SCOTTISH AMBULANCE SERVICE LOCAL DELIVERY PLAN

SCOTTISH AMBULANCE SERVICE 2014-15 LOCAL DELIVERY PLAN Scottish Ambulance Service National Headquarters Gyle Square 1 South Gyle Crescent Edinburgh EH12 9EB 14 March 2014 1

List of Contents Section 1: Introduction to Local Delivery Plan 2014/15 Section 2: Improvement & Co-production Plan Priorities for 2014/15; Workforce; Patient safety; Person-centred care; Transforming patient care; Integration; Innovation Section 3: SAS contribution to community planning Section 4: HEAT measurement framework Section 5: Financial Plan Financial trajectories 2

Scottish Ambulance Service Section 1: Introduction to Local Delivery Plan 2014/15 1.1 Introduction This Local Delivery Plan (LDP) sets out the key objectives for the Scottish Ambulance Service for 2014/15 and outlines our key performance indicators through a suite of HEAT targets. The focus of the LDP this year has shifted towards longer-term planning aligned to the delivery of the Scottish Government s 2020 Vision. The LDP is designed to: Demonstrate the contribution that SAS will make to the delivery of the 2020 Vision and NHS Quality Strategy; Demonstrate how SAS will take forward its contribution to the 2020 Workforce Vision Everyone Matters ; Set out clearly the level of service SAS will provide and any associated measures of quality and performance; Clearly set out to the SAS Board, managers and staff the objectives and priorities for the Service as a Corporate Plan for 2014/15; Ensure robust governance and monitoring arrangements are in place. The LDP for 2014/15 incorporates our Improvement and Co-Production Plan, setting out the Service s key objectives and priorities in supporting delivery of the 2020 Route Map. The LDP ensures alignment across all SAS plans and will act as a Corporate Plan for the service in 2014/15. In addition, the LDP will reflect the commitments set out in the SAS Local Unscheduled Care Action Plan and align to the development of the Service s 2020 Strategic Workforce Plan. There is also recognition that the Service continues to maintain its capability to plan and respond to emergencies in keeping with our statutory duties as defined in the Civil Contingencies Act 2004 (Contingency Planning) (Scotland) Regulations 2005. In pursuit of the national quality ambitions for safe, effective and person centred care, the Scottish Ambulance Service aims to continue to develop our service to: improve access to healthcare; support the shift in the balance of care by taking more care to patients; enhance our clinical skills and take care to the patient as a key and integral partner within primary and secondary care teams; build and strengthen community resilience: expand our diagnostic capability and use of technology to improve patient care and; develop a more flexible, responsive and integrated scheduled patient transport service. This LDP sets out the Scottish Ambulance Service s proposed contribution to the Route Map towards delivery of the 2020 vision and builds on our 2010 2015 strategy Working Together for Better Patient Care. Working towards this 2020 vision requires transformational change across all aspects of health and social care. The Scottish Ambulance Service appreciates that we will need to adapt in order to take more care to the patient. 3

However, when patients do require their care and treatment to be delivered within an acute hospital setting, we need to be able to respond to new models of care and demand patterns to support the whole system to manage patient flow. There are some core principles which underpin our intentions going forward: We will strive to deliver person-centred care and to develop in partnership alternative care pathways which reflect Scotland s commitment to delivering more care closer to home. The overarching principle is to improve outcomes and patient experience ensuring those pathways direct patients towards the most appropriate definitive care first time and prevent avoidable hospital attendances and admissions; As a 24/7 mobile healthcare provider, we aim to enhance our contribution to wider NHS as part of an integrated health and social care service, delivering the highest quality of clinical emergency, unscheduled and scheduled care for patients; We will strive to improve safety and effectiveness and to support our staff with clinical assessment and decision-making for those patients with complex, long-term conditions and multi-morbidities, through access to enhanced senior clinical decision-support and technology solutions to make safer decisions with and for patients: We will embrace the shared values of the NHS in Scotland in everything that we do to ensure our service is designed to deliver: care and compassion; dignity, equality and respect; openness, honesty and responsibility, quality and teamwork. We will develop the capability and skills within our workforce, fit for the future role of the service within an integrated approach, flexible and sustainable and with the right leadership to drive a culture of innovation, co-production and improvement. Pauline Howie Chief Executive David Garbutt Chairman 4

Section 2: Improvement and Co-Production Plan The Scottish Ambulance Service is currently refreshing its strategy towards 2020 building on the framework set out in the current strategy Working Together for Better Patient Care. This process is fully aligned to the 2020 Vision and NHS Quality Strategy. Throughout development and delivery of our current strategy and, as we refresh the strategy towards 2020, SAS has engaged with a wide range of stakeholders and partners and demonstrated a commitment to working in partnership to develop and improve the quality and contribution of our service. The Improvement and Co-Production Plan (ICP) sets out the key priorities for SAS in 2014/15 and demonstrates how these will support the wider delivery of the 2020 Route Map. As a frontline service, the Scottish Ambulance service has a key role to play in ensuring patients receive the highest quality of clinical care, are able to access care easily and are routed to definitive care first time. SAS recognises the benefits for patients in working as part of an integrated health and social care service and in partnership with NHS Boards, and the priorities identified in this ICP reflect ongoing discussion and work with Boards and other key partners to drive forward this agenda. The ICP is set out in a number of sections and has identified an Executive Lead for each of the twelve 2020 Route Map priorities, as set out in the table below: Objectives for 2014/15; Workforce; Patient safety; Person-centred care; Transforming patient care; Integration; Innovation Our Medical Director is Lead Officer for Equalities and will work with NHS Boards and other partners to develop plans to reduce inequalities faced by people in Scotland and ensure this informs our strategy refresh towards 2020. In 2014/15 we will particularly focus on people with a learning disability. This work will focus on determining the usage of ambulance services, waiting times, proportion taken to hospital and whether users were flagged as having learning disabilities. Scottish Ambulance Service will work in partnership with regional health boards, SCOTPHO and the SLDO to develop this work. A SMART action plan to reduce inequalities faced by this population will be available by 2015/16. The Scottish Ambulance Service recognises the requirement to work in partnership with a wide range of stakeholders in risk assessment, planning, preparation, response and recovery in respect of major incidents. This requires both UK and Scottish level engagement including membership of the Resilience Advisory Board for Scotland, Regional and Local Resilience Partnerships. 5

Person-centred Care Safe care Primary Care Unscheduled Care Integrated Care Care for Multiple and Chronic Illness Early Years Health Inequalities Prevention Workforce Innovation Efficiency NOT PROTECTIVELY MARKED 2.1 SAS Priorities for 2014/15 The table below sets out the corporate objectives for the Scottish Ambulance Service for 2014/15 and demonstrates alignment to the 12 priorities set out in the 2020 Route Map. The strategic role for SAS in supporting the 2020 vision and its position as a national Board is illustrated by the extent of impact across the 12 priorities of our core objectives. Quality of Care Health of the Population Effective Value & Financial Sustainability Objective Unscheduled Care Enhance triage to improve patient access and response Support the development and implementation of professional to professional decision support for SAS staff and responders across the country Support the development and implementation of care pathways, specifically, frail and elderly patients who have fallen, dementia, COPD, mental health and alcohol Within the context of strategic workforce planning, review and consider the scope of practice and education and training of paramedics and specialist paramedics with the aim of meeting the NHS 2020 workforce plan draft by June 2014 6

In partnership with NHS Boards, continue to expand the use of ambulance staff roles to care for more patients at home or as close to home as possible and to support the delivery of Local Unscheduled Care action plans Strengthen community resilience and work with communities and partners to develop appropriate service response models Support the extended use of anticipatory care planning integrating the specialist paramedic practitioner role and work with primary care to develop new models of care and continue to develop information sharing and access to e-kis Support the development and implementation of a national trauma pathway and service in line with regional plans, including introducing a fully staffed specialist operations triage and tasking desk by October 2014 Establish the new SCOTSTAR specialist retrieval service for Scotland by April 2014 and develop sustainable services thereafter Develop a roll out plan for the 3RU response to prehospital cardiac arrest to improve outcomes for patients by December 2014 Roll out the national Paediatric Early Warning System developed to improve care for children from April 2014 as part of our patient safety programme, and continue to support the work of the Early Years Collaborative Complete Development Programme across 3 Ambulance Control Centres including implementation of first phase of Optima Live by September 2014 7

Scheduled Care Implementation of auto-planning and reconfiguration of planning desks to improve punctuality for patients by August 2014 Extend development of integrated transport models in partnership with NHS Boards and Regional Transport Partnerships to improve access for patients Working with NHS Boards to improve discharge and transfer planning & capacity to support effective flow management and measurement Improve patient needs assessment process ensuring clinical need is met and access for frequent users of the service is simplified Workforce Continue implementation of workforce modernisation in partnership in line with agreed priorities for action Continue to implement the Developing Frontline Leaders and Managers Programme working towards 20% protected management time and 100% e-ksf completion for the cohort by April 2015 Review and develop a learning and education plan to help achieve the 2020 vision by October 2014 Develop and implement a wellbeing programme to support staff to stay at work and progress the Gold HWL status by summer 2015 Continue to implement the 4 point plan to improve sickness and absence 8

Develop the 2020 strategic workforce plan and associated transition plans by summer 2014 Develop a person-centred programme and continue to develop the SAER process. Publish anonymous SAERs for learning by summer 2014 Implement eees HR system, SSTS and interface with e-payroll in line with nationally agreed implementation plan Implement GRS workforce planning system from July 2014 Respond to the results of the staff survey with local and national plans developed and those priority actions implemented by December 2014 Implement Everyone Matters in line with nationally agreed implementation programme Innovation Progress mobile health strategy Progress telehealth strategy in partnership with Digital Health Initiative Other Support Glasgow 2014 Commonwealth Games Continue to involve patients and develop methods of obtaining their feedback with the aim of improving services to deliver person-centred care Implement and monitor equality outcomes action plan and publish annual updates as per agreed national plan and develop joint plans with partners to reduce inequalities for patients in Scotland 9

2.2 Implementing 2020 Workforce Vision SAS is developing its strategic workforce plan aligned to its strategy refresh towards 2020. This work is being developed in partnership with staff through our Developing our Future Workforce Group and, additionally, supported by Skills for Health who have worked with the Service in 2013/14 to strengthen workforce planning capacity and skills and explore key roles requiring development across the Service. Whilst the specific number of staff is not yet fully modelled, there are a number of key assumptions set out, which will be progressed in this transition year 2014/15; Review the role of frontline paramedics and support staff to ensure that those dealing with patients are able to operate effectively in an integrated model with access to alternative pathways, remote diagnostic capability and increased treatment at home and in the community; Develop the role of specialist paramedic to support both the integration of health and social care and provide additional critical care capability; Review the education and training model for frontline staff to ensure that staff continue to be appropriately trained for the roles they are performing; Strengthen leadership and management capability implementing SAS Developing Frontline Leaders and Managers programme and creating capacity for managers; Enhance clinical supervision in the Ambulance Control Centres to ensure more effective triage and dispatch of appropriate response to patients; Development of a one ambulance service model reviewing and developing the role of the scheduled care service particularly to better support a more clinically focussed non-emergency service and management of flows across the wider NHS system. SAS has developed a specific plan to take forward implementation of the 5 key priorities set out in the 2020 Workforce Implementation Framework which will be monitored by the Staff Governance Committee. Key actions include; Embedding the NHS Scotland values as part of ongoing organisational development programme; Developing Frontline Leadership and Management capacity and capability across the Service; Developing talent management and effective succession planning; Ensuring the Service has the right mix of skills and resources to effectively contribute in an integrated health and social care system; Robust staff governance and Partnership arrangements 10

SAS will also undertake staff governance audits; develop and deliver a staff governance action plan; and take forward actions and recommendations arising from the NHS Staff Survey at a national and local level. We will continue with our programme of workforce modernisation and will continue to implement our action programme to improve attendance. 2.3 Delivering patient safety The Service has developed its own internal patient safety programme and will continue to build on this work in 2014/15. In addition to an established focus on HAI and hand hygiene, the Service has been successful in taking forward a number of care bundles and clinical developments which have delivered patient safety, not least in strengthening our clinical leadership and governance. In 2013/14, we developed our approach to the management and review of significant and adverse incidents and this process now features prominently in our clinical governance arrangement nationally and locally. Learning from these events is shared across the organisation at all levels and will continue to influence and shape our practice and improvement going forward. We also delivered a programme of flying lessons in 2013/14 aimed at challenging the impact of culture and behaviours on patient safety and clinical care. A number of recommendations have emerged from those sessions which have been factored into our organisational development programme for 2014/15. The development of our Quality Improvement Collaborative and Hub also supports our patient safety programme focussing our priorities for improvement around mainstream service provision and ensuring we build capacity for improvement and learning and this will continue in 2014/15. We will continue to focus on improving the use and recording of care bundles such as SPESIS and PVC, in 2014/15 and supporting the development of national and local care pathways, such as hyper-acute stroke and the national trauma review, aimed at getting patients to definitive care as quickly as possible. Our patient safety programme will ensure a specific focus on improving care for children, not least following the development of a national paediatric early warning system, which will be rolled out to staff in 2014/15. We will also continue to develop staff skills in paediatric CPR and early identification of SEPSIS and ensure we work with NHS Boards to put in place appropriate care plans for children living with chronic conditions and in respect of end of life care planning. We will continue to actively participate in the Early Years Collaborative and MCQIP. 11

2.4 Person-centred care The Service has developed a specific plan to take forward the person-centred agenda across SAS, focussing on three key strands patients, staff and coproduction. The plan is comprehensive and sets 38 key actions being progressed across a number of themes including, leadership, mission and values, listening, quality improvement, staff, environment and design, information and education, equality and diversity, care, care support, and documentation. The Service was an early adopter of Patient Opinion and has developed additional feedback mechanisms through yourscottishambulance.com, Facebook and Twitter social media, all of which have been used to good effect in engaging with patients and public ahead of service developments and in testing their effectiveness and impact post-implementation. The Service has a well established mechanism for capturing comments, complaints, commendations and concerns, called Viewpoint. This system ensures prompt response to all complaints and feeds into service improvements. In 2013, SAS established a Quality Improvement Collaborative and Hub, which is building organisational capacity for quality improvement. A number of local and national improvement initiatives have been taken forward and will be built on in 2014/15, aligned to the delivery of our corporate objectives, for example, embedding care pathways for frail and elderly patients who have fallen. This work is also closely aligned to the Developing Frontline Leaders and Managers Programme. 2.5 Transforming care SAS set out in its Local Unscheduled Care Action Plan a clear direction of travel and specific objectives for supporting NHS Boards and the wider system to transform care. This LDP reiterates those priority areas where SAS can play a key role in supporting Boards to better manage patient flows, reducing avoidable hospital attendances and linking more effectively with primary care. Specifically, we will; Continue to enhance our triage and assessment within our Ambulance Control Centres to increase levels of hear and treat, and extend our clinical supervision model; Increase levels of see and treat where patients are safely treated at home without onward conveyance to hospital; Complete review of professional-to-professional decision support and take forward recommendations from short-life working group with NHS Boards; 12

Work with NHS Boards and partners to develop and embed care pathways, specifically for frail and elderly patients who have fallen, dementia, COPD, mental health and alcohol; Work with NHS Boards to improve discharge and transfer planning where SAS is the appropriate resource to ensure improved flow throughout the system; Improve decision-support for crews through internal and external professional-to-professional support and access through technology to e- KIS and anticipatory care plans. Having completed our strategic assessment as to capacity and capability to support delivery of the 2020 vision for primary care, we believe SAS has a key role to play in supporting greater integration with primary care both in and out of hours, building on established links already in place, specifically; Supporting the delivery of out of hours services through integration with specialist paramedic practitioner role, which is already proving successful in a number of NHS Boards; Supporting the management of anticipatory care plans, again through the specialist paramedic practitioner role; Extending the sharing of patient care records electronically to ensure GPs have a full awareness of ambulance attendance and treatment for patients, building on a pilot in Glasgow in 2013; Developing decision support for crews, notably through access in cab to e- KIS and anticipatory care plans to improve patient care; Enhancing our telephone triage systems to identify alternatives to ambulance dispatch and onward referral to appropriate intermediate and primary care services. This will be supported by the developments set out under workforce. 2.6 Integrated health & social care SAS set out in its Local Unscheduled Care Action Plan a clear direction of travel and specific objectives for supporting NHS Boards and the wider system to shift the balance of care and support the development of community based intermediate and integrated models of care. SAS will build on work ongoing with NHS Boards to develop these models with a specific focus on extending the role and use of specialist paramedic practitioner role. This role has already proven successful in increasing the number of patients safely treated at home, supporting the management and assessment of patients at home as part of an integrated team, and building skills and relationships with 13

NHS Boards and other partners. In 2013/14, we put in place 3 pilot schemes with allocated LUCAP funding, working with NHS Lanarkshire Asset Team, NHS Borders and NHS Shetland and we will continue to extend this model with other NHS Boards as they develop their approach to integration. Our practitioner model is also in operation working with NHS Grampian and their Decision Hub and out of hours service, NHS Western Isles, working alongside A&E colleagues, NHS Lothian working through minor injuries, NHS Forth valley linked to the out of hours service, and in NHS Fife and NHS Tayside aligned with nurse practitioners. We see this model as hugely beneficial for patients with significant reductions in avoidable attendances at hospital and in supporting the wider integration agenda; its effectiveness is, in fact, dependent on integration with teams locally and with the availability of alternative pathways. Initial modelling suggests that around 25-30% of our current emergency workload would be appropriate for first assessment by a practitioner, however, our intention this year is also to review the scope of our core paramedic cohort to ensure all frontline staff are better able to treat patients at scene and develop additional minor injuries/minor illness skills, as well as a review of paramedic prescribing, and the development with NHS Boards of direct referral to services. Again, this will be supported by the developments set out under workforce. 2.7 Innovation SAS is committed to developing innovative solutions both through increased use of technology, but also in respect of different models of care and service. Our key priorities in 2014/15 will be focussed on developing our ICT infrastructure to support our transition towards 2020, specifically; Working with the Digital Health Initiative to develop our platform and infrastructure for mobile telehealth, facilitating increased opportunities for near-patient testing and remote diagnostics, decision-support and consultations; Progressing replacement of current generation of in-cab mobile technology, streamlining patient record-keeping systems and facilitating real time access to decision-support information and sharing of information with other areas of the health service; Extending the use of near-patient testing, building on successes such as the Troponin testing with NHS Borders, exploring the potential for lactate monitoring for early identification of possible SEPSIS, and testing the use of ultrasound technology to identify a potential stroke; Through research and development and in partnership with NHS Boards, exploring opportunities to improve our clinical care and treatment, such as the successful work with NHS Lothian for the management of community 14

based cardiac arrests which has resulted in world class survival rates in Edinburgh; Working with NHS Boards, voluntary sector and communities to develop appropriate response models for remote and rural communities, such as the Emergency Responder Model in West Ardnamurchan. We recognise that the scale of change required as we work towards 2020 necessitates innovative solutions and we will continue to work in partnership to explore these opportunities as a mobile 24/7 service. 15

Section 3: SAS Contribution to Community Planning As with all NHS Boards SAS has a role to play in supporting effective community planning outcomes. As this is a transitional year with the development of locality planning arrangements and funding streams, in 2014/15, we will focus our efforts on determining how best to build capacity for effective engagement with all planning mechanisms across Scotland. As a national Board, SAS will engage across an increasingly complex landscape, but our focus around effective community and locality planning will be; Supporting the development of integrated transport to healthcare solutions where an ambulance is not required; Supporting the development of integrated health and social care models; Ensuring equity of access to care working with the voluntary sector, NHS Boards and communities to develop appropriate response models and strengthen community resilience. Continuing to engage with multi-agency partners through active involvement with Regional and Local Resilience Partnerships. 16

Section 4: HEAT Measurement Framework The table below sets outs the key performance measures for the Scottish Ambulance Service in 2014/15 in line with the national HEAT performance management framework. The Service uses a broader range of measure internally through its quality scorecard to ensure a balanced and robust monitoring of performance and service quality. SAS Board and Executive Team monitor these measures on a weekly and monthly basis. For 2014/15, there is only one change proposed to targets whereby we will increase the target for SAS T3 Infection Control to 70% from the previous 67% target in 2013/14; all other targets and measures remain as 2013/14. 2014/15 will be an extremely challenging year for the Service in balancing delivery of performance within our overall funding levels. The Service is working to ensure it has the right mix of skills and resources available to match demand and deliver performance, in the context of: A continued increase in emergency and unscheduled care demand, notably in the out of hours period; Continued high levels of unplanned discharge and transfer requests; The transformational change still to be realised in the development across the Health & Social Care system of alternative care pathways for patients; 17

Continued pressure on the overall mix of A&E resources in relation to emergency and urgent demand The Service will work with NHS Boards and key partners to ensure emergency, unscheduled and scheduled care demand is appropriate and to support improved patient flow. Recognising the wider system is in transition towards 2020, SAS will ensure it continues to develop its workforce to support this transition and develop a range of performance measures that focus on clinical service delivery and better outcomes for patients. 18

Section 5: Financial Plan 2014/15 will be another challenging year for the Service in delivering its financial plan and cash releasing efficiency savings. In addition to pay and pension pressures, there are a number of developments in year which are key to the successful delivery of SAS corporate priorities as described in section 2.1, but which present a significant financial challenge for the Service. The SAS Board is committed to the Developing Frontline Leaders and Managers programme aimed at creating increased frontline leadership capacity across the Service. This will be vital in delivering enhanced clinical leadership and embedding care pathways and new models of care to support integration locally. Our frontline leaders are also vital in supporting the transition across the workforce required to deliver our 2020 vision and our organisational development and quality improvement agenda. The Service received funding to support the transition to a 37.5 hour working week in 2012/13, however, a funding pressure remains as a result of the overresourcing of a number of on call stations to prevent any increase in on call at these locations; this has resulted in a shortfall in cover in some larger, urban stations, as a consequence which is both a financial and a performance pressure for SAS. The forthcoming three years will be challenging from a financial perspective. However, we have in place sound systems of governance. These provide a platform to enable the Service s strategy to be progressed in the knowledge that redesign will produce efficiencies that can be reinvested in shaping a modern ambulance service. A key enabler in delivering the 2020 vision will be our workforce. SAS is developing its 2020 strategic workforce plan in tandem with its 2020 strategy but recognises that this may bring some additional staff cost pressures as we develop new roles and models of service delivery with our partners given the complexity of the landscape for SAS and the variance in pace of change amongst our partners. A detailed financial plan and trajectories against NHS HEAT targets to deliver within budget and identify cash releasing efficiency savings are submitted as an appendix to the LDP. 19