.

• Sharing commendations is importantand provides balance and theimportance of sharing positive feedbackhas been reiterated throughout theService. Last year we recorded over200 written commendations.

Lessons learnedfrom complaints• The Patient Transport Project Board

looks at complaints and implementsimprovements to the current Service.Some of these improvements includeliaising and working in partnership withHealth Boards on the eligibility criteriaand prioritisation to ensure that patientswho require transport based on clinicalneed are able to access this.

• A complaint was received froma GP following the timescale for a onehour Urgent request for an ambulance(non life threatening) being over thetime requested. A bulletin was issuedto Emergency Medical Dispatch Staffreminding them that if the time frameis not going to be met to upgradethe call to an emergency call and thispoint was made clearer in the trainingto new recruits.

• Concerns raised throughout the yearrelating to a variety of issues includingdelays with PTS transport and accessto remote and rural healthcare werefed into the Strategy Consultationwhich began work in 2009.


The numberof emergencyA&E calls hasincreasedby 4.6%

Complaints madeComplaints upheld

404147

Number in 08/09+21%-1%

Comparison with 07/08

\\Capital investments

//Patient feedback

Total expenditure on the acquisition ofassets during the year was £14.1million.Of this £7.9million was required for theacquisition of vehicles. £5.3million wason property and £900k on IT equipment,plant and furniture.

Major projects included:As part of an overall project that examinedthe best locations for the EmergencyMedical Despatch centres in Scotlandthe Scottish Ambulance service is movingto a model of co-location with NHS 24advice centres. As part of the projectthe co-location in the West of Scotlandat Cardonald Glasgow was completed ata cost in excess of £1million. This projectwas delivered on time and within budgetand the benefits to patients have alreadybeen demonstrated. A number of stationupgrades were also completed in yearbenefiting both staff and patients alike.

The ongoing replacement of frontlineemergency and patient transport vehicleswas also undertaken and the Servicewas successful in securing future fundingfor the next 3 years to continue thisreplacement and upgrade programmeto ensure the patient care the AmbulanceService provides in with the most modernmechanically and fuel efficient vehiclesit can provide.

A number of software and system upgradesalso took place during 2008/09 the mostsignificant of which was for the systemfor planning and delivering the PatientTransport Service across Scotland.

Eleanor& JamieWhite

Jamie’s mum, Eleanor, hadrecently been diagnosed withdiabetes. Jamie was awareof his mum’s illness, so whenfound her lying motionlesson the kitchen floor, he didn’tpanic. Instead he managedto get his mum to drink somefruit juice, and she was ableto dial 999.

When the ambulancecrew arrived, the housewas locked from the inside.Once again, Jamie stayedcalm. He pushed the housekey through the letterbox,so the crew could come intothe house to help his mum.

“When I saw my mum onthe floor, I knew giving herfruit juice would help. I wasreally glad when the peoplefrom the ambulance came.They couldn’t get in at first,but once I got the key tothem through the letterbox,I knew it would be alright.”


Scottish AmbulanceService Annual Review:13 October 20091. This letter summarises the main areas

of discussion and the actions arisingfrom the Scottish Ambulance Service(SAS) Annual Review and associatedmeetings in Clydebank on 13 October2009. I would want to thank all thoseinvolved in organising the day, I amaware of the significant work that goesin to this process.

2. I welcomed the chance to hear moreabout the delivery of OptimalReperfusion Therapy in the West ofScotland and to be walked through thejourney taken by a patient who hasrequested an ambulance in response tochest pain. From the time a crewarrives on scene, through the clinicaldecision making and treatmentundertaken by the crew in consultationwith NHS colleagues, and on to arrivaland treatment at hospital, it is clearthat this service is an excellentexample of different parts of the healthservice working collaboratively todeliver effective and high qualitypatient care. I would be grateful if youcould convey my thanks to all those Imet during the session.

Meeting with ClinicalAdvisory Group3. I was pleased to see the broad range of

clinical skills and experiencerepresented within the Clinical AdvisersGroup and we had a detaileddiscussion about the progress that hasbeen made by the organisation tofurther develop and embed robustclinical governance strategically andlocally. The newly-formed MedicalDirectorate, local clinical leads in eachdivision, clinically-led servicedevelopment and strong clinicalengagement with partners have allplayed a part and we talked about afew specific examples, such as thedevelopment of a commonunscheduled care triage tool, thedevelopment of the OptimalReperfusion Service and the focus theservice is now putting on clinicalperformance targets including those forhyper-acute stroke patients.

4. We talked about the increasingnumbers of patients who were nowbeing treated at home, thus avoidingan unnecessary admission to hospital.Clinical Governance is, of course,crucial in ensuring patient safety and Iwas told that this is integral to the 'seeand treat' protocols. Communicationwith patients and their representativegroups and charities is also key and atthis meeting, and also when I met thegroup of patient representatives lateron, it was good to hear about the workthat has gone in to the advice leafletsthat are given to patients so that theyknow what to do should they need tofollow up on the care they receive athome.

5. We also discussed the ongoing flusituation and the preparations andplanning the service has taken forwardto ensure any impacts for the serviceare managed effectively.

6. Please could you thank all those whotook the time to meet with me.

Deputy First Minister & Cabinet Secretaryfor Health and Wellbeing

Nicola Sturgeon MSP

T: 0845 774 1741E: [email protected]

David Garbutt, ChairScottish Ambulance Service,National Headquarters,Tipperlinn Road, EdinburghEH10 5UU

4 November 2009


\\Annual Review 2009Key action points

The Scottish Ambulance Service should continue to ensure its active participationin the Scottish Patient Safety Programme.One

The Scottish Ambulance Service should develop the management and performanceof its Patient Transport Service, alongside working with partners to support thosepatients who do not have a medical need for this transport.

Two

Ensure robust arrangements are in place to ensure the Local Delivery Plan identifieskey actions and how any risks to delivery will be mitigated in order to demonstraterequired levels of progress against the NHS QIS Clinical Governance and RiskManagement Standards will be achieved.

Three

Ensure the Board (and its Clinical Governance Committee) continues to have evidenceavailable to it in order to provide assurances with regard to the robustness of clinicalgovernance and risk management arrangements.

Four

The Scottish Ambulance staff and management structures should be kept underreview to ensure the infection control structure is fit for purpose and that good linksare maintained between the Service's Infection Control Manager and NHS Boards.

Five

The Scottish Ambulance Service should continue to maintain a focus on increasingattendance levels across the organisation .Six

The Scottish Ambulance Service should continue to ensure it has robustarrangements in place for handling complaints, including responses to the findingsof the Scottish Public Sector Ombudsman and have evidence to demonstrate howthese arrangements drive improvements in the services provided.

Seven

Eleanor & Jamie Whitefrom Edinburgh>30/31

Annual Review 2009

>32/33

//Contents

Annual Report and Accounts 08/09 01

WilliamLee

William was in his doctor’ssurgery when he passedout. The doctors whoattended to him realisedhe was very ill and calledfor an ambulance totake William to RaigmoreHospital. During thejourney, ambulance crewmembers relayed diagnosticinformation to specialistsat Raigmore ahead ofWilliam’s arrival. Oncethe team at Raigmorecarried out more tests,it became clear Williamwould have to be transferredby Air Ambulance forneurosurgery at AberdeenRoyal Infirmary. William’ssurgery was a success.

Deliveringfor youScottish Ambulance ServiceAnnual Report and Accounts 2008/2009

Chairman and ChiefExecutive’s Statement>02/03

Elizabeth & John Mallinsonfrom North Berwick>04/05

Sophie & Helen Smithfrom Bishopton>22/23

The patients featured in this annual reporttell their own stories about the quality ofcare they received through the Service’sEmergency Response Team and fromstaff of the Patient Transport Service.In the course of the last year, despiteincreasing demands on resources,response times to both life threateningand urgent calls, improved. In March theService exceeded its target to respondto 75% of life-threatening calls withineight minutes. Clinical capability hasbeen improved through the introductionof a Medical Directorate which hasintroduced new ways of clinical working,and strengthened clinical governance,driving better patient outcomes. Sicknessabsence has been reduced througha number of initiatives, including theprovision of additional support suchas fast-track physiotherapy. Against thispicture of improved performance, theService has continued to deliver a strongfinancial performance.

The staff of the Scottish AmbulanceService are key to delivering the highquality clinical care expected by patients.Their professionalism and motivationis recognised, and much appreciated,by the Board. It is further recognisedthat despite the increasing demand madeon the Service through alcohol misuse,Service staff continue to provide clinicalcare to all patients with high levelsof professionalism.

The strong focus on improvingperformance, strengthening governanceand driving innovation to deliver thegoals set out in the Scottish government’sstrategy for a healthier Scotland hasbeen underpinned by making time tolisten. The Service has just undertakenits biggest-ever consultation exercise,asking patients and their carers, staff,key stakeholders, colleagues and partnersacross the NHS, and other emergencyservices, about the direction of theScottish Ambulance Service in the nextthree to five years. This has promptedsome challenging questions about thefuture of the Service and generated somelively debates about the right path to takein order to provide even better care forpeople across Scotland.

The Scottish Ambulance Service has risento the challenges it has faced in the last12 months. It is developing an increasinglycollaborative working style, which putsit in a stronger position than ever to meetthe needs of the tens of thousands ofpeople it cares for every year.

We are extremely proud of the dedication,professionalism and enthusiasm seenacross the Service and are extremelyconfident that these qualities, combinedwith clinical excellence, rigorous governanceand patient focus will pave the way foran even stronger performance in thecoming year.


David GarbuttChairman

Pauline HowieChief Executive

//Chairman and ChiefExecutive statement for2008/09 annual reportEvery day of the year,the Scottish AmbulanceService continues tomeet the clinical needsof patients and carersacross Scotland

“The staff of theScottish AmbulanceService are key todelivering the highquality clinical careexpected by patients.”

Elizabeth& JohnMallinson

Elizabeth collapsed in herhome. She was in a lotof pain. John called anambulance. The ambulancecrew members whoattended Elizabethdiagnosed the problem andalleviated her symptoms.They rushed her toEdinburgh Royal Infirmarywhere she underwentcomplex surgery andhas now recovered. “I feel it is down to the

skill and dedication of theambulance crew that mywife was sufficiently stableon arrival at RIE that surgerycould be undertaken with anyconfidence of success, andcannot thank and commendthe crew members involvedtoo highly… my wife, whois nearly 80, is still with meto share a few more yearstogether after 52 yearsof marriage.”


Sound GovernanceThe Scottish Ambulance Service isunderpinned by sound clinical, staffand financial governance arrangements.These ensure safe and effective clinicalcare for our patients, fair and effectivemanagement and development of allstaff and sound financial managementof the Service.

Staff governanceThe Scottish Ambulance Service takespride in the way that it continues tomanage staff fairly and effectively andmake improvements in line with theStaff Governance Standard.

This included the continuation and highuptake of the of fast track physiotherapyfor all staff who require it as well as theconfidential employee counselling service.An Anti Bullying and Harassment campaignwas successfully launched, supportedby posters, cards, training for managersas well as Confidential Advisers. Theresults of the staff survey have been fedinto the action plan for the coming year.

Self assessment exercises for staffgovernance were carried out with localDivisions which fed into the nationalself assessment process carried out inDecember 2008. Final documentationwas submitted to the Scottish Governmentin line with prescribed timescalesin April 2009.

Patient safety and clinical governanceClinical Governance means makingsure that systems and processes arein place for ensuring patient safety whilstmaintaining and improving the qualityof treatment and care we provide andthat this is encouraged and supportedin everything we do.

A wide range of areas are coveredsuch as the provision of patient centredcare, clinical performance, trainingand development, clinical policiesand procedures, clinical audit andthe management of clinical risk.

National audits were conducted to reviewa wide range of clinical activities includingthe management of asthma, acute coronarysyndromes, pain management and the airwing activity. The Service also prepared forthe second review by NHS QIS against theNational Standards for Clinical Governanceand Risk Management which is scheduledfor August 2009.

Overall, in 2008/09, there has beenan improvement in clinical performanceand effectiveness for example the numberof patients treated at home has risenand increasing the numbers of paramedicadvisors in the EMDCs.

The Scottish Ambulance Service deliversaccident and emergency care to patientsthe length and breadth of the country.

Accident and emergency care is deliveredby specially trained paramedics andambulance technicians who, last year,responded to almost 600,000 incidentsacross Scotland.

999 calls are handled by one of threeEmergency Medical Dispatch Centres(EMDCs) and ambulance crews aredispatched from stations and deploymentpoints situated near to areas where the

fastest response can be provided whichcould be in the form of a double crewedambulance, motorbikes, all-terrainvehicles and even mountain bikes toreach patients as quickly as possible.

Crews provide life saving emergencymedical care. Having assessed themedical needs of the patient, theymay take patients to hospital, treatthem at the scene or refer them toan appropriate clinic.

Annual Report and Accounts 08/0900 Annual Report and Accounts 08/09 00Annual Report and Accounts 08/0906 Annual Report and Accounts 08/09 07

Last year, the Patient TransportService (PTS), undertook 1.6 millionjourneys across Scotland.

PTS provision is prioritised accordingto clinical need. The service is providedby specially trained ambulance careassistants who are increasingly providingthis service to patients with more complexneeds for example palliative care.

The service is provided by speciallytrained ambulance care assistants.

The Patient Transport Service operates601 vehicles.

Patient TransportService

The air ambulance service is deliveredby four purpose built aircraft, twohelicopters and two fixed wing aircraft.

The air ambulance service is the onlyintegrated, publicly funded air ambulanceservice in the UK.

Air wing

//Overview of our yearThis section of the reportprovides an overviewof how we performedin 2008/09

//Our servicesThe Scottish Ambulance Service isa Special Health Board. We operatefrom 178 locations across five Divisionscovering the whole of Scotland, thelargest geographic area of any ambulanceservice in the UK.

The Scottish Ambulance Servicecontinues to deliver for patients acrossScotland – saving lives by respondingto life threatening emergency calls,increasingly preventing unnecessaryhospital admissions by treating

or referring people at the scene and,by taking patients requiring clinical careduring transport to hospital in timefor their appointment.

Accident andemergency care

This is being supported by the co-locationof our Emergency Medical Dispatch Centreswith NHS 24, implementation of a numberof clinical advisor posts to support clinicaldecision making, advanced technologyin the form of the electronic care recordand clinical database.

The New Ways of Clinical Working grouphas also made inroads into reviewingand improving new and innovativeways of treating patients. This has beenunderpinned by the approval of a newMedical Directorate structure and byparticipation in the National PatientSafety Programme.

Healthcare Acquired Infection (HAI)continues to be of national importance.Reducing the risk of HAI to both patientsand staff continues to be a priority for theService with the Infection Control teamworking towards achieving the objectivesof an annual rolling programme over2008/9. These actions have been furthersupported by the appointment of anInfection Control Advisor in May 2008.

Financial governanceThe Scottish Ambulance Service deliveredanother balanced budget for the yearending March 2009.

The Service ensures that both financialprocesses and controls are in place andis working effectively though a system ofinternal audit reviews. The Corporate RiskRegister is used as a basis for developingthe internal audit plan. The ScottishAmbulance Service commissioned 20Internal Audit Reports during the yearto 31 March 2008. Action plans havebeen developed to ensure that allrecommendations are implemented.

The Service also met its financial targetsfor the year and exceeded the 2% cashreleasing efficiency savings target for theyear. These efficiencies have been investedin front line services for the public.

Equality & Diversityand Reducing HealthInequalitiesThe Scottish Ambulance Service hasa strong commitment to equality anddiversity. It recognises that is has madea good start and build on the positivesteps it has taken to date.

A review of the Race Equality Schemewas undertaken in 2008 setting out whathas been achieved during the last threeyears and developing our Action Planfor 2008 -2011. Key developments forthe future include improving links withblack and minority ethnic communities,identifying ways of attracting more newrecruits across all the communitieswe serve and reviewing training andinduction programmes.

Our annual report on the Disability EqualityScheme highlights some of the work wehave done and areas where developmentis still underway. For example, the Serviceis continuing to develop see and treatprocedures. Leaflets have been designedfor distribution to patients when they havebeen treated at home. These includepatients the Service has treated forasthma, epilepsy and diabetes. In future,additional information will be availableto operational staff regarding disabilityvia the Service’s cab based terminals.

The Service is also making progressin specific areas of work outlined in theGender Equality Scheme. For example,an Anti Bullying and Harassment campaignwas launched in order to raise awarenessof unacceptable behaviour by all staffacross the organisation and to encouragestaff to raise any concerns/issues at theearliest opportunity, in order to resolveproblems as soon as possible. Staffcan contact Confidential Bullying andHarassment Advisers, who have beenappointed to support them raise anddeal with their concerns.

Risk and resilienceThe Service continues to providea specialised response to major incidentsas well as serious road traffic accidents,fire calls and explosions.

Special Operation Response Team skillshave been demonstrated effectively atemergencies and exercises across thecountry. Risk and resilience crews alsoattended emergency incidents relatingto the following: hazardous materials,firearms, airports; public order sieges,high rise and ship based fires and majorroad crashes.

Involving patientsand the publicSince the inception of a Patient FocusPublic Involvement (PFPI) Steering Grouplast year, the Service approved a PFPIStrategy for 2008-2011 in October 2008.The objectives of the strategy are:

• develop good practice in engagementmethods, ensuring that all methodsmeet quality standards

• seek wider, and more representative,patient and public involvement

• improve staff awareness of PFPI

• enhance the co-ordination of PFPIactivity nationally

• ensure the full integration of PFPIinto strategic planning

• seek opportunities for consultation incollaboration with other departments,divisions and organisations

• encourage community resilienceand development.

The Service is working closely withthe Scottish Health Council, patientrepresentatives, other key stakeholdersand its own staff to progress the actionswhich will deliver the objectives.

Patient Focus Publicinvolvement (PFPI)The Scottish Ambulance Service conductsan annual self assessment exercise withcontributions from a range of stakeholdersin order to check it has met its PFPI activitytargets. This year that has included thesubmission of quarterly returns to theScottish Health Council detailing workcarried out across its five divisions as partof a process overseen by the Service PFPISteering Group. The full self assessmentis available on the Service website.

Areas of progress this year have includedthe production of eight information leafletsto complement the development of “Seeand Treat” care pathways. Input wasreceived from over 600 stakeholdersincluding 300 patients as well as specialistand other healthcare professionals. TheService has also further developed its FirstResponder Scheme with 52 now in placesupported by 500 volunteers.

Areas of development for the next yearinclude building work started with theBritish Heart Foundation to develop schoolsand community training in resuscitation.Four paramedics are currently engagedin teaching emergency life support skills.

The sixth annual patient experiencesurvey undertaken by Market ResearchUK demonstrated continuing high levelsof patient satisfaction of 97% for bothPTS and A&E.


The Service treatedapproximately 50,000more patients atscene or at home,reducing the need foradmission to hospital.

\\Overview of our yearContinued


AnnieClark

Annie has been receivingtreatment for breast cancerat the Beatson Hospitaland Ayr Hospital. ThePatient Transport Servicehas taken Annie to andfrom her appointments.

“The service givento me by the ScottishAmbulance Servicehas been first-class.”



\\How we performedThis section of the reportcovers how we performedin 2008/09 against ourHEAT targets

Target H1:Save more lives


Maintain rates of survivalof cardiac arrest on arrivalat hospital within bandof reasonableness

Target for 2008/09

17% to 21% full year


20%

A key performance measure for SAS is the return of spontaneous circulation (ROSC) for cardiac arrest patients on arrival athospital. The service set a target range of 17-21% for 2008/09 and achieved 20%. International evidence suggests a targetrange of 12-20% is realistic, so the Service has performed extremely strongly.

Saving more lives

The Scottish Ambulance Service is committed to operating within our allocated budget. The Service has a track record of meetingits financial targets in recent years and, accordingly, financial planning and monitoring is rigorous. Once again, the Service operatedwithin our revenue and capital resource limits for this financial year. Key risks are identified and assessed annually and then on anongoing basis, arrangements are put in place to mitigate or reduce these risks. In addition, contingency plans are put in place todeal with them if they arise.

The Service has achieved this financial balance in a challenging environment which has included significant pressures from: risingfuel costs, inflationary costs of parts and equipment and additional overtime worked to provide 24/7 cover in some areas. This isagainst a backdrop of the 4.6% increase in emergency demand in 2008/09, as well as a 16% increase in air ambulance demandin 2008/09 compared to the previous year.

The Service met and exceeded this target and was able to use the cash releasing savings to invest in additional frontline staff.The additional savings were able to be carried over to the coming financial year.

Meeting financial targets

Sickness absence rates reduced from 5.8% in 2007/08 to 5.3% in 2008/09. In 2009/10, sickness absence has remainedconsistently below 5% due to the continued focus on identifying the drivers of absence and responding to these quickly.The Service has invested in additional Personnel support for managers through the appointment of a dedicated resourceto focus on absence management, initially piloted in the West of Scotland.

The roll out of workforce planning teams and the availability of station based management information through the intranetare driving the streamlining of processes for reporting and recording sickness absence.

Reducing sickness absence

Improving response timesTarget E1:Meet financial targets


Operate within the revenueand capital resource limits;meet the cash requirement

Target for 2008/09

Meet targets


25K revenue underspend

8K capital underspend

Cash requirement of £196mwas under achieved by £12k

Target A1:Improve response time to Lifethreatening calls

Target A2:Improve response timeto serious but not lifethreatening calls

Target A3:Improve response timein Island Board


Improve Response time toCategory A (Life Threateningemergency incidents (mainland)– from 62% within target time(8 mins) in 2007/08 to 75%by March 2009

Improve Response time toCat B emergency incidents(serious but not life threatening(Mainland) – from 91.4%within target time in 2007/08to 95.00%

Improve Response time to allemergency incidents (IslandNHS Board areas) – targettime is 50% in 2008/09

Target for 2008/09

75%

95%

50%


70.7% (77.4% in March 2009)

94.4%

50.5%

Target E2:Meet cash efficiency


To generate 2% cash releasingefficiency savings per annum

Target for 2008/09

2% (£3,668,000)


2.93%

Target E4:Utilisation of CommunityHealth Index (CHI)


Number of patient transportregistrations where CHInumber is used

Target for 2008/09

75%


79.4%

Target E3:Reduce sickness absence


Reduce the % of hours lostfrom current 5.6% in 2006/07to 5% in 2009/10

Target for 2008/09

5% full year


5.3%

This target reflects the percentage of Patient Transport journeys where the Community Healthcare Index number is recordedand the Service exceeded the targets of 75%.

Target E5:Implementation of Knowledgeand Skills Framework


Number of available staffcovered by AfC with KSFpersonal development plans

Target for 2008/09

100% by May 2009


98%

The Service implemented the e-KSF system on 2008/09. It reached 98% of all eligible staff, resulting in a Personal DevelopmentPlan in place for them by May 2009. Role profiles have been developed and training delivered to managers and staff as part of theroll out, including e-learning packages.

2008/09 saw a significant improvementin performance both in terms of life-threatening Category A calls and seriousbut not immediately life-threateningCategory B calls. In March 2009, theService achieved 77.4% for Category A,exceeding the 75% target for the first time.For the full year, Category A performanceof 70.7% was achieved – an 8.7%improvement on 2007/08. This equatesto an additional 14,139 incidentsresponded to within 8 minutes. Theaverage response time for Cat A callsin March 2009 was 6.5 minutes; or 7.2minutes for the full year. On average,this is 1 minute faster than in 2007/08.

The uplift in Category A performancewas matched by an improvement inCategory B which was ahead of targetat 95.5% in March 2009; or 94.4% for theyear. For the full year, this showed a 3%improvement on 2007/08 which comparesfavourably with the experience of otherUK ambulance services.

Performance in the 3 Island Boards wasmaintained at 50.5%, exceeding target forthe second consecutive year. The Servicealso appointed a dedicated Head ofService in 2008/09 for the Island Boards,which has driven increased focus on

performance and engagement withthese NHS Territorial Boards. The Servicehas been able to extend the role of FirstResponder Schemes and in Shetlandthe Service is currently looking to pilota retained service model following onfrom our involvement in the Remote& Rural Implementation Group.


In terms of performance against pick up prior to appointment, the Service achieved 69.6% against a target of 71%. However,performance in the last quarter of 2008/09 was 71% and this level of performance has continued into the first quarter of 2009/10.Pick up after appointment for 2008/09 was 83% for the full year and 84% for the last quarter.

Every year the Service commissions an independent patient survey to assess levels of satisfaction with both A&E and PTSservices. This involves contacting a random sample of patients with experience of SAS in that year. Patient satisfaction resultsamongst service users for the year continued to be high at 97% in 2008/09.

The level of service from PTS has been enhanced in some areas in 2008/09. Around 100 Patient Transport Vehicles (PTV) havebeen fitted with vehicle location trackers, which allow staff in the EMDC to locate available PTVs in the same way they track A&Eambulances. This has resulted in additional resources being available for patient discharge and inter-hospital transfers.

Improving punctuality

The Service increased the number of patients treated at scene or at home in 2008/09 by up to 9.7% of emergency calls (around50,000 patients) from 9.2% in 2007/08. This equates to a saving for the Scottish health economy of approximately £12 million andhas helped an additional 2,741 patients through further development of see and treat protocols for specific conditions andincreased training for staff.

Reducing hospital admissions

Target A4:Improve punctualityfor appointment forpriority 1 patients

Target A5:Improve punctuality forpick up for priority 1 patients


Patient Transport Service:Improve punctuality forappointments for priority 1patients from the current69.4% within the targettime in 2007/08 to 71%

Patient Transport Service:Improve punctuality pick upfor priority 1 patients fromthe current 83.7% within thetarget time in 2008/09 to 89%

Target for 2008/09

71% full year

89% full year


69.6%

83.0%

HEAT Summary


H1 Save more lives 12%-20%Rate of survival of cardiac arrests on arrival at hospital

H12 Cat A chest pain patients 75%% of cardiac arrest patients responded to with 8 minutes

E1 Meet financial targets Meet targetOperate within revenue and capital limits; meet the cash requirement

E2 Meet cash efficiency target 2% (£3,786,000)Cash releasing savings achieved

E3 Implement knowledge and skills framework 20%80% of AfC staff to have had KSF PDP reviewed by March 2011

E4 Sickness absence 5%Rate of sickness absence

E5 Universal use of CHI number 75%% of PTS journeys where CHI number is used

E6 Reduce emissions 2%Reduce energy consumption

A1 Response to Cat A incidents 75%% Cat A incidents responded to within 8 minutes

A2 Response to Cat B incidents 95%% Cat B incidents responded to within 14,19 or 21 minutes

A3 Response to emergencies on Island Boards 50%% Emergency incidents responded to within 8 minutes

A4 PTS: punctuality for appointment 70%% P1 patients at hospital 30 minutes prior to appointment

A5 PTS: punctuality for pick up after appointment 87%% P1 patients picked up 30 minutes after appointment

T1 Improve health outcomes for patients 10 or aboveNHSQIS standards for patient safety and clinical governance

T2 Health acquired infection Meet targetCompliance with Red Amber Green HAI monitoring

T3 Reduce hospital admissions 11%% of emergency calls treated at scene

T4 SEWS 95-98%% patients with SEWS score above 4 taken to hospital

T5 Hyper acute stroke 90%% hyper acute stroke patients taken to hospital within 55 minutes

2009/10 full year targets

Target T2:Reduce Hospital Admissions


Increase % of emergency callstreated at scene from thecurrent 9.2% for 2007/08 to10-15%

Target for 2008/09

10% - 15%


9.7%

Note: Where performance is not reported monthly, relevant indicators will be shaded unless they are reported in line withthe timetable outlined in the comments section.

Clinical GovernanceCommitteeThe Clinical Governance Committeecurrently comprises four Non-ExecutiveDirectors: Mrs Christine Humphries(Chair), Mr Andrew Richmond, MsSuzanne Dawson and Mr David Garbutt.Mr David Nelson is the Public/PatientRepresentative. Until Mr Garbutt’sappointment on 29 November 2008,Mr Alan Lawton was a Non-Executivemember. The Committee meetsapproximately four times per year tomonitor standards of care and measurethe effectiveness of pre-hospital treatment.

Audit CommitteeThe Audit Committee comprises fourNon-Executive Directors: Mr Douglas Marr(Chair); Mr Andrew Richmond; Mr DavidAlexander; and Ms Theresa Houston.Mr Alan Lawton was a Non-Executivemember until 28 November 2008. Mr DAlexander took up his position on the AuditCommittee on 1 December 2008 as didMs T Houston. The Audit Committee meetsfour times per year to consider the variousreports from both internal and externalauditors to assess the risks which mayarise in the Service.

Staff GovernanceThe Staff Governance comprises threeNon-Executive Directors: Mr AlanBickerstaff (Employee Director and Chair);Mrs Christine Humphries; Mr DouglasMarr; and the Chairman, Mr WilliamBrackenridge. The Committee meetsfour times per year to ensure effectivemonitoring of staff governance withinthe organisation.

Remuneration CommitteeThe Remuneration Committee comprisesthe Chairman and three Non-ExecutiveDirectors: Mr Douglas Marr; Ms SuzanneDawson; and Mr David Alexander joinedthe Committee on 1 December 2008.The Committee is chaired by the Chairman,Mr William Brackenridge. It meets atleast three times per year to considerthe evaluation of performance and payawards for Executive Directors.

The committees have an important role inensuring consistency of policy and equityof treatment of staff across the local NHSsystem, including remuneration issues,where these are not already covered byexisting arrangements at national level.


Over 4,000 highlyskilled staff respondto around 600,000Accident andEmergency callseach year.

\\Our Committee andMembership 2008/09

//Vital statistics

Scotland 8.3

CAT A AverageResponse Time (mins)

7.2

Argyll and ClydeAyrshire and ArranBordersDumfries and GallowayFifeForth ValleyGrampianGreater GlasgowHighlandLanarkshireLothianOrkneyShetlandTaysideWestern Isles

6.77.29.08.27.07.76.87.08.57.16.9--

7.4-

7.68.39.79.07.98.87.68.79.18.08.511.314.28.39.7

584,108 599,052 + 2.6%Total A&E IncidentsVariance08/0907/08

All EmergencyResponse Time (mins)

3,274 3,797 +16%Air MissionsVariance08/0907/08

1,607,590 1,567,499 -2.5%PTS JourneysVariance08/0907/08

2009£000

2008£000

Fixed assetsIntangible fixed assets 1,356 1,657

Tangible fixed assets 84,644 66,127

Total Fixed Assets 86,000 67,784

Debtors falling due after more than one year 3,511 5,594

Current assetsStocks 0 0

Debtors 9,570 11,402

Investments 0 0

Derivative financial instruments 0 0

Cash at bank and in hand 60 60

9,630 11,462

Current liabilitiesCreditors due within one year (17,353) (14,461)

Net current assets/(liabilities) (7,723) (2,999)

Total assets less current liabilities 81,788 70,379

Creditors due after more than 1 year (1,713) (470)

Provisions for liabilities and charges (5,206) (6,544)

(6,919) (7,014)

74,869 63,365

Financed by:General Fund 61,268 58,041

Revaluation Reserve 13,597 5,324

Donated Asset Reserve 4 0

74,869 63,365


\\Operating cost statementFor the year ended 31March 2009

//Balance sheetFor the year ended 31March 2009

2009£000

2008£000

Clinical services costsHospital and Community 182,094 204,724

Less: Hospital and Community Income 4,549 6,992

177,545 197,732

Family Health 0 0

Less: Family Health Income 0 0

Total Clinical Services Costs 177,545 197,732

Administration Costs 2,176 2,716

Less: Administration Income 241 157

1,935 2,559

Other Non Clinical Services 1,443 2,556

Less: Other Operating Income 1,350 867

93 1,689

Net Operating Costs 179,573 201,980

Summary of revenue resource outturnNet Operating Costs (per above) 179,573 201,980

Capital Grants (to)/from Other Bodies 0 0

Profit/(Loss) on disposal of fixed assets 340 (472)

Annually Managed Expenditure (Write Downs) (285) (12,858)

FHS Non Discretionary Allocation 0 0

Other Allocations 0 0

Net Resource Outturn 179,628 188,650

Revenue Resource Limit 179,666 188,675

Saving/(excess) against Revenue Resource Limit 38 25

We have examined the summary financialstatement which comprises the OperatingCost Statement for the year ended31 March 2009 and the Balance Sheetas at 31 March 2009.

This report is made solely to the partiesto whom it is addressed in accordancewith the Public Finance and Accountability(Scotland) Act 2000 and for no otherpurpose. In accordance with paragraph123 of the Code of Audit Practice approvedby the Auditor General for Scotland, wedo not undertake to have responsibilitiesto members or officers, in their individualcapacities, or to third parties.

Respective responsibilitiesof the Board and the AuditorThe Board of the Scottish AmbulanceService is responsible for preparingthe summary financial statement withinthe Annual Report in accordancewith guidance issued by the ScottishGovernment Health Directorate.

Our responsibility is to report to you ouropinion on the consistency of the summaryfinancial statement with the full auditedfinancial statements of the Board and theDirectors’ Report.

We also read the other informationcontained in the Annual Report andconsider the implications for our reportif we become aware of any apparentmisstatements or material inconsistencieswith the summary financial statement.

Basis of OpinionWe conducted our work having regardto Bulletin 2008/3 ‘The auditor’s statementon the summary financial statement’issued by the Auditing Practices Board.Our report on the Board’s full annualfinancial statements describes thebasis of our opinion on those financialstatements and on the Directors’ Report.

OpinionIn our opinion the summary financialstatement is consistent with the fullaudited annual financial statementsand the Directors’ Report of the ScottishAmbulance Service for the year ended31 March 2009.

We have not considered the effects ofany events between the date on whichwe signed our report on the full financialstatements and the date of this statement.

PricewaterhouseCoopers LLP141 Bothwell StreetGlasgowG2 7EQNovember 2009


The Service has alsofurther developedits First ResponderScheme with 52 nowin place supportedby 500 volunteers.

\\Independent auditors’statement to the Membersof the Scottish AmbulanceService on the summaryfinancial statement

Sophie &Helen Smith

Helen went into labourand was being takento the Royal AlexandraHospital by ambulancewhen it became clear thather baby was not goingto wait. The ambulancecrew decided to pull offthe road to a safe locationwhere baby Sophie couldbe delivered, beforecontinuing the journeyto hospital. Both Helenand Sophie are doing well.

“I wasn’t expecting togive birth in the ambulance,but the crew were reallycalm and looked after mereally well. I’m extremelygrateful for the care bothSophie and I were given.”


Equality and DiversityThe SAS took part in an equality anddiversity benchmarking exercise betweenOctober 2008 and February 2009conducted by the equalities support team,part of Health Scotland’s Equalities andPlanning Directorate. The aim of theexercise was to develop a national pictureof the status of equality and diversitydelivered in NHS Scotland to date.A final report [The Big Picture: A reviewof progress on equality in the NHSin Scotland] included outcomes fromthe information gathering exercise andcontained suggestions for changesand improvements on all strandsof equality and diversity.

The Service is currently developing anaction plan in order to prioritise workto be taken forward. More details areavailable by writing to the Equality andDiversity Manager, National Headquarters,Tiperlinn Road, Edinburgh EH10 5UU.

Hand HygieneCompliance MonitoringThe Scottish Ambulance Service hasbeen part of NHS Scotland’s NationalHand Hygiene Campaign since it startedin 2007. In that time the national handhygiene audits which form part of theCampaign have shown a significantimprovement in hand hygiene complianceacross the Service. This has beenachieved by raising awareness throughpromotional materials, newsletters,staff training, a zero tolerance approachto non-compliance and providing staff withindividual alcohol hand rub dispensers.The most recent national audit resultsshowed an average compliance with handhygiene of 95% with the last few auditsshowing a consistent improvement.

Over and above the national bi-monthlyaudits the Hand Hygiene Coordinatorcompletes monthly local hand hygieneaudits across the service.

National bi-monthly audit results arepublished in NHS Scotland ‘NationalHand Hygiene Campaign Audit Reports’.

Annual PatientExperience Survey2008 was the sixth consecutive yearthe Scottish Ambulance Service hasconducted research into qualitative andquantitative patient experience, continuingour determination to routinely seek theviews of our users and thereby improveservices to patients requiring emergencyand patient transport pre hospital care.As before, this research was carried outindependently by Market Research UKand the results were very positive.

With regards Accident and EmergencyPatients overall satisfaction was 97%and 93% were satisfied with the timetaken to reach patients. PTS patientshad an overall satisfaction rate of 97%and 94% were satisfied with arrival timeat hospital for their appointment. In depthqualitative interviews were also carriedout with patients who lived in remoteand rural areas, under 16s and thosewho had experienced the Inter hospitaltransport. These results have been fedinto various programmes of work acrossthe organisation.

Copies of the survey can be obtainedby writing to the Corporate AffairsManager, National Headquarters,Tiperlinn Road, Edinburgh EH10 5UU.

Health and Safety AuditIn January the Service commissioned theBritish Safety Council to conduct a Servicewide Health and Safety Audit using their5 star audit process. Following completionof the audit process the Service wereawarded a 3 star result with an audit scoreof 83.2%, a healthy improvement overthe previous audit.

The audit report is being used to shapethe Services Health and Safety plansfor the future.

The next planned audit will be in 2012when it is expected that a four starresult will be achieved. More detailscan be obtained [email protected]

Informationgovernance reviewsThe Service conducts quarterly selfassessments which are provided to NHSQIS through completion of an “online toolkit”managed by the Information ServicesDivision of NHS National Services Scotland.

In addition, the Service has been involvedin a number of internal and external reviewsand all have shown that current informationgovernance arrangements are fit for purpose.

Further information is available fromwww.isdscotland.org orwww.nhshealthquality.org

Patient focuspublic involvementThe Scottish Ambulance Service is formallyassessed on its PFPI activity by the ScottishHealth Council on a quarterly basis. Thesesubmissions include evidence relating toactions identified as important to patientsin the previous year. These actions areprogressed via the PFPI steering groupand a full annual self assessment whichis approved and commented on by theScottish Health Council is available onthe Scottish Ambulance Service website.

Areas of praise in our self assessmentincluded First Responder Schemes,developments in complaints feedbackand a survey of PTS patients.

Areas for improvement included developingmore lines of communications to patientswho wish to be involved in the Service andbuilding on links with Patient Public Forums.

Full details of the assessment by theScottish Health Council are availableon www.scottishambulance.com

Internal auditThe Scottish Ambulance Servicecommissioned 20 Internal Audit Reportsduring the year to 31 March 2008. Actionplans have been developed to ensure thatall recommendations are implemented.

For further information contact:Director of Finance on 0131 446 7000.


\\Top10 Category A incidents

%of All Cat A% of Top 10 TotalCount of IncidentsTop 10 Cat A incidents

//Our Staff

\\Accident and Emergency Journey

//Audit and inspection

Chest PainBreathing ProblemsUnconscious/Fainting (near)ConvulsionsTraffic/Transport AccidentsFallsCardiac/Resp ArrestHaemorrhage/LacerationsAssault/Sexual AssaultOverdose/Poisoning

30,77725,42225,23914,47213,37210,8606,0055,9833,6402,940

20.2%16.7%16.6%9.5%8.8%7.1%3.9%3.9%2.4%1.9%

22.2%18.3%18.2%10.4%9.6%7.8%4.3%4.3%2.6%2.1%

% of All Emergencies% of Top 10 TotalCount of IncidentsTop 10 Emergency IncidentsTransfer/InterfacilityFallsUnconscious/Fainting (near)Breathing ProblemsChest PainConvulsionsOverdose/PoisoningAssault/Sexual AssaultTraffic/Transport AccidentsHaemorrhage/Lacerations

102,38849,55138,39930,97330,90421,89921,59018,04814,45112,290

23.5%11.4%8.8%7.1%7.1%5.0%5.0%4.1%3.3%2.8%

30.1%14.6%11.3%9.1%9.1%6.4%6.3%5.3%4.2%3.6%

Variance07/0808/09A&E Journeys – Type of CallEmergencyUrgentPlanned

435,907152,10111,044

4.6%-2.5%-1.7%

416,803156,06911,236

Number of EmployeesStaff CategoryParamedicTechnicianPTS (ACA’s, Drivers, PTS Amb Assts)EMDCAdmin & ClericalManagersAncillary & MaintenanceAmbulance auxiliariesTotal number of staff overall

1321100910842342241867924

4161

The Scottish Ambulance Serviceis committed to delivering high quality,safe, effective, patient focused careand to using the views and experiencesof the people who use its serviceas part of a process of continuousquality improvement.

The Scottish Ambulance Service seeksto learn from feedback given by patientsand use this information to make positiveimprovements to the Service. It recognisesthe importance in understanding that theway in which the Service responds and actsto the complaints is a marker of its attitudeto and engagements with patients, carersand their families. The Service has put inplace measures to improve its currentcomplaint handling process in 2008/09.

• Ensuring that complaints aremore patient/consumer focused:a complainants questionnaire waspiloted in March 2009. This workwill be progressed in 2009/2010.

• Considering staff training needs andhelp them develop the knowledgeand skills required: the Service hasdeveloped a training pack to assistits Divisions and has started todeliver training.

• Learning from complaints by sharinginformation throughout the organisation:a quarterly report is presented to boththe Senior Management Team Meetingand the Clinical Governance CommitteeMeeting.

• Use complaints/audit findings tofacilitate service improvements:senior Managers are provided withthe necessary information fromcomplaints to enable them to takeforward any actions that couldbenefit the Service as a whole.

• Closer working with Clinical Governance:serious clinical complaints were reviewedby the Medical Director for the Serviceand the necessary remedial action.In 2009/2010 the newly appointed Headof Clinical Governance will play developthe mechanisms for ensuring clinicalcomplaints are effectively managed.

• Sharing commendations is importantand provides balance and theimportance of sharing positive feedbackhas been reiterated throughout theService. Last year we recorded over200 written commendations.

Lessons learnedfrom complaints• The Patient Transport Project Boardlooks at complaints and implementsimprovements to the current Service.Some of these improvements includeliaising and working in partnership withHealth Boards on the eligibility criteriaand prioritisation to ensure that patientswho require transport based on clinicalneed are able to access this.

• A complaint was received froma GP following the timescale for a onehour Urgent request for an ambulance(non life threatening) being over thetime requested. A bulletin was issuedto Emergency Medical Dispatch Staffreminding them that if the time frameis not going to be met to upgradethe call to an emergency call and thispoint was made clearer in the trainingto new recruits.

• Concerns raised throughout the yearrelating to a variety of issues includingdelays with PTS transport and accessto remote and rural healthcare werefed into the Strategy Consultationwhich began work in 2009.


The numberof emergencyA&E calls hasincreasedby 4.6%

Complaints madeComplaints upheld

404147

Number in 08/09+21%-1%

Comparison with 07/08

\\Capital investments

//Patient feedback

Total expenditure on the acquisition ofassets during the year was £14.1million.Of this £7.9million was required for theacquisition of vehicles. £5.3million wason property and £900k on IT equipment,plant and furniture.

Major projects included:As part of an overall project that examinedthe best locations for the EmergencyMedical Despatch centres in Scotlandthe Scottish Ambulance service is movingto a model of co-location with NHS 24advice centres. As part of the projectthe co-location in the West of Scotlandat Cardonald Glasgow was completed ata cost in excess of £1million. This projectwas delivered on time and within budgetand the benefits to patients have alreadybeen demonstrated. A number of stationupgrades were also completed in yearbenefiting both staff and patients alike.

The ongoing replacement of frontlineemergency and patient transport vehicleswas also undertaken and the Servicewas successful in securing future fundingfor the next 3 years to continue thisreplacement and upgrade programmeto ensure the patient care the AmbulanceService provides in with the most modernmechanically and fuel efficient vehiclesit can provide.

A number of software and system upgradesalso took place during 2008/09 the mostsignificant of which was for the systemfor planning and delivering the PatientTransport Service across Scotland.

2007/08£000

2006/07£000

William Brackenridge

Suzanne Dawson

Christine Humphries

Alan Lawton(until 30/11/08)

Douglas Marr

Andrew Richmond

David Alexander

David Garbutt

Theresa Houston

Alan Bickerstaff

Kevin Doran(until 14/11/08)

Pauline Howie

Shirley Rogers

Grace Kennedy(until 14/11/08)

Chairman

Non-Executive Director








Employee Director/StateRegistered Paramedic

Chief Executive

Acting Chief Executive(from May 2008)

Director of HumanResources andOrganisationalDevelopment

Director of Operations

Scottish Ambulance Service;CiPFA – occasional sub-contractor;Non-Executive Director NHS Highland;Chairman, Argyll and Bute, CHP

Scottish Ambulance ServiceSelf employed marketing consultant

Scottish Social Services Council – DueRegard Member Registration and ConductCommittee – Allowance plus expenses;Scottish Ambulance Service

Scottish Ambulance Service


Scottish Ambulance Service;Non-Executive Member of NHS Tayside;Director of Laverock Properties Ltd;Director of Rushyglen Ltd.

Scottish Ambulance Service;Falkirk Council Elected Member

Scottish Ambulance Service;Self Employed Consultant

Scottish Ambulance Service;NHS Education for Scotland






None

None

None

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Share-holder of Rushyglen Ltd.Share-holder of LaverockProperties Ltd

None

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None

None

None

Chairman “The Helensburgh Partnership”

Chair of the Borders College Boardof Management; Member of the Boardof the Association of Scotland’s CollegesChair of BC Consultants (wholly ownedsubsidiary of Borders College); Fellowof Chartered Institute of Marketing

Member British Associationof Social Workers

None

None

Associate of Society of InvestmentProfessionals (ASIP); Member of AngusConservative & Unionist Association;Member of Carlton Club; Member ofNational Childbirth Trust (NCT); Memberof Church of Scotland; Member ofCongregational Board of the Isla Parishes(Church of Scotland); Trustee TaysideNHS Board Endowment Fund

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

Chartered Fellow of Chartered Instituteof Personnel and Development;Fellow, Scottish Police College;Visiting Fellow Australian Instituteof Police Management

None

None

Member of Management Committeeof Reid Kerr College

None

Non-Executive Member of the Boardof Management of Borders College

None

None

None

Vice Chairman, Scottish BordersValuation Appeal Committee

None

Chair Thriepmuir Investment ClubRotary Club Currie & Balerno

None

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Chair, Peebleshire Committeeof MacMillan Cancer Support;Member Tweed Valley Bike Patrol

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\\Register of interests2008/09

Name Position Remuneration Related Undertakings Contracts Houses, Landand Buildings

Shares and Securities Non-Financial Interests Voluntary/Charity Work

Relative(s)in ScottishAmbulance Service

Eleanor& JamieWhite

Jamie’s mum, Eleanor, hadrecently been diagnosed withdiabetes. Jamie was awareof his mum’s illness, so whenfound her lying motionlesson the kitchen floor, he didn’tpanic. Instead he managedto get his mum to drink somefruit juice, and she was ableto dial 999.

When the ambulancecrew arrived, the housewas locked from the inside.Once again, Jamie stayedcalm. He pushed the housekey through the letterbox,so the crew could come intothe house to help his mum.

“When I saw my mum onthe floor, I knew giving herfruit juice would help. I wasreally glad when the peoplefrom the ambulance came.They couldn’t get in at first,but once I got the key tothem through the letterbox,I knew it would be alright.”


Scottish AmbulanceService Annual Review:13 October 20091. This letter summarises the main areas

of discussion and the actions arisingfrom the Scottish Ambulance Service(SAS) Annual Review and associatedmeetings in Clydebank on 13 October2009. I would want to thank all thoseinvolved in organising the day, I amaware of the significant work thatgoes in to this process.

2. I welcomed the chance to hearmore about the delivery of OptimalReperfusion Therapy in the West ofScotland and to be walked throughthe journey taken by a patient who hasrequested an ambulance in responseto chest pain. From the time a crewarrives on scene, through the clinicaldecision making and treatmentundertaken by the crew in consultationwith NHS colleagues, and on to arrivaland treatment at hospital, it is clear thatthis service is an excellent exampleof different parts of the health serviceworking collaboratively to delivereffective and high quality patient care.I would be grateful if you could conveymy thanks to all those I met duringthe session.

Meeting with ClinicalAdvisory Group3. I was pleased to see the broad

range of clinical skills and experiencerepresented within the ClinicalAdvisers Group and we had a detaileddiscussion about the progress thathas been made by the organisationto further develop and embed robustclinical governance strategically andlocally. The newly-formed MedicalDirectorate, local clinical leads ineach division, clinically-led servicedevelopment and strong clinicalengagement with partners have allplayed a part and we talked abouta few specific examples, suchas the development of a commonunscheduled care triage tool,the development of the OptimalReperfusion Service and the focusthe service is now putting on clinicalperformance targets including thosefor hyper-acute stroke patients.

4. We talked about the increasingnumbers of patients who were nowbeing treated at home, thus avoidingan unnecessary admission to hospital.Clinical Governance is, of course,crucial in ensuring patient safety andI was told that this is integral to the ‘seeand treat’ protocols. Communicationwith patients and their representativegroups and charities is also key andat this meeting, and also when I metthe group of patient representativeslater on, it was good to hear about thework that has gone in to the adviceleaflets that are given to patients sothat they know what to do should theyneed to follow up on the care theyreceive at home.

5. We also discussed the ongoing flusituation and the preparations andplanning the service has taken forwardto ensure any impacts for the serviceare managed effectively.

6. Please could you thank all those whotook the time to meet with me.

Deputy First Minister & Cabinet Secretaryfor Health and Wellbeing

Nicola Sturgeon MSP

T: 0845 774 1741E: [email protected]

David Garbutt, ChairScottish Ambulance Service,National Headquarters,Tiperlinn Road, EdinburghEH10 5UU

4 November 2009


\\Annual Review 2009Key action points

The Scottish Ambulance Service should continue to ensure its active participationin the Scottish Patient Safety Programme.One

The Scottish Ambulance Service should develop the management and performanceof its Patient Transport Service, alongside working with partners to support thosepatients who do not have a medical need for this transport.

Two

Ensure robust arrangements are in place to ensure the Local Delivery Plan identifieskey actions and how any risks to delivery will be mitigated in order to demonstraterequired levels of progress against the NHS QIS Clinical Governance and RiskManagement Standards will be achieved.

Three

Ensure the Board (and its Clinical Governance Committee) continues to have evidenceavailable to it in order to provide assurances with regard to the robustness of clinicalgovernance and risk management arrangements.

Four

The Scottish Ambulance staff and management structures should be kept underreview to ensure the infection control structure is fit for purpose and that good linksare maintained between the Service’s Infection Control Manager and NHS Boards.

Five

The Scottish Ambulance Service should continue to maintain a focus on increasingattendance levels across the organisation.Six

The Scottish Ambulance Service should continue to ensure it has robustarrangements in place for handling complaints, including responses to the findingsof the Scottish Public Sector Ombudsman and have evidence to demonstrate howthese arrangements drive improvements in the services provided.

Seven

Meeting withPartnership Forum7. My meeting with the Partnership

Forum was extremely useful and mythanks go to everyone who attended.We talked about a range of issues,including the service response to theNHS staff survey, where I was updatedon the various ways in which theorganisation is, at both a national andlocal level, seeking to respond to theconcerns voiced by staff, the progressmade on sickness absence levelsand the focus that has been put onengaging staff in service development.I was impressed with the progress thathas been made on infection controlacross the service, including the handhygiene compliance levels and theprotocols for vehicle and uniformcleaning. Engaging with staff at a locallevel has played a significant partin this and I look to the service tomaintain this focus and success.

8. Finally, we talked about the pressuresput on the service and staff by alcoholrelated calls, particularly at theweekend. I am in no doubt about thescale of this problem and, as you know,the Scottish Government is stronglycommitted to tackling this behaviour.The city centre initiatives representa pragmatic and efficient way ofaddressing the immediate care needsof these individuals whilst avoidingunnecessary and often disruptiveA&E attendances.

9. The overall sense I got from themeeting was that partnership workingacross the ambulance service is valuedand has moved on from what was adifficult set of circumstances in recenttimes. That said, there is now anopportunity for partnership to developfurther and strengthen right acrossthe Service. Achieving this will standthe organisation in good stead and,I believe, will be a key componentin staff, their union representatives,the management team and the Boardworking together effectively. It is onlythrough robust and open dialogue thatthe forthcoming challenges for theservice and the wider NHS and publicsector will be met.

Meeting withPatient Representatives10. I had an extremely interesting meeting

with a group of patient representativeswho had a variety of interests andexperiences of the work of the service.I have no doubt that the ScottishAmbulance Service is actively ensuringthat patient views and input are integralto their work and particular examplesof this were in the work to developadvice leaflets for those patients treatedat home, the willingness of the serviceto ensure that the needs of individualpatient groups are addressed, and theway in which the service is working inpartnership with NHS colleagues tosupport remote and rural communities.

11. Those round the table were veryenthusiastic about the importantcontribution that Community FirstResponder schemes make tocommunity resilience, and also aboutthe professional and reassuring servicethat ambulance crews give to patientswho are distressed and in pain.I know that every day crews acrossthe country strive to deliver the bestpossible care to patients so it is goodto hear that this is appreciated so much.

12. There was a feeling round the tablethat the Patient Transport Servicewas an area where service couldbe improved and I agree with thecomments made around the needfor better information and awarenessof the eligibility criteria and accessarrangements, as well as thealternatives for patients whodo not meet the criteria.

13. I would be grateful if you could passon my thanks and best wishes toeveryone who came along to meetwith me, particularly those who hadtravelled such long distances.

Annual Review MeetingAction Points from 2008 Annual Review

14. Following my report back from thevarious morning meetings you providedan update on the actions from the2008 review and an overview of2008/09 for the service. I was ableto confirm that all of the actionsfrom the previous review had beenprogressed and that we would returnto some of these as we movedthrough the substantive agenda.

Performance15. 2008/09 has seen the Scottish

Ambulance Service performwell across a range of measures.As you know, your HEAT and LocalDevelopment Plan standards andtargets remain one of the keymechanisms by which performanceis assessed and it is importantto ensure these are achieved,particularly so that patients can haveconfidence in the speed and qualityof the service they can expect.

16. There is no question that theambulance service is very differentto the one that operated five or 10years ago and our discussion aboutclinical performance highlighted howfar the service continues to travel.Robust clinical governance, evidencebased service developments andthorough evaluation and analysis mustunderpin everything you do. Some ofthe areas we talked about where thisapplies included the wealth and valueof information now being collected byyour electronic patient report forms,the Edinburgh City cardiac arrest pilot,the use of ‘see and treat’ protocols andthe development of professional advicesupport for crews.

17. Finally in relation to clinical performance,you were able to report that the serviceachieved a ‘Return to SpontaneousCirculation’ rate of 20% for the year.

18. Reaching 77.4% of Category A callswithin eight minutes in March 2009was a fantastic achievement for theservice and, as I said at the time, andagain on the day, my congratulationsgo to everyone across the wholeservice who contributed to this.It is clear that a range of factorscontributed to this success and thatthe whole service really focussed onthis important target. This producedfull-year performance of 70.7% for2008/09, up by 8% from 2007/08, andreduced the average response timeby 1 minute to 7.2 minutes. It was alsogood to get your confirmation that thisachievement had not been at theexpense of Category B performance,where the full year figure was 94.4%,up from 91.4% in the previous year andonly fractionally short of the 95% targetfor the year. Across the Island Boards,performance was also sustained,50.5% of all emergency calls reachedwithin eight minutes against a targetof 50%.

19. I know that sustaining 75% throughout2009/10 and beyond will be challenging,but I was pleased to be assured of yourongoing commitment to what is nowa national HEAT standard. As wellas continuing the best practice thatachieved the success in March 2009,it was acknowledged that there is morethat the service can and will do toembed this level of performance andsecure a solid platform from which theservice can develop its range of clinicaltargets. Issues of demand levels,patterns of demand and geographywill all impact on performance levelsand the service will need to workin partnership both internally andexternally to manage these.

20. As I have said many times, the SASPatient Transport Service is vital topatients across Scotland and highimportance is placed on each andevery journey. In 2008/09, the numberof journeys dropped by around 2.5%to just under 1.6 million journeys.Over the year, a number of specialistresources have been put in place todevelop a more tailored clinical service,for example the dedicated palliativecare vehicles, and the service haveintroduced extended hours andweekend availability to widenaccess. I know that these types ofdevelopments, alongside improvedtracking and deployment of PTSresources, will help to deliver improvedpatient care. Your Patient TransportService targets record that:

• 69.6% of priority 1 patientsarrived at hospital 30 minutesor less before their appointmenttime, up from 69.4% in 2007/08and just short of the target of71% for the year.

• 83% of priority 1 patients werepicked up within 30 minutes of theagreed pick up time, down from83.7% in 2007/08 and short of thetarget of 89% for the year.

21. In the coming year, and as part of yourstrategic framework, I would look tothe service to focus on improving thePatient Transport Service to ensurethat it meets the needs of the patientwho use it. I know from users of theservice that there is no one ‘fix’ butI hope that you can look at a rangeof areas, perhaps some that areinnovative, that will combine toimprove the patient experience.

22. Alongside this, I recognise the widertransport challenges to healthcarefacilities across the country and Iappreciate the significant efforts of theservice in working with territorial NHSBoards, Local Authorities and otherpartners to support those patientswho do not meet the clinical eligibilitycriteria for SAS patient transport.I know that, particularly in remote andrural areas, the ambulance serviceis still filling social or geographic gapsbut I hope that successful partnershipwork will help to reduce this demandover time.


\\Annual Review 2009Continued

Text to be supplied Text to be supplied

23.We concluded this agenda itemby talking about the sustainedperformance of the air ambulanceservice against a background ofincreasing demand, up some 16%from 2007/08, much of which beattributed to the emergency andspecialist retrieval services. I waspleased to hear that despite theseincreases in demand you havemaintained and improved performancetimes and coverage across Scotland.The re-procurement process for thenew air ambulance contract has nowcommenced and I look to you toensure that the service engages widelywith stakeholders and communitiesto inform this work, as well as carefullyconsidering the current and futuredemand on this important resource.

Finance, Efficiencyand Workforce24. For 2008/09, the Scottish Ambulance

Service met finance and efficiencysavings targets and is on track to doso again in the current year. This isall underpinned by the principles ofBest Value and I support the focusthe service is placing on this. Efficiencysavings have been re-invested in patientcare, including in the recruitment ofadditional frontline ambulance crews.We spoke about the key financial risksand challenges going forward andI was reassured that the service isactively planning to manage andmitigate these risks. As you know, thepublic sector is moving towards a timeof financial challenge and it will beever more important to make the bestpossible use of resources to deliverpatient care.

25. The service has continued to makegood progress in reducing sicknessabsence levels, down to 5.4% for theyear. Considerable efforts, particularlyin relation to management focus andsupport and the employee assistanceprogramme have seen benefits and itwas striking to hear that the decreasein absence since 2007/08 means theservice regained the equivalent of 21full time staff over the year. I welcomethis positive progress and, while I knowthe NHS standard of 4% remainschallenging, I look to the service tosustain the continuing progress ithas made in this important area. Theservice has rolled out the use of e-KSF,and by 31 May 2009 98% of relevantstaff had a PDP in place. By movingimmediately to the electronic system,the service is well placed to meet theMarch 2011 HEAT target that 80% ofstaff must have development reviewsand PDPs completed and recorded one-KSF and confidence was expressedthat this would be achieved. Moregenerally, high priority continues tobe placed on education and training,leadership development andworkforce planning.

26.We spoke about the staff surveyand the response by the service hasprovided me with reassurance of thecommitment and focus that will goin to addressing the views expressedby staff. We also discussed the highpriority placed by the ScottishGovernment on infection control andit is evident that, even in challengingphysical environments such as anambulance, the focus given by staffcan ensure positive results.

27. Since my announcement in September2008, the service has made excellentprogress in minimising incidents ofrostered single crewing in the Northand South West of Scotland. InSeptember 2009 there were, onaverage, less than four incidents perday and you confirmed that, by nextSeptember, the practice of rosteredsingle-crewing will be eliminated.39 of the 40 additional staff have beenrecruited and trained and the remainingpost will be filled as soon as possible.

Strategic Direction28. The last year has seen a continued

focus by the Scottish AmbulanceService on strengthening partnershipworking, most notably with NHS 24.The co-location of the west EmergencyMedical Dispatch Centre with theNHS 24 contact centre in Cardonaldhas seen positive benefits for bothorganisations and this is to bereplicated in the east in the comingmonths. I was pleased to note theclear commitment of the service tosupporting our remote and ruralcommunities and I know that your teamhave been working closely with theScottish Government, territorial NHSBoards and other partners to makeprogress in this important area.Examples of this progress include therecruitment of five CommunityResuscitation Development Officers,the further development of CommunityFirst Responder schemes and thedevelopment, by the Remote and RuralImplementation Group, of specificmodels of healthcare for remote andrural communities.

29.We had a useful discussion aboutthe importance of a sound evidencebase and robust governance whendeveloping services, to understand theimpact and benefits of change but alsoto build confidence in both staff andcommunities. I agree with the viewsexpressed that the focus must alwaysremain on quality and safety of careand on the patient experience.

30. A renewed focus on your volunteeringstrategy will ensure that the variouselements of this will be in place bynext summer. As you know, I value theconsiderable contribution made byvolunteers across our NHS, includingthose who support Community FirstResponder Schemes and the volunteercar service.

31.While we only had a chance to touch onit briefly, I welcomed the update on thesignificant consultation exercise thatis informing the development of yourstrategic framework for the next threeto five years. I look forward to seeingmore on this as work progresses.

Q&A32. Both the pre-submitted questions

and those asked by the audienceallowed the opportunity to exploreissues such as the support andservices available for deaf people,the role and contribution of CommunityFirst Responder schemes, theimportance of effectively managingand minimising financial risk and theimportance of ensuring that the PatientTransport Service meets the needs ofthose who use it. I am grateful to thosewho asked questions and to those whotook the time to attend on the day.

Conclusion33. It was clear from the various

discussions and meetings throughoutthe day that considerable progress hasbeen made by the ambulance serviceover the last year and I would want tooffer again my congratulations. TheService has a great deal to be proud of.I do not underestimate the challengesthe service has had to respond to inrecent times, nor the challenges ahead,but I feel the service is in good shapeas we move forward.

34. I would want to extend my thanksto you, your Board and to all the staffof the Scottish Ambulance Service fortheir efforts and commitment over theyear. The Scottish Government looksforward to working with you and yourteam to ensure that we meet the needsof patients across Scotland.

35. The attached annex sets out the mainaction points arising from the review.

Nicola Sturgeon MSPDeputy First Minister& Cabinet Secretaryfor Health and Wellbeing

\\Annual Review 2009Continued


Equal Opportunities PolicyThe Scottish Ambulance Service firmlybelieves that all employees should betreated equally and fairly. The Boardopposes all forms of discriminationon grounds of colour, race, nationality,ethnic origin, disability, marital status,sexual orientation, gender or age.

Information about the Service, the fullfinancial accounts for 2008/09 anddetails of the organisation and operationof the Service can be obtained from:Secretary to the Scottish AmbulanceBoard, National Headquarters, TiperlinnRoad, Edinburgh EH10 5UU. Telephone:0131 446 7000 email [email protected] or visit ourwebsite www.scottishambulance.comA full Annual Report will also be availableon our website.

A summary is available in other languagesand formats on request. Please telephonethe Interpretation and Translation Serviceon 0131 242 8181 and quote referencenumber 08571.

Un résumé est disponible en d’autreslangues et autres formats sur demande.Veuillez téléphoner au Serviced’Interprétation et de Traduction au0131 242 8181 et indiquez le numérode référence 08751.

Краткое содержание на других языкахи в других форматах предоставляетсяпо просьбе. Пожалуйста, звонитев Службу устных и письменныхпереводов (ITS) по тел. 0131 242 8181и указывайте исходящий номер: 08751.

Paprašius santrauką galima gauti kitomiskalbomis ir formatais. Skambinkite vertimotarnybai (Interpretation and TranslationService) telefonu 0131 242 8181,nurodykite kodą 08751.

Streszczenie dostępne jest na �yczeniew innych językach lub formatach. Proszęskontaktować się telefonicznie z BiuremTłumaczeń Ustnych i Pisemnych (ang.Interpretation and Translation Service)pod numerem telefonu: 0131 242 8181i podać numer referencyjny: 08751.

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