1
South Central Ambulance Service
NHS Trust
Strategy & Business Plan
2008 - 2011
CONTENTS
1.0 Introduction 1.1 Structure Business Plan
2.0 Trust Profile
2.1 Development of the Strategy and Business Plan 2.2 The Vision
Vision Statement
3.0 National Policy and Framework
3.1 “Taking Healthcare to the Patient –Transforming NHS Ambulance Services” 3.2 “Reforming Emergency Care” (2001)
3.3 Other Key NHS Strategic Themes SCAS Transformational Map
4.0 Core Objectives and Key Priorities (3-5 years) 4.1 Clinical Excellence
4.1.1 Improving Clinical Practice
4.1.2 Research, Audit and Effectiveness 4.1.3 Education and Training
4.1.4 Clinical leadership 4.1.5 Infection Control 4.2 Emergency Operations
4.2.1 New Service Delivery Model 4.2.2 Speed of Response
4.2.3 Other supporting work streams and initiatives 4.2.4 Indirect resources
4.2.5 New Computer Aided Despatch System (CAD) 4.2.6 Ambulance Radio Replacement Project (ARRP) 4.2.7 Major incident planning
4.2.8 Fleet management 4.3 Urgent Care
4.3.1 Business Development
4.3.2 Development of alternative pathways of care 4.3.3 Payment by Results (PbR)
4.3.4 Market Analysis 4.4 Non Emergency Services
4.4.1 Non Emergency Patient Transport
4.4.2 Commercial and Contractual Business Development 4.5 Corporate Functions
4.5.1 Information Management and Technology 4.5.2 Estates Strategy
4.5.3 Human Resources and Organisational Development 4.6 Governance
4.6.1 Risk Management
4.6.2 Patient & Public Involvement 4.6.3 Information Governance 4.6.4 Communication
4.6.5 Effective Board Working 4.6.6 Financial Management
1.0 Introduction
This Strategy and Business Plan represents the second full year of our five year strategy. It sets out the Trusts strategic aims and objectives for the next three to five years and moves the Trust forward from its initial post-merger ‘Transitional’ phase into a ‘Developmental’ phase of the Trusts evolution.
The NHS continues to operate in an environment of change. This year will see the
publication of. The Lord Darzi review which will detail how services must change to reflect the expectations and needs of the public. The Strategy and Business Plan will be reviewed and adapted to reflect such changes and the required service improvement.
The role of the Ambulance Service is changing; the ambulance service is working hard with the wider health community to ensure members of the public contacting the service receive a response appropriate to their needs. The publication of Taking Healthcare to the Patient –
transforming NHS Ambulance Services suggests a potential service model for these changes
to take place. This strategy and business plan incorporates the principles and recommendations contained within this report.
SCAS has embarked on a programme of change in the way pre-hospital care is delivered, working to treat more patients in their homes to better meet their needs and prevent
unnecessary trips to hospital. Where hospital treatment is required modern ambulances will be available and ambulance personnel will have the right skills to be able to assess and provide the required care.
To achieve this change, SCAS will be training more paramedics and emergency care practitioners and will be engaging with other health and social care partners to ensure the most appropriate options for care are available to the patient.
Over the past year around £6million has been committed to new vehicles. A programme of workforce redesign has commenced together with a programme to recruit a further 350 additional staff by June 2008. By the end of 2008 plans are in place for a further 100 plus Paramedics to be trained and operational.
In April 2008 we face extremely challenging new emergency performance targets with the introduction of call connect and later in the year will implement the new Ambulance Radio Replacement Programme throughout our fleet and Emergency Call Centres. To support this far reaching modernisation programme the trust will strive to improve the infrastructure through; securing and completing moves to new headquarters in both the north and the south of the South Central area and replace the IT operating system used within our Emergency Operation Centres (EOC).
In looking to the future, Ambulance Trusts will be eligible to apply to become Foundation Trusts (FT) from 2009. Whilst we await final notification as to the detail of the application process, work will need to be undertaken in 2008/09 to align the organisation to the characteristics of an aspiring FT. This will include: greater public and stakeholder engagement and a greater understanding of our future business.
The SCAS Board recognises the importance of partnership working and will be engaging fully with the public, patients and stakeholders in our future proposals.
1.1 Structure of Business Plan
Associated to the Business Plan are the Milestone Tracker and Assurance Framework. The Milestone Tracker (Appendix 1) details specific objectives / tasks arising from the
Business Plan and the timetable for delivery, providing a framework against which the Board can monitor progress and performance.
The Assurance Framework (Appendix 2) identifies the key strategic risks arising from the Business plan and the delivery of the Trusts primary objectives.
2.0 Trust Profile
SCAS was established on the 1st July 2006 following the merger of the former Hampshire, Royal Berkshire and Oxfordshire Ambulance Service Trusts and the Buckinghamshire component of the former Two Shires Ambulance Trust.
The South Central Ambulance Service NHS Trusts (SCAS) primary function is to provide an emergency 999 pre-hospital care across the counties of Hampshire, Berkshire, Oxfordshire and Buckinghamshire, with a resident population of 3.9 million. The area covered has a geographic area of 4,600 square miles, which is co-terminus with the NHS South Central Strategic Health Authority (SHA).
There are urban areas of high density population such as Portsmouth, Southampton, Reading, Slough, Oxford and Milton Keynes together with large areas of rurality in areas such as the New Forest, North Hampshire and West Oxfordshire. This profile presents significant variation in population profile with the inner city areas having a larger prevalence of social deprivation than the rural areas.
2.1.1 The Development of the Strategy and Business Plan
The Strategy and Business Plan was approved by the Board in 2007 and has been updated to reflect the progress made and the priorities for 2008-09 which are reflected in the
Milestone tracker.
The Business Plan was shared widely with stakeholders during 2007 and has been available for public comment on the Trusts website http://www.southcentralambulance.nhs.uk.
Feedback has been supportive of the direction of travel.
2.2.1 Where are we now?
In order to assess our current position both SWOT and PESTLE models were used, both are available upon request.
The SWOT model analyses Strengths, Weaknesses, Opportunities and Threats, whilst the PESTLE tool considers external factors including, Political, Economic, Social & Demographic, Technological, Legal and Environmental.
2.2.1 Where do we want to be?
Overall we want to achieve our vision; however we have converted our vision into 3-5 year objectives each with detailed measurable targets. Our Business Plan is
structured around the achievement of these objectives which are detailed in Section 4 below and at the start of each of the sections of the Business Plan.
2.2.2 How are we going to get there?
Our pathway to delivery is outlined in the objectives detailed within the Business Plan (Section 4) and the detailed Milestone Tracker (Appendix 2) which provides clear timeframes and responsibility for delivery, for the current year. The Milestone Tracker will be reported at each Public Board providing a framework from which the Board can take assurance that progress against the Business Plan is being achieved. We have developed a transformational map outlining where we are now, our vision and objectives and the key tasks that form the journey. The SCAS transformational map is included at Appendix 1.
2.3 The Vision
The Trust Board has developed a vision for the future of our organisation which is set out in the following diagram.
3.0 National Policy and Framework
3.1 “Taking Healthcare to the Patient – Transforming NHS Ambulance Services”
The Trust is focused on delivering the recommendations, as stated in the June 2005 report,
Taking Healthcare to the Patient - transforming NHS Ambulance Services, around which our
vision and objectives are based.
The report describes a very different model of ambulance care provision than has historically been the case. It clearly identifies a strategy for improvement which South Central
Ambulance Service embraces including:
• Continuing to improve the speed and quality of 999 services to emergency patients including those with critical care needs and those requiring critical care transfer between hospital facilities
• Starting the measurement of response times to Emergency Calls when the call is connected to the ambulance control room - Call Connect.
• Providing and co-ordinating an increased range of mobile healthcare services for patients who need urgent care
• Improving the speed and quality of call handling with more telephone assessment and higher levels of call taker clinical knowledge and competencies, with the ability to arrange for alternative services when a 999 response is clearly not required
• Higher level face to face clinical assessments, and broader treatment and management options by a wider range of ambulance Trust staff, integrated better with members of the wider healthcare team.
• Working in partnership with primary care teams and community matrons to provide comprehensive services in support of patients with long-term conditions
• Workforce modernisation to ensure the right skills and education, in the right numbers at the right time to deliver the service our patients and commissioners require of us. • Developing the resilience, scale and capability to respond effectively to major incidents
and to ensure business continuity.
Consistent with but building upon this approach, SCAS has identified that it could act as the urgent care contact centre for the South Central area or localities within it to provide a
consistent, resilient and cost effective infrastructure for patients with urgent care needs. This concept of a single point of access, together with a directory of services available 24 hours a day to all available NHS and social care services would be a major step in providing
appropriate and rapid care for patients whatever their needs.
3.2 “Reforming Emergency Care” (2001)
Published in 2001, Reforming Emergency Care sets out a 10 year strategy for urgent and emergency care. Six years on and considerable progress has been made:
• A&E waits down – most patients seen within 4 hours
• More patients with life threatening emergencies being reached by ambulance within 8 minutes.
• Survival rates from cardiac arrest improving year on year
It is recognised that a greater whole systems approach needs to be developed and the Department of Health will publish an urgent and emergency care strategy, which will undoubtedly have a significant impact on the future role of Ambulance Services.
Other Key NHS Strategic Themes
In the new NHS as described in Our Health, Our Care, Our Say – A New Direction of
Community Services, (2006), it is clear that patient choice and a patient focussed service are
paramount. This will entail working with patients and their representatives to understand what they actually want and need.
There are contrasts in the geography, population distribution and levels of deprivation across the South Central Region with a corresponding variance in the requirement for, and access to, health care. Understanding the issues of both rurality and population requirements is critically important for the new trust in planning its services and working in partnership with other agencies to deliver care in these wide ranging communities with their diverse needs. Currently key predominant themes for the NHS are as follows:
Choice - This is the need to cater for patients’ desire for choice by offering alternative
services. This needs a specific interpretation within the context of the services provided by SCAS. We need to plan services, together with patients, commissioners and stakeholders to ensure patients get the right care, in the right place, in the right time.
Voice - A consistent theme of designing services that are personalised to the individual and
responsive.
Safe, reliable and high quality - In emergency care in particular it is critical that services
should consistently achieve these standards.
The development and separation of Commissioning and Provision - From the
perspective of SCAS this means the development of a strong and effective new organisation that can survive and flourish in an environment of competition and choice, and has the capacity to innovate and modernise. For providers in the NHS this means Foundation Trust status.
Value for Money - Essential for all services funded by the taxpayer and of particular
4.0 Core Objectives and Key Priorities (3-5 years) Key Priorities
The following 3 key priorities have been agreed by the Board as the being the foundation for this Business Plan.
• Improving response times and operational performance
• Improving outcomes – including treating and maintaining more people in the community, Modernisation /urgent care
• Improving capability: Leadership Governance Sustainability
4.1 - Clinical excellence
Objective
• to deliver benefits for patients as a result of our focus on Clinical Effectiveness and Education
Targets
• To be in the top 25% of English ambulance services in National Clinical Standards • To reduce patient incidents and improve patient safety year on year
The clinical directorate has been established to create and build a centre of excellence for the delivery of high quality patient-based emergency and urgent care. It has also been designed to plan and deliver the new ways of working as outlined in the National Ambulance Review – Taking Health care to the Patient.
The clinical directorate has three key areas, clinical practice and leadership, education, training and development, and clinical effectiveness. Through these systems and processes the directorate will support all other trust directorates and ensure that clinical care is based on patient need, provided by competent healthcare professionals and based on the best evidence available.
Outlined below are the key strategic areas that the directorate will address in the next three years. Specific strategies and action plans to address the issues will be constantly monitored by the trust Board and its sub committees.
4.1.1 - Improving clinical practice
4.1.1.1 - The merger of four ambulance trusts has resulted in variances in clinical practice and equipment, in comparable work groups, across the new trust. Such variances are now being addressed so that staff can work flexibly across divisional boundaries and work consistently to jointly agreed protocols and practices. Clinical development courses have been specifically planned and programmed for all front line staff to standardise practice and provide a coherent and consistent approach to patient care.
4.1.1.2 - The trust has standardised paramedic clinical practice with the adoption of the most up to date Joint Royal Colleges Ambulance Liaison Committees’ (JRCALC) Pre-Hospital Care Guidelines, (2006), and continues to implement any new guidance from the JRCALC committee through the Clinical Review Group, Governance Committee and the cascade of information through the provision of Clinical Directives.
4.1.1.3 - Specialist policies and procedures have been developed for child and vulnerable adult protection that provide detail on reporting processes and training but also highlight locality differences and approaches with local statutory boards and committees.. A new policy and register of reported Child and Vulnerable Adult Protection concerns by staff has been created which provides a benchmark across the divisions.
4.1.2.4 - A range of national and trust clinical performance indicators have been developed feeding into a balanced scorecard, which will be communicated to staff and stakeholders with the aim of local ownership being taken for improvement.
4.1.2.5 - The trust will develop a Patient Safety culture throughout the organisation. This will be achieved through raising staff awareness through targeted campaigns and internal news articles. All reported Patient Safety incidents will be fully investigated and learning points shared. A programme of formal and informal clinical reviews and audits will be undertaken to ensure good clinical practice is maintained and learning put in place to minimise patient harm in the future..
4.1.2 - Research, audit and effectiveness
4.1.2.1 - Clinical research, audit and effectiveness in the ambulance service has been historically restricted by a lack of accurate clinical data, information and expertise. The development of the new Clinical Audit and Research system (CARS) has provided the trust with a rich information base from which data can be provided for audit, research and quality improvement functions.
4.1.2.2 The programme of clinical performance indicators will provide information on the clinical standards of the trust and also benchmark the trusts performance against other ambulance services.
4.1.2.3 The Trust through the Head of Clinical Effectiveness is participating in national audit groups to develop national programmes of audit, evaluation and research. These will incorporate all previous national audits undertaken by the Ambulance Service Association. 4.1.2.4 - The Connecting for Health Project will eventually provide an Electronic Patient Report Form (ePRF), which will greatly enhance clinical data recording, storage and retrieval and information transfer across the health community. Engagement with the SHA and Local Service providers is ongoing to plan for the implementation of the Connecting for Health ambulance bundle. The timescale for implementation is unknown. The Director of Clinical Services along with the Director of Information Management and Technology will lead on the project and will produce a business case for Board approval once details are known on the full implementation of the Connecting for Health ambulance bundle.
4.1.2.5 - In the short-term the trust will continue to utilise the current CARS system across all three divisions. This will facilitate the electronic gathering of electronic clinical data
enhancing the accuracy of clinical performance information currently available and make it available for quality improvement across all levels of the trust.
4.1.2.6 - The trust will approve an annual audit plan in line with the nationally agreed clinical performance indicators and will measure comparable data across the trust’s three divisions and, where available, against national performance to provide further detail for quality improvement programmes
4.1.2.7 - New national guidance and clinical evidence, such as National Service Frameworks and NICE guidelines, will be appraised, translated and implemented into policies, processes and guidelines for the improvement of patient care. A database will be designed to
document the appraisal and implementation process to provide evidence of the decision making process..
4.1.2.8 - The trust will improve its clinical performance in the provision of thrombolysis, and meet the national call to needle performance target.
4.1.2.9 - The trust will also work with the lead commissioners of the ambulance service and local acute trusts to plan new service delivery models around the development of Primary Angioplasty services to provide improved outcomes of care for patients with acute
myocardial infarctions.
4.1.2.10 - The trust will also work with the lead commissioners of the ambulance service and local acute trusts to plan new service delivery models around the development of acute stroke services to provide improved outcomes of care for patients with stroke symptoms. 4.1.2.11 - The trust will contribute to national clinical effectiveness programmes by
participating in the development of a research strategy that builds on existing systems and procedures and will provide an evidence base on which to base future practice. A trust wide research strategy has been developed that maintains the principles of research governance, fosters an enquiry and evidence-based learning approach and builds research expertise and capacity.
4.1.3 - Education and training
4.1.3.1 - A transition from the traditional model of ambulance training will be made over the next 12 months. New educational programmes are being developed to prepare all
ambulance staff to competently perform their roles and to also provide a career pathway. Partnerships will be developed with higher education institutions to provide adult learning environments where academic learning can be translated in to every day practice within the service
.
4.1.3.2 - Work is ongoing with both the Operations and Human Resources directorates to develop robust work force plans that take into account the changes to training provision and impacts on service delivery that the new approaches to education will make.
4.1.3.3 - A new relationship is being built with National Education South Central (NESC) to ensure that ambulance education is part of main stream commissioning and funding and that programmes meet the needs of organisational service delivery.
4.1.3.4 - The trust is committed to providing education and training and development
opportunities for all staff, providing equality of access for all, and encouraging and embracing the principles of adult and life long learning.
4.1.3.5 - The Head of Education and Training will be required to produce regular
performance reports to the Clinical Governance Committee showing training activity against plan and to provide updates on the transitional planning towards Higher Education.
4.1.3.6 - An annual education and training programme will be developed based on an organisational, personal and professional needs analysis. This will be based on an appraisal process that is underpinned by the national Knowledge and Skills Framework (KSF).
Progress on the plan will be reported through the Clinical Governance Committee. .
4.1.4 - Clinical leadership
The trust will:
4.1.4.1 - Provide clinical leadership to drive the improvement of clinical quality and develop clinical experts that can coach, mentor and support all staff groups.
4.1.4.2 - Establish and maintain positive and effective clinical relationships within the wider health and social health care community and enable cross-organisational and multi
disciplinary working.
4.1.4.3 - Review and recommend the appropriate use of different skill sets from pre-hospital British Association for Immediate Care Service (BASICS) doctors to emergency care
assistants in both control room and front line duties to improve outcomes of patient care, especially those patients that are critically injured or ill.
4.1.4.4 The trust will continue to improve the use and management of medicines in daily practice, ensure that daily practices fall within the legislative framework and progress the availability of drugs for us in pre hospital care
4.1.5 - Infection Control
4.1.5.1 - The trust recognises it has a duty to minimise the spread of infection and prevent harm to patients and will work closely with other health partners to implement good practice infection control measures.
4.1.5.2 - The trust has undertaken an assessment of current control of infection practices and has developed an improvement plan which provides assurance of the processes and
practices put in place to provide high quality standards in infection control and prevention 4.1.5.3 - An Infection Control Working Group has been established, that reports through the Clinical Review Group to the Clinical Governance Committee and Board on the progress made with implementation of the new policy and procedures
4.1.5.4 - The provision of ‘make ready’ services to maintain hygiene and cleanliness of emergency vehicles will be explored and pilots will be established to determine the effectiveness of the proposed new intervention.
4.2 - Emergency operations
Objective
• To strengthen our emergency operations in all respects to improve our speed of response, quality of vehicles, equipment and facilities and be on course to becoming an internationally recognised ambulance service comparable, in terms of our service delivery and patient care, with the best in the world.
Targets
• 2008-09 – cumulatively achieve all national response targets as agreed with commissioners • 2010-11 – cumulatively achieve top quartile performance compared to English ambulance services
• To have standardised equipment and ambulances with no ambulances over seven years old or without tail lifts by April 2009
• To have no facility exceed a category B average on the six facet Estates survey by April 2010.
4.2.1- The Operations directorate is responsible for delivering a service to patients that is fast, clinically effective and reassuring to those in need. The directorate has a decentralised structure based on its Hampshire, Berkshire and
Oxfordshire/Buckinghamshire Divisions. Each Division is led by a Divisional Director who has overall responsibility for delivering the Business objectives in their Division.
4.2.1- New Service Delivery Model
4.2.1.1-The Operations Strategy has been developed over the last year, building on the national guidance contained in Taking Healthcare to the Patient. The model has been widely shared throughout the local health system through a consultation exercise and has received widespread support from stakeholders.
4.2.1.2 - Our New Service Delivery Model outlines the operational model of care towards which we are working. The objectives we set for our new model are
• Faster response for patients
• More accurate assessment of patient need • Improved healthcare advice to patients • More appropriate response
4.2.1.3 The key features of the model that we have developed to deliver these objectives are • Investment in enhanced clinical skills in control rooms, providing better advice for
patients and greater support for crews.
• Response Vehicles (RRVs) respond to calls unless it is clear to control that a transporting ambulance will be required on clinical or other grounds
• On arrival on scene, RRVs triage and assess, only asking for a transporting ambulance where it is appropriate to do so
• Our staff are given the extra training and skills to ensure that they are able to assess and treat significantly more patients, avoiding the need to take patients inappropriately to A&E
• Better access to alternative care pathways • Skills are aligned to the needs of the job
4.2.1.4 The benefits of this approach can be looked at in terms of patients, employees, SCAS and the wider health system.
Patients will experience • Faster response
• Improved assessment of clinical needs • More appropriate response for clinical needs
• More effective treatment and management of symptoms
• A lower probability of being taken to A&E, as increased skills enable more care to be delivered outside the hospital setting, where this is clinically appropriate
• Promotion of health and well being Employees will benefit through
• Better training and development opportunities to maximise potential
• Better career pathway
• Greater variety of work
• Clearly defined deployment model SCAS will benefit from
• Contribution to Call Connect
• Improved efficiency
The Health system will benefit from
• Fewer, inappropriate trips to A&E
• Fewer inappropriate admissions to acute trusts
• Enabler for support for care in the community
• Health professionals working in partnership
4.2.1.5- Although the general direction of travel described above is the one outlined in Taking Healthcare to the Patient and is being followed by most ambulance trusts; no trust has yet fully deployed the model. There are, therefore, risks and unknowns
associated with it. For example, we are unsure how much longer on average our crews will spend on scene, given the extra assessments they will be able to carry out. We are also unsure how many more patients we will be able to assess and treat or send appropriately to alternative care pathways. Given these uncertainties, it is sensible to proceed in the general direction outlined but to have regular reviews along the way to ensure that our assumptions are properly validated before proceeding further. It is vital that we ensure the ongoing support of patients, stakeholders and our staff.
4.2.1.6- We also need to do more work to assess the extent to which the model works as well in rural areas as urban ones. It is likely that a more sophisticated model will be needed in rural areas. We will work with our Commissioners and PCTs to build a service model that delivers equity of care across the whole of SCAS.
Patient safety must be paramount in developing the new model.
4.2.2. Speed of Response
4.2.2.1- A key element of the new model is a faster response to patient need. This is rated as number one priority by our patients and we must respond accordingly. It is essential to our credibility as a Trust that we meet the national targets for speed of response. Our efforts to develop as an organisation will be severely hampered if we cannot deliver these minimum standards by which we are presently judged by patients, local stakeholders, the DH and the media.
4.2.2.2- From April 2008, we will be required to deliver the new Call Connect national performance targets. Our plan focuses on the following key elements
• Ensuring our control processes are upper quartile so that we answer the 999 call, identify the location of the patient and assign the appropriate resource as quickly as possible
• Ensuring our operational processes are upper quartile so that efficiently and effectively, we provide the highest standards of care for our patients
• Maximising the benefits we can secure for patients through effective use of indirect resources
4.2.2.3.- It is vital that we underpin our plan with an effective performance management process that drives improvement through engaging and supporting the key players. We are currently piloting a new systematic approach to performance improvement based on an approach that has already proved successful in other ambulance services. This involves analysing performance and designing responses that are appropriate to the different environments in which we provide services. It will be vital
to secure widespread understanding and support for this approach before full deployment.
4.2.2.4- Our experience to date suggests that our plan needs refinement if we are to deliver the national targets on a consistent basis. In particular, we need to
• Work with PCTs to ensure that we are delivering service to patients on an equitable basis that meets commissioner needs and aspirations
• Recognise that our original aspiration to achieve best in class in all our processes by April 2008 is unrealistic given our starting point and the constraints we face,
particularly around estates, technology and fleet.
• Aim to deliver a resilient service that meets patient need even when demand is high and the operating environment is difficult
4.2.2.5- We have already begun to explore these issues with our commissioners and the outcome of this will be crucial to the future development of the Service Improvement Plan.
4.2.3 Other supporting work streams and initiatives
4.2.3.1-In support of our plan to deploy the new Service Delivery Model, we are planning a number of other work streams and initiatives, both local and national, designed to improve our performance and benefit patient care. Among these are:
• Providing our staff with training that will enhance their ability to assess and treat more patients
• Developing new alternative care pathways and strengthening those that already exist
• Improving our use and governance of indirect resources.
• Deploying the new national ambulance radio replacement programme
• Buying and deploying a single, integrated CAD for all of our control rooms
• Providing a fleet that is fit for purpose
• Buying and deploying a single time and attendance system
• Providing an estate that is fit for purpose
4.2.4 Indirect Resources
4.2.4.1-Indirect resources are a vitally important element in our model of service delivery. The vision for indirect resources within the Trust is to increase the provision of Basic Life Support and defibrillation to patients suffering from cardiac arrest and other specified life threatening incidents that occur in the out of hospital environment. 4.2.4,2- Our dedicated community responder teams are developing initiatives both within
their local communities and through the formation of partnerships with external organisations , the Police and Nursing Homes, with the aim of contributing toward the goal of reducing premature death from coronary heart disease, respiratory and cerebral events.
4.2.4.3-The focus for the community responder teams will be:
• To work towards a 10% contribution to Category A 8 Minute performance, particularly in those areas where response standards are more difficult to achieve by more traditional ambulance resources.
• To ensure that indirect resources are integrated fully within the Operations directorate and are fully resourced and funded to ensure that initiatives are sustainable and able to expand and grow
• To develop a comprehensive Governance Framework for all community and co-responders to adopt and implement as best practice
• To further extend static, community responder, staff responder and co-responder schemes in high demand and/or hard to reach locations so as to improve the clinical outcome for patients and assist in response times
• To review the community responder team structures and processes across the Trust to ensure standardisation and consistency and that an appropriate level of support is in place across the Trust.
4.2.5 New Computer Aided Dispatch System
4.2.5.1 - A critical part of our plans to modernise, improve and standardise our services is the purchase and deployment of a new Computer Aided Dispatch system throughout the Trust. The opportunities afforded by a modern, state of the art system are substantial both in terms of better integration of operations and technological improvement, especially compared to our older current systems. Equally, the potential disruption from implementation of a new system needs to be fully risk assessed and planned. 4.2.5.2 Among the benefits to be delivered as part of the programme are
• improvements in speed of response
• improvements in the sharing and deployment of vehicles and resources across SCAS
• operational consistency in delivery
• one A&E CAD system to help enable the different Emergency Operations Centres (EOCs) to more readily provide fall-back for each other as part SCAS business continuity and corporate improvement plans
• the creation of standardised systems and tools for EOC staff training throughout SCAS
• the production of a standard measurement tool for the collation, recording and reporting of performance and information management
• a tool to provide a single, Trust-wide source of data to enable root cause analysis to be performed on areas where issues are occurring
• implementation of one single medical dispatch system in each SCAS EOC to improve operational and clinical consistency in service delivery
• capture of data to improve the clinical assessment of patients’ needs
• integration of the information gained in the call and that provided by a face to face assessment;
• provision of information for the development of a continuous quality improvement programme for EOC staff
4.2.6 - Ambulance Radio Replacement Project (ARRP)
4.2.6.1- As part of the national ambulance radio replacement programme (ARRP), we will make provision for the new radio system. A Project Board has been established to oversee the project.
4.2.6.2- The trust has developed a robust project plan that has been signed off and supported by the Department of Health, Strategic Health Authority, lead commissioners and the trust Board. A Risk Register appertaining to the project has been developed and project assurance processes are being put in place.
4.2.6.3- The trust’ s ARRP Project Team is working in co-ordination with the Department of Health and ARRP accredited technical and radio communication suppliers to ensure the implementation process on all operational aspects of the project will be
completed by 2009 in line with the national roll out programme timeframe.
4.2.7- Major incident planning
4.2.7.1- SCAS recognises its duty, under the Civil Contingencies Act and accompanying non-legislative measures, to work with stakeholders to deliver a single framework for civil protection in the UK capable of meeting the challenges of the twenty-first century. 4.2.7.2- Within this framework the trust will:
• Assess the risk of emergencies occurring and use this to inform contingency planning.
• Implement trust-wide emergency plans.
• Develop and implement trust-wide business continuity management arrangements. • Put in place arrangements to make information available to the public about civil
protection matters and maintain arrangements to warn, inform and advise the public in the event of an emergency.
• Share information with other emergency services and local agencies to enhance coordination.
• Work in partnership with other local responders and stakeholders to enhance coordination and efficiency.
4.2.8 Fleet management
4.2.8.1-SCAS has inherited from the former trusts a fleet that varies hugely in terms of structure, suitability and age. A capital investment programme of £5m for 2008-09 has been made to replace vehicles over 7 years old. Continued planned investment in subsequent years will bring the A & E replacement period down to five years in line with the recommendations of National Fleet Strategy Group.
4.2.8.2- A comprehensive fleet strategy will be developed following the review being carried out currently by the Freight Transport Association. In the meantime, the key priorities for the fleet strategy are
• Developing a fleet that will support the new model of care and performance standards • Implementing a standard fleet maintenance management software system within all
the workshop and maintenance facilities.
• Coordinating centrally all fleet related activities to ensure consistent approach based a good practice throughout SCAS.
• Reconfiguring workshops where necessary to ensure best practice and improve efficiency and safety. This will be undertaken in line with the recommendations from the review being undertaken by the Freight Transport Association.
• Working with the divisional heads of Operations and Non-emergency Services
managers to ensure the availability of vehicles meets the rota requirements on a daily basis.
• Continuing to develop protocols and systems to reduce the number of vehicle related incidents or accidents, to include an internal points system, as detailed in the Driving and Care of Trust Vehicles policy. The Trust has a dedicated team of trained
accident investigators who will work closely with the Driver Training Manager to analyse accident trends and adjust driver training programmes accordingly to assist in the reduction of vehicle accidents.
• Aligning Non Emergency Patient Transport Service vehicle replacements with contract periods. These vehicles will be leased over the contract period thereby reducing risks to the Trust if contracts are withdrawn.
• Ensuring that new A&E vehicles in the future meet the National Specification and CEN/BSI requirements. Representatives from the Trust will be fully engaged in the National Fleet Strategy Group in the future design of fast Response Cars, patient carrying vehicles etc.
4-3 - Urgent care
Objective
• To extend our role further into the delivery of Urgent Care services, across the whole of South Central. Offering more clinical advice on the telephone and offering patients a wider range of options to the traditional Accident and Emergency (A&E)
departments, including more face to face assessment and treatment.
Targets
• 2% to 5% increase in patients non-conveyed to A&E by March 2008 and top quartile in year two
• 80% category C calls transferred for complex telephone assessment by April 2009 • Provide the common single assessment for all South Central by April 2010
The Service Development directorate is primarily responsible for ensuring existing work undertaken by the trust is sustainable, and that new areas of work are explored and, if appropriate, proposals developed to increase the trusts ‘market share’ of non-emergency business.
The new directorate has a small core team of a director and four supporting managers. It is envisaged however that the team will expand and flex as the agenda and portfolio develop and that joint work will be commissioned which spans numerous directorates.
The key strategic themes of the directorate are: • Business development
• Modernisation • Project Support
4.3.1 Business development
Urgent care service development
4.3.1.13 A concept paper detailing the trust’s approach to urgent care was developed and consulted upon in 2007. Response to the consultation was poor, reflecting, the high levels of change experienced with the health community. During the consultation period, the position of commissioners who firmly believed key concepts were the domain of the commissioner.
4.3.1.2 The initial concept was developed around SCAS hosting a single point of access on behalf of the health community, undertaking secondary triage and onwards
navigation of the system.
4.3.1.3 Recognising the outcome of the consultation – the concept has evolved with SCAS acknowledging the need for a short term solution to managing increasing demand for the ‘999’ system. The emergency ‘999’ system is a well known brand, to such an extent that the public, often confused by the plethora of services and access routes default to using the emergency system. SCAS has therefore established a clinical support desk within the Hampshire EOC, to take calls not requiring an ambulance response and offer secondary clinical assessment and onward advice and referral.
4.3.1.4 Once a common operating systems is available across SCAS, the aim will be to ‘roll out’ the clinical support desk across all divisions. Until such time work is being undertaken to ensure an Emergency Care Practitioner (ECP) is available in each of our EOC to perform a similar function.
4.3.1.5 Incentives have been included within the financial settlement for 2008/09 to support such initiatives. However further work is required to develop the financial
4.3.2 - Development of alternative pathways of care
4.3.2.1 The recommendations of Taking Healthcare to the Patient need to be translated and implemented to ensure a range of alternative care pathways are open to ambulance staff as an alternative to transportation to A&E departments.
4.3.2.2 An audit was undertaken in 2007 which highlighted areas of good practice and areas where gaps in service provision often resulted in ambulance crews having no alternative but to take patients to acute hospitals. Feedback has been given to the PCTs as the commissioners of community services and further work is being undertaken to open access to services for ambulance crews.
4.3.2.3 The aim is in 2008/09 to link the clinical support desk to the Thames Valley
Emergency Access system, giving an immediate overview of capacity and also links into a local directory of services.
4.3.2.4 Joint targets for the number of patients not conveyed to acute hospitals have been agreed between primary care trusts and SCAS.
4.3.2.5 Opportunities for piloting new initiatives and new ways of working will be actively pursued and explored. Outcomes will be shared and, where proven to be effective, business cases prepared for continuing the work.
4.3.2.6 The aim for 2008/09 will be to increase the number of care pathways accessible to SCAS by 10%.
4.3.2.7 The role of the emergency care practitioner should be further developed and
evaluated, enabling a larger number of patients to be assessed and treated either in their home or referred to a specialist source of advice or treatment in the
community. The strategy and commissioning intension need to be agreed with the PCT’s
4.3.2.8 Good practice in other ambulance services and in other healthcare systems will be identified and developed further within SCAS.
4.3.2.9 Appropriate service improvement techniques will be utilised to map care pathways across different healthcare providers to identify pressures, bottlenecks,
inefficiencies and issues.
4.3.2.10 Ensure good engagement with stakeholders within and outside SCAS to identify and resolve service delivery and care pathway issues.
4.3.3 - Payment by Results
The opportunity currently exists for ambulance services to move away from the traditional role, involved in treating at the scene and conveying to emergency departments within Acute Hospitals. For this to be embraced it is necessary to develop and refine the current funding mechanisms to more accurately reflect the work undertaken. SCAS will this year as part of national pilot work develop and evaluate a tariff based funding system.
A project plan has been developed which draws on past experiences of developing Payment by Results (PbR) in acute sector and will ensure SCAS utilises the expertise and skills available to develop a tariff system which does not destabilise service delivery.
The aim for 2008/09 will be to develop a tariff for evaluation for part of the financial year, shadowing the trusts income.
4.3.4 - Market Analysis
Ambulance trusts will be eligible to apply for FT status from 2009 onwards. Although the exact timetable is not known SCAS will be required to undertake the diagnostic process in the coming two years. A considerable component of this will be for SCAS to have absolute clarity as to its core business and future business assumption.
4.3.4.1 To support this, two key pieces of work will be undertaken in 2008/09:
• A market analysis of non emergency services business, which SCAS would wish to acquire
• Agreeing commissioning assumptions with commissioners, including the strategy for required levels of service and model of delivery in the urban and rural areas.
4.3.5 – Stakeholder Engagement
4.3.5.1 A strategy aimed at improving stakeholder engagement and understanding of the Ambulance Service will be developed.
4.3.5.2 The strategy will promote the concept of linking key individuals within the organisation to key external stakeholders, to ensure their needs are understood, expectations met and information exchanged in a timely fashion.
4.3.5.3 Regular communication processes will be developed outside of the performance review cycle to enable strategic exchanges occur in a ‘safe’ and conducive environment.
4.3.6 Modernisation
4.3.6.1 To support internal modernisation the Service Development Team will develop organisational capacity and capability to support service improvement processes and initiatives.
• Provide a toolkit of service improvement and modernisation tools and techniques for use across SCAS
• Provide training and development to staff in the selection and application of appropriate service improvement techniques and methodologies
• Provide ongoing consultancy, advice, support and coaching to staff on specific service improvement/modernisation projects and initiatives.
4.3.6.2 Develop good practice in change management processes
• Develop clear guidelines and principles for ensuring change is effectively planned, led and implemented
• Provide advice and support for change management initiatives
• Ensure a consistent approach to management of change across SCAS
• Ensure each change is evaluated, examples of good practice highlighted and shared and any lessons learnt documented and plans put in place to ensure improvements are made.
4.3.6.3 Specific modernisation and service improvement initiatives, projects and programmes will be planned and delivered, including:
• Provide capacity and expertise in planning, leading or implementing specific and agreed service improvement projects on behalf of operational or clinical teams • (e.g. improving turnaround times at A&E; modernisation of urgent care; developing
the role of the ECP; improving control room processes to support the achievement of Call Connect targets)
4.3.6.4 Sustainability and spread of changes will be supported through:
• Develop and encourage robust evaluation of service developments and changes • Develop approaches to embed change and spread good practice and learning across
4.3.7 Project Support
Robust project management processes are essential to ensure projects are given appropriate focus within the trust and staff working on the projects have their work
recognised, are supported in a learning environment and are able to manage the project as defined within the initial plan.
The Service Development Team will:
Support developing organisational capacity and capability to manage projects through: • Development and implementation of a governance framework for project
management
• Develop a register of all current projects with reporting schedule and milestones clearly identified.
• Provide a toolkit of for staff to utilise regarding project management tools and techniques for use across SCAS
• Provide training and development to staff in the selection and application of appropriate project management techniques and methodologies
• Provide ongoing consultancy, advice, support and coaching to staff on specific projects and initiatives.
4.4 - Non-emergency services
Objective
• To protect our existing non-emergency services and extend coverage across South Central.
Targets
• To win all profitable, re-tendered patient transport contracts within SCAS catchment area by April 2009.
The trust recognises and values the contribution that Non-Emergency Patient Services (NEPS) makes to our patients, the health economy and the trust. NES currently contributes approximately 25% of the Trust’s total overheads and this is a situation the Trust is keen to preserve and expand. Previously these services have been overshadowed by the
emergency aspects of the former trusts business.
In order to provide a strong focus on this important aspect of our business portfolio, the trust has appointed a Non-emergency Services Director, accountable to the Director of
Operations, for the development and performance of Non-emergency services.
The trust regards Non-emergency Patient Transport as part of our core business and will seek to hold all health service patient transport contracts within our area, by offering an efficient and value for money service to our patients and stakeholders.
We believe that the existing courier services and Community Equipment Loans Services offered in some divisions, provides an opportunity for development and we will be seeking to market these services across the South Central area.
4.4.1 - Non-emergency Patient Transport
The trust will develop a SCAS-wide strategy for the provision of non emergency services. Services will be developed that meet the needs of patients and stakeholders, with a
focus on customer service and value for money.
Relationships will be developed with patients and stakeholders and these groups engaged in the design and delivery of services.
New opportunities for business growth and development will be sought.
The trust will tender competitively for new or existing business, ensuring each contract stands alone in terms of financial viability contributing acceptable levels towards overheads. The trust has adopted a non-competitive approach to pursuing PTS business beyond its geographical boundaries. If however the “home” Ambulance Trust does not wish to tender, then we will consider responding.
4.4.2 - Commercial and contractual business development
4.4.2.1 - The trust will seek to develop further its income from commercial training and associated business activity. Marketing will be extended into the wider trust area. It is believed that the size and resources of the new trust will provide a greater competitive edge when competing for new business.
4.4.2.2 - The successful Berkshire Community Equipment Service offers opportunity for expansion and development into other counties. The trust will investigate other markets, such as Nursing Homes and also consider the viability of bringing its own laundry needs in-house, rather than paying external contractors.
4.4.2.3 – A pilot for the provision of children’s equipment has been successfully concluded with the Windsor and Maidenhead Unitary Authority and the Trust will work with stakeholders to extend this service.
4.4.2.4- We will examine the feasibility and viability of setting up and operating a private ambulance service and also consider extending the range of private events we cover. 4.4.2.5- Both Oxfordshire and Berkshire former trusts operated a courier and non patient transport service. It is believed that there is a marketing opportunity to extend this service into Hampshire and Buckinghamshire.
4.4.2.6 - The trust is developing a business case with both Thames Valley and Hampshire Police to provide paramedic and nursing cover alongside the Forensic Medical Services for Police Custody Suites.
4.5 - Corporate functions
Objective
• To develop and integrate our trust wide Corporate functions ensuring that they are
resourced, capable and so equipped to deliver the highest levels of support ensuring that we retain excellent customer focus at all times.
Targets
• Virtual/IT systems environment by December 2009
• Monthly Performance and Activity Monitoring report as ‘single source of truth’ for managers and stakeholders
• Customer Satisfaction Survey improvement year on year
• Staff satisfaction rates (October 2008)
As a minimum, maintain the response rate of the 2007 survey Achieve an improved ratings in 25% of the scores overall.
The trust’s corporate functions include, Information Technology, Estates, Human Resources, Service Delivery, Finance and Corporate Affairs, whose roles are to provide specialist
support to the Operations and Clinical directorates in the provision of emergency and non-emergency care. The strength, capacity and knowledge base within these specific teams are critical to the future modernisation, integration and development of the trust.
4.5.1 - Information Management and Technology
The Information Management & Technology directorate has responsibility for the support and development of all information and communications technology across the trust. During 2008/09 this will include continuing involvement in a number of significant national projects including Connecting for Health, Electronic Patient Record, and the Ambulance Radio Replacement Programme (for the latter see also paragraph 4.2.3).
Locally the development of a single SCAS wide networking infrastructure has enabled the introduction of a corporate e-Mail system and underpinned the introduction of single Finance and HR systems. These will be further enhanced during the year as a number of additional systems are standardised including the Emergency Operations and Control CAD (Computer Aided Dispatch system).
The corporate IM&T strategy demonstrates the additional resilience that the Trust has in place to ensure that all functions can continue to be delivered from any of the three main divisional bases.
The Information Analysis team transferred into the directorate in January 2008. Traditionally their main role was to provide regular detailed analysis in respect of front line services. Whilst this will continue throughout the year there will also be increased involvement in other areas of activity across the trust, which will be demonstrated through the provision of a
comprehensive monthly Performance Report which will provide a “single source of truth” for corporate and stakeholder use.
4.5.1.1 - An Information and Communications Technology Programme Board will work within the corporate governance framework to oversee and agree all ICT development work, agreeing priorities and funding proposals
4.5.1.2 - The common corporate e-Mail address will be embedded within a single portal solution providing all staff with access to timely news and information and improved data sharing facilities
4.5.1.3 - Usage policies and procedures developed during 2007/08 will be implemented across the Trust, to ensure standardisation by year end.
4.5.1.4 - Remote working processes will be improved, with access enabled from all corporate buildings to network and internet services as well as extended home access options where approved.
.
4.5.1.5 - Technical support will be provided to major projects including ARP, ePRF, CAD, EPR and Finance/Procurement
4.5.1.6 – Information management and analysis provision across the Trust will be reviewed to ensure that all divisions are provided with consistent and relevant information to support decision making and service delivery planning. This will include the
development of a Monthly Performance and Activity reporting service which will provide a “single source of truth” for all managerial and monitoring information required across the organisation for managers and commissioners.
4.5.1.7 – Performance reporting tools will be developed for all areas of the Trust, including Operations and HR which will be available to line managers enabling them ready access to timely activity data.
4.5.2 Estates Strategy
The trust has appointed a Head of Estates, who reports to the Director of Finance and
Estates. As with IM&T, the provision of suitable premises in which to conduct our business is essential. A new divisional Headquarters for Hampshire will be established when the
existing lease on Highcroft expires in December 2008.
There is also a pressing need for the provision of a new Oxfordshire and Buckinghamshire divisional Headquarters. The existing Oxfordshire HQ is not fit for purpose and the
Deanshanger site, while owned by the trust it is not considered central enough to combine facilities for the division. It is planned to establish a combined divisional and new Corporate office.
The trust has inherited a property portfolio which varies considerably in terms of age, suitability and state of repair. It is important that the trust develops an Estates Strategy which is fit for purpose for the changing model of the ambulance service.
4.5.2.1 - A comprehensive trust-wide Estates Strategy has been developed which outlines the modernisation and rationalisation of the Estate and supports the new model of care and improved and sustainable performance across the trust
4.5.2.2 - A number of key priorities have been identified which impact significantly on the development of the Trust and delivery of the Business Plan, these are:
• The relocation of Hampshire Division HQ, due to termination of the lease
• Convergence of the Oxfordshire and Buckinghamshire existing HQs and control centres into a single division HQ building and the provision of a Corporate HQ.
4.5.3 - Human Resources and Organisational Development
During 2007/08, the trust has made a number of substantive appointments to the Human Resources directorate, strengthening the Divisional operational HR teams and providing specialist workforce planning and information corporately. . The strengthening of the team has enabled a number of key priorities to be addressed during the year, including the successful go live of the Electronic Staff Record (ESR).
The appointments to the new structure within the agreed procedures which involved all internal displaced candidates as a result of the merger were completed during the year, and only a few posts now remain to be filled, which will be through external recruitment. This has assisted in building the necessary capacity, capability and stability to be able to address our business agenda in year and to advance this agenda in the coming year.
An important step, in terms of integration, has been the standardisation and harmonisation of many of the HR policies, procedures and conditions of employment across the trust. The development of these policies has been an excellent example of partnership working with our staff side organizations, and this will continue as the remaining policies are agreed, and reviewed in the future.
It is our aim to be a model employer and we will continue to work with the staff side to develop an open and consultative culture. We are currently working together to develop equality of opportunity, through family friendly and flexible working conditions responsive to the diverse needs of our workforce.
4.5.3.1 The trust relies on its employees delivering the best care and service they can to patients and the public. We will endeavour to create an environment and culture where staff can grow and develop their skills and their career while balancing this with the demands of their life outside of work. These aspirations fit directly into the NHS Plan and the goal of becoming a model employer and an employer of choice.
4.5.3.2 - The trust has developed a strong partnership base with our unions fostering an environment and culture where staff ideas and innovations positively contribute to the development of the Trust, and the quality of services delivered to patients and other stakeholders.
4.5.3.3 - We aim to deploy Leadership and management training across the trust, addressing the needs of all staff in a management or supervisory role,aligned with the
development programme for the Board, including non-executive directors.
4.5.3.4 - The trust has in place an approved Single Equality Scheme which encompasses the requirements of current legislation in relation to equality and diversity including race, gender and disability. This document will be reviewed and reissued in 2008 with the intention of moving beyond simply meeting statutory requirements, and to encompass all six strands of equality legislation. The revised action plan for this document will detail the priorities for the Trust for the next three years.
4.5.3.5 - Prior to merger three of the four former trusts had achieved Improving Working Lives Practice Plus status. The trust will continue to build on this existing best practice and the momentum of Practice Plus in its pathway towards Model Employer status.
4.5.3.6 - New HR policies and procedures are continuing to be developed and agreed with the staff side through the Policy Review Group, Most policies and locally agreed procedures have now been redrafted as SCAS wide, replacing the old policies of the former Trusts.
4.5.3.7 - The trust successfully implemented the National Electronic Staff Record (ESR) as part of the 10th wave across the NHS, going live in October 2007. This major project demanded considerable resources and project management. It has been closely linked to Payroll, and as a result of the successful implementation the trust has now been able to award the tender to allow of the move to a single payroll provider with effect from 1 April 2008.
.
4.5.3.8 - In the longer term ESR will provide accurate and timely reports in relation to HR performance for sickness, staff profiles, turnover etc. with line managers able to directly access their own workforce information. The roll-out of ESR to ensure maximum benefit and full integration with other trust systems, e.g. Time and
Attendance, is being managed as one project, known as the Intelligent Management Project (IMP). The NHS ESR National Team is interested in working with SCAS to support the implementation of IMP as a case study for the NHS.
4.5.4.9 - The HR team has worked closely with Operations and Training to develop a 5 year Workforce Plan for operational staff, which reflects the future recruitment and skill mix needs of our staff. Further work will be done this year to develop a workforce plan encompassing all other non emergency and support functions.
4.6 - Governance
Objective
• To develop and integrate our trust wide Corporate functions ensuring that they are
resourced, capable and so equipped to deliver the highest levels of support ensuring that we retain excellent customer focus at all times.
Targets
• Virtual IT systems environment by December 2009 • Customer Satisfaction Survey improvement year on year • Staff satisfaction rates (October 2008)
As a minimum, maintain the response rate of the 2007 survey Achieve an improved ratings in 25% of the scores overall.
Governance is led by the Director of Corporate Affairs, who is also the trust Secretary. The trust aims to deliver a fully embedded ‘integrated’ governance system, which combines the principles of corporate and financial accountability with clinical and management
accountability. In so doing, the trust will move towards a single risk sensitive process which covers all of the trust’s objectives, supported by a coordinated source of information. Firm foundations have already been laid and these will be further developed.
In July 2007 the Government announced its decision to allow Ambulance Trusts to apply for Foundation Trust status from April 2009. Further details are awaited; in the meantime the Trust will be developing the resources and work plan necessary for a successful FT application.
4.6.1 - Risk Management
4.6.1.1 - The trust has in place a Board approved Risk Management Strategy which will be reviewed annually.. It is the trust’s aim to ensure Risk Management permeates throughout the organisation and becomes part of the everyday management activity. 4.6.1.2 - It is essential that the Board is aware of the strategic and high level risks facing the
organisation. This is achieved through regular reviews of the Board Assurance Framework and high level Strategic Risk Register.
4.6.1.3 - The trust will seek to obtain a further two year NHSLA level 1 rating during 2008-09 and will seek to apply for Level 2 accreditation during 2009-010.
4.6.1.4 - The trust will build on its 2007-08 Auditors Lines of Enquiry (ALE) self-assessment score, by further developing and embedding its policies and procedures, with the aim of achieving an overall Level 3 score for 2009-010.
4.6.1.5 - The Healthcare Commission performance ratings require an annual self-assessment against the Standards for Better Health Core and Development standards (Annual Health check). The trust will annually scope its position against these standards and will produce an ongoing improvement plan which will ensure compliance.
4.6.1.6 - The trust has adopted an inclusive approach to risk management, making no distinction between clinical and non-clinical risks. A standard reporting system is in place which ensures all risks to be reported in a uniform manner.
4.6.1.7 - The trust endorses an open and fair blame culture, which encourages and supports staff to report both clinical and non clinical identified risks, accidents, and adverse incidents. The trust will seek to learn from such reports incidents and make improvements rather than apportion blame to an individual.
4.6.1.8 - The trust will ensure that it conforms to all new and current legislation and best practice in relation to its management of Health and Safety and Risk Management. . 4.6.1.9 - The trust will continue to develop its central risk management database.
4.6.1.10 - Mandatory training requirements, in relation to health and safety has been
identified and will be incorporated into the Trust’s Training Strategy and Programme Schedule. Records will be maintained to evidence the Trusts compliance against its statutory duties.
4.6.1.11 - Complaints and compliments will continue to be monitored and performance trends reported to the Board.. The Complaints Review group, chaired by the chief
executive, will meet quarterly to review performance and ensure improvements are made from the lessons learnt.
4.6.2 Patient and Public Involvement
Section 11 of the Health and Social Care Act 2001 places a duty on NHS trusts, to make arrangements to involve and consult patients and the public in service planning and operation, and in the development of proposals for changes.
The trust has already established a positive working relationship with its Patient and Public Involvement Forum (PPIF) and meets regularly with PPIF representatives at both a central and local level.
Recently the government has announced proposals to disband forums and create Local Involvement Networks (LINKS) based on geographic areas. The trust will watch these developments carefully and will put an effective framework in place to ensure patients using the ambulance service are represented and have a voice.
