COUNT ON US SCOTTISH AMBULANCE SERVICE ANNUAL REPORT FOR

Transcription

1 COUNT ON US SCOTTISH AMBULANCE SERVICE

2 THE SCOTTISH AMBULANCE SERVICE IS DEDICATED TO DEALING WITH ANY SITUATION AND EVERY EVENTUALITY, 24 HOURS A DAY, 7 DAYS A WEEK. THIS ANNUAL REPORT CONTAINS ONLY A FEW EXAMPLES OF THE WIDE-RANGING SKILLS OUR HIGHLY TRAINED STAFF CAN DELIVER, WHERE AND WHENEVER YOU NEED US.

3 YOU CAN COUNT ON US... Bidh sinne ann SCOTTISH AMBULANCE SERVICE PARAMEDIC OPERATIONS ROOM ASSISTANT AMBULANCE CARE ASSISTANT AMBULANCE TECHNICIAN

4 HERE an seo A 50 YEAR OLD MAN COLLAPSES IN A BUSY STREET. A PASSER-BY DIALS 999 AND THE EMERGENCY DISPATCH CENTRE DIAGNOSE AN ARRESTED HEART. FOLLOWING TELEPHONE LIFE SUPPORT ADVICE, BYSTANDERS ARE ABLE TO PROVIDE CPR WHILST THE RAPID RESPONSE PARAMEDIC UNIT, WITH DEFIBRILLATOR, IS DEPLOYED. THIS ARRIVES WITHIN FIVE MINUTES AND ADVANCED LIFE SUPPORT COMMENCES. A BACK UP AMBULANCE THEN TRANSPORTS THE PATIENT ALIVE, WITH A PULSE, TO THE INFIRMARY.

5 JOE HAS ACUTE RENAL FAILURE AND IS DEPENDENT ON AN AMBULANCE TO TAKE HIM TO HOSPITAL FOR DIALYSIS TREATMENT THREE TIMES A WEEK. HIS REGULAR AMBULANCE CARE ASSISTANT HAS HAD TRAINING IN HIS SPECIAL NEEDS AND HAS A DEDICATED VEHICLE TO MAKE THE REGULAR JOURNEY AS COMFORTABLE AND TOLERABLE FOR JOE AS POSSIBLE. THERE an siud

6 AND agus A 25 YEAR OLD HOUSEWIFE SUFFERS AN ASTHMA ATTACK. THE ATTENDING PARAMEDIC QUICKLY ASSESSES THE SEVERITY USING RESPIRATORY MONITORING METERS. TREATMENT WITH A RANGE OF MEDICINES SUCCESSFULLY HALTS THE ATTACK. FURTHER ASSESSMENT INDICATES THAT SHE IS SAFE TO BE LEFT. THE PATIENT IS THEN HANDED AN ADVICE LEAFLET AND FOLLOW UP ARRANGEMENTS MADE.

7 A 22 YEAR OLD GOES INTO LABOUR UNEXPECTEDLY IN A REMOTE LOCATION. THE LOCAL AMBULANCE TECHNICIAN DELIVERS THE BABY AT THE SCENE, PROVIDING NEONATAL CARE FOR MOTHER AND CHILD, WITH THE TRAINING RECEIVED FROM OUR MATERNITY TRAINING MODULE. A HELICOPTER AMBULANCE IS THEN SUMMONED TO TAKE MOTHER AND BABY TO THE MATERNITY HOSPITAL SOME DISTANCE AWAY. EVERYWHERE anns gach àite

8 HAIRMAN S STATEMENT SCOTTISH AMBULANCE SERVICE I AM PLEASED TO REPORT ANOTHER SUCCESSFUL YEAR FOR THE SCOTTISH AMBULANCE SERVICE. The Service achieved all the targets set for it by the Minister for Health and Community Care in the Performance Assessment Framework. Importantly, the Scottish Ambulance Service operated within the funds allocated to it. As well as delivering service, we achieved considerable progress on a number of fronts. With all the new Emergency Medical Dispatch Centres brought in line by the end of , the focus in the year under review has been to derive the full benefits of the investment; substantial progress has been achieved. The Service brought emergency care to 11,000 more A&E patients in We will continue to develop the accident and emergency service ensuring that care will be delivered ever more expeditiously to those who have an urgent and unscheduled need for it. We continued to modernise the non-emergency service ensuring that those patients whose condition requires them to receive the highest levels of care, do indeed receive that level. Modernisation will continue to ensure that the service patients receive is seamless and of the highest quality. To this end, we will work even more closely with our partners both inside and outside NHS Scotland. In , 2,878 patients were carried by the Air Wing bringing the most sophisticated of healthcare to the most remote and isolated parts of Scotland. However, during we re-procured the Air Ambulance Service. The existing arrangements have served us well for many years, but it was time to ensure the Air Wing was totally fit for the 21 st Century. The new arrangements will come into force in April 2006 when all our aircraft will be sophisticated flying ambulances and not just aircraft which carry patients.

9 CHAIRMAN S SCOTTISH AMBULANCE SERVICE In the longer term, the future is very bright for the Scottish Ambulance Service. The Kerr Report, which maps out the future of NHS Scotland, suggests that the Scottish Ambulance Service has much more to contribute to unscheduled patient care. The Scottish Ambulance Service looks forward to making its contribution to delivering this exciting vision. The Scottish Ambulance Service does not work in isolation. It operates in concert with partners inside NHS Scotland, in other parts of the public sector, in the commercial sector, in the voluntary sector and, importantly, in the community. They are all of vital importance to us. I am deeply grateful for their wonderful preparedness to work with us. It is very reassuring to have our Divisional General Managers welcomed to the Board Meetings of Territorial NHS Boards and invited to join their Service Redesign Committees. It is even more reassuring to find real co-operation at operational level. It is also very reassuring to find co-operation with our local authority partners growing apace; profound co-operation here could have a very significant impact upon patient care. The help and co-operation we receive from other agencies in the public sector is vital to our success. We are grateful to them all. STATEMENT Police and Fire Services and to They cover a wide spectrum of services ranging from the Health and Safety Executive, to Scotland s Local Authorities. Our commercial partners, almost without exception, work in real partnership with us. Through their working with us, we have some of the most sophisticated ambulances in the world, we have state-of-the-art communications systems, which are the envy of many, and we are able to bring an Air Ambulance Service, which is second to none, to the people of Scotland. Our partners in the voluntary sector are vital to the Scottish Ambulance Service. Most visibly the sector augments our non-emergency service bringing patients often, but not always, from remote or rural locations to important hospital appointments. But in a zillion other ways, we rely upon volunteers to work with us to improve the patient experience. Very importantly, we look to people in their communities to work with us. First Responder schemes are a vital part of bringing care to those who need it urgently very quickly. These individuals who are First Responders are prepared to put themselves out to be trained, to be available and to serve their neighbours when required. Their contribution is vital and much appreciated.

10 STATEMENT SCOTTISH AMBULANCE SERVICE Our past year has been a success, but that success depends upon Ambulance Service staff on the front line in blue or green suits. To a woman or man they have patient orientation of the highest order. I and the whole Board are profoundly grateful to them all for their commitment; without that preparedness to go the extra mile, the Scottish Ambulance Service CHAIRMAN S would be much less significant to the wellbeing of the people of Scotland. I am very grateful to my fellow Board Members both Executive and Non-Executive for their contribution throughout the year. We meet ten times a year. Running the Scottish Ambulance Service is no easy task for Executive Directors. Directing the Service and monitoring performance is a challenging task for the whole Board. Respectful challenge has been the order of the day at Board Meetings and we have always managed to reach consensus. I am particularly grateful to my colleagues who chair Board Committees Iain McMillan (Audit Committee), Alan Lawton (Clinical Governance Committee) and Alan Bickerstaff (Staff Governance and Remuneration Committee) for the particular contribution they make. I am also grateful to the Minister for the help, support and guidance he has provided during the year. His active involvement is much appreciated. The support and involvement of Scottish Executive Health Department staff over the past year has been much appreciated and welcomed. Sadly, I must record the air accident which befell us during the year. Just after midnight, in the very early morning of Tuesday 15 March 2005 Loganair s Britten Norman Islander G-BOMG was lost as it approached Machrihanish Airport on an Air Ambulance mission. On board were the pilot, Guy Henderson, and a paramedic of the Scottish Ambulance Service, John McCreanor. Both were killed in the accident. On behalf of the Board and all the staff of the Scottish Ambulance Service I extend our sympathies. Both men died taking care to a patient who needed it very urgently. WILLIAM BRACKENRIDGE Chairman

11 HIEF EXECUTIVE S SCOTTISH AMBULANCE SERVICE THE WRITING AND PRODUCTION OF AN ANNUAL REPORT IS NOT JUST AN OBLIGATORY AND STATUTORY REQUIREMENT, IT ALLOWS ME THE OPPORTUNITY, AS CHIEF EXECUTIVE, TO TAKE STOCK OF WHAT HAS HAPPENED IN THE REPORTING YEAR; TO REFLECT ON WHAT CHANGES HAVE TAKEN PLACE AND TO CONSIDER WHAT PROGRESS WE, AS AN INTEGRAL PART OF NHS SCOTLAND, HAVE MADE IN IMPROVING THE DELIVERY OF HEALTHCARE SERVICES TO PATIENTS. It is now more that five years since we began our Beyond 2000 project which consisted of the modernisation of our ambulance control rooms, a review of the way non-emergency services are delivered and a radical change in the way we respond to 999 calls. This project has now been completed and our three new Emergency Medical Dispatch Centres and 30 local, hospital based, non-emergency centres are up and running and are bringing improvements through the new ways in which we now operate. These, along with the prioritisation of emergency calls, are improving our operational effectiveness. Indeed, I am very pleased to be able to report that the average time taken to respond to a life threatening emergency call across Scotland as a whole has now fallen to 8.6 minutes. This is a major milestone and is the lowest ever response time which the Scottish Ambulance Service has achieved. However, we are not content with this and we intend to continue to strive to improve our response times and improve the efficiency of our non-emergency service. In this respect, we have introduced special arrangements for condition specific groups of patients and have improved the punctuality and arrival times for treatment for cancer, cardiac, mental health and renal patients. Additionally, we have also managed to greatly reduce the number of patients who do not attend for their hospital, clinic or outpatient appointments. All of the changes which we have made so far would not have been possible without the co-operation and flexibility of our staff. As well as investments in buildings and technology and changes to operating procedures, we have recently carried out a re-procurement exercise for our air ambulance service. The result of this process is two brand new custom built aircraft, specially designed and equipped for improved patient care and control of infection. These aircraft are in addition to the two dedicated air ambulance helicopters which we have. All of these assets will be available 24 hours a day, 365 days a year.

12 HIEF EXECUTIVE S SCOTTISH AMBULANCE SERVICE Looking to the future, we have developed a new vision of how ambulance services will be delivered. I foresee a role for our staff in which there will be more treatment at home provided by our paramedics and technicians thus resulting in less hospital admissions. This vision dovetails nicely with Professor Kerr s report Building a Health Service Fit For the Future. We find many of the recommendations in his report to be consistent with initiatives which we have already undertaken to enhance the skills and contribution of our paramedics, working as part of multi-disciplinary teams supported by intelligent technology, which are already in development within the Service or are being piloted by the Service with NHS partners. We have started the development of patient care pathways and now have more than 60 paramedics across the Service who have been trained to treat certain common conditions on demand in the patient s home in addition to receiving the accredited clinical training received by every paramedic and to help divert patients from admission to accident & emergency receiving units. The development of a national ICT system, including electronic patient records, will greatly enhance the readiness and capability of paramedics to treat patients locally. We have paramedics with even more extended skills who work in Out of Hours Partnerships or who deal autonomously with many of the conditions which previously would have been dealt with by the ambulance service transporting a patient to an accident & emergency department. In areas where there may be very few emergency incidents each year, integrated working schemes are the only certain way to ensure that adequate numbers of appropriately experienced and skilled paramedics can be kept available to provide an emergency response when it is needed. Staff are now also given specific training about certain patient groups children, vulnerable adults, mental health patients and palliative care patients. In our experience, patients would prefer to see someone competent immediately than wait to see the highest qualified practitioner. STATEMENT The roots of our Service have always lain in the provision of emergency care and the transport of medically and stable patients to treatment facilities. But, as I have explained above, in recent years there has also been sustained investment by the Service in the improvement of clinical skills of our staff to enable them to deal with a wider range of common conditions and to help divert patients from admission to accident and emergency receiving units. Finally, and as ever, I place on record my admiration for the services provided by all Scottish Ambulance Service staff and my thanks to them. I also wish to echo the remarks made by my Chairman and send my sympathies to the families of Paramedic John McCreanor and Pilot Captain Guy Henderson. ADRIAN LUCAS Chief Executive

13 22 23 SCOTTISH AMBULANCE SERVICE OVER VIEW THIS PART OF THE REPORT COVERS OUR PERFORMANCE IN PERFORMANCE FOR US MEANT: F THE YEAR HEALTH IMPROVEMENT /REDUCING INEQUALITY In respect of our Non-Emergency Service Development Programme phase two has been completed. This has already resulted in improvements to punctuality 54% of patients are now at hospital or clinic for treatment 30 minutes before appointment times. There has been an increase in renal activity and we are providing additional staff and vehicles to cope with this very important treatment. Priority is now being given to oncology, mental health, cardiac and renal patients. Other improvements made to the delivery of non-emergency service include the introduction of out-patient waiting time reduction initiatives and a further reduction in the number of patients who did not attend their hospital or clinic appointment thereby leaving empty seats on our ambulances. As part of Accident and Emergency Service Development Programme we have been bedding in the system of prioritising 999 calls so that life threatening situations are responded to first. We have also been implementing our new emergency medical dispatch centre protocols and procedures. To improve emergency ambulance deployment and ensure that the most efficient use is made of our resources, a resource modelling tool has been procured. The Ministerial target set some years ago for us to have sufficient paramedics so that every accident and emergency call which required a paramedic response got one has been met. We remain on target that by the end of , 75% of category A, life threatening calls will be responded to within 8 minutes. Our paramedics have also been introduced into various schemes across Scotland providing out of hours services for patients. Child protection and mental health procedures have also been introduced. Our child protection arrangements will be extended to vulnerable patients as well. Our staff can now, in certain instances, verify the fact of death and appropriate procedures have been introduced. In addition, our 30 local non-emergency offices are providing more face to face contact between hospital staff and non-emergency staff is beginning to improve our effectiveness and efficiency. FAIR ACCESS Our Fair for All Programme is on target and is being implemented as confirmed by the Commission for Racial Equality. Our social inclusion schemes have been extended and the Freedom of Information Act requirements have been introduced. We are proud of our Easterhouse Development Corporation Patient Transport Works Project which provides improved transport for oncology patients whilst offering social inclusion employment opportunities for long term unemployed. A similar scheme is being proposed for the Gorbals area and all of our General Managers have been asked to identify any areas in their division where similar schemes can be implemented. CLINICAL GOVERNANCE EFFECTIVENESS/QUALITY We continue to implement our clinical effectiveness strategy and we received a very positive interim standards report from Quality Improvement Scotland. Our ICT strategy is directly aligned to our clinical strategy and our control of infection strategy has also been approved by Quality Improvement Scotland. As part of our progress for ongoing improvement, we have established a research and development steering group.

14 OVERVIEW SCOTTISH AMBULANCE SERVICE In respect of direct patient care, we have achieved our target of a 13% rate of survival of cardiac arrest. Over 100 patients received thrombolytic (clot busting) treatment. Defibrillators, associated telemetry and training have been rolled out across Scotland and morphine sulphate (a pain killer) has been introduced. We have extended the role of our paramedic through the development of alternative care pathways. Treat and refer procedures are already in place for asthma, diabetes and fits. We have strengthened our child protection arrangements and introduced a vulnerability code of practice. In respect of administrative efficiency, I am pleased to report that our North Emergency Medical Dispatch Centre in Inverness has gained ISO9002. We are now working towards our East and West Emergency Medical Dispatch Centres gaining this award. Running in parallel are our plans for all ambulance divisions achieving chartermark and our corporate functions in departments gaining EFQM status. We have also begun a programme of publicly releasing clinical bulletins which highlight the skills and treatments which our paramedics and technicians can deliver. OF THE PATIENT EXPERIENCE YEAR The strategy for the development of a non-emergency service and our air reprocurement process were widely consulted upon with high patient and public agreement with the proposed ways forward. We value patient and public input and focus groups and survey research projects are well underway. Socially excluded groups have included; exampled by the Easterhouse Development Corporation Patient Transport Works Project. The new NHS complaints system is up and running and we have developed a cadre of specially trained investigating staff. There has been a general reduction in the number of upheld complaints. The new complaints system meant that independent local review could be dispensed with and claimants who were not satisfied with the outcome of their complaint can now go direct to the Public Service s Ombudsman. INVOLVING PATIENTS AND THE PUBLIC The Board travels around the country for its meetings to enable patient and public access to the Board. NHS stakeholders are also invited to attend Board meetings. We are continually developing this process to ensure that the Board is visible and accessible. Our Patient Focus and Public Involvement Framework has been updated and will be implemented across all six ambulance divisions. To keep the public and media informed, we have developed a pro-active media communications plan. Our National Involving People Group is working well and is heavily involved in the planning of service developments. This input is especially valuable. The Scottish Health Forum has been involved in the drawing up of our Health Plan, Non-Emergency Service Development Programme and our Air Reprocurement Project. Where possible and practical, we have integrated with NHS Board Patient Focus and Public Involvement initiatives. Twenty three first responder schemes are operating across Scotland. These schemes ensure that basic life saving treatment is given while an accident and emergency ambulance is on

15 OVERVIEW SCOTTISH AMBULANCE SERVICE its way. These schemes are especially important in very rural areas. Running parallel to this, a volunteering scheme has been developed. To meet the spiritual needs of both public and patients, we have a spiritual care policy in place. STAFF GOVERNANCE During the year, an Employee Director was appointed and we have a Staff Governance Group in place. A report by Audit Scotland on staff governance arrangements found these to be very effective and working well. This report was based on a corporate self assessment which was completed during the year and Divisional self assessments are currently underway. There is a joint approach with the Staff Side for Agenda for Change via 3 regional planning groups. Our Prevention of Violence to Staff at Work Group is looking at various ways of preventing violence to our staff. Partnership Information Network (PIN) Guidelines have all been taken on board. Our peer support programme continues to operate and across Scotland we have maintained a cadre of 44 peer supporters. The recommendations made by the Health and Safety Executive following their audit are being addressed and an action plan is in place. The Improvement Notices issued by the Health and Safety Executive presented some challenges but actions are underway to ensure that all of these will be complied with within the timescales. ORGANISATIONAL AND FINANCIAL PERFORMANCE AND PROFICIENCY Once again, I am pleased to be able to announce that the Service delivered a balanced budget for the year ending 31 March 2005 and achieved all of the financial targets set by the Scottish Executive Health Department. The Service has achieved full use of PECOS (an electronic procurement system) which has improved contract coverage with resultant savings. We continue to be the highest value user of PECOS for e-procurement in NHS Scotland. We have adopted and are implementing the recommendations of the NHS Scotland Shared Services Review. OF THE YEAR place along with our annual festive Productivity has been increased in the delivery of our emergency ambulance services through re-rostering and resource modelling. In respect of nonemergency services, we have reduced the number of patients who do not attend for their hospital and clinic appointments. An environmental Policy has been developed and adopted throughout the Service. Our Training and Education Strategy has been developed and endorsed. With regard to risk management, this is now woven into our procedures and processes and we have created a combined risk, health and safety, claims and complaints database. In the current year, we played our part in planning for the G8 Summit and have flu pandemic plans in season planning arrangements. Our Property Strategy has been comprehensively reviewed and work on the replacement of our Dumfries Ambulance Station has commenced. PARTNERSHIP FOR CARE We continue to work closely with NHS Boards and are able to give our input into the overall NHS planning agenda. The Service s Redesign Committee meets regularly to consider Out of Hours cover. With regard to the future, as mentioned in other parts of this report, we look forward to implementing the Kerr Report which maps out the future of NHS Scotland.

16 LINICAL EFFECTIVENESS AND GOVERNANCE SCOTTISH AMBULANCE SERVICE There is a corporate responsibility for clinical governance and the Medical Directorate receives valuable support throughout the year from the Human Resources, Finance and Operational Directorates of the Service. The role of the Clinical Governance Committee is to superintend developments and to provide assurance to the Board that they are introduced with vigour. Assurance is also required that clinical business is conducted effectively and safely whilst providing good value for money. If deficiencies are identified, the Board requires assurance that corrective actions has been devised and implemented. The Chairman of the Clinical Governance Committee has been able to provide this assurance to the Board during the year in question. During the year, a large number of initiatives were introduced which fell under the clinical governance umbrella. The Chairman of the Clinical Governance Committee considers that one of the most notable has been the publication of a range of clinical bulletins. These focus on the treatments which paramedics and technicians administer in response to often very serious symptoms. The breadth of treatments has also grown and now includes improved pain relief, child care, mental health and thrombolytic assistance in certain cardiac cases. The Clinical Governance Committee is particularly pleased with the ability to obtain decision support from specialist consultants via so called telemedicine links. It is important that clinical issues are taken forward in a way which supports both the Service s and NHS Scotland s longterm division. Coming into this category is the development of new ways of working such as see and treat, treat and refer or treat and transfer. The Clinical Governance Committee has also reviewed and approved a revised Clinical Effectiveness Strategy and a newly introduced Research and Development Initiative. Very importantly, in respect of improvements to delivery of non-emergency services, changes which will arise through the non-emergency service development programme are beginning to come in the direction of the Clinical Governance Committee. As begun in last year s report, the patient treatment studies contained in this report are intended to give the reader an understanding of some of the wide range of skills which our paramedics and ambulance technicians can deliver. (A copy of the full Clinical Governance Annual Report can be obtained from the address on the back cover of this Report).

17 EACH LIGHT REPRESENTS ACCIDENT & EMERGENCY INCIDENTS SCOTTISH AMBULANCE SERVICE 509,485 (-0.1%) ACCIDENT & EMERGENCY INCIDENTS YOU CAN COUNT ON US

18 EACH HEART REPRESENTS 1,990.9 NON-EMERGENCY PATIENT JOURNEYS SCOTTISH AMBULANCE SERVICE 1,734,058 (-4.2%) NON-EMERGENCY PATIENT JOURNEYS YOU CAN COUNT ON US

19 EACH HELICOPTER PAD REPRESENTS 3.5 AIR AMBULANCE MISSIONS FLOWN SCOTTISH AMBULANCE SERVICE 2,878 (-11.5%) AIR AMBULANCE MISSIONS FLOWN YOU CAN COUNT ON US

20 TOP TEN CATEGORY A INCIDENTS REPORTED IN : VITAL STATISTICS (AVERAGE RESPONSE TIMES IN MINUTES) (AVERAGE RESPONSE TIMES IN MINUTES) NHS BOARD LIFE-THREATENING ALL EMERGENCY A&E INCIDENTS NES PATIENT AIR AMBULANCE CALLS INCIDENTS JOURNEYS MISSIONS SCOTTISH AMBULANCE SERVICE 01 CHEST PAIN 31, BREATHING PROBLEMS 23, CONVULSIONS / FITTING 14, UNCONSCIOUS / FAINTING 12, HAEMORRHAGE / LACERATIONS 5, CARDIAC / RESPIRATORY ARREST 5, TRAFFIC / TRANSPORTATION ACCIDENTS 5, ASSAULT / SEXUAL ASSAULT 3, OVERDOSE / POISONING 3, HEART PROBLEMS 2,937 STAFF AND RESOURCES IN : TOTAL: 3,780 OF WHICH 191 ARE IN MANAGEMENT AND ADMINISTRATION AND 14 ARE BOARD MEMBERS COMPLAINTS RECEIVED (+0.2%) COMPLAINTS UPHELD 174 (-7.9%) COMMENDATIONS 344 (+15%) PLANNED 13,276 (-10.7% FROM ) EMERGENCY 999 INCIDENTS 332,474 (+3. 55% FROM ) DOCTORS INCIDENTS 163,735 (- 5.79% FROM ) ARGYLL AND CLYDE , , AYRSHIRE AND ARRAN , , BORDERS ,597 51, DUMFRIES AND GALLOWAY ,191 66, FIFE , , FORTH VALLEY , , GLASGOW , , GRAMPIAN , , HIGHLAND ,757 80, LANARKSHIRE , , LOTHIAN , , ORKNEY , SHETLAND , TAYSIDE , , WESTERN ISLES ,079 6, AVERAGE ACROSS SCOTLAND TOTAL: 509,485 1,734,058 2, % -4.2% -11.5%

21 3. NON-EMERGENCY TRANSPORT SERVICES: you will report back to the Department by 31 March 2006 on progress with your scoping work for improving non-emergency transport services for patients; 4. AGENDA FOR CHANGE: you will continue to keep in touch with the Department on issues around on-call working and Agenda for Change; Minister for Health & Community Care ANDY KERR MSP Mr W Brackenridge Chairman Scottish Ambulance Service National Headquarters Tipperlinn Road Edinburgh EH10 5UU 5 December 2005 St. Andrew s House Regent Road Edinburgh EH1 3DG Telephone: scottish.ministers@scotland.gsi.gov.uk 5. SERVICES RE-DESIGN: you will continue the good work you are doing around the implications of the Kerr Report, and will flesh out some of the developments being considered. I attach a written record of the Annual Review meeting. The Ambulance Service provides a swift, priority based and effective service for patients. The organisation has travelled a long way over the last ten years or so and is involved at the frontline of many of the issues currently challenging the NHS in Scotland. The standard of performance has improved and, whilst I acknowledge there is a challenge in improving the performance further, I am confident that you will achieve this. I found the Annual Review very helpful in updating me on the current issues and challenges affecting the Ambulance Service. Please pass on to your staff my thanks for their hard work and dedication over the year SCOTTISH AMBULANCE SERVICE Dear Bill SCOTTISH AMBULANCE SERVICE ANNUAL REVIEW , 4 OCTOBER 2005 I am writing to record the issues raised during the Annual Review meeting when we meet to discuss the Scottish Ambulance Service s performance during , and your plans for This letter supplements the Department s comments on the Scottish Ambulance Service s written self-assessment. I was very grateful to you and your colleagues for making the arrangements for the Board s Annual Review meeting. I was also impressed with the enthusiasm and commitment of the representatives of the Partnership Forum and Clinical Advisers who met with me. Please pass on my thanks to them. I identified a list of specific actions which you agreed you would progress over the coming months. These are set out below: AMBULANCE TURNAROUND TIMES: I will raise the issues of delays in the turnaround times of ambulances at Accident & Emergency Departments with NHS Chairs, and you agreed to invite the Centre for Change and Innovation to look at this as part of their work on unscheduled care; RESPONSE TIMES: you will report to the Department by 31 December 2005 on progress toward the end of March 2006 milestone of responding to 63% of category A calls across mainland Scotland within 8 minutes, covering an action plan for any remedial action that may be required; ANDY KERR SUMMARY OF SCOTTISH AMBULANCE SERVICE ANNUAL REVIEW: 4 OCTOBER 2005 PARTNERSHIP FORUM The Minister recognised the culture of partnership that exists within the Ambulance Service. The process of having an Employee Director and two full-time Convenors clearly worked well. A variety of issues has been discussed with the Partnership Forum including absenteeism, health and safety and Agenda for Change. The Minister acknowledged the complexities the Ambulance Service was working through in relation to Agenda for Change and passed on his thanks to the management and workforce teams for progressing this task. It was the MInister s belief that the outcome for staff would be better rates of pay with the opportunity to develop their careers, resulting in better retention. CLINICAL ADVISERS The Minister indicated that his meeting with the Clinical Advisers had been very positive. There was an interesting discussion around how the Ambulance Service might look in the future. One of the Ambulance Service s paramedics attended this meeting and it was useful to hear from his point of view how his role was developing as a paramedic practitioner, and how vital the clinical support role was in assisting the Ambulance Service staff to carry out new functions.

22 40 41 SCOTTISH AMBULANCE SERVICE PROGRESS ON ACTION POINTS FROM THE ACCOUNTABILITY REVIEW LETTER 2004 All the points from the Accountability Review Letter 2004 had either been implemented, covered at the Partnership Forum or were on the agenda for the Annual Review. One of the issues which was causing some concern however was the continuing problems the Ambulance Service was experiencing at some Accident & Emergency (A&E) Departments where there were often delays in transferring a patient and freeing up the ambulance to take the next call. Whilst typically the time taken at A&E Departments was around 18.5 minutes, there were two NHS Board areas in particular where it could take more than 20 minutes to transfer a significant number of patients. The Minister agreed to raise the issue with NHS Chairs and the Chair agreed to invite the Centre for Change and Innovation to look at this as part of their work on unscheduled care. REVIEW OF OPERATIONAL PERFORMANCE The Ambulance Service continued to work towards the target of responding to 75% of Category A life-threatening calls within 8 minutes by March The milestone for this year (to end March 2006) is to respond to 63% of Category A calls within 8 minutes and the Chair confirmed that the Board took the response times performance very seriously. He pointed out that pre-hospital thrombolysis was one of the areas where the Ambulance Service could make a big difference this wasn t just about life saving but was actually about improving the quality of life of the patient too. Paramedics could authorise the use of these drugs in their own right the decision support was still there but it was not being used as often. Another change to the way in which the emergency service worked was the see and treat cases. These were patients with illnesses such as diabetes, asthma or epilepsy, where the paramedics could treat and stabilise them in their own homes without having to transfer them to hospital after treatment. There were several schemes in place across the country where paramedic practitioners were being trained to carry out other skills they learnt in hospital A&E departments, cardiac units and operating theatres and then carried out whilst they were on the road. In other areas, some paramedics were working in Minor Injuries Units, but could be used as a Rapid Response Unit if and when required. And the Chair confirmed that a business case for inter-hospital transfers were being developed which would provide for a different tier of ambulance transport. The Chair described the changes that were taking place around the transport of non-emergency patients where prioritisation was now taking place to ensure that the patients with the greatest clinical need received the highest priority for transport. Patients with cancer, mental health problems or requiring renal dialysis were among those who received the highest priority. Punctuality of this service was being addressed and the aim was to be arriving at 60% of appointments on time by the end of the year. The Service was also working on those patients who were being marked down as did not travel and there were initiatives running in Orkney, Lanarkshire and Perth & Kinross. The Chair confirmed that the service was also working with other partners, such as local authorities and voluntary organisations, on non-emergency transport. The Chair confirmed that the re-procurement of air ambulance services was a major and complex exercise for the Ambulance Service which had involved all its stakeholders and was going to cost 42 million over 7 years. However, this had given the Ambulance Service the opportunity to deal with infection control and health & safety issues. PARTNERSHIP WORKING The Chair indicated that the Ambulance Service was working well with its partners, especially the NHS area Boards, on a number of issues. These included the Ambulance Service s General Managers attending the area Boards service re-design committees and board meetings, and working with colleagues on out-of-hours services and with NHS 24. The Chair and Chief Executive also held annual meetings with the area Boards The Chair confirmed that the Ambulance Service was involved in the development of Boards winter plans as well as working on its own. And it was expected that as out-of-hours services developed across the country, area Boards would be looking towards the Ambulance Service more often to provide paramedic practitioners to help in the delivery of those services. HR ISSUES The Chair confirmed the progress the Ambulance Service was making against the Agenda for Change process. Costs were high but the service was dealing with that. The Minister encouraged the Ambulance Service to keep focussing on this and to keep in touch with the Department about the progress being made. In relation to on-call working, the Chair confirmed that the Ambulance Service had reduced its reliance on on-call and that the Project Board was looking at what else on-call paramedics could do to avoid skills atrophy and continue to deliver value for money. It was recognised that due to the demographic and geographic layout of Scotland, some stations would always have to work with on-call procedures. EFFICIENCY It was noted that the Ambulance Service is good at ensuring against excessive costs. The Chair indicated that work was going on to consider shared estates wherever possible, but also noted the need to support the can-do approach which is so prevalent in the Ambulance Service. FINANCE 10. The Chair highlighted that it was the Board s and the Management Team s view that it was vital for the organisation to stay within budget. He noted that the business case for a new radio system had been approved, along with the development of the Dumfries Ambulance Station. The service had also looked at the back office systems to ensure that they were running effectively and efficiently. The Minister confirmed that he was pleased with the efforts the Ambulance Service made to keep within budget which was very tightly controlled. THE KERR REPORT 11. The Chair updated the Minister on what the Ambulance Service was already doing in response to the implications of the Kerr Report. A number of areas were covered including the use of community paramedics to keep people out of hospital, first responder units, bringing care closer to the communities through the use of paramedic practitioners, work around the non-emergency transport service and a dedicated retrieval service. The Minister noted that the Ambulance Service was involved in a wider strategic planning across Scotland and it would play a central role in delivering the vision of the Kerr Report. An early win would be the out-of-hours services which were to include the paramedics with extended skills. It was agreed that it was important that the people of Scotland understood the role of the Ambulance Service in delivering Kerr and that the Service would flesh out the developments it was looking at so that they would be better understood. CONCLUSION 12. Mr Kerr indicated that the Ambulance Service had travelled a long way, but noted that there were further challenges ahead. He suggested that the Ambulance Service ethos of being swift, priority-based, informed and effective, matched his vision for the NHS as a whole, and congratulated all those involved in the excellent performance over the last year. The Minister highlighted the performance on Category A calls as being of prime importance, but also acknowledged the need for other Health Boards to address the difficulties being faced with regard to turn around times in A&E units. In particular Mr Kerr welcomed the work that the Ambulance Service is doing to address the care agenda and asked that he be kept updated on this work.

23 42 43 SCOTTISH AMBULANCE SERVICE OPERATING COST STATEMENT FOR THE YEAR ENDED 31 MARCH CLINICAL SERVICES COSTS Hospital and community 123, ,513 Less: Hospital and community income (4,238) (6,326) TOTAL CLINICAL SERVICES COSTS 119, ,187 Administration costs 1,513 1,591 Less: Hospital and community income (436) (194) 1,077 1,397 Other Non clinical services 1, Less: Other operating income (778) (884) 374 (142) NET OPERATING COSTS 120, ,442 SUMMARY OF REVENUE RESOURCE OUTTURN Net resource outturn 120, ,442 Revenue resource limit 120, ,492 SAVING AGAINST REVENUE RESOURCE LIMIT MEMORANDUM FOR IN YEAR OUTTURN Brought forward surplus from previous financial year (5) (22) Saving against in year revenue resource limit Adopted by the board on 29 June 2005 PAULINE MOORE Director of Finance ADRIAN LUCAS Chief Executive BALANCE SHEET FOR THE YEAR ENDED 31 MARCH FIXED ASSETS Intangible fixed assets 1,669 1,324 Tangible fixed assets 76,653 77,973 TOTAL FIXED ASSETS 78,322 79,297 CURRENT ASSETS Stocks 17 1 Debtors 6,608 7,065 Cash at bank and in hand ,689 7,127 CURRENT LIABILITIES Creditors due within one year (10,594) (12,837) Net current liabilities (3,905) (5,710) Total assets less current liabilities 74,417 73,587 Creditors due after more than one year 15,928 11,186 Provisions for liabilities and charges 2,213 11,884 18,141 23,070 TOTAL NET ASSETS 56,276 50,517 FINANCED BY: General fund 43,956 37,547 Revaluation reserve 12,208 12,888 Donated asset reserve ,276 50,517

24 44 45 SCOTTISH AMBULANCE SERVICE REGISTER OF INTERESTS NAME/ REMUNERATION RELATED CONTRACTS POSITION UNDERTAKINGS WILLIAM BRACKENRIDGE Scottish Ambulance Service; Non Executive None None Chairman Director Highlands & Islands Airport Ltd. CiPFA occasional sub-contractor CHRISTINE HUMPHRIES Scottish Social Services Council Due Regard None None Non Executive Director Member Registration and Conduct Committee Allowance plus expenses; Scottish Ambulance Service ALICE LAMBERT Member of Committee on the Medical Effects None None Non Executive Director of Air Pollutants; Member of West Regional Board of Scottish Environmental Protection Agency; Self employed Shellfish & Environmental Issues Consultant; Self-catering accommodation business ALAN LAWTON Scottish Ambulance Service None None Non Executive Director IAIN MCMILLAN, CBE Scottish Ambulance Service; Confederation None None Non Executive Director of British Industry business representative organisation; Scottish Qualifications Authority DOUGLAS MARR Scottish Ambulance Service None None Non Executive Director NORMAN MURRAY Scottish Ambulance Service; None None Non Executive Director Leader of East Lothian Council JIM ROYAN, OBE Scottish Ambulance Service; None None Non Executive Director NHS Grampian (Chairman); Royan s of Elgin HOUSES, LAND SHARES NON FINANCIAL VOLUNTARY/ RELATIVE(S) IN AND BUILDINGS AND SECURITIES INTERESTS CHARITY WORK THE SERVICE None None Community Councillor None None Helensburgh Community Council None None Member British Association Member of Scottish Borders None of Social Workers Valuation Appeal Committee None None Mull representative of Scottish Wildlife Occasional lay reviewer with None Trust; Convenor of Mull & Iona Waste Quality Improvement Scotland Watchers; Membership Secretary of Progressive Care Trust None None None None None None None None Board member Scottish North None American Business Council None None None Chair Fundraising Committee None and Threipmuir Investment Club (Rotary Club Currie & Balerno) None None None None None None None None Rotary Club; Robert Gordon None University Governor

25 46 47 SCOTTISH AMBULANCE SERVICE REGISTER OF INTERESTS NAME/ REMUNERATION RELATED CONTRACTS POSITION UNDERTAKINGS ALAN BICKERSTAFF Scottish Ambulance Service None None Employee Director/ State Registered Paramedic ADRIAN LUCAS Scottish Ambulance Service None None Chief Executive ANDREW MARSDEN Scottish Ambulance Service Officer of Faculty of None Consultant Medical Director Prehospital Care of Royal College of Surgeons; Member of Panel of Examiners in Diploma of Immediate Care RCSEd PAULINE MOORE Scottish Ambulance Service None None Director of Finance SHIRLEY ROGERS Scottish Ambulance Service None None Director of Human Resources MARY NEWMAN Scottish Ambulance Service None None (from 30/08/04) Director of Operations PHIL SPENCE Scottish Ambulance Service None None (to 13/06/04) Director of Operations HOUSES, LAND SHARES NON FINANCIAL VOLUNTARY/ RELATIVE(S) IN AND BUILDINGS AND SECURITIES INTERESTS CHARITY WORK THE SERVICE None None None None None None None None None None None None None None None None None None None None None None None None None None None Chairman British Sub-Aqua Club None None (South Queensferry Branch) None None Non paid general manager of Duffnote None None Records Ltd

26 COMMITTEES AND CURRENT MEMBERSHIP AUDIT COMMITTEE The Audit Committee comprises three Non-Executive Directors, Mr Iain McMillan, CBE (Chair), Mr Alan Lawton and Mr Doug Marr. It meets four times per year to consider the various reports from both internal and external Auditors to assess the risks which may exist in the Service. STAFF GOVERNANCE AND REMUNERATION COMMITTEE The Staff Governance and Remuneration Committee comprises four Non-Executive Directors, Mrs Alice Lambert, Mr Iain McMillan, CBE, Mr Norman Murray, and Mr Jim Royan, OBE. The Committee is chaired by the Chairman, Mr William Brackenridge. It meets at least three times per year to consider the evaluation of senior posts and pay awards for Executives. The Staff Governance Committee is chaired by Mr Alan Bickerstaff. SERVICE REDESIGN COMMITTEE The Service Redesign Committee includes two Non-Executive Directors, Mr Doug Marr and Mrs Christine Humphries, among its membership. The Committee is chaired by the Chief Executive, Mr Adrian Lucas. It meets four times per year to consider the delivery of national change and innovation and Service redesign targets set by Ministers, co-ordinate the various components of the Service s Modernisation Programme, develop a change and innovation plan and monitor its implementation. This is done to ensure that the criteria for change and innovation set out in Partnership for Care are complied with. 48 SCOTTISH AMBULANCE SERVICE CLINICAL GOVERNANCE COMMITTEE The Clinical Governance Committee comprises three Non-Executive Directors, Mr Alan Lawton (Chair), Mrs Christine Humphries and Mr Jim Royan, OBE. Dr Tom Beattie, a Consultant in Accident and Emergency Medicine of the Royal Hospital for Sick Children, Edinburgh is also a member along with Mr David Nelson who is the Public/Patient Representative. The Committee meets approximately four times per year to monitor standards of care and measure the effectiveness of pre-hospital treatment.

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