Scottish Ambulance Service Self-Assessment
Section 1- Introduction The aim of this Annual Review Self-Assessment document is to provide information on the performance of Scottish Ambulance Service for the period 2014/15. Throughout 2014/15 the Service undertook a refresh of its strategy and formally launched Towards 2020: Taking Care to the Patient in February 2015. This strategy builds on the platform of Working Together for Better Patient Care: 2010 2015. Our strategy remains consistent with the Scottish Government s 2020 Vision and sets out an ambitious programme of transformation for the Scottish Ambulance Service over the next 5 years. 2014/15 represented year five in the implementation phase of our strategic framework, Working Together for Better Patient Care: 2010-2015. This selfassessment document sets out the progress made during 2014/15 and reflects the culmination of delivery of our strategy which provides an excellent platform as we transition towards 2020. Key to the successful delivery of Working Together for Better Patient Care: 2010-2015 has been the partnership working with staff, patients and partners across the NHS, third sector and other key organisations. We have engaged with these same partners to refresh our strategy towards 2020, and we are committed to continuing this partnership approach as we take the Service forward over the next 5 years. 2014/15 has been a challenging year for the Service with continued growth in unscheduled demand and financial constraints. Despite this, we have delivered improvements, specifically in saving more lives, treating more patients more appropriately in their local communities, and effectively planning and delivering services for major international events and incidents. - 1 -
Section 2- Update on 2014 Annual Review Actions Following the 2013/14 Annual Review, the Cabinet Secretary for Health, Wellbeing and Cities agreed the following actions with the Scottish Ambulance Service: 2013 Annual Review Action Update and Progress Significant adverse events review process fully embedded and review findings fed back for discussion and action at Executive, Board and Senior Management Team meetings; Early adopter of Patient Opinion and continue to use this and your.scottishambulance.com to gather feedback from patients building on themes to inform service improvement. We are now working with a patient who provided feedback on Patient Opinion who is now co-producing/co-delivering a module at the Scottish Ambulance Academy. Our film, which encourages people, specifically those in seldom heard groups, to share their experiences has been well-received. We have made extensive use of other digital channels to promote and encourage patient involvement and increased the number of patients and members of the public keen to work with us as a result; Continue to develop channels and mechanisms for the learning and changes implemented as a result of patient and staff feedback to be publicised more widely Involving People Groups or Public Partnership Forum networks established in all Divisions and Patient Focussed Public Involvement strategy continues to be progressed. We have also sought to use our regional Patient Focussed Public Involvement events as a route to encourage more patient involvement; Supported NHS Education for Scotland with a feedback learning resource to demonstrate how positive feedback helps embed good practice; Viewpoint system fully embedded and used to capture all complaints, comments, commendations and compliments with regular feedback to the Service s Executive Board and Clinical Governance Committee; Scottish Health Council facilitated a series of workshops targeting key groups, such as long-term conditions and carers, focussed on strategy refresh and particularly in terms of gauging response to development of hear and treat and - 2 -
Submit to the Scottish Government by the end of 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. see and treat, and we continue to ensure patients are helping to inform the Service s strategic direction and service improvement; Patients regularly attend Board meetings to reflect with Board members on their experience of the Service. Suite of proposals submitted which support the Service s strategic framework and shifts focus in line with new clinical model, wider system expectations and staff and patient feedback; A new suite of measures has been agreed and those for 2015/16 reflect a transition towards the 2020 vision. Agreement that the measurement framework will continue to be refined towards 2020. Specific work with NHS Lanarkshire Age Specific Service Emergency Team (ASSET) hospital at home team targeted towards older patients and supported by the Service specialist practitioner paramedics; Working with NHS Borders to support redesign of unscheduled care model, developing pathways and supporting out of hours, again using the enhanced skills by specialist paramedic practitioners; Continue to see successful embedding of care pathways for frail and elderly patients, notably those who have fallen, those living with dementia and other longterm conditions such as Chronic Obstructive Pulmonary Disease. This work is being progressed across all Divisions working in partnership with NHS Boards and Community Health and Care Partnerships with a 10% reduction in frail and elderly patients who have fallen taken to A&E as a result; - 3 -
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 Healthcare Environment Inspectorate reports. Work with NHS Boards to support more effective discharge planning and transfer of patients to better manage flows. Lothian Hub model continues to deliver improvements and discussions have been progressed with other South East and Tayside (SEAT) Boards to link in with Lothian and/or develop local models along similar lines; Continue to extend the use of specialist paramedic practitioner role with a further 12 now in training and more planned for 2015. Work is ongoing with a number of Boards to explore how this model can support unscheduled care, specifically with NHS Greater Glasgow & Clyde, NHS Ayrshire & Arran and with NHS Highland in Argyll, in respect of GP Out of Hours. We are also working to build on established models with NHS Western Isles and with NHS Forth Valley; Leading work with Joint Improvement Team and Scottish Government Health Directorates Innovation Lead to develop single point of contact arrangements; Internal Quality Improvement Collaborative methodology being adopted to spread good practice across Scotland. Work continues to progress and complete all 3 requirements in our current Healthcare Environment Inspectorate Action Plan; Standard Infection Control Precautions audits are conducted monthly across the Service and include hand hygiene audits. Overall Standard Infection Control Precautions compliance for the Service ranges between 93-96%. The Service s overall monthly hand hygiene compliance for the period from January March 2015 was maintained above 90%. The Healthcare Associated Infections (HAI) Quality Improvement Facilitator is targeting elements of the Standard Infection Control Procedures (SICPs) audits that score less well and is working on a number of improvement projects in order to address this. This has included work at the Scottish Ambulance Academy to ensure students are applying the theory of Standard Infection Control Procedures into practical training scenarios and the need to apply Standard Infection Control Precautions with every patient; The Service is also working to ensure full compliance against the new Healthcare Associated Infections Standards and the recommendations within the Vale of - 4 -
Leven Inquiry Report in the context of the ambulance setting. Maintain a strong focus on the delivery of effective partnership structures and cultures across the organisation, particularly in the development of your refreshed strategic framework. Maintain focus on reducing absence levels across the organisation, working towards the NHS HEAT Standard of 4%. Partnership have been fully engaged in strategy refresh, particularly in respect of the Developing our Future Workforce Group. This group has reviewed the workforce model linked to the new clinical model, reviewed the skills and roles required and progressed development of the education model to deliver the future workforce; Staff engagement in strategy refresh has included a number of presentations to staff in stations, divisional meetings, and Chief Executive s webcast as well as inviting staff to respond to the discussion document circulated as part of the initial consultation phase; Presentations have also been given to national stewards meetings, and to each cohort of team leaders and managers attending the two-day Developing Future Leaders and Managers programme as well as to those attending the Quality Improvement Collaborative meetings; Partnership is fully engaged in the delivery framework for the Service s 2020 strategy. The Attendance Management taskforce completed its review. The recommendations from this exercise continue to be implemented including reviewing return to work paperwork and running attendance management workshops for managers; Regular meetings have taken place with the providers of the Occupational Health consortium to ensure this is meeting the needs of the Service and to discuss any challenges that arise; In addition, work is being completed on a wellbeing strategy for the organisation, and a welfare plan to support staff following traumatic incidents; Absence rates for the Service are higher than the projected figures, and the areas with the highest absence are West Central division, West Ambulance Control Centre and West Patient Transport Service. Detailed analysis of the absence in these areas has been carried out to identify potential trends, reasons for absence - 5 -
Continue to achieve in-year and recurring financial balance and keep the Health Directorates informed of progress in implementing your local efficiency savings programme. and action taken to mitigate this. 2014/15 remained a challenging year with a number of pressures, which we continue to work to mitigate to achieve financial targets; We continue to have pressures from demand increases which impacts our non pay in terms of medical supplies and drugs. - 6 -
Section 3 - Safe Care 3.1 Clinical Care Throughout 2014/15, the Service has been refreshing its corporate strategy with a clear focus on delivery of safe and effective care for patients. A key component of our refreshed strategy has been a thorough review of our clinical and operational response model to support delivery of the 2020 Vision, treating more patients safely at home or in a homely setting. Specific key achievements in 2014/15 include: Extension of the Rapid Response Resuscitation (3RU) model for the effective response and treatment of out of hospital cardiac arrest. This work was successfully developed in Edinburgh and has now been extended into Glasgow and across Lothian. The Service received a British Medical Journal recognition award for its 3RU work in 2014/15. Results were extremely positive during the year with 658 lives saved with successful Return of Spontaneous Circulation (ROSC) on arrival at hospital, 149 more patients than in 2013/14; Contribution to the development of a national Out of Hospital Cardiac Arrest Strategy for Scotland aiming to save 1,000 lives by 2020. The Service will have a critical role to play in achieving this ambition, continuing to extend the 3RU model, working with our Community First Responders to develop their skills, and extending access to community based Public Access Defibrillators; Contribution to the development of a major trauma network for Scotland aimed at enhancing the response and treatment of major trauma and improving patients quality of life. The Service led the development of a national trauma tool to be used by crews to identify major trauma at scene and route patients to definitive care, either at a Major Trauma Centre or Trauma Unit first time; The Service will also have responsibility for co-ordination of any response to major trauma through development of a trauma co-ordination desk within Ambulance Control Centre. In 2014/15, we continued to manage our response to major trauma through our existing trauma desk and to scope out the requirements for the future network due for implementation in 2016; Development of Ambulance Control Centre Practice Developer role and specific Learning in Practice training delivered to all call handlers, dispatchers and supervisory staff. This training was developed as a direct result of learning from our Significant and Adverse Event Review process to ensure safe and effective decision-making and a focus on standardising call taking and dispatch processes; - 7 -
Implementation of the Manchester Triage System into the Ambulance Control Centres to support our Clinical Advisors to make safe and effective clinical decisions. Manchester Triage System provides enhanced decisionmaking guidance based on symptom presentation. Our intention is to extend the availability of Manchester Triage System to road crews following upgrades to communications infrastructure across our fleet in 2015; Review of calls to identify those suitable to be responded to as hear and treat without the need to dispatch an ambulance. These are lower acuity calls where our clinical advisors will be better placed to offer telephone advice to patients or where calls can be directly transferred to NHS 24 for advice or onward referral to a more appropriate service. The review work began in 2014/15 and clinical protocols will be fully implemented early in 2015; Enhanced audit of Medical Priority Dispatch System (MPDS) including acquisition of National Emergency Management Association (NEMA). This is part of our commitment to achieve Accredited Centre of Excellence status in our Ambulance Control Centres, which will ensure more audit of calls, greater opportunities for learning, and evidence with which to develop training and learning for staff and improve care for patients; In conjunction with the International Academy of Emergency Dispatch (IAED), participation in major research study designed to enhance management of patients with breathing difficulties and facilitate changes to Medical Priority Dispatch System protocols for all users in the UK; The Service continued to see improvement in the appropriate adherence and implementation of the Peripheral Vascular Catheterisation (PVC) Care Bundle being recorded by staff, improving from 72.5% in 2013/14 to 75.5% (25,982 patients) in 2014/15. This is an increase of 1,032 patients compared to last year; We continue to engage in a number of research projects to develop safe and effective clinical care and throughout 2014/15, this included collaborative research around sepsis, diabetes and cardiology. - 8 -
3.2 Clinical Performance The above developments have resulted in the following summarised Clinical Performance in 2014/15: Measure Target Number of patients 2014/15 2013/14 performance 2014/15 performance Return of spontaneous circulation (ROSC) Return of spontaneous circulation Ventricular Fibrillation/Ventricular Tachycardia (ROSC) Cat A cardiac arrest patients responded to within 8 minutes Hyper-acute stroke patients to hospital within 60 minutes of call* Recorded used of Peripheral Vascular Catheterisation Bundle 12-20% 3,272 (11.4%) >20% 808 (1.5%) 80% 4,542 (0.5%) 80% 3,211 (16.5%) 67% 25,982 (4.1%) 17.3% 20.1% 32.5% 33.9% 77.1% 74.2% 78.8% 72.8% 72.5% 75.1% * We have recently been funded to employ a Stroke Clinical Lead who is reviewing our arrangements for the management of stroke patients with a view to improving outcomes. 3.3 Infection Control The Service continued to maintain strong performance against key performance indicators in respect of hand hygiene and National Cleaning Services Specification. Compliance with hand hygiene opportunity was 91% and against a target of 90% for the full year. Compliance with National Cleaning Services Specification was 95% and National Cleaning Services Specification for estates was 94% against a target of 90%. - 9 -
Following Healthcare Environment Inspectorate inspection in June 2014, we received 3 requirements and 3 recommendations, addressed throughout 2014/15. This demonstrated considerable improvement from previous inspections and the Service continues to proactively manage infection control through regular Standard Infection Control Precautions audits reporting overall compliance ranging between 93-96%. The Healthcare Associated Infection Quality Improvement Facilitator is working on a number of improvement projects in order to ensure that all elements of Standard Infection Control Precautions achieve good compliance scores. The Service now has over 1,150 staff that have successfully completed NHS Education for Scotland s Cleanliness Champions infection control training programme. The Service is also working to ensure full compliance against the new Healthcare Associated Infection Standards and the recommendations in the Vale of Leven Inquiry Report that are relevant to the ambulance setting. 3.4 Patient Safety The Service developed its Patient Safety Improvement Programme and progressed a number of key areas during 2014/15, including: Continued improvement of our processes around Significant Adverse Events to ensure timeous review and embed learning effectively; Co-ordination of thematic learning from incidents, complaints, concerns, external reviews through National Clinical Governance Group; Programme for improvements in safe clinical decision making progressing; National Early Warning Score (NEWS) scoring implemented and Paediatric Early Warning Score (PEWS) scoring being rolled out; Several Research and Development projects in place relating to improved diagnostics and management of patients with Sepsis in the pre-hospital environment; Adult Protection Policy and Standard Operating Procedures progressing; Fully engaged with Mental Health Scottish Patient Safety Programme, particular around transitions of care, include safe air transfer of patients in crisis; We continued to undertake a series of Patient Safety Walk Rounds with staff in stations throughout the year and identify areas for improvement. 3.5 Improved Response Demand on the Service continued to increase in 2014/15, with 7% more emergencies attended compared to 2013/14. Category A, immediately lifethreatening demand, continued to increase with 72.2% (103,287 patients) - 10 -
responded to within 8 minutes. Category B, serious but not immediately lifethreatening calls also increased, up 4.8% in 2014/15 compared to 2013/14. Despite this continued increase in demand, the Service maintained average response to Category A incidents at 6.6 minutes. Our continued investment in our Ambulance Control Centres, including training and development of call handlers and dispatchers throughout the year, has shown improvement in the responsiveness of our 999 service, exceeding a target of 90% of 999 calls answered within 10 seconds in 2014/15 at 92.9% (428,508 calls). Our focus on more effective management of GP urgent calls within an hour has also delivered improved performance. Specifically in 2014/15, we implemented improvements to our command and control system in the Ambulance Control Centres to better identify these calls to dispatchers allowing them to more proactively manage our response. A summary of our performance against key HEAT Local Delivery Plan response targets is set out below: Measure Target Number of incidents 2014/15 2013/14 performance 2014/15 performance Respond to lifethreatening emergencies in 8 minutes (Cat A) 75% 143,096 (+0.5%) 73.9% 72.2% Respond to serious but not immediately lifethreatening emergencies in 19 (Cat B) 95% 309,703 (+4.9%) 91.3% 87.8% Respond to GP 1 hour urgent calls within 1 hour 91% 49,344 (+2.5%) 88.4% 90.1% % of 999 calls answered within 10 seconds 90% 428,508 (+2.4%) 88.1% 92.9% While the response time is an important aspect of pre-hospital care, the clinical expertise of ambulance teams is key to maintaining good patient outcomes. The ongoing development of clinical care skills is reflected in the consistently high survival rates that are now being achieved in Scotland. - 11 -
Section 4 Person-Centred Care The delivery of person-centred care remains central to the Service s approach to service delivery and quality improvement. In 2014/15, we continued to develop our capacity and capability for quality improvement, strengthening our leadership capability and further embedding in partnership care pathways aimed at routing patients to definitive care more effectively. Specific key achievements in 2014/15 include: Worked with Scottish Health Council to facilitate a series of focus groups as part of the refresh of our strategy. A number of workshops were held with patients exploring key aspects of the Service s new clinical model, notably in respect of hear and treat and see and treat, with representation from young people, black and minority ethnic patients, patients affected by mental health and long terms conditions, carers, and those living in remote and rural and island communities; 62 partnerships in place or in development with NHS Boards to support more person-centred care, notably in responding to frail and elderly patients with a continued reduction in the percentage taken to hospital (down 3% to 65.8% in 2014/15); With a number of NHS Boards, further developed decision support and professional to professional advice for crews to reduce avoidable attendances at A&E and refer patients onto more appropriate services; Continued support for the NHS Lanarkshire hospital at home model with two specialist paramedics providing a link from the Service to the ASSET team in Lanarkshire to offer frail elderly patients and alternative to A&E; Partnership with North East Glasgow Rehab Service to develop a referral pathway, initially for uninjured elderly patients who have fallen, reducing avoidable attendance at A&E; With NHS Lothian and NHS Fife, developed and tested a pathway for patients who suffer an exacerbation of Chronic Obstructive Pulmonary Disease; Worked with NHS Borders to develop, test and implement a model whereby Specialist Paramedics operate in support of A&E minor flow, GP out of hours service, and with primary care in hours; Engagement with Integrated Joint Boards as they have developed throughout 2014/15, to outline the Service s strategy and the role the Service can play in supporting integration locally as they develop their strategic plans; Our Quality Improvement Collaborative is now in its third year with a further 60 staff and managers trained in key improvement tools and - 12 -
techniques. This collaborative approach has been key to the successful development of local partnerships and person-centred care pathways; Significantly increased the number of patients safely managed at home or at scene, reducing conveyance to hospital. 86,059 patients were safely treated at scene in 2014/15, 11.2% more than in 2013/14. Measure Target Number of patients 2011/12 2013/14 performance 2014/15 performance % emergency incidents managed at scene 17% 86,059 (+11.2%) 16.2% 17.5% 4.1 Developing our Future Workforce As we refreshed our strategy for 2020, we developed alongside that our Strategic Workforce Plan, a key enabler to the successful delivery of our new clinical model and more effective person-centred care. In 2014/15, as part of this development we progressed a number of key areas, including: Modelling our future workforce requirements for 2020 to meet the needs of our patients and our partners within an integrated health and social care system; Reviewing our education model with a view to moving towards a graduate programme for paramedics from 2016, which will offer scope to enhance the skills of new paramedics in terms of minor injuries and minor illness and support our commitment to safe and effective care at home; Begun scoping out the roles required and the scope of practice of each role to support the new clinical model as part of our strategy. Ambulance Care Assistant, Technician, Paramedic, Specialist Paramedic, and Advanced Paramedic roles and scope of practice will be reviewed as we look to develop a flexible future workforce, operating at the full scope of their practice. Our workforce will be critical in supporting the development and enhancement of hear and treat, see and treat, greater integration with wider health and social care partners and delivery of effective emergency, unscheduled and scheduled care; Completed the first two-day session for team leaders and managers as part of the delivery of our Developing Future Leaders and Managers programme. During this first two days, all managers identified their own personal development needs and a series of continuous professional development sessions is planned for 2014/15. This cohort of managers - 13 -
will be critical in embedding person-centred care pathways and robust clinical supervision across the Service to support staff to make the right decisions for patients. 4.2 Staff Engagement The Service embraced the imatter staff engagement approach in 2014/15, with an initial staff engagement index score of 67% achieved. Departments have developed action plans to improve this score and will continue to work with staff to ensure effective engagement going forward. The Service continued to work in Partnership throughout the year following the review of arrangements in 2013/14. Partnership colleagues have been involved in the refresh of the Service s strategy, most notable in the discussions and planning around our future workforce and will continue to be actively involved in the delivery of this significant organisational transformational change programme over the next 5 years. We continued to use our Team Talk approach to engaging staff in organisational developments that affect them and seeking their views and ideas. We have extended the use of webcasting to keep staff informed of key developments and progress and carried out a series of sessions across stations as part of the refresh of our Service Strategy in 2014. Our NHS Scotland staff survey results improved in a number of key areas in 2014/15, reflecting the improvements made in terms of staff engagement and involvement. Specific improvements in 2014 compared with 2013 were around staff feeling better informed, treated more fairly and consistently and more committed to the Service as an employer. Sickness absence was higher in 2014/15 at 7.2%, compared to 6.1% in 2013/14. An attendance task force was established and has been working with each of the divisions and Ambulance Control Centres to focus on effective attendance management with positive results. The Service has developed its staff governance action plans in line with the Everyone Matters framework and progressed a number of key developments in 2014/15. These include early adoption of imatter with plans in place for full organisational roll out in 2015/15, review of policies in respect of staff wellbeing and work life balance, a focus on absence management and occupational health, strengthening and enhancing staff communication and engagement channels, for example through Chief Executive webcasts, Team Talk, Patient Safety Walk Rounds, and through specific engagement in relation to the development of the Service s 2020 strategy. - 14 -
We have robust procedures in place for the ongoing monitoring and review of this plan in partnership with staff and firm plans in place for 2015/16 which address any issues arising through our staff governance framework, through staff engagement, and in response to staff surveys. 4.3 Complaints We have continued to encourage patient feedback using a variety of channels. There was an 11.5% increase in complaints in 2014/15 up to 530 for the year compared with 475 in 2013/14, and our systems and processes for capturing and managing complaints, comments, commendations and concerns continued to improve throughout the year. 65.1% of all complaints were responded to within the target 20 days compared to 64.3% in 2013/14. We use the feedback from complaints and concerns to improve our practice. We saw a 21% reduction in complaints about staff attitude, behaviour and communication has been influenced by the Service s Developing Future Leaders and Managers Programme and other interventions, such as Flying Lessons. This 4-module course is based on good practice in aviation safety and quality, and looks at human factors and promotes the NHS Scotland values and a culture of person-centredness. The number of complaints received in relation to clinical assessment/care is the same percentage of total complaints as the year before (16% of total complaints.) Mitigating actions to feedback include reflective practice with crew members who cared for the patient where care fell below the expected standard. Our annual Patient Safety Walk Round programme is continuing to promote a culture of improvement, with members of the senior management team and the Board meeting with frontline staff, on station, to seek their input on improving clinical care. This work is also supporting a reduction in complaints about operational issues. The Patient Transport Service has improved performance for punctuality in getting patients to their appointment, and for patient pick up after appointment during 2014/15. When the resource management tool Autoplan is introduced in 2015/16 we expect this to significantly reduce the number of complaints about the Patient Transport Service. The Service continued to progress implementation of its Patient Focussed Public Involvement Strategy in 2014/15; through our Involving People groups in each division to take work forward locally reporting into a National Patient Focus Public Involvement Steering Group. We have continued to engage with patients through social media and patient portals, including Patient Opinion and yourscottishambulance.com. - 15 -
Section 5: Effective Care 5.1 Scheduled Care In 2014/15, the Service carried out 1,034,925 patient journeys, down 9.7% on 2013/14. This reflects the focussed developments throughout the year to improve the delivery of the scheduled care Patient Transport Service and ensure demand for ambulances is appropriate to patients clinical need. Specific progress in 2014/15 included: Completion of Phase 2 of the Scheduled Care Improvement Programme and effective transition to business as usual recognising that operational divisions will continue to build on the success of this programme and embed improvement moving forward; Review of the Patient Needs Assessment, improving the coaching for staff to use the tool effectively, implementing technical solutions to make the tool easier to use for staff and ensure consistency in application, and more robust audit of the process. This has made a significant contribution to the reduction of inappropriate demand on the service creating capacity; Worked with NHS Boards to improve discharge and transfer planning to support more effective flow of patients across the system, supporting the effective delivery of scheduled and unscheduled care. This has resulted in continued improvement in performance in the pick up and drop off of patients before and after appointments; Continued to maintain levels of cancellations due to the Service below 1%; Instigated a performance management and staff development programme across the 3 Ambulance Control Centres to ensure consistency in approach, the development of a set of core competencies and ongoing coaching and support for staff and supervisors; Tested Autoplan for more effective journey planning and use of Patient Transport Service resources. This required significant system configuration and upgrade of Information and Communication Technology infrastructure within the Ambulance Control Centres. Autoplan effectively automates around 80% of all journeys planned, freeing planners in the Ambulance Control Centres to address more complex issues and creating additional day control capacity. Once Autoplan is rolled out fully in 2015/16, we anticipate significant improvements in the allocation and utilisation of our Patient Transport Service resources, notably in supporting demand between and across NHS Board boundaries; Worked with NHS Boards and Regional Transport Partnerships specifically supporting the two pilots areas within Lochaber and the West of Scotland supported by Strathclyde Partnership for Transport (SPT). - 16 -
Scheduled Care Performance We continued to see improvement across performance indicators for scheduled care in 2014/15 and performance against our HEAT Local Delivery Plan targets is set out in the table below; Measure Target Number of patients 2014/15 2013/14 performance 2014/15 performance Punctuality for appointment 75% 511,982 (-9.6%) 71.4% 73.7% Punctuality for pick up after appointment 90% 522,969 (-8.9%) 78.0% 78.9% Cancellations by Scottish Ambulance Service <0.5% 18,738 (-33.3%) 0.5% 0.8% Patient Transport Service calls answered within 60 seconds 80% 607,931 (-10.3%) 68.5% 64.7% 5.2 e-health & Technology We continued to develop our Information and Communication Technology infrastructure in 2014/15 and progress the future development of our mobile telehealth strategy and our future communications platform, both of which are significant investments for the Service and key enablers to the successful delivery of our 2020 strategy. Specific achievements in 2014/15 included: Completion of tendering and award of contract for phase 1 of the mobile telehealth programme to replace the existing communications infrastructure across the entire Service fleet. This will be rolled out in 2015 and will significantly improve the Service s capacity for remote diagnostics and near-patient testing and enhance crew ability to share and access information and decision support; Commenced scoping for next generation of electronic patient record to be finalised in 2015/16; Completion of the transition from the N3 Network to the Scottish Wide Area Network (SWAN); Roll out of Wi-Fi across the Service estate enabling wider access for staff; Signed a 5 year service level agreement for continued management of Information and Communication Technology service delivery for Health - 17 -
Improvement Scotland as part of our commitment to the wider shared services agenda; Implemented call virtualisation for Patient Transport Service - Scheduled Care Service; Updated telephony platform software across all sites; Continued to work with NHS Boards to explore potential for linking systems and sharing access to patient records and information to improve treatment. 5.3 Air Ambulance Demand for the air ambulance service increased by 5.0% in 2014/15, and performance levels continued to improve. The table below sets out the key measures of activity and performance in 2014/15 compared to 2013/14. Air Ambulance 2013/14 2014/15 Total Activity 3,427 3,559 Change on previous year 192 132 % change on previous year 5.9% 3.9% To cover all Scotland within 60 minutes (target 95%) 95.2% 95.6% Average time to patient (minutes) all calls 34 31 Average travel time with patient to hospital for emergency demand (minutes) 18 14 5.4 Specialist Retrieval In April 2014 the Scottish Ambulance Service launched the national retrieval service for Scotland under the banner of ScotSTAR, bringing together the existing Emergency Medical Retrieval Service, with regional neonatal, paediatric and trauma retrieval teams. The number of specialist retrieval missions completed by air transport in 2014/15 was 491 compared to the 442 missions in 2013/14. 5.5 Financial Position The Service again met its three financial targets in 2014/15 in terms of managing budgets and meeting its cash releasing efficiency target for the year. This was - 18 -
an extremely challenging year due to the tight financial allocations and in year cost pressures that developed post budget setting process. Therefore the achievement of these targets cannot be underestimated. Indicator 2012-13 2013-14 2014-15 Under spend against Core Revenue Releasing Limit Against Total Revenue Releasing Limit Against Capital Releasing Limit 32K 41K 59K 32K 87K 61K 4K 3K 1K Cash Requirement 220m - under requirement by 588K 214m under requirement by 813K 229m under requirement by 557K 5.6 Efficiency Programme The Service exceeded the 3% target set by Scottish Government and generated 4.18% cash releasing efficiency savings in 2014/15, totalling 8,793,000. This level of savings was required to enable the organisation to deliver its financial targets and to fund the additional in year cost pressures. The table below sets out the areas where these savings were realised. Cash Releasing Revenue Target 3% Realised 000s Service Productivity 6,396 Workforce 479 Shared Services 431 Support Services 1,080 Estates and Facilities 407 Total In-Year Savings 8,793 Scottish Government Health Directorates Target 6,299-19 -