Scottish Ambulance Service Annual Report and Accounts 2013 / 14

Scottish Ambulance Service Annual Report and Accounts 2013 / 14

All patients used in this publication for photography purposes are models. Contents

Chair and Chief Executive Statement Welcome to the 2013/14 Annual Report for the Scottish Ambulance Service, in which we review our performance and highlight a number of improvements we have made over the course of the last year. We undertook extensive planning and preparation for the 2014 Commonwealth Games in Glasgow to provide the best patient care for the spectators, competitors and the Commonwealth family during the Games. This was a highly successful operation and during this intensely active period we were able to maintain our normal standards of service to the public throughout Scotland. In order to continually improve services for patients we have acted on their feedback. On a daily basis, the Service receives feedback, comments, concerns and complaints by letter, phone, email, text or via social media channels such as Facebook, Twitter, Patient Opinion or our eportal: your.scottishambulance.com. We use this feedback to make improvements to our services, such as changes to how we respond to certain diseases, or changes to equipment and training. Everyone at the Scottish Ambulance Service is committed to bringing our vision to life: to deliver the best patient care to the people of Scotland when and where they need us. of this would be possible without the commitment, professionalism and desire of our staff to do their best for patients and we would like to acknowledge their efforts throughout the year. David Garbutt - Chair Pauline Howie - Chief Executive Our strategic framework Working Together for Better Patient Care 2010-2015 was published in January 2010. The strategy set out an ambitious programme of development and quality improvement which has guided our service developments since 2010. In 2013/14 we specifically aimed to improve access and outcomes for patients, improve punctuality for Patient Transport patients, further develop our staff and deliver value for money. These aims were achieved, despite continued increases in emergency and unscheduled care demand, increasing costs and pressures on public finances. Our successful progress has been enhanced by the valuable contribution made by our stakeholders, partners and, in particular, by extensive patient engagement throughout the design and delivery of changes. Turning to our performance during 2013/14, we are able to report that we maintained average response time to Category A immediately life threatening incidents at 6.5 minutes and, despite a 9.7% increase in Category A demand, reached 73.9% of these calls within 8 minutes across Scotland. Following significant investment in our Ambulance Control Centres the average time to answer a 999 call reduced to 3 seconds. We significantly improved punctuality for patient appointments by the Patient Transport Service up from 52.1% in 2012/13 to 71.4% in 2013/14. Punctuality for conveying patients home after appointments also improved in 2013/14, to 78% compared to 73% in 2012/13. There is good evidence that getting patients to the correct stroke facilities quickly improves outcomes and last year over 2,172 patients benefited from this. At the end of the year we also launched ScotSTAR, the specialist retrieval service for Scotland bringing together specialist neonatal, paediatric, trauma teams and the Emergency Medical Retrieval Service (EMRS) co-ordinated by the Scottish Ambulance Service. We established our Developing Future Leaders and Managers (DFLM) programme to build capacity and strengthen clinical leadership across the organisation. We also continued to develop a cohort of staff through the Scottish Ambulance Service National Quality Improvement Collaborative, building capacity and capability within the Service for continuous quality improvement and driving forward service innovation, improvement and patient safety. During 2013/14, the Service reviewed its strategy in response to the Scottish Government s 2020 Vision. We have engaged widely with our stakeholders, internally and externally, to develop our clinical and workforce models to support the transition required by the 2020 Vision and ensure we have the right skills and response in place. The Vision requires the Service to work collaboratively and innovatively and we have now developed a new strategic framework Towards 2020; Taking Care to the Patient. This describes the role the Scottish Ambulance Service can play within an integrated health and social care system focused on delivering high quality, person-centred, clinical care. 03 02 Scottish Ambulance Service Annual Report and Accounts 2013/14 03

Our Services At the frontline of the NHS in Scotland, the Scottish Ambulance Service currently provides an emergency, unscheduled and planned service to more than five million people across Scotland and its island communities. The Service employs over 4,400 highly skilled staff and, together with over 1,200 volunteers, responds to over 686,000 emergency and urgent incidents a year, undertakes 1.1 million patient transport journeys and flies over 3,400 air ambulance missions. quickly and with the right skills for each patient. We are saving more lives than ever before, responding to calls faster and continuously improving the quality of patient care. We have continued to develop our skills, our systems and our staff through investment in enhanced training, in leading-edge technology and providing the tools they need to do their job effectively. Our frontline Accident and Emergency staff provide life-saving emergency medical care and having assessed the medical needs of the patient, may take patients to hospital, treat them at scene or refer them to an appropriate clinic or service. In 2013/14, we continued to work with NHS Boards to reduce avoidable attendance at Accident and Emergency. We treated 77,399 patients at scene, which was 16.2% of all emergency incidents attended. This was enabled through further investment in clinical leadership, professionalto-professional decision support systems and increasing the number of Clinical Advisors available 24/7 across the three Ambulance Control Centres. We also continued to develop a number of pathways to route patients more effectively to definitive care. These include care pathways for frail and elderly patients who have fallen, which account for a significant number of calls to the Ambulance Service, and we continued to work in partnership with health, social care and voluntary organisations to support patients receiving care in the community, and at home, more effectively. Key achievements in the year included: We developed clinical decision support arrangements for ambulance staff to help refer patients to the most appropriate services. We have supported the establishment of more Community First Responder Schemes than ever before and are working with local communities to ensure Public Access Defibrillators are identified and maintained. Patient Transport Service Scheduled care is a planned appointment service and has a role to play in ensuring patients who need our clinical skills get to and from their appointments. Last year, the Patient Transport Service undertook 1,140,048 patient journeys across Scotland. Our primary responsibility is to provide a service for patients with a medical care need or with limited mobility. The Service also transfers patients between hospitals and takes them home upon discharge, following surgery for example. The service is delivered by specially trained Ambulance Care Assistants who are able to provide this service to patients with more complex needs. We have three Ambulance Control Centres based in Glasgow, Edinburgh and Inverness, which handle in excess of 1.8 million calls for help each year. These range from life-threatening cardiac arrests requiring immediate response, to requests from our NHS partners to transfer patients to or between hospitals, or requests directly from patients requiring ambulance transport to hospital appointments. As a Special Health Board, the Scottish Ambulance Service is a national operation based at over 150 locations in five operational Divisions across Scotland. As such, we continue to cover the largest geographic area of any ambulance service in the UK. Accident and Emergency Care We respond to 999 calls from the public and healthcare partners such as General Practitioners (GPs), in addition to requests for an urgent response by clinicians. The Scottish Ambulance Service delivers Accident and Emergency care to patients the length and breadth of the country. This care is delivered by specially trained staff who, last year, responded to 686,530 emergency and urgent incidents across Scotland. 999 calls are handled by one of three Ambulance Control Centres which are co-located with NHS24 and NHS Boards Out of Hours GP services teams. Calls are prioritised to ensure we respond Improving survival rates for patients who have suffered cardiac arrest. The BMJ award winning Rapid Resuscitation Response Unit (3RU) programme is now being rolled out to other parts of Scotland. In partnership with NHS Boards, we progressed implementation of a national framework and care pathways for elderly patients who have fallen in partnership across 23 Community Health and Care Partnership areas. This means more patients are able to be cared for in their own homes, rather than in a hospital setting. 04 Scottish Ambulance Service Annual Report and Accounts 2013/14 05

In 2013/14, we progressed the development of integrated transport models, working with NHS Boards, such as Lothian, to support the development of a hospital discharge and transfer hub, and with regional transport partnerships, local authorities and community transport providers to signpost patients who do not require an ambulance to have an appropriate alternative provider. Ambulance Control Centres In 2013/14 significant investment was made in our Ambulance Control Centres to develop a single computer aided dispatch system and improvements in telephone answering for 999 calls, 24/7 operational management and more effective operational management of cross boundary incidents. In the year, our Ambulance Control Centres received 1.8 million calls. 418,311 were 999 calls, approximately 470,000 were GP or other agency calls and 677,661 were Patient Transport Service requests. Air Ambulance The Air Ambulance Service provides an emergency response and a vital hospital transfer service across Scotland, not least for remote, rural and island communities. All of our aircraft operate with Scottish Ambulance Service Paramedics on board and flew 3,427 missions in 2013/14. The Air Ambulance fleet comprises two helicopters and two fixed wing planes, all of which have been purpose built to our specifications. In addition, we work closely with Scotland s Charity Air Ambulance (SCAA) to provide a long-term sustainable and scalable air ambulance capability complementing our other resources across Scotland. SCAA is dispatched by the Scottish Ambulance Service and operates alongside our helicopters and planes to enable an emergency response to be made to more 999 calls. Our helicopters are based in Glasgow and Inverness - responding to emergency calls and requests from remote, rural or island clinicians to provide medical care and transport to mainland health care facilities. Our planes are based in Aberdeen and Glasgow responding to medical requests to transfer patients between hospitals. In 2015 our two helicopters will be replaced with two new EC145T2 helicopters. These will enhance the quality of patient care by: Improving coverage of Scotland within 60 minutes Providing clinicians more space and access to patients Enhancing support for the Specialist Retrieval Services, through more space for personnel and equipment Increasing opportunities for parents and carers to travel with patients Reducing the need for refuelling stops. 06 Scottish Ambulance Service Annual Report and Accounts 2013/14 07

HEAT * Summary * ( Health, Efficiency, Access, Treatment) Clinical: Over the year, we have continued to develop the clinical skills of staff and clinical governance arrangements. In particular, we have focused on improving survival from cardiac arrest, stroke management and infection control. 2013-14 outturn Achieve between 12-20% of eligible cardiac arrest patients with Return of Spontaneous Circulation (ROSC) on arrival at hospital. Achieve a return of spontaneous circulation for 20% of VF/VT patients on arrival at hospital. 17.3% 32.5% Reach 91% of 1 hour GP urgent calls within time agreed. 88.4% Answer 90% of 999 telephone calls within 10 seconds. 88.1% Patient Transport Service: Based on feedback from patients and carers, we have undertaken significant development of patient transport services and throughout the year we have improved performance against key measures. We are confident these will show further improvement in coming months. Treat 17% of emergency incidents at scene. 16.2% Ensure 75% of all PTS Patients arrive at hospital before their appointment time. 71.4% Convey 80% of hyper acute stroke patients to hospital within 60 minutes of receipt of call at SAS. 78.8% Ensure 90% of all PTS Patients are picked up within 30 minutes of agreed time after appointment. 78.0% Achieve 67% recorded use of PVC insertion care bundle. 72.5% Ensure that no more than 0.5% of booked PTS journeys are cancelled by SAS. 0.5% Emergency: As we know, Scotland s population is ageing and many more people are living longer with multiple chronic conditions. These factors are driving a significant increase in demand for our unscheduled care services and, despite this, we have continued to reach the most seriously ill patients, in an average of 6.5 minutes across Scotland. Reach 80% of cardiac arrest patients within 8 minutes (mainland). 77.1% Answer 80% of PTS telephone calls within 60 seconds. 68.5% Organisational: There are three specific financial targets which have all been achieved, despite the significant increase in demand for the services and cost pressures. We are disappointed that sickness absence remained above target and have subsequently organised new Occupational Health Service arrangements and support for staff. Reach 75% of Category A (life-threatening) emergency incidents within 8 minutes. 73.9% NHS Boards to operate within their agreed revenue resource limit; operate within their capital resource limit; meet their cash requirement. Target Met Reach 95% of Category B (serious but not life-threatening) incidents within 19 minutes. 91.3% Achieve sickness absence rate of less than 5% for full year continuing direction of progress towards the national HEAT Standard of 4%. 6.1% 08 Scottish Ambulance Service Annual Report and Accounts 2013/14 09

Committee Membership 2013/14 The Clinical Governance Committee comprised four Non-Executive Directors: Ms Theresa Houston (Chair), Ms Neelam Bakshi, Mr Andrew Richmond, Mr Martin Togneri and Mr David Garbutt (ex officio member). Mr Martin Togneri joined the Committee on 1 January 2014 to replace Ms Theresa Houston who was appointed Audit Committee The Audit Committee comprised four Non- Executive Directors: Mr Edward Frizzell (Chair); Ms Moi Ali; Mr Andrew Richmond and Councillor David Alexander. The Audit Committee met four times during the year to consider the various reports from both internal and external auditors to assess the risks and internal controls in the Service. as Chair. Mr David Nelson is the Public/ Patient Representative. The Committee met four times during the year to monitor standards of care and measure the effectiveness of pre hospital treatment. Staff Governance Committee The Staff Governance Committee comprised four Non-Executive Directors: Ms Neelam Bakshi (Chair), Mr Alan Bickerstaff, Ms Moi Ali, Councillor David Alexander and Mr David Garbutt (ex officio member). From November 2013, Neelam Bakshi took up position as chair of the committee, replacing Matt Bell, Employee Director. Alan Bickerstaff joined the committee as vice-chair on 6 January 2014 following his appointment as Employee Director. The Committee met four times during the year to ensure effective monitoring of staff governance within the organisation. Remuneration Committee The Remuneration Committee comprised Mr David Garbutt (Chair) and four Non-Executive Directors: Mr Alan Bickerstaff, Mr Edward Frizzell and Councillor David Alexander. Mr Martin Togneri replaced Suzanne Dawson from 1 January 2014. It met twice during the year to consider the evaluation of performance and pay awards for Executive Directors. The Committee has an important role in ensuring consistency of policy and equity of treatment of staff across the local NHS system, including remuneration issues, where they are not already covered by existing arrangements at national level. 10 Scottish Ambulance Service Annual Report and Accounts 2013/14 11

Our Activity Health Board PTS Journeys* A&E Incidents Air Ambulance Missions Category A Average Response Time (mins) All 999 Incidents Average Response Time (mins) Ayrshire & Arran 111,471 52,756 107 6.4 8.7 Borders 35,041 13,907 2 7.6 9.8 Dumfries & Galloway 41,831 17,921 34 7.0 9.2 Fife 106,506 44,425 0 6.2 8.1 Forth Valley 74,005 32,264 0 7.0 9.6 Grampian 76,407 61,623 199 7.2 8.9 Greater Glasgow & Clyde 285,580 168,961 685 6.0 8.5 Highland 65,223 43,516 1,165 7.6 9.5 Lanarkshire 124,266 71,597 1 6.3 8.4 Lothian 124,139 101,714 41 6.2 9.0 Orkney 845 2,411 438 8.1 10.6 Shetland 526 1,949 300 10.0 11.9 Top 10 Chief Conditions All Emergency Incidents Transfer / Interfacility / Palliative Care 119,788 Unconscious / Fainting 37,226 Breathing Problems 31,522 Overdose / Poisoning 24,347 Haemhorrage / Laceration 13,361 Falls 65,637 Chest Pains 36,671 Sick Person 29,302 Convulsions / Fitting 22,196 Assaults 13,176 Top 10 Chief Conditions Category A Incidents Chest Pains Unconscious / Fainting 35,886 23,957 Breathing Problems Haemhorrage / Laceration Cardiac / Respiratory Arrest 6,211 4,591 Transfer / Interfacility / Palliative Care 23,288 11,333 Convulsions / Fitting 10,882 Heart Problems / AICD Falls 9,098 Overdose / Poisoning 3,957 2,656 Tayside 92,090 48,176 10 6.3 8.5 Western Isles 2,104 4,124 441 9.1 10.1 Scotland 1,140,048 686,530 3,427 6.5 8.8 *The number of PTS Journeys differs from the number quoted in the 2013/14 Annual Review due to the retrospective entry of volunteer car driver journeys. Staff Numbers (Full Time Equivalents) Paramedics 1355.2 Technicians 1128.1 PTS staff 856 Ambulance Control staff 342 Administrative services staff 364.4 Support services staff 118.3 Other staff 68.1 Total number of staff 4232.1 12 Scottish Ambulance Service Annual Report and Accounts 2013/14 13

Financial Performance For year end 31 March 2014 Net Expenditure Statement Summary of Core Revenue Resource Outturn 2014 2013 2014 2013 Clinical Service Costs Hospital and Community Less: Hospital and Community Income 216,838 6,961 214,041 6,096 Net Operating Costs Total Non Core Expenditure (see below) Donated Assets Income 215,303 (15,889) 103 212,032 (14,311) 0 209,877 207,945 Total Clinical Services Costs 209,877 207,945 Total Core Expenditure Core Revenue Resource Limit 199,517 199,558 Saving / (Excess) against Core Revenue Resource Limit 41 32 197,721 197,753 Administration Costs 1,761 1,739 1,761 1,739 Summary of Non Core Revenue Resource Outturn Other Non Clinical Services Less: Other Operating Income 5,859 (2,194) 3,523 1,175 Capital Grants to / (from) Other Bodies 2014 0 2013 0 Other Comprehensive Net Expenditure 3,665 2,348 Net Operating Costs 215,303 212,032 Depreciation / Amortisation Annually Managed Expenditure - Impairments Annually Managed Expenditure - Creation of Provisions Annually Managed Expenditure - Depreciation of Donated Assets Additional SGHSCD non-core funding Total Non Core Expenditure 12,483 271 2,054 46 1,035 15,889 12,794 852 665 0 0 14,311 2014 2013 Net (gain) / loss on revaluation of Property Plant and Equipment (558) (153) Non Core Revenue Resource Limit 15,935 14,311 Saving/(Excess) against Core Revenue Resource Limit 46 0 Net (gain) / loss on revaluation of Intangibles 0 0 Net (gain) / loss on revaluation of available for sales financial assets 0 0 Other Comprehensive Expenditure (558) (153) Summary Resource Outturn Resource Expenditure Saving / (Excess) Core 199,558 199,517 41 32 2013 Saving / (Excess) Non Core 15,935 15,889 46 0 Total Comprehensive Expenditure 214,745 211,879 Total 215,493 215,406 87 32 14 Scottish Ambulance Service Annual Report and Accounts 2013/14 15

Balance Sheet 2014 2013 Total non-current assets Total current assets 92,967 18,441 92,140 16,456 Total assets 111,408 108,596 Capital Investment Total current liabilities (17,758) (14,962) Non-current assets plus/less net current assets/liabilities 93,634 93,650 Provisions Financial liabilities: Trade and other payables (6,581) 0 (4,912) Total non-current liabilities (6,581) (4,912) Assets less liabilities 87,069 88,722 Taxpayers equity General fund Revaluation reserve 81,879 5,190 0 83,990 4,732 Capital expenditure during the year was 14 million. This was made up of 10.3m for vehicles, 2.4m for property, 0.2m for medical and related equipment, and 1.1m for IT equipment. Total taxpayers equity 87,069 88,722 Summary of Capital Outturn 2014 2013 Total Capital Expenditure 13,956 17,146 Total Capital Resource Limit 13,959 17,150 Saving/(Excess) against Total Capital Resource Limit 3 4 The Scottish Ambulance Service contained its costs within the revenue and capital resource limits set by Scottish Government for the financial year ending 31 March 2014. The table below indicates the financial performance against each target. Revenue resource limit Core Revenue resource limit Non Core (1) Limit as set by SGHD 000 (2) Actual Outturn 000 199,558 199,517 41 15,935 15,889 46 Capital resource limit 13,959 13,956 3 Cash requirement 214,000 213,187 813 (3) Variance (over) / under (1)-(2) 000 Major projects included: An ongoing programme of replacing our existing Accident and Emergency vehicles with updated vehicles fully equipped to deliver modern mobile healthcare - including meeting the demands of the 2014 Commonwealth Games Completing a new purpose built station at Prestonpans The refurbishment of Blairgowrie station Partial completion of a project to build a new station in the grounds of Borders General Hospital at Galashiels Investment in the technological infrastructure required to support the delivery and development of our services into the future. 16 Scottish Ambulance Service Annual Report and Accounts 2013/14 17

Working Across the Service for Improvement Review of Complaints and Concerns The Service reviewed complaints and developed specific arrangements to make improvements which will enhance the management of complaints and further support learning from the patient experience. Feedback and Complaints about Scheduled Care The top five concerns and complaints in relation to Patient Transport Service were: 1. Delay in returning home 26% 2. Staff attitude and behaviour 15% 3. Delay in travelling to hospital 10% 4. Cancellations 8% 5. - Vehicle suitability 6% The remaining 23% of complaints and concerns about the Patient Transport Service relate to a range of issues, including: hospital/gp booking arrangements, lack of communication, or the patient s escort not being booked. Feedback and Complaints about Unscheduled Care The top five themes in relation to complaints and concerns in Unscheduled Care were: 1. Staff attitude and behaviour 38% 2. Clinical assessment 24% 3. Accident and emergency resource/ Operational cover 12% 4. Driving standards 10% 5. Lack of communication 5% Total 89% Feedback - Promoting Learning and Improvement - Missed appointments 6% - Eligibility 6% Total 77% Encouraging Feedback and Complaints The Scottish Ambulance Service has continued to encourage feedback from patients and carers, and to make providing feedback as accessible as possible. Feedback was received via a range of channels, including social media. In line with the ongoing activity to encourage feedback on care experiences, the total number of complaints and concerns received by the Service increased by 3% on the previous year: from 839 (412 complaints and 427 concerns) to 866 (471 complaints and 395 concerns). This is within the context of 2 million patient contacts each year. In line with Scottish Public Services Ombudsman guidance on complaints handling, the Service aims to resolve more issues early, at the frontline, ensuring apologies are given freely and action taken where things go wrong. Scottish Public Services Ombudsman In 2013/2014, the Scottish Public Services Ombudsman published one Investigation Report and five Decision Reports about the Scottish Ambulance Service. This compares to one Investigation Report and eight Decision Reports in the previous year. 18 Scottish Ambulance Service Annual Report and Accounts 2013/14 19

The remaining 11% of complaints and concerns were in relation to a wide range of issues, including: questions about the choice of hospital the patient was taken to (3%) and where the patient has been walked to or from an ambulance (3%). A number of programmes are in place to build a person-centred culture, thereby improving staff attitude and behaviour towards patients and their carers. This includes the development of a personcentred session for cohorts of Team Leader and Area Service Manager staff who are undertaking the Service s Delivering Future Leaders and Managers development programme, as well as the development of a human factors programme which looks at how we can improve team working, communications and behaviour to promote safe, effective, person-centred care. Triage Complaint I explained that my daughter has a chronic condition and that the severity of pain she was experiencing was abnormal and never experienced before. Yet, my request was refused by the operator who deemed my daughter s condition as not an emergency. Response: The Service apologised to the complainant and recognised that patient feedback had highlighted that triage of abdominal pain could be improved, driving a change of practice in our Ambulance Control Centres to help improve patient safety. 20 Scottish Ambulance Service Annual Report and Accounts 2013/14 22 21

Board Members and Positions Name Position Remuneration Related Undertakings Contracts Houses, Land & Buildings Shares & Securities Non Financial Interests Voluntary/ Charity Work Relative(s) in Scottish Ambulance Service David Garbutt Chair Scottish Ambulance Service Self Employed Consultant Chartered Fellow of Chartered Institute of Personnel and Development Fellow, Scottish Police College Visiting Fellow Australian Institute of Police Management MacMillan Cancer Support Volunteer Member Tweed Valley Bike Patrol Associate Member College of Paramedics Pauline Howie Chief Executive David Alexander Non Executive Director Scottish Ambulance Service Falkirk Council Elected Member Vice Chair, Fife and Forth Valley Criminal Justice Authority Member and local Office Bearer Scottish National Party Member C.N.D Scotland Moi Ali Non-Executive Director Scottish Ambulance Service Education Scotland Judicial Complaints Reviewer Self Employed Consultant Non Executive Director, Scottish Police Authority Fellow, RSA Governor, Napier University Public Appointments Ambassador Cabinet Office Member Project Delivery Sub Committee Govan Law Centre Education Law Unit Non Executive member of Education Scotland s management board Member, Council of the Postal Redress Service Neelam Bakshi Non-Executive Director Scottish Ambulance Service NB Associates-owner Scottish Government, Non-Executive Member Lay Member Employment Tribunals Scotland Reserve Forces Tribunal & Lay Race Equality Assessor to Judiciary Member Scotland Committee of Equality & Human Rights Commission Member Chartered Institute of Personnel & Development (Affiliate) Federation of Small Businesses; Co-operative Society National Autistic Society Royal Horticultural Society; Member BBC Audience Council Scotland Approved Training Institute American Board NLP 22 Scottish Ambulance Service Annual Report and Accounts 2013/14 23

Board Members and Positions (cont) Name Position Remuneration Related Undertakings Contracts Houses, Land & Buildings Shares & Securities Non Financial Interests Voluntary/ Charity Work Relative(s) in Scottish Ambulance Service Matt Bell Alan Bickerstaff Employee Director (to 05.01.14) Employee Director (from 06.01.14) Scottish Ambulance Service Scottish Ambulance Service Professor George Crooks Medical Director (to 17.01.14) Scottish Ambulance Service Medical Director, NHS24 Suzanne Dawson Non-Executive Director (to 30.11.13) Scottish Ambulance Service Self employed marketing consultant Fellow of Chartered Institute of Marketing Lay member of the Council of the Law Society of Scotland Member of the Board of Newbattle Abbey College Edward Frizzell Non-Executive Director Scottish Ambulance Service Chair of Court of Abertay University, Dundee Chair of Trefoil Visiting Professor, Queen Margaret University, Edinburgh Theresa Houston Non-Executive Director Scottish Ambulance Service Andrew Richmond Non Executive Director and Deputy Chair Scottish Ambulance Service Non Executive Chair of Frontier IP Group PLC Associate of Society of Investment Professionals (ASIP) Member of Church of Scotland Trustee, Scotland s Charity Air Ambulance Lay Court Member of the University of Dundee Trustee of the University of Dundee Superannuation and Life Assurance Scheme Martin Togneri Non Executive Director (from 01.01.14) Scottish Ambulance Service Board member, Cogbooks Ltd, Edinburgh Board member, Scottish Fire and Rescue Services Owns 1.1% of the issued share capital of CogBooks Ltd, Edinburgh Trustee of the Scottish Waterways Trust, New Port Downie, Lime Road, Falkirk, FK1 4RS Pamela Mclauchlan Director of Finance and Logistics Scottish Ambulance Service Executive Member CIPFA in Scotland Non-Executive Member of the Audit Committee of the National Theatre for Scotland Cub Scout Leader, Church of Scotland Elder South Queensferry First Responder 24 Scottish Ambulance Service Annual Report and Accounts 2013/14 25

Key Action Points Continue to develop channels and mechanisms for the learning and changes to be implemented as a result of patient and staff feedback to be publicised more widely to the public Letter from the Cabinet Secretary for Health & Wellbeing Submit to the Scottish Government, by the end October 2014, proposals for a suite of performance targets and quality indicators that not only build on the existing Local Delivery Plan targets but present a more holistic view of the role and contribution of the Scottish Ambulance Service to high quality patient care and the best possible clinical outcomes Ensure your active engagement in the delivery of the National Unscheduled Care Action Plan and contribute fully to the structures that underpin its delivery Continue to review, update and maintain robust arrangements for the prevention and control of Healthcare Associated Infection and ensure sustainable progress is made against requirements and recommendations in HEI report Maintain a strong focus on the delivery of effective partnership structures and cultures across the organisation, particularly in the development and implementation of your refreshed strategic framework Maintain focus on reducing absence levels across the organisation, working towards the NHS HEAT Standard of 4% Continue to achieve in-year and recurring financial balance, and keep the Health Directorates informed of progress in implementing your local efficiency programme. 26 Scottish Ambulance Service Annual Report and Accounts 2013/14 27

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