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South Western Ambulance Service NHS Foundation Trust
Annual Report and Financial Accounts
1 April 2011 – 31 March 2012
The South Western Ambulance Service NHS Foundation Trust has a longstanding reputation for quality, innovation and high performance. It is one of the best known ambulance services in the UK, with a positive national profile. Chief Executive, Ken Wenman, is a member of the Association of Ambulance Chief Executives and the Chairman, Heather Strawbridge, is also the Chairman of the National Ambulance Service Network and a Non Executive Director and Trustee of the NHS Confederation.
The Trust is proud of its successful history of clinical and performance excellence.
This Annual Report for the 2011/12 financial year formally records the ongoing success of the Trust. More details are available from www.swast.nhs.uk.
foreword
The Minister of State for Health, Simon Bur
ns MP, visited W
eymouth and
Portland to find out mor
e about the T
rust’s plans ahead of the 2012 Games.
He was welcomed by the T
rust’s Chairman Heather Strawbridge and Acting
Chief Executive Jennie Kingston.
Welcome from our Chief Executive and Chairman
Welcome to the 2011/12 Annual Report and Financial Accounts for the South Western Ambulance Service NHS Foundation Trust, covering our first full year as an NHS Foundation Trust.
Four of the 11 Ambulance Services around the country are now NHS Foundation Trusts and we are proud to have been the first registered on 1 March 2011. Since then we have continued to foster a culture of providing care to standards we would be proud for our own relatives to experience and we strive constantly to achieve our mission to ‘respond quickly and safely to save lives, reduce anxiety, pain and suffering’.
As an emergency and urgent care provider and gateway to the NHS we serve a resident population of almost three million people plus an influx of over 17 million visitors each year across the four counties of Cornwall and the Isles of Scilly, Devon, Dorset, Somerset. We receive around a million patient contacts each year and we aim to serve each patient with respect, dignity and compassion. We do this by placing patients at the heart of every decision we make.
Of course it is people who make our organisation what it is, and we are privileged to have high calibre staff and volunteers working tirelessly to achieve outstanding results across the South West. Our extended team includes BASICS doctors, community based ‘first responders’, charities like the Front Line Emergency Equipment Trust (FLEET) in Cornwall, and the three Air Ambulance charities with whom we work very closely. As an NHS Foundation Trust we are also supported by around 11,800 public and staff Members. Our
members elect Governors who, together with representatives from key organisations across our region, form our Council of Governors. Our full Council of Governors comprises 17 elected public governors, nine appointed governors and five staff governors. Our Members and Governors enable us to engage with the population we serve to hear what we are doing well and what we could be doing better. Our Governors play a particularly important role in helping to create mutual understanding between the Trust, our patients and the wider population we serve. We regard our Members and Governors as being informed; involved; and influential; and if you would like to become a member please contact the Trust or visit our website at www. swast.nhs.uk.
Our Members, Governors and staff help to inform the Trust Board of Directors who lead the translation of our strategic intent into well planned and effective services, taking full account of the economic climate, NHS reforms, increasing demand for services, and less predictable events such as major incidents and unexpected weather conditions.
Some current developments are described in our publication ‘Re-investing in Care’ which can be viewed at www.swast.nhs.uk. These developments, particularly in medical and information technology, coupled with our excellent working relationships with partner organisations, mean we can optimise the care pathways that patients experience and ensure that they receive the right care, in the right place at the right time.
During the last year we held two staff award ceremonies that recognise long service, outstanding
achievements and the absolute commitment of our staff who deliver excellent care on a daily basis. These events are attended by representatives from our partner agencies, local dignitaries and patients who we have
supported during the year. One of the highlights is when we hear from patients whose lives we have touched, which invariably moves the audience to silence as we reflect upon the importance of what we do for the people we serve, their friends, families and loved ones. This again came home to us on the M5 in November 2011 when we attended the largest motorway incident in England for two decades in which tragically seven people lost their lives. The impact of this incident was dreadful and could have been even worse without the commitment and professionalism of the emergency services that step up and deliver even under the most demanding of conditions.
Some other examples of our commitment to the people we serve include:
❙ Implementation of HART (Hazardous Area Response Team) adding resilience to our ability to respond to more complex and hazardous situations;
❙ Delivered performance above both of the national targets for ambulance response times;
❙ Care Quality Commission registration without compliance conditions;
❙ Maintained a Monitor financial risk rating of four (where five is the best) throughout the year and a Green Governance Risk Rating;
❙ Stronger public engagement through multi-agency events and television broadcasts;
❙ Achieved above the national average for ambulance services in the NHS Staff Survey 2011 in areas like staff engagement, and staff recommending the Trust as a place to work or receive treatment;
❙ Top score for NHS Litigation Authority Risk Management Standards level 1;
❙ Patient satisfaction reports consistently exceed 94% for our Urgent Care Service which provides GP ‘Out of Hours’ (OOH) cover;
❙ Continued to meet all local non-emergency Patient Transport Service performance targets;
❙ Received positive outcomes from both of the financial audits carried out during the year, which focused on financial planning and financial systems;
❙ Helped over 2000 patients at stroke awareness events in partnership with the Stroke Association;
❙ For the Information Governance Toolkit achieved at least the minimum level 2 compliance for all of the requirements.
In these austere times the Trust Board of Directors must protect our future and exercise prudence in managing our finances, which is underpinned by our Long Term Financial Model setting out a robust financial position over the next five years. In 2011/12 we achieved ambitious cost efficiency savings and closed the year with a retained surplus in line with plan. This puts us in a strong position to achieve our corporate objectives for 2012/13 and enables us to further invest in delivering patient care and supporting the wider health and social care community; with every investment we make aimed at maximising the value for patients and taxpayers. Over the coming year we will maintain our commitment to providing accessible, high quality, safe and effective services. We are proud of our achievements and, on behalf of the Board of Directors, we sincerely thank our staff, volunteers, partner agencies, Commissioners, Council of Governors, Members and numerous charities who continue to support us.
Ken Wenman Heather Strawbridge
Ken Wenman, Chief Executive of South W
estern Ambulance Service
NHS Foundation T
rust, is pictur
ed in the T
rust’s West 999 Contr
ol Room
(Clinical Hub) with Emergency Medical Advisor
contents
In 2011 South W
estern Ambulance Service NHS Foundation T
rust was awar
ded
the Ambulance T
rust of the Y
ear. Just one of many accolades that the T
rust has
been awar
ded.
In 2011 South W
estern Ambulance Service won many accolades nationally
,
including thr
ee ‘Trust of the Y
ear’ awards. Her
e is Non Executive Dir
ector Trevor
Ware and Emergency Medical Dispatcher Shar
on Crocker collecting an awar
d at a
ceremony in London.
contents
f o r e w o r d 6
Welcome from our Chief Executive and Chairman 7
c o n t e n t s 1 0
a b o u t u s
1 4
d i r e c t o r s ’ r e p o r t 2 0
Business Review 21 Improvements in Services 38 Valuing Staff 50q u a l i t y r e p o r t
5 8
A Statement on Quality from the Chief Executive 59
Priorities for Improvement and Statements of Assurance from the Board 60
Quality Priorities for Improvement 2012/13 65
Statement of Assurance from the Board 70
Quality Overview 72
Assurance Statements - Verbatim 76
Statement of Directors’ Responsibilities in respect of the Quality Report 79 Independent Assurance Report to the Council of Governors of South Western Ambulance Service
NHS Foundation Trust on the Annual Quality Report 80
h o w w e a r e o r g a n i s e d
8 6
Board of Directors 87
p u b l i c i n t e r e s t d i s c l o s u r e s
1 1 0
s t a t e m e n t o f a c c o u n t i n g o f f i c e r ’s r e s p o n s i b i l i t i e s
1 1 6
a n n u a l g o v e r n a n c e s t a t e m e n t
1 1 8
o p e r a t i o n a l a n d f i n a n c i a l r e v i e w
1 3 0
Financial Review 131 Remuneration Report 138Independent Auditor’s Report 143
Annual Accounts 145
The television pr
esenter Nick Knowles is pictur
ed during a br
eak
in filming at the T
rust’s East 999 Contr
ol Room (Clinical Hub) for the
BBC Real Rescues’ series seven.
about us
effective
The Trust’
s biggest asset is its workfor
ce. Here, a member of clinical staf
f takes
part in a training exer
cise.
South Western Ambulance Service NHS Foundation Trust is a high performing ambulance trust that operates across four counties; Cornwall and the Isles of Scilly, Devon, Dorset and Somerset. It was the first ambulance service to become registered as an NHS Foundation Trust, and obtained its licence on 1 March 2011.
The Trust serves a total population of almost three million, is estimated to receive an influx of over 17 million visitors each year and covers an area of over 17,000 square kilometres. This includes 32,000 kilometres of road and 1,330 kilometres of coastline. The operational area is predominantly rural with a number of major urban centres such as Bournemouth, Poole and Plymouth, and served by six Unitary Authorities, four County Councils and a range of District, Borough and Parish Councils.
The Trust is a high quality, effective and efficient NHS organisation and the primary provider of 999
ambulance services across its vast operational area. The Trust’s core operations include the following service lines:
❙ Emergency Ambulance 999 Services (A&E);
❙ Urgent Care Services (UCS) - GP Out of Hours’ Medical Care (Dorset and Somerset);
❙ Patient Transport Services (PTS) - non emergency transport for eligible patients with a medical need for transport.
The Trust successfully registered with the quality regulator, the Care Quality Commission on 1 April 2010. Its current registration status is ‘compliant without conditions’. This means the Trust has received external assurance of it’s commitment to providing high quality care for patients. No inspections were carried out in the 2011/12 financial year.
To support the delivery of its activities the Trust has a diverse fleet of over 600 vehicles including:
❙ Emergency Ambulance 999 Service (A&E) frontline vehicles;
❙ Rapid Response Vehicles including Urgent Care Services (UCS) cars;
❙ Patient Transport Service (PTS) vehicles;
❙ Motorcycles and bicycles;
❙ A boat (used across the Isles of Scilly);
❙ Specialist vehicles introduced during this financial year for the Hazardous Area Response Team (HART);
❙ Medical Cleaning Units.
The Trust provides the clinical teams for four air ambulances (two in Devon, one in Cornwall and the Isles of Scilly, and one shared across Dorset and Somerset), and has a dedicated response desk in its 999 Control Room (Clinical Hub) in Exeter, Devon, which is used solely for the dispatch of air ambulances.
The Trust’s two busy 999 Control Rooms (Clinical Hubs), in St Leonards, Dorset, and Exeter, Devon, provide an around the clock call-handling service. During the year the Trust answered a total of 470,622 A&E telephone calls. A total 417,191 of these resulted in a response being sent to patients. This is a significant increase in the number of calls taken and responded to when compared to last year.
Education, Training and Professional Development
The service continues to drive forward professional standards by bringing together first class teaching, research and clinical services. It has two well respected training colleges, which are at the forefront of teaching lifesaving clinical skills. The professional and highly skilled tutors are predominantly registered paramedics and deliver an annual training schedule, which includes:
❙ Recertification for clinical personnel;
❙ Conversion courses for Technicians training to become Paramedics;
❙ Driver training for frontline operational crews;
❙ Bespoke courses including a Trauma Training package which each clinician is required to undertake;
❙ Conflict resolution;
❙ Refresher courses for hub staff and clinicians in the 999 Control Rooms (Clinical Hubs) linked to the new Ambulance Clinical Quality Indicator (AQI) reporting;
❙ Training for Hazardous Area Response Team (HART) members.
Information, Management and Technology
This year the Trust has installed NHS Pathways for clinical and call taking staff and virtualised the two 999 Control Rooms (Clinical Hubs) into a single entity. NHS Pathways software helps ensure that patients receive the most appropriate response to their calls to improve clincial outcomes and patient satisfaction and
maximise the use of frontline clinical staff by targeting their responses to patients with life threatening illness or injury.
Our Mission
‘To respond quickly and safely to save lives, reduce anxiety, pain and suffering.’
The Trust sets itself apart by delivering and exceeding challenging quality and performance targets, and maintaining clinical focus on developing high quality and safe emergency and urgent care services, whilst sustaining financial health.
Our Vision
‘To deliver high performing emergency, urgent care and non urgent patient transport services that are responsive, safe, clinically effective, financially viable, legally constituted and well governed.’ To support the delivery of this vision the Trust has developed a number of core values based on the NHS Constitution including; respect and dignity, commitment to quality and safety of care, compassion, improving lives, working together for patients, everyone counts, and being an employer of choice.
Our Strategy for 2012/13
The Trust strategy is focused on the further modernisation of all three core services summarised below. Strategic Goal 1: High Quality, High Performing
To deliver improvements at county level, and achieve upper quartile performance at a Trust level, for all national ambulance clinical quality indicators in a phased way over the period 2012/13 to 2016/17. Strategic Goal 2: Improving Patient Pathways
To implement changing patient pathways in line with national strategy and local direction. These will be emergent based on extant policy with a current emphasis on major trauma.
Strategic Goal 3: Right Care, Right Place, Right Time
Align Trust strategies and working practices to deliver the right care to patients, in the right place, at the right time, with a continued focus on delivering a safe reduction in inappropriate A&E attendances at acute hospitals
Strategic Goal 4: Strengthen, Secure and Grow Urgent Care Services
To retain the existing Trust contracts for the delivery of Urgent Care Services when tendered, ensuring they are high quality, clinically safe, cost effective and fit for purpose. Where appropriate the Trust will seek to expand and grow the service line, independently or supported by innovative business partnerships. Strategic Goal 5: Retain, Strengthen and Grow Patient Transport Services
To retain the existing Trust contracts for the delivery of Patient Transport Services when tendered, ensuring they are high quality, clinically safe, cost effective and fit for purpose. Where appropriate the Trust will seek to expand and grow the service line, independently or supported by innovative business partnerships.
In addition, the Trust has four annual corporate objectives which reflect relevant ambulance local priorities:
❙ Deliver and improve upon the national clinical quality indicators;
❙ Deliver and improve upon the national and local commitments;
❙ Work towards sustainable services;
❙ Demonstrate the Trust commitment to its social and organisational responsibilities.
The Trust’s impressive performance is only possible because of the dedication and commitment shown by its staff, along with its excellent performance track record from previous years and the regular reviews carried out to continuously improve ways of working.
Every year new challenges are experienced, exciting opportunities present themselves and many achievements are realised. Significant events in 2011/12 included:
❙ The introduction of the Trust’s Hazardous Area Response Team (HART). The team comprises 42 ambulance paramedics who have undergone extensive additional training and are able to triage and treat patients under hazardous and potentially contaminated conditions;
❙ The Trust was announced as the preferred partner of its neighbour Great Western Ambulance Service after it decided not to pursue its own independent NHS Foundation Trust application and instead looked for a partner to help drive forward its business objectives. The acquisition process commenced in 2011/12 and continues into the 2012/13 financial year, with an estimated completion of the process due towards the end of 2012;
❙ SWASFT clinicians attended one of the worst road traffic collisions ever to occur within the operational area served by the Trust. Tragically seven people lost their lives on the M5 near Taunton in November 2011 and the service dispatched over 40 vehicles and almost 60 personnel in response. A total of 51 casualties were treated. Many letters of recognition for the excellent job carried out by Trust personnel were received from family members of those involved in the incident, MPs, the Secretary of State for Health, local dignitaries and Her Majesty the Queen;
❙ The ‘Right Care’ campaign was launched in support of the Trust’s third strategic goal, which looks at supporting clinicians across the NHS by ensuring that the right care is delivered to patients in the right place at the right time, which ultimately enhances patient outcomes and experience. A number of
roadshows have been held across the Trust area in support of the ‘right care’ philosophy, which have been very well supported;
❙ The introduction of revised Ambulance Clinical Quality Indicators (AQIs). Historically, targets have largely focussed on the time taken to respond, but these new national indicators measure clinical outcomes and take a more holistic approach to care;
❙ The Trust Chief Executive Ken Wenman was seconded to neighbouring Great Western Ambulance Service in November 2011 to take up the post of Interim Chief Executive, as a temporary measure whilst retaining his position as the overall Accountable Officer for SWASFT. Jennie Kingston, the Deputy Chief Executive and Executive Director of Finance and Performance subsequently became Acting Chief Executive of SWASFT;
❙ the Trust tendered to provide the 111 service across our operating region. NHS 111 is a new service being introduced to make it easier to access local NHS healthcare services for non-emergency situations.
All the Trust’s goals and objectives focus on improving clinical quality and enhancing the patient experience. All are set out in support of national policy and guidance.
Our Annual Plan provides more detailed information about our business objectives for each year, and copies are available on our website www.swast.nhs.uk or from Trust Headquarters, Abbey Court, Eagle Way, Exeter, Devon, EX2 7HY.
The latest high tech softwar
e can be found on T
rust operational vehicles.
Here, a paramedic liaises with a colleague in a 999 Contr
ol Room (Clinical Hub)
over the Airwave system befor
directors’report
Ian Knight, one of the T
rust’s Community Engagement Officers, speaks to a
Community First Responder about some forthcoming training. Responders fulfil
a vital supportive r
ole to the T
rust and attend thousands of incidents every year
.
Business Review
The Trust provides a range of high quality services across Cornwall and the Isles of Scilly, Devon, Dorset and Somerset, working from 92 sites, including 65 ambulance stations and four air bases. Our clinicians also work right in the heart of communities such as Local Treatment Centres and Minor Injury Units.
We employ over 2,500 mainly clinically and operationally focussed staff (including Paramedics, Emergency Care Practitioners, Advanced Technicians, Ambulance Care Assistants and Nurse Practitioners) plus GPs and around 850 volunteers (including Community First Responders, BASICS Doctors and Fire Co-Responders). With control centres in Exeter (Devon) and St Leonards (Dorset) working 24/7, we serve a resident population of almost three million plus an influx of over 17 million visitors each year.
Our fleet of over 600 vehicles is one of the most diverse in the country, including ambulances, rapid response cars, cycle response units, motorbikes, air ambulances and a boat on the Isles of Scilly.
The business of the Trust is delivered predominantly through three core services; Emergency Ambulance ‘999’ Services (A&E), Urgent Care Services (UCS) and Patient Transport Services (PTS).
We are undoubtedly best known for our emergency ambulance service, and just over 75% of our income from local commissioning contracts is for the provision of this service. Our UCS business is the provision of the GP ‘out-of-hours’ service across Dorset and Somerset and this accounts for almost 11% of our contracted income. PTS is the non-emergency transport we provide for those patients who have a medical need for transport to their hospital appointments and this accounts for just over 5% of our contract income. The remaining 9% of our income is derived mainly from the HART (Hazardous Area Response Team), VACS (Volunteer Ambulance Car Service) and Air Ambulances.
People are at the heart of our success, supported by our business philosophy of ‘focus and grip’. Our focus is embodied in our strategic activities and our grip is embodied in our operational and performance management activities. This approach has helped position the Trust regularly amongst the best ambulance services in national performance and quality league tables. We are proud of this achievement as a worthy accolade for the relentless hard work, passion and efforts of our staff and volunteers; more importantly it evidences our commitment to serving residents and visitors across the South West region.
Our reputation for breaking new ground continues with the implementation last year of ‘NHS Pathways’, which is a patient focussed suite of software tools enabling us to more appropriately assess the needs of our patients. This technology, coupled with our excellent working relationships with partner organisations and our ‘Pathways Support Vehicles’ (PSVs) that convey patients with non-life threatening conditions to appropriate health or social care units, means we can optimise the ‘care pathway’ that patients experience and ensure that they receive the right care, in the right place at the right time.
Particularly during austere times we must ensure that any investment maximises the value of services for patients and taxpayers and the Trust’s Long Term Financial Model sets out a sound strategic financial base to drive up productivity and drive down costs whilst sustaining high quality services. This is supported by a robust cost improvement strategy which is based on forecast income and cost assumptions whilst maintaining high service standards.
As an NHS Foundation Trust we receive regular external assurance and rigorous assessment of our quality arrangements and our organisational development plan ensures quality remains a top priority. Any
unnecessary waste is stripped out of our systems to improve productivity and help us make the most of every taxpayer penny spent.
Achieving NHS Foundation Trust status has also helped strengthen our business planning and allocation of resources through greater engagement with our Members and Council of Governors which enables us to more fully understand what we are doing well and what we could do better.
Our engagement with the wider public has also been transformed over the last year as we have taken part in several television programmes including Emergency with Angela Griffin, Real Rescues, and Emergency Bikers. These programmes provide a real insight into the work we do and the challenges we face. Other public engagement includes multi-agency initiatives and events where we meet with the public, offer health checks and demonstrate how we respond to incidents and how we support the ongoing improvement in standards of public health.
The Trust’s strategy embraces continued modernisation of our three core services, to ensure delivery of all standards and quality requirements and to provide wider health community benefits. Our business is underpinned by clinical leadership, quality, safety and productivity and we ensure this aligns fully to Primary Care Trust and the emerging Clinical Commissioning Groups (CCG) commissioning plans to deliver the optimum patient experience within a safe working environment for staff, who operate around the clock healthcare services 365 days a year.
Social and community issues - Responders
Responders are invaluable and highly regarded volunteers who have been trained to attend medical emergencies and deliver basic life support, oxygen therapy and defibrillation. The Trust has:
❙ 602 Community First Responders;
❙ 1,565 Establishment Based Responders;
❙ 244 Fire Co-Responders.
Additionally, there are volunteers from a range of organisations such as the RNLI, BASICS and St John Ambulance.
These all add up to 2,654 Responders in 505 different locations across our four Counties.
An increase in coverage and availability by volunteer responders this past year has seen a 14% increase in allocations to emergency calls, with a 28% increase in emergency life threatening calls attended ahead of an ambulance arriving on scene.
We continue to strengthen our governance arrangements for Responders by changing the way they are managed and dispatched. At the touch of a button we are now able to see the availability of all of our responders, which helps us to focus on group activity, availability and specific recruitment. Our 999 Control Room (Clinical Hub) process has speeded up with the introduction of SMS Dispatch, enabling a responder to be allocated to incidents by Area Dispatchers. This has increased the amount of individuals reviewing calls for allocation and as it develops will see an increase in patients attended more rapidly.
The placement of Defibrillators within communities for public access has increased dramatically this year. There are now 22 Public Access Defibrillators managed by SWASFT which can be accessed by anyone around the clock. Further integration with communities this year will enhance this vital volunteer service and shape it for the future.
Transformation
We recognise that real efficiency gains and service improvements can only be achieved by changing our business processes. The Trust has a dedicated steering group which lead on transformation work and is overseen by the Board of Directors. This important group is successfully spearheading the Trust service
developments and cost improvement programmes to drive up efficiencies and productivity whilst stripping out waste and duplication.
Main commissioners
Within the NHS South West area, there are 14 Primary Care Trusts responsible for commissioning healthcare services for the local population, seven of which are in the Trust’s four county operational areas. As
Emergency Ambulance 999 Services (A&E) are provided across seven Primary Care Trusts a coordinated commissioning arrangement exists led by Torbay Care Trust. Quality monitoring, performance and contracting meetings are held bi-monthly.
Urgent Care Services (UCS) are delivered across three Primary Care Trust areas covering the counties of Dorset and Somerset. The quality management of the contract is through two separate Commissioning and Quality Boards who meet quarterly.
Patient Transport Services (PTS) is provided across Cornwall and the Isles of Scilly, North and East Devon, Plymouth, Somerset and Dorset. The Trust works closely with the Lead Commissioner to deliver the service and works in partnership with the Acute commissioning agents. Meetings are scheduled with the commissioning agents to discuss operational requirements and developments and to provide a performance framework for quality and contractual obligations.
Performance against Contract
The Emergency 999 Ambulance Services (A&E) contract is provided on a block basis. This means that a financial value is agreed for each year and anticipated activity levels set. Performance indicators are set and subject to performance monitoring by Commissioners. The Trust’s Emergency 999 Ambulance contract is measured by activations (the number of times an ambulance response vehicle is mobilised).
The Urgent Care Services (UCS) contract is also provided on a block basis. This is measured by patient contacts.
The Patient Transport Service (PTS) contract is provided primarily on a block basis with an element of marginal variance for activity above and below contract. This is measured by the number of journeys it carries out as well as patient seats occupied.
Quality and wider performance issues of UCS and PTS are also scrutinised throughout the year in order to ensure that patient experiences are as positive as they can be.
A summary of the performance against contract for each of the three core service lines is summarised below. Activity Levels and Contract Values for 2011/12
Service Contracted 2011/12 2011/12Actual Contracted2012/13
Emergency 999 Ambulance Service
activations 427,723 436,711 446,775
Urgent Care Services (UCS) Patient Contacts
There is no contracted activity level. Monitoring is undertaken against the activity for the same period in the previous financial year (which equates to 204,245 patient contacts for 2010/11).
208,018
There is no contracted activity level. Monitoring is undertaken against the activity for the same period in the previous financial year. (which equates to 208,018 patient contacts for 2011/12)
Patient Transport Services (PTS) Patient
National Performance targets
Emergency Ambulance 999 Service (A&E)
Challenging national targets for call categories are set out by the Department of Health and they apply to every ambulance service in England.
2011/12 saw the discontinuation of the B19 target. This category was defined as ‘Non life threatening but serious calls, presenting conditions, which though serious, are not immediately life threatening and must receive a response within 19 minutes in 95% of cases. The two categories for A8 and A19 are still applicable. Definitions of these, along with the performance levels achieved by the Trust for 2011/12 are below.
Category A8 – Life threatening emergency calls presenting conditions which may be immediately life
threatening and should receive an emergency response within eight minutes irrespective of location in 75% of cases. Eight minutes is just 480 seconds.
Category A19 – Life threatening emergency calls presenting conditions which require a fully equipped ambulance vehicle to attend the incident, and must have an ambulance vehicle arrive within 19 minutes in 95% of cases, unless the 999 Control Rooms (Clinical Hubs) determine that an ambulance is not required.
Key Performance Indicator agreed Target Nationally % Actual Performance 2011/12 % Actual Performance 2010/11 % Category A8 75 76.05 76.86 Category A19 95 95.78 96.11 Category B19 95 B19 was discontinued in 2011/12 95.58 Despite a 6.25% increase in activity with the same resources the Trust continues to surpass national targets which provides strong assurance for patients and Commissioners that the South Western Ambulance Service NHS Foundation Trust is able to consistently accomplish its goals and objectives as part of its long term programme of reform and modernisation.
The expectations of Patients, Commissioners and the Trust remain high. The Trust is not complacent and recognises the hard work ahead to retain its high performing status. These results not only reflect the exemplary performance record, against continuing pressing operational needs and external influences but also our staff and volunteers; ability, determination and drive to always put the patient first and accomplish consistently outstanding results.
Regulatory ratings
South Western Ambulance Service NHS Foundation Trust was authorised as an NHS Foundation Trust on 1 March 2011 and achieved the following risk ratings for 2010/11 and 2011/12 based on assessment of its submissions:
Authorisation
Rating Quarter 1 2010/11 Quarter 2 2010/11 Quarter 3 2010/11 Quarter 4 2010/11
Financial Risk Rating 3 n/a n/a n/a 3 Governance Risk Rating Green n/a n/a n/a Green
Annual Business Plan Quarter 1 2011/12 Quarter 2 2011/12 Quarter 3 2011/12 Quarter 4 2011/12
Financial Risk Rating 4 4 4 4 4 Governance Risk Rating Green Green Green Green Green The outcome from the Trust’s quarterly monitoring return for quarter 4 2011/12 has not been confirmed at the time of publication.
The overall financial risk rating of four (on a scale of one to five, with one being poor) clearly demonstrates a strong financial performance by the Trust. The governance rating of green indicates the Trust is meeting the standard of performance required in respect of specified key measures and has not identified significant challenges to the governance of the organisation.
Urgent Care Services (Out of Hours GP and/or other healthcare professional
clinical services)
National targets for Urgent Care Services (UCS) are set out by the Department of Health and are applicable to every Urgent Care Service in England. These targets do not exist for in hours GP and/or other healthcare professional clinical services.
The Urgent Care Services has 13 challenging quality targets. The majority of these were successfully met, with a greatly improved performance on 2010/11, despite an increase in activity. A robust improvement plan is in place to ensure those targets not met will be achieved in the year ahead. This strong performance result demonstrates the Trust’s commitment to establishing robust action plans to achieve tough and demanding targets to benefit patients.
A list of the 13 quality requirements targets (some of which have several components) are listed opposite for 2010/11 and 2011/12. These are ‘RAG’ rated, which stands for Red, Amber or Green. A rating of red means that the requirement has not been met, amber means ‘partially met’ and green means ‘fully met’.
Requirement
Number Quality Requirement RAG Rating for 2010/11 RAG Rating for 2011/12 1 Providers must report regularly to Primary Care Trusts on their compliance with the
Quality Requirements Green Green
2
Providers must send details of all OOH consultations to the practice where the patient is registered by 0800 hours the next working day
Green Green
3
Providers must have systems in place to support and encourage the regular exchange of information between all those who may be providing care to patients with predefined needs (including patients with terminal illness)
Green Green
4
Providers must regularly audit a random sample of patient contacts. The sample must be defined in such a way that it will provide sufficient data to review the clinical performance of each individual working within the service
Green Green
5 Providers must regularly audit a random sample of patients’ experiences of the service
(eg 1% per quarter) Green Green
6 Providers must operate a complaints procedure that is consistent with the
principles of the NHS complaints procedure Green
Green
7
Providers must demonstrate their ability to match their capacity to meet predictable fluctuations in demand for their contracted service
Green Green
8a No more than 0.1% of calls engaged Green Green
No more than 5% of calls abandoned Green Green
8b Calls to be answered within 60 seconds of the end of introductory message Red Amber 9a All immediately life threatening conditions to be passed to the ambulance service within
three minutes Green Green
9b
Definitive Clinical Assessment for urgent calls
started within 20 minutes Red Red
Definitive clinical assessment for all other
Requirement
Number Quality Requirement
RAG Rating for 2010/11
RAG Rating for 2011/12
10a (walk-in patients)
All immediately life threatening conditions to be passed to the ambulance service within three minutes of face to face presentation
This quality standard is not applicable to this service as a separate clinical assessment is not carried out in between presentation and clinical consultation at walk-in centres This quality standard is not applicable to this service as a separate clinical assessment is not carried out in between presentation and clinical consultation at walk-in centres 10b (walk-in patients)
All definitive clinical assessment for urgent cases presenting at treatment location started
within 20 minutes This quality standard is not applicable to this
service as a separate clinical assessment is not carried out in between presentation and clinical consultation at walk-in centres This quality standard is not applicable to this service as a separate clinical assessment is not carried out in between presentation and clinical consultation at walk-in centres All definitive clinical assessment for less
urgent cases presenting at treatment location started within 60 minutes
10c At the end of the assessment, the patient must be clear of the outcome Green Green 11 Providers must ensure that patients are treated by the clinician best equipped to meet
their needs in the most appropriate location Green Green 12
(presenting at base)
Emergency consultation started within
an hour Green Green
Urgent consultations started within
two hours Amber Green
Less urgent consultations started within
six hours. Green Green
12
(home visit)
Emergency consultations started within
one hour Green Green
Urgent consultations started within
two hours Red Red
Less urgent consultations started within
six hours Green Green
13
Patients unable to communicate effectively in English will be provided with an
interpretation service within 15 minutes of initial contact. Providers must also make appropriate provision for patients with impaired hearing or impaired sight
Patient Transport Service (PTS)
Our Patient Transport Service (PTS) provides support for patients who have a medical need for transport, where their GP has determined they cannot use public or other transport because of their medical condition. Eligible patients can access PTS support for:
❙ Attending hospital outpatient clinics;
❙ Being admitted to or discharged from hospital wards;
❙ Transferring between hospitals;
❙ Needing life-saving treatments such as chemotherapy or renal dialysis and supporting end of life (EOL) decisions.
Our PTS performance was good last year; however, there are still areas where we need to improve and we are working hard with our teams to achieve this. We are committed to continuous improvement and providing a service that is always centred on patients.
PTS operates in an open market where we compete against other organisations, often private companies, to provide pre-arranged transportation for patients to and from outpatient appointments; and in 2011/12 we supported 141,452 patient journeys.
Last year, our PTS patient survey demonstrated 98.7% patient satisfaction and whilst this is an excellent achievement we remain committed to keeping patients at the heart of all decisions to make further improvements. As a result of working in partnership with our Commissioners, PTS core vehicles are now equipped with an Automatic External Defibrillator, which increases the level of clinical care that can be delivered by our Ambulance Care Assistants (ACA).
In the coming year, we are working to enable journeys to be sent electronically to staff on the road with ‘real-time’ data updates throughout the day. This offers greater control in maximising resource availability and also helps us to provide vital information to our commissioners on key performance indicators (KPI’s) to ensure continuous improvements.
Over the coming year we will work to improve call answering technologies and to develop ever more meaningful KPI’s to ensure we provide a high quality service. We will invest in new ways of working to drive efficiencies and better utilisation of our available resources. This approach together with a rigorous focus on finances will ensure that we use resources wisely to deliver quality solutions for our patients and Commissioners.
Key Performance Indicator Locally agreed Target % Actual Performance 2010/11 % Actual Performance 2011/12 % Calls received answered within 25
seconds 80 87 90
Calls into the Patient Transport Services
(PTS) Control abandoned Less than 4 3 3
Contracted activity levels to be
Medical Transport Service (MTS) – our hospital and inter-surgery courier service
With our pool of experienced drivers we offer a secure and reliable NHS ‘internal’ courier service; carrying everything from mail, Pathology Laboratory samples, case notes, x-rays and so on. We deliver between departments, hospitals and GP surgeries, meeting our clients needs in the most cost effective and efficient ways. Drivers are ADR trained; and for peace of mind when carrying documents of a sensitive nature such as patient case notes, we have, in consultation with Health trusts, devised and work to data protection policy procedures. Specific features of our MTS include:
❙ All vehicles specially designed to carry medical samples and supplies;
❙ All vehicles ADR compliant;
❙ Drivers trained to ADR Class 6;
❙ All drivers carry company photographic security I.D. tags;
❙ Pathology, and specimen collections;
❙ Pharmacy re-supply;
❙ Vaccine delivery.
Ambulance Clinical Quality Indicators (AQIs)
National clinical indicators have completely transformed over the past 12 months. All ambulance services must now provide monthly data in relation to a number of factors. This more holistic approach, set out by the Department of Health (DH), was introduced in pilot/shadow form in April 2011 to measure and monitor the quality of care provided to patients.
Under the entitled Ambulance Clinical Quality Indicators (AQIs) regime, ambulance trusts are required to publish all data in relation to each AQI indicator on a monthly basis both locally (on an ambulance service’s website) and nationally (by the DH). AQIs are used to understand the quality of care provided, focussing particularly on the outcome of care provided for patients, as well as the speed of responding to patients. Ambulance service providers use AQIs to stimulate continuous improvements in the care they provide for patients. AQIs were created to provide a comprehensive and balanced view of care and should be used as a complete set rather than focussing only on a few specific indicators.
As a complete set, AQIs provide a much fuller picture of how ambulance services are performing. AQIs are designed to be consistent with measures in other parts of the NHS, most notably those in hospital emergency departments.
It is widely recognised that the first year of AQI data collection in 2011/12 was a transitional year from the previous reporting measures to ensure all ambulance services have consistent definitions and reporting methods. For this reason it is not yet possible to directly compare AQI performance across ambulance trusts; however, AQIs produced by individual ambulance trusts can be used to monitor changes and improvements in performance month by month within those individual ambulance trusts.
SWASFT is committed to using AQIs to support continuous improvement in the quality of care provided to patients, and to help patients understand how we are performing.
Ambulance response times, that is how quickly we respond to and, where necessary, reach patients to provide care and support, remain important for the most seriously ill patients and performance against the
national response time targets continue to be monitored. Category A patients, i.e. those with immediately life threatening conditions, should receive a response within eight minutes for 75% of all cases. Presenting conditions, which require a fully equipped ambulance vehicle to attend the incident, must have an ambulance vehicle arrive within 19 minutes of the request for transport being made in 95% of cases.
The AQI data which is held, along with that of other ambulance services from around the country, includes;
❙ Outcome from Cardiac Arrest – return of a pulse (spontaneous circulation) on handover;
❙ Outcome from Cardiac Arrest – survival to leaving hospital (discharge);
❙ Outcome from patients having a heart attack (ST Segment Elevation Myocardial Infarction (STEMI));
❙ Outcome from Stroke;
❙ Call abandonment and re-contact after discharge;
❙ Calls closed with advice or A&E non conveyance;
❙ Patient experience measures;
❙ Time to answer call and time to treat. Refer to page 74 for AQI data.
Clinical Performance Indicators (CPI)
During 2011/12 the national requirements were for ambulance services to continue to participate in the National Clinical Performance Indicator programme (CPI). The programme continues to monitor and report the ongoing clinical care delivery in four clinical topic areas, ST segment elevation myocardial infarction (a type of heart attack), stroke, asthma and hypoglycaemia (a diabetic emergency caused by a low sugar level).
Commissioning for Quality and Innovation (CQUIN) - 2011/12
Lord Ara Darzi introduced ‘High Quality Care for All’ in 2008 which included a commitment to make a proportion of providers’ income conditional on quality and innovation, through the NHS Commissioning for Quality and Innovation (CQUIN) payment framework. The tables that follow sets out the Trust CQUIN targets for 2011/12, which represented 1.5% (£1.409m) of the Emergency 999 Ambulance Service (A&E) block contract value.
Emergency 999 Ambulance Service (A&E) CQUIN - 2011/12
CQUIN Target Description Target Name Contracted value £ Actual value £ Delivery of the 2011/12 non-conveyance trajectory. In line with
the Trust philosophy to keep patients at or closer to home when it is clinically and socially safe. The Trust will target a number of clinical and operational areas to reduce the number of conveyances to A&E departments. The three key areas are health promotion, triage and skills
Non
conveyance 500,000 400,000
Develop an innovative approach to gathering information on the patient experience across all three service lines. Including patient experience from the introduction of NHS Pathways
Patient
Experience 69,900 69,900
As the majority of Healthcare Professional Calls are received from General Practitioners, the Trust will explore the number and demand profile of Healthcare Professional Calls received from each practice and analyse the ratio of Healthcare
Professional Calls to the number of patients registered at each practice during the in and out-of-hours period
Analysis of Healthcare Professional Calls
139,801 139,801 Work in partnership with a range of other local agencies, to
support the delivery of focussed health promotion. Whilst areas which have traditionally received support will be strengthened with a renewed focus, new areas of importance will be explored and developed
Health
promotion 139,801 139,801
Explore the delivery of effective safety netting arrangements for non conveyed patients (approximately 38% of patients remain on scene following a 999 call), whilst developing further approaches to enhance patient safety. Share
information with General Practitioners, both with the current paper based patient clinical record system, and the future electronic record Safety Netting Arrangement for Non Conveyed Patients 139,801 139,801
Explore the current clinical performance of Emergency Care Practitioners across the Trust, to identify examples of best practice and to determine new opportunities and models of service provision. Explore opportunities that arise for the Emergency Care Practitioner role through the move to GP Consortia and the effectiveness of working in the primary care setting Emergency Care Practitioner Performance Measurement Tool and Development Plan 209,701 209,701
CQUIN Target Description Target Name Contracted value £ Actual value £ Build on examples of best practice and innovation developed
during 2010/11 to identify patients who have fallen, develop an integrated fall alert pathway to improve referrals, and support General Practitioners in the identification of patients at high risk of fragility fractures. For neck of femur fractures, work will be undertaken to scope further interventions that can be delivered by ambulance clinicians to improve the patient experience following the development of good practice with South Devon Healthcare NHS Foundation Trust
Development of falls Referral and Fractured Neck of Femur Pathways 139,801 139,801
This CQUIN will scope the key areas required to assist with the reporting requirement against the SQU03_07 ambulance clinical quality indicator of survival to discharge after cardiac arrest National Ambulance Clinical Quality Indicators 69,900 69,900 Totals 1,308,705
Patient Transport Service (PTS) CQUIN - 2011/12
CQUIN Target Description Target Name Contracted
value £
Actual value £ Merge Patient Transport Service (PTS) and Emergency 999
Ambulance Service (A&E) hubs Command and Control software to achieve economies of scale and improve information flows to Commissioners Merge A&E and PTS Command and Control systems 42,490 14,163
Carry out a feasibility study on the ability to report on patient cycle times and implement if achievable
Feasibility study on reporting patient cycle times 4,722 4,722 Develop a process to disseminate the reporting of call handling
performance and implement a further improvement plan
Report call handling
performance 4,721 4,721
Provide or replace Automated External Defibrillators (AEDs) on all Patient Transport vehicles across the Trust. Devise and provide a training programme to all Patient Transport Service staff in the use of AEDs
Provide AEDs on all PTS vehicles and train staff appropriately 42,490 42,490 Totals 66,096
Urgent Care Service (UCS) CQUIN - 2011/12
Target Description Target Name Contracted value £
1: Improve communication across organisations;
2: Liaise with GP practices to ensure they are using SWASFT standard special notes forms / Ensure SWASFT is receiving special notes from from all practices re palliative care patients;
3: Ensure that all special notes appertaining to palliative care patients include preferred place of death;
4: Ensure GPs working in the service are up to date with their palliative care training needs;
5: Ensure a timely response at the time of a patients death which is supportive to family and friends
End of Life
Care 37,046
1: Improve the outcomes for patients who are triaged by clinicians; 2: Improve the performance and competencies of the practitioners.
Improve outcomes from
triage 37,046
1: To improve the quality of prescribing practice in relation to antibiotic indicators;
2: To reduce the number of emergency supplies provided during Out of Hours
Prescribing
Practice 37,046
To ensure a robust skills mix on all shifts to further improve the quality of care for patients
Skill mix and shift
compliance 37,046
Develop the use of NHS Pathways for OOH. This will allow call receivers to provide improved assessment and more appropriate dispositions for patients contacting the service
Effective Call
Steaming 37,046
Total 185,230
Commissioning for Quality and Innovation (CQUIN) 2012/13
Nine CQUINs for 2012/13 have been agreed with Commissioners and represents 2.0% (£1.993m) of the Trust block contract for Emergency 999 Ambulance Services (A&E).
Emergency 999 Ambulance Services (A&E) CQUIN - 2012/13
CQUIN Target Description Target Name Contracted
value £ Delivery of the 2012/13 non-conveyance trajectory. In line with the Trust
philosophy to keep patients at or closer to home when it is clinically and socially safe, the Trust will target a number of clinical and operational areas to reduce the number of conveyances to A&E departments. The three key areas are health promotion, triage and skills
Right Care, Right Place,
Right Time 500,000
Develop a targeted approach to gather feedback on patient experience, utilising discovery interviews, telephone questionnaires, feedback clinics and a feedback leaflet to enhance organisational learning
Patient
Experience 119,607
Establish the clinical rationale behind re-contacts with the 999 service, in order to ensure patient safety. The project will identify trends, manage associated risks and develop potential means to reduce re-contact rates, leading to the agreement of a re-contact rate performance threshold
Re-Contacts with the 999
Service 199,345
Deliver high quality and clinically safe care to patients under two years old who are not conveyed to hospital
Non
conveyance of patients under 2 years of age
CQUIN Target Description Target Name Contracted value £ Support the avoidance of unnecessary admissions to hospital for people at
the end of life by evaluating the provision and utilisation of 'just in case' boxes in end of life care. Improve the knowledge base and awareness of palliative care for clinical staff
Improving the quality of end of life care delivered to patients 199,345
Provide structured interventions to promote a healthy, fit workforce, with
the longer term aim of reducing staff sickness rates Staff Wellbeing 114,623 Increase staff awareness of the identification and reporting of pressure
sores, according to NICE guidance Pressure Sores 99,673
Support the implementation of a clinically safe and appropriate major trauma system across the South West. Evaluate the impact of the system on the Trust, following the major trauma business case
Trauma training and mental health urgent care evaluation 311,420
Evaluate the care delivered to patients requiring mental health urgent care, which does not result in a Section being applied
Trauma training and mental health urgent care evaluation 250,000 Total 1,993,358
Patient Transport Service (PTS) CQUIN - 2012/13
The following CQUIN targets have been agreed for 2012/13 with the total value of the 2012/13 CQUIN £94,423.
Target Description Target Name Contracted
value £ The Trust is to devise a mechanism whereby PTS crews are utilised to
disseminate health related information, based on at least 3 National or local schemes in particular, but not restricted, to health improvement initiatives
Distribution of health improvement information
9,442
The Trust is to devise a mechanism whereby information relating to carer support groups is handed out as a mail shot and undertake a short questionnaire on receipt and usefulness of information supplied
Leaflet drop relating to carer support and survey to evaluate usefulness & effectiveness 9,442
The Trust is to design an awareness training programme in dementia and ensure all staff are trained by 31st March 2013
Dementia awareness
training 56,654
The Trust is to provide a deep cleaning schedule for PTS vehicles and undertake sampling checks and report outcomes
Vehicle deep clean
programme 18,885
Total 94,423
Urgent Care Service (UCS) CQUIN - 2012/13
Our Commissioners are currently considering the Urgent Care Service CQUINs for 2012/13 and once established and agreed they will be published on the Trust website www.swast.nhs.uk.
Risks
The Trust is committed to developing a responsible risk management culture to empower all staff to make sound judgments and decisions concerning risk and risk taking for promoting the safest possible environment for patients and staff. The Trust’s Risk Management Strategy is subject to annual review. It was revised and approved by the Trust Board of Directors in March 2012 and was updated to ensure it met best practice requirements.
Risks are identified at all levels of the Trust and the triangulated approach to risk management is led by the Trust Risk Manager with a clear escalation process in place. Risks are scored on a 5 x 5 matrix, the first relating to the impact of the risk and the second to the likelihood of it occurring. One represents low impact or likelihood and five represents high impact or likelihood. Where the risk value exceeds 14, risks are included on the Corporate Risk Register ensuring the Board of Directors are aware and able to assure themselves that appropriate actions are addressing and mitigating the risks. It is important to recognise that all organisations face risks all the time. The key issue is that the risks are assessed and addressed and, in particular, high level risks where the impact and likelihood are elevated receive robust management attention to reduce the risk. The Corporate Risk Register is reported at each Director’s Meeting, Board of Directors’ Meeting, and at each Quality and Governance Committee. The following table sets out the Trust’s highest risks as at 31 March 2012.
Key Risks Mitigating Actions
Call Answering Performance
❚ Clinical Hub restructure;
❚ Recruitment and training of additional Call Takers;
❚ Implementation of Demand Management Protocol;
❚ Improved call audit feedback to improve performance;
❚ Reconfiguration of ICCS database to support prioritisation of represented calls.
Ambulance Clinical Quality Indicators (AQIs) and New Response Targets
❚ AQI action plan with trajectory;
❚ AQIs incorporated within Corporate Objectives and monitored by the Corporate Performance Review Group;
❚ Clinical Hub restructure;
❚ Implementation of version 6.4.2 of NHS Pathways;
❚ Re-modelling exercise.
Impact of Resource Escalatory Action Plan (REAP) Levels, and Summer, Winter and Peak pressures
❚ Gold Resource Escalatory Action Plan meetings in place if required;
❚ Monitoring by Corporate Performance Review Group;
❚ Business Continuity Policy in place with plans developed for each function;
❚ Member of Local, Regional and National Resilience Forums;
❚ Handover procedure agreed with Commissioners.
Attendance and Wellbeing
❚ Attendance trajectory monitored by Corporate Performance Review Group;
❚ Sickness Absence Work Programme developed;
❚ Introduction of operational manager scorecard;
❚ Tightened procedures relating to sickness absence notifications.
Industrial Action
❚ Resilience and mitigation plan in place;
❚ Mutual aid arrangements;
❚ Guidance developed for managers;
❚ Service exemptions agreed with staff side;
❚ Ongoing communication and involvement to engage positive industrial relations.
Tender Application
❚ Dedicated Senior Project Manager;
❚ Project Board established;
❚ Mobilisation Plan developed.
Fuel Price Increases
❚ Escalation process for expenditure overspend;
❚ Fuel Reduction Action Group;
❚ Fuel Reduction Action Plan with identified lead monitored by Corporate Performance Review Group.
External Impacts
The Trust has identified the key external factors that are likely to affect the future of the Trust’s business. As a provider of Emergency 999 Ambulance Services, Urgent Care Services and Patient Transport Services our development is affected by external changes within the health and social care environment, as well as wider economic and demographic changes. Some key factors influencing external Trust impact include:
❙ Changes to funding priorities and commissioning structures as a result of NHS reforms and new health policies;
❙ NHS constitution including new rights for patients;
❙ Savings and activity plans;
❙ Trust transformation plans;
❙ Increased competition for tendered services;
❙ The implementation of the new national ambulance contract for ambulance services which significantly strengthens the contractual arrangements between Commissioners and the Trust. The contract focuses on the quality aspects of service delivery;
❙ The ageing population is expected to continue to grow with the number of people aged over 85 in this country forecast to double in the next 20 years. This will significantly influence the way in which health services are delivered;
❙ Volatility in fuel prices;
❙ Public sector financial deficit;
❙ Ongoing challenge of delivering a range of emergency and urgent care services within an area that is largely rural, sparsely populated and with an annual influx of over 17 million visitors;
❙ Global economic downturn;
❙ Cultural shift for workforce from command and control to empowered clinicians;
❙ National programme for information technology introducing the electronic patient record;
❙ Quality, Innovation, Prevention, Productivity (QIPP) programmes at differing stages across the south west region;
❙ Governance reforms for the NHS which include elected governors with more powers and responsibilities;
❙ A tougher and continually changing regulatory regime by Monitor; the economic regulator and the Care Quality Commission; the quality regulator, Information Commissioner; the information regulator, Health and Safety Executive; the health, safety and security regulator;
❙ Tougher environmental and sustainability targets;
❙ Continuing increased demand for round the clock ambulance services;
❙ Challenging new Ambulance Clinical Quality Indicators (AQIs);
❙ Environmental factors including weather and pandemics;
❙ Pay and non pay inflation in line with planning assumptions;
❙ The GWAS acquisition process;
❙ Possible terrorist activity.
The Trust Directors and Trust Board appraise all risks on a regular basis and will continue to do so to ensure that our plans are well thought through and sufficiently robust to enable us to respond to the rapidly changing environment.
Improvements in Services
Medical developments and clinical care
The past year has seen a wide range of clinical innovations and developments being adopted into practice. The Clinical Care Team continue to proactively seek out evidence based interventions and medicines which have the potential to further improve patient care. From becoming the first ambulance service to introduce a drug which significantly reduces the chance of dying from bleeding after trauma, to developing an online referral system for patients who experience a fall, the Trust continues to innovate in order to ensure that every patient receives the very best possible care.
Medicines Management
During 2011/12 medicines management procedures were critically reviewed in order to further strengthen the Trust’s governance arrangements and to allow greater clinician involvement. The Trust’s Medicines Management Group is divided into two subgroups; one covering emergency ambulance practice, the other on the Urgent Care Service (UCS), in order to increase the focus given to both areas. Further clinicians were recruited into each sub group and allocated an active role in the business of the Group. Commissioning PCTs were invited to attend meetings of the UCS sub group and a representative from NHS Dorset attends regularly, improving communication between both organisations on medicines related issues.
Throughout the year there has been a particular focus on strengthening arrangements for controlled drug management and improving existing reporting arrangements. The importance of utilising new technologies to improve efficiency and reduce clinician time spent on administration has been recognised and actively explored.
The Trust has participated in two important national consultations connected to controlled drug use and management, and is already preparing for potential changes to medicines legislation that are expected in 2012. The changes will give the Trust’s clinicians greater freedom to possess, supply, prescribe, direct to supply and administer a greater range of controlled drugs. The Medicines Management Group recognises that with freedom comes responsibility and much of the work in 2011/12 has been geared to ensuring that the Trust can offer greater clinical freedom to clinicians within a robust governance framework.
Managing Major Bleeding
Uncontrollable bleeding is responsible for about a third of deaths in patients who experience trauma. The Trust was the first UK ambulance service to prioritise major bleeding (haemorrhaging) in the patient assessment process, and the first to introduce arterial tourniquets to stem bleeding from limbs. Building on our reputation for innovation in trauma care, during June 2011 all ambulances began carrying a major haemorrhage pack, containing a range of advanced dressings to stem bleeding, including a special type of gauze which uses a chemical reaction to stem blood flow.
Working closely with the Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC), the Trust became the first ambulance service in the UK to provide a new drug to patients experiencing significant bleeding. Tranexamic Acid works on the mechanism that controls bleeding within the body, reducing blood loss and reducing the risk of dying by up to 30%. As the drug is more effective when given rapidly after the injury, Paramedics have been administering it since December 2011.
