annual report and accountsthe proportion of elderly people living in the region is the highest in...

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Annual Report and Accounts

1 April 2014 – 31 March 2015

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South Western Ambulance Service NHS Foundation Trust

Annual Report and Accounts

1 April 2014 – 31 March 2015

Presented to Parliament pursuant to Schedule 7, Paragraph 25 (4) (a) of

the National Health Service Act 2006

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Foreword

South Western Ambulance Service NHS Foundation Trust (SWASFT) has a

longstanding reputation for quality, innovation and high performance.

It is the most rural of the 10 ambulance services in England and covers 10,000 square miles (20% of mainland England), but also serves many urban conurbations including Bath, Bournemouth, Bristol, Exeter, Gloucester, Plymouth, Poole and Swindon. The resident population of our area stands at approximately 5.3 million. The proportion of elderly people living in the region is the highest in the country and this presents unique challenges to the organisation. Additionally, there is an influx of over 17 million visitors to the region every year which the Trust proactively accounts for in its annual operational planning. The Trust delivers a range of emergency ambulance and urgent care services, including NHS 111 and Out of Hours services. It employs over 4,000 staff who work across more than 100 sites including ambulance stations, clinical control rooms and air ambulance bases. A diverse fleet of 1,056 vehicles is available to respond to patients, including ambulances, helicopters, motorcycles, bicycles and even a boat on the Isles of Scilly. The Trust’s diverse workforce is supported by a network of around 5,000 volunteers who are highly valued and make a real difference to patients. They include members of the public, off duty staff, colleagues from the fire service and RNLI, GPs and those from third sector organisations, such as St John Ambulance. This Annual Report covers the performance of the Trust in the 2014/15 financial year.

More details are available from www.swast.nhs.uk

http://www.swast.nhs.uk/

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Contents

Strategic Report A welcome message from our Chief Executive and Chairman…………………... 7 7 Our business…………………………………………………………………………… 9 9 Performance against contract………………………………………………………... 16 Improvements in services…………………………………………………………….. 45 Patient experience and stakeholder engagement…………………………………. 53 Valuing staff……………………………………………………………………………. 58 NHS Staff Survey……………………………………………………………………… 59 Sustainability report…………………………………………………………………… 69 Board of Directors…………………………………………………………………….. 74 Council of Governors………………………………………………………………… 96 Our membership……………………………………………………………………… 110 Operating and financial review………………………………………………………. 115 Remuneration Report……………………………………………………………….

122

Quality Report Part 1 – a statement on quality………………………………………………………. 129 Part 2 – priorities for improvement and statements of assurance……………….. 131 Part 3 – quality overview 2013/14…………………………………………………… 153 Assurance statements – verbatim…………………………………………………… 170 Statement of Directors’ responsibilities in respect of the Quality Report……….. 190 Independent Auditors Limited Assurance Report to the Council of Governors… 192 Statement of the Chief Executive’s responsibilities…………………………...

196

NHS Foundation Trust Code of Governance…………………………………….

198

Corporate Governance Statement…………………………………………………

207

Enhanced Quality Governance Reporting……………………………………….

213

Annual Governance Statement…………………………………………………….

216

Independent Auditors Report………………………………………………………

237

Annual Accounts……………………………………………………………………..

246

Glossary of terms and acronyms………………………………………………….

294

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Strategic Report A welcome message from our Chairman This has been a year of great demand and achievement for SWASFT. My thanks go

to all staff for their commitment to providing excellent patient care throughout the

whole year, especially during times of unprecedented demand on our services.

As we are all aware the NHS is working to find new ways of providing high quality

emergency and urgent care. Today’s health service needs organisations to work

together for the benefit of patients.

During the past 12 months we have been pleased to work with an increasing number

of organisations, particularly in the public sector and have experienced the benefits

of integrated working and shared services to deliver improved patient care. As

partnership working continues we look forward to continue being a part of this

developing landscape.

Not only have we realised the numerous benefits of working closely with our

stakeholders, thus improving the provision of health services to the communities that

we serve across the South West, but have also directly contributed to providing

additional services and facilities. A good example of this is the tremendous work

carried out across the county of Gloucestershire, where we have been pleased to

work with the Rotary Club and many other voluntary sector organisations, schools,

colleges, businesses and numerous stakeholders including MPs and Councillors.

Together we have raised the awareness of sudden cardiac arrest and placed many

defibrillators in various locations across the county. These defibrillators are

accessible to and can be used by members of the public.

Joined up working has never been more important and we maintain close contact

with our commissioning colleagues and other NHS partners, our fellow emergency

services and other statutory bodies, including local councils and Health and Well-

being Boards.

As we reflect on the achievements and challenges from the last year, we look forward to another productive year. Working with others will continue to help us achieve our priorities, and with the continued commitment of all staff and the significant contribution made by our partners, we will continue delivering excellent patient care.

Heather Strawbridge Chairman

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A welcome message from our Chief Executive

The ways in which ambulance services and indeed the wider NHS are operating

continues to evolve. The demand for our services has never been greater and this

means we have to be continually mindful of and responsive to the needs of our

patients by ensuring that we offer the most appropriate mix of emergency and urgent

care services.

To carry out our day to day business in this ever-changing landscape means that we

need a workforce that is dedicated, passionate and wholly committed to patient care.

The Trust could not have achieved the results it has during 2014/15 without staff who

have risen to the challenge and worked incredibly hard under considerable pressure.

It is vital to acknowledge that we would not be where we are now without their

support and so, on behalf of myself and my director colleagues, we would like to

offer our sincere thanks for all their efforts.

As another financial year draws to a close, it is important to look at what we have

achieved over the past 12 months. In addition to successfully meeting our Red 1

target set out by the Government, we have continued to embrace change and

innovation. An example of this is our involvement with the national ‘Dispatch on

Disposition’ pilot in which we participated during the early part of 2015. This means

essentially giving our call handling personnel longer to triage patients in a non-life

threatening condition to continue tailoring our responses and in doing so ensuring

that more patients get the right care in the right place at the right time.

As we move forward into another year I have every confidence that we will continue

to overcome these challenges and provide the most appropriate help to our patients

whilst supporting the most precious asset that we and indeed the whole NHS has,

and that is our staff.

Ken Wenman Chief Executive

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Our business

South Western Ambulance Service NHS Foundation Trust (SWASFT) provides a range of emergency and urgent care services to the people of the South West of England. We work in a way that upholds the values and pledges of the NHS Constitution and actively promote best practice. SWASFT was the first ambulance service to be authorised as a NHS Foundation Trust on 1 March 2011. In February 2013 we acquired the neighbouring former Great Western Ambulance Service NHS Trust (GWAS). This means that our operating area now covers a fifth of England. Our enlarged operating area covers the counties of Cornwall and the Isles of Scilly, Devon, Dorset, Somerset, Wiltshire, Gloucestershire and the former Avon area (Bristol, Bath, North and North East Somerset and South Gloucestershire). SWASFT is recognised as a high-quality, effective and efficient NHS organisation. We provide the 999 ambulance service across the South West and in addition we provide the following:

Urgent Care Services, encompassing out of hours medical care across Dorset, Gloucestershire and Somerset and NHS 111 call handling and triage services for Cornwall, Devon, Dorset and Somerset;

Patient Transport Services (PTS) for Bristol, North Somerset and South Gloucestershire and on the Isles of Scilly;

Hazardous Area Response Teams (HART) for the entire Trust area.

In addition to these core services, we provide a range of other services including:

Chemical, Biological, Radiological, Nuclear and Explosive (CBRNE) training;

Commercial and higher education training to meet the requirements of both the private and public sector;

Medical services at a range of events;

Driving tuition, statutory compliance advice and incident investigation.

Our mission, vision, values and goals

Our mission statement is: To respond to patients’ emergency and urgent care needs quickly and safely to save lives, reduce anxiety, pain and suffering.

Our vision is: To be an organisation that is committed to delivering high quality services to patients and continue to develop ways of working to ensure patients receive the right care, in the right place at the right time.

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Our values are: Respect and dignity: We value each person as an individual, respect their aspirations and commitments in life, and seek to understand their priorities, needs, abilities and limits. Commitment to quality of care: We earn the trust placed in us by insisting on quality and striving to get the basics of quality of care – safety, effectiveness and patient experience – right every time. Compassion: We ensure that compassion is central to the care we provide and we respond with humanity and kindness to each person’s pain, distress, anxiety or need. Improving lives: We strive to improve health and well-being and people’s experiences of the NHS. Working together for patients: We put patients first in everything we do, by reaching out to staff, patients, carers, families, communities and professionals inside and outside the NHS. Everyone counts: We maximise our resources for the benefit of the whole community, and make sure nobody is excluded, discriminated against or left behind. Our strategic goals are: Strategic goal 1: Safe, clinically appropriate responses Delivering high quality, compassionate care to patients in the most clinically appropriate, safe and effective way. Strategic goal 2: Right people, right skills, right values Supporting and enabling greater local responsibility and accountability for decision making; building a workforce of competent, capable staff who are flexible and responsive to change and innovation. Strategic goal 3: 24/7 Emergency and urgent care Influencing local health and social care systems in managing demand pressures and developing new care models; leading emergency and urgent care systems; providing high quality services 24 hours a day, seven days a week. Strategic goal 4: Creating organisational strength Continuing to ensure the Trust is sustainable by maintaining and enhancing financial stability. In this way we will be capable of continuous development and transformational change by strengthening resilience, capacity and capability.

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Our commissioners

The South West region comprises 12 Clinical Commissioning Groups (CCGs) responsible for commissioning healthcare services for the local population. As emergency 999 ambulance services are provided across all 12 CCG areas, we have a coordinated commissioning arrangement led by NHS South Devon and Torbay CCG. We have bi-monthly quality monitoring, performance and contracting meetings with the CCG. Out of Hours services (OOH) are delivered across three CCG areas covering the counties of Dorset, Gloucestershire and Somerset. The quality management of the contract is carried out through quarterly meetings with three separate Commissioning and Quality Boards. The NHS 111 service in England was established in February 2013. During the 2014/15 financial year we delivered four of the NHS 111 services across the South West (Cornwall and the Isles of Scilly, Devon, Dorset and Somerset). We continue to provide PTS services for the Bristol, North Somerset and South Gloucestershire areas and the Isles of Scilly. We work closely with the relevant commissioners to deliver these services and have regular meetings to discuss operational requirements and developments, and to provide a performance framework for quality and contractual obligations.

How we operate

SWASFT is run by a Board of Directors comprising a Non-Executive Chairman, Mrs Heather Strawbridge, a Chief Executive, Mr Ken Wenman, six Non-Executive Directors and five Executive Directors. Three of the Executive Directors, including the Chief Executive, are male and three are female. The Non-Executive Directors are split as three female, including the Chairman, and four male. As an NHS Foundation Trust, we have a Council of Governors and a membership base drawn from the general public and our staff. Governors are either elected by public and staff members or appointed by partnership organisations. More details about the Board of Directors, Council of Governors and our members can be found in the Directors’ Report on pages 74-115 of this document. We employ 3,839 mainly clinical and operational staff plus GPs. The gender split of the workforce is 2,223 males and 1,616 females. SWASFT operates from over 100 sites, including 96 ambulance stations, six air bases and three emergency control rooms (clinical hubs). We also have clinicians based in the heart of communities at treatment centres and minor injury units (MIU). We have three operational divisions:

East Division – Dorset and Somerset (including North Somerset);

North Division – Gloucestershire, Wiltshire, Bristol, South Gloucestershire, Bath and North East Somerset;

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West Division – Devon, Cornwall and the Isles of Scilly. Our headquarters is in Exeter, Devon, where we also have one of the clinical hubs. We are registered with the quality regulator, the Care Quality Commission (CQC). Our current registration status is ‘compliant without conditions’. This means that we have received external assurance of our commitment to providing high quality care for patients.

Our fleet The Trust continues to invest in its diverse fleet and the table below shows a breakdown of SWASFT’s portfolio of vehicles:

Type of vehicle North

Division

East and

West

Divisions

Total

Double-crewed ambulance (DCA) 114 192 306

Rapid response vehicle (RRV) 98 120 218

Clinical Support Officer (CSO) / Bronze

Officer cars 6 10 16

Clinical Team Leader (CTL) cars 6 0 6

Patient Transport Service (PTS)

vehicles 57 0 57

Pathways support vehicles (PSV) 0 25 25

Hazardous Area Response Team

(HART) vehicles 13 11 24

Civil Contingency Unit (Resilience

department) 12 28 40

Driver training vehicles 8 11 19

Motorbikes 2 5 7

Responder vehicles 18 17 35

Leased Cars 39 90 129

Preservation (restored vehicles) 3 2 5

Out of Hours (OOH) vehicles 7 13 20

Auxiliary (other vehicles) 11 8 19

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Fleet department 6 23 29

Pool cars 14 81 95

Total 414 636 1050

Boat 1

Cycle Response Unit 5

1056

A total of 92 vehicles including ambulances, motorcycles and rapid response

vehicles were purchased during the reporting period, with a further 25 former Patient

Transport Service vehicles converted to Pathway Support Vehicles (PSV).

Our strategy

We published our first five year Integrated Business Plan (IBP) as part of our application to become an NHS Foundation Trust. Published in 2010/11, the IBP sets out our strategy, describing what the Trust would look like in five years’ time (2015/16), our plans for the life of the IBP and how we intended to deliver them. Since that strategy was published, we have been through a number of significant changes, including achieving NHS Foundation Trust status, implementing NHS Pathways, securing NHS 111 contracts, responding to significant changes to national targets for emergency 999 services and acquiring the former Great Western Ambulance Service NHS Trust. In addition, the Trust is operating in the context of wide scale NHS reforms that will have a significant impact on the future structure and business of the organisation. To meet these demands, we have produced a second IBP (IBP2) covering the period 2014/15 to 2018/19 /14 to reset our priorities and establish a new overarching strategy.1

Risks and uncertainties We are committed to developing a responsible risk management culture that supports all staff to make sound judgments and decisions concerning risk identification and management. Our Risk Management Strategy is reviewed annually. It was last updated in July 2014 to ensure it meets best practice requirements and was approved by the Board of Directors. Risks are identified at all levels of the Trust and the function is led by our Risk Manager, with a clear escalation process in place. Risks are scored on a 5x5 matrix,

1 A copy of the IBP2 can be found here

http://www.swast.nhs.uk/Downloads/SWASFT%20downloads/IntegratedBusinessPlan2.pdf

http://www.swast.nhs.uk/Downloads/SWASFT%20downloads/IntegratedBusinessPlan2.pdf

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the first relating to the impact of the risk and the second to the likelihood of it occurring. A value of 1 represents low impact or likelihood and 25 represents the most significant impact or likelihood. Where the risk value exceeds 14, risks are included on the Corporate Risk Register ensuring the Board of Directors is aware and able to assure itself that appropriate actions are being taken to manage and mitigate or remove each risk. It is important to recognise that all organisations face risks all the time. The key issue is that all risks are properly 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 Directors’ Group meeting, Board of Directors and at each Quality and Governance Committee meeting.

In addition, the following risks to business will be highlighted within our Annual Plan for 2015/16:

National response time targets for the emergency 999 service;

Increases in demand and activity;

Handover delays at hospitals;

Workforce establishment levels;

The continuing national shortage of paramedics;

Non-delivery of statutory and mandatory education;

Increased Resource Escalation Action Plan (REAP) levels and summer, winter and peak pressures;

Major IT service failure;

Increasing financial tension in the health system.

The Directors’ Group and the Board of Directors appraise all risks regularly 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. More information about risks to the Trust can be found in the Annual Governance Statement on page 216.

Trends and factors

We have identified the key external factors that are likely to affect our business. As a provider of emergency 999 and urgent care services, our development is affected by external changes within the health and social care environment, as well as by wider economic and demographic changes. These are presented within the following summary:

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Political Economic Social Technological Legislative Environmental Reorganisation of the NHS delivery structure following the General Election in May 2015.

Public sector financial deficit.

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.

National programme for information technology introducing the electronic care system.

Health and Social Care Act 2012 – changes to commissioning and providing structures and requirements.

Volatility in fuel prices and requirement to reduce fuel usage.

Increased encouragement of competition for services amenable to choice.

Changes to funding priorities and commissioning structures as a result of NHS reforms and new health policies.

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.

Growth in use of social media.

NHS constitution –including new rights for patients.

Tougher environmental and sustainability targets.

Development of outcome-focused contracts (increased focus on quality of services).

National funding settlement for the NHS.

Continuing increased demand for round the clock ambulance services.

Development of specialist centres for specific services (beyond historic highly specialised services).

A tougher and continually changing regulatory regime by regulators.

Environmental factors including weather and pandemics.

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High profile reviews of standards of care in health and social care system such as the Francis and Winterbourne View inquiries.

Quality, Innovation, Prevention, Productivity (QIPP) programmes at differing stages across the South West region.

Recognition of needs of vulnerable adults and those with specific health needs within health contracts (safe-guarding, mental health, dementia, bariatric patients).

Political Economic Social Technological

Going concern

After making enquiries, the Directors have a reasonable expectation that the Trust has adequate resources to continue in operational existence for the foreseeable future. For this reason, they continue to adopt the going concern basis in preparing the accounts. Please refer to the Financial Outlook reported in the Operating and Financial Review on page 120.

Performance against contract During 2014/15, the Trust received a total number of 867,505 emergency and urgent

incidents. This was an increase of 9.75% in the total number of incidents when

compared with 790,460 emergency and urgent incidents across the same period and

geographical area during the 2013/14 financial year.

Background

For 2014/15, the Trust had a single contract to deliver A&E (emergency 999) services for the South West. The single contract was commissioned by all 12 Clinical Commissioning Groups. In addition to this contract in 2014/15, we had contracts to provide a range of urgent care services throughout the South West:

Three Out of Hours contracts in Dorset, Somerset and Gloucestershire (mobile response service only in Gloucestershire), all of which were block contracts. These were monitored against activity (patient contacts) compared with the same period in the previous financial year, National Quality Requirements and against local Key Performance Indicators (KPIs);

In 2014/15 the Trust was successful in securing the contract for the entire Out of Hours service in the county of Gloucestershire which includes operating the

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Primary Care Centres in the locality. The commencement date for the enlarged service is 1 April 2015;

During 2014/15 the Trust held four contracts to provide NHS 111 services in Cornwall and the Isles of Scilly (Kernow), Devon, Dorset and Somerset. Contracts are provided on a block basis with Dorset and Kernow incorporating elements of variance if activity levels are not as anticipated.

The Trust was unsuccessful in retaining the Somerset Out of Hours and NHS 111 contracts as part of a tendering exercise by Somerset CCG in 2014/15. As part of the transition arrangements to the new provider, the Trust has agreed to extend the service provision to 30 June 2015;

During 2014/15 the Trust was successful in securing the contract to run the Tiverton Urgent Care Centre on behalf of Northern, Eastern and Western Devon CCG (NEW Devon CCG). The 20 month contract for this service commenced on 8 July 2014;

A number of smaller urgent care service contracts, including a Single Point of Access (SPoA) to healthcare professionals in Dorset, dental call handling and triage, Out of Hours services to prisons in Dorset and GP practice telephone cover.

In 2014/15 the Trust delivered Patient Transport Services for Bristol, North Somerset and South Gloucestershire and on the Isles of Scilly. Quality and wider performance issues for Urgent Care Services and Patient Transport Services are scrutinised throughout the year in order to ensure that patient experiences are as positive as they can be. Performance against contract in 2014/15 for each of our core services and for PTS is summarised in the following table.

Activity Levels and Contract Values for 2014/15 and 2015/16

Service-currency/activity measure

Contracted 2014/15

Actual 2014/15

Contracted 2015/16

Emergency 999 ambulance service – incidents

839,932 867,505 896,065

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Service-currency/activity measure

Contracted 2014/15

Actual 2014/15

Contracted 2015/16

Out of Hours services – patient contacts

There is no contracted activity level. Monitoring is undertaken against the activity for the same period in the previous financial year.

Dorset: 97,322 Somerset: 58,643

There is no contracted activity level. Monitoring

is undertaken against the activity for the same period in the previous

financial year.

The contract for Somerset Out of Hours services is until 30 June

2015.

NHS 111 – calls received

Cornwall: 152,343 Devon: 386,716 Dorset: 236,043

Somerset: 173,349

Cornwall: 129,940 Devon: 384,831 Dorset: 248,683

Somerset: 154,773

Cornwall 205,277 Devon 394,296 Dorset 253,222

Somerset 44,130*

Patient Transport Service – patient seats / journeys

Isles of Scilly operated on a block contract basis for 2014/15. Bristol, North Somerset and South Gloucestershire = 101,806.

Isles of Scilly operated on a block contract basis for 2014/15. Bristol, North Somerset and South Gloucestershire: 99,907

Isles of Scilly will operate on a block contract basis until 30 September 2015.

The contract for Bristol, North Somerset and South Gloucestershire runs to 30 September 2015. However the CCG has requested continuation to 31 March 2016 and the Trust is currently in discussions regarding this extension.

* The contracts for the provision of Out of Hours services and NHS 111 services in the county of Somerset run to 30 June 2015.

Emergency 999 Ambulance Services (A&E)

Challenging national targets for call categories are set by the Department of Health and apply to every ambulance service in England. The relevant targets are set out below, along with the performance levels achieved in 2013/14 and 2014/15.

Category A8 (Red 1): Total number of category A Red 1 incidents that may be immediately life threatening and the most time critical should receive an emergency response within eight minutes irrespective of location in 75% of cases. Eight minutes is just 480 seconds;

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Category A8 (Red 2): Total number of category A Red 2 incidents presenting conditions which may be life threatening but less time critical than Red 1 and should receive an emergency response within eight minutes irrespective of location in 75% of cases;

Category A19: Category A incidents presenting conditions, which may be immediately life threatening and should receive an ambulance response at the scene (an equipped vehicle able to transport a patient in a clinically safe manner if required) within 19 minutes irrespective of location in 95% of cases.

Historically ambulance services have experienced year on year growth in demand for their services. In recent years, this level of growth has been in the region of 4% to 5%. During 2014/15 we experienced a significant increase in activity levels, with year on year incident numbers increasing by 9.75%. This increase was seen throughout the year. However, the most significant increase was seen during the winter period (November 2014 to January 2015) where activity levels were 10.81% higher than for the same period in 2013/14. The unprecedented uplifts in ambulance activity levels over the winter period saw weekly activity volumes increase from approximately 15,600 incidents per week in April 2014 to 19,000 incidents per week in December 2014. On the week commencing 29 December 2014 the Trust recorded 19,190 incidents across the South West and on 1 January 2015 the activity level on that one day was 3,334 incidents, by far the busiest individual day for A&E activity reported in the Trust’s history. The sharp increase in activity levels experienced in the South West was replicated across the country, with all ambulance services reporting significant uplifts and increased pressure on resources and performance targets. The pressure on operational resources during these periods of significant demand made the delivery of national response targets extremely difficult, particularly in Quarter 3. As a result, the Trust developed and implemented a Performance Recovery Plan during Quarters 3 and 4 of 2014/15. As a result of the actions and investment identified within the Performance Recovery Plan, the Trust was successful in recovering Red 1 performance and delivering an annual Red 1 performance of 75.24% (for the year ending 31 March 2015), 0.24% above the national target of 75%. Our ability to achieve Red performance targets is affected by many factors. SWASFT is the most rural ambulance service in England and this has direct consequences for our performance, as the target is measured across the whole operating area and makes no allowances for rurality. Other factors impacting on performance included localised peaks in activity; the impact of the NHS 111 service across the South West region; hospital handover

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delays creating pressure points in the system; and a national shortage of paramedics in order to support service delivery.

Key Performance Indicator National Target

%

Actual Performance

2013/14 %

Actual Performance

2014/15 %

Category A8 Red 1 75 73.15 75.24

Category A8 Red 2 75 77.23 71.42

Category A19 95 95.76 93.62

Dispatch on Disposition In February 2015 SWASFT were delighted to have been chosen, in partnership with London Ambulance Service, to pilot a new way for ambulance services to respond to 999 calls. The trial allows call-handlers a small amount of extra time to triage the patient over the telephone before dispatching an ambulance resource to respond. This additional triage time does not apply to those incidents which are identified as immediately life-threatening (i.e. Red 1 incidents) where an ambulance resource will continue to be dispatched immediately. The limited extra assessment time will ensure that call handlers are able to better deploy resources where they are most needed. The additional triage time will also provide an opportunity to identify the most clinically appropriate response to meet the needs of the patient. In some cases this may not be an ambulance response, and patients may be better served by an immediate referral to another service (e.g. local GP, pharmacy or a walk-in centre). SWASFT is working with NHS England, the Association of Ambulance Chief Executives (AACE), the College of Paramedics and the London Ambulance Service during the trial period with strict oversight and monitoring of the results and impacts of these service changes, including patient safety. The trial is also subject to rigorous and independent external evaluation, the findings of which will be published in due course. The trial commenced on 10 February 2015 and during the trial period (i.e. for the period 10 February 2015 to 31 March 2015) the Trust has been required to monitor against two sets of metrics for Red 1, Red 2 and A19 performance. In agreement with NHS England new calculation metrics for both Red 2 and A19 performance were introduced to take into account the additional telephone triage time before an ambulance resource is dispatched. The performance figures included within the Annual Report relate to the national ambulance performance target metrics, however had the Trust been using the

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calculation metrics identified in the trial, this would have improved both Red 2 and A19 performance figures for the year as set out in the table below:

Key Performance Indicators (Based on Trial Performance Metrics)

National Target

%

Actual Performance

2014/15 %

Category A8 Red 1 75 75.24%2

Category A8 Red 2 75 72.30%

Category A19 95 93.78%

Regulatory Ratings

As part of its regulatory regime, Monitor assigns risk ratings to each NHS Foundation Trust as an indicator of the risk of failure to comply with the conditions of its licence. Continuity of Services Risk Rating The Continuity of Services Risk Rating states the risk facing a provider of key NHS services. There are four rating categories ranging from 1, which represents the most serious risk, to 4, representing the least risk. This rating system has been applied by Monitor since 1 October 2013 as part of the Risk Assessment Framework. Governance Risk Rating From 1 October 2013, as part of the Risk Assessment Framework, Monitor assigns a green rating if there is no governance concern identified. Where a potential material cause for concern is identified, Monitor will replace a trust’s green rating with a description of the issue and the steps (formal or informal) being taken to address it; or Monitor will assign a red rating if regulatory action is to be taken. Trusts are required to include forecast risk ratings within their forward plans. During 2014/15 we consistently achieved our planned governance risk rating of green for the first three quarters. We also achieved our planned continuity of services risk rating of 4 for those three quarters. These scores have been determined through an assessment of key submissions to Monitor supported by assurance reports to the Board of Directors against the requirements of the Risk Assessment Framework. For the fourth and final quarter of 2014/15 (January to March 2015), we submitted a forecast governance risk rating of green and a continuity of services risk rating of 4 to Monitor.

2 The A8 Red 1 performance figure is identical in both performance tables because the way that life threatening emergency

calls are handled did not change during the trial.

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Our governance and continuity of services risk ratings for 2013/14 and 2014/15 are set out below:

2014/15 Annual Business Plan

Q1 Q2 Q3 Q4

Continuity of Services Risk Rating

4 4 4 4 4*

Governance Risk Rating Green Green Green Green Green*

2013/14

Financial/Continuity of Services Risk Rating

3 3 3 4 4

Governance Risk Rating Green Green Green Green Green

* The outcome of the Trust’s monitoring return for quarter 4 of 2014/15 had not been confirmed by Monitor at the time of publication. Therefore the risk ratings presented here represent those submitted by the Trust for review.

Urgent Care Services – Out of Hours Quality Requirements

National targets for Out of Hours services are set out by the Department of Health and are applicable to every Out of Hours service in England. These targets do not exist for in hours GP services or other healthcare professional clinical services. There are 13 quality requirements that specifically relate to Out of Hours services. However, not all of these targets are applicable to all of the services delivered by SWASFT. This is dependent upon the service that is commissioned in each area. For example, quality requirements 8 and 9 no longer apply to our Out of Hours services, as the call taking and triage functions transferred to NHS 111 services when launched. The table below sets out all quality requirements for our Out of Hours services with performance stated for 2013/14 and 2014/15. These have been rated red, amber or green (RAG). A rating of red means that the requirement has not been met (89% or lower), amber means partially met (between 90% and 94% inclusive) and green means fully met (95% or above). Despite a challenging year, the Out of Hours services performed well and improved on last year’s performance against the quality requirements. In order to meet some of the challenges faced by the service, we implemented a number of actions including changes to the triage queue to enable GPs in local treatment centres (and in some cases from their own homes) to triage patients when they have spare capacity, thereby enhancing and supporting the capacity of our central triage team; revising the training plan for supervisors and dispatchers to ensure a high level of focus on responding quickly to patients with urgent needs; enhancing GP pay in both Dorset and Somerset to encourage good levels of shift coverage; reviewing shift patterns to make them more attractive for GPs; and implementing direct booking into treatment centres by the NHS 111 services to free up GP time.

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Urgent Care Services – Out of Hours Quality Requirements Quality Requirement

NQR Number

National Quality Requirement (NQR)

RAG Ratings for 2013/14


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NQR1

Providers must report regularly to Primary Care Trusts on their compliance with the Quality Requirements.

Green Green Green Green Green Green

NQR2

Providers must send details of all OoH consultations to the practice where the patient is registered by 0800 hours the next working day.


NQR3

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).


NQR4 Providers must regularly audit a random sample of


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NQR Number




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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

NQR5

Providers must regularly audit a random sample of patients’ service experience (e.g. 1% per quarter)


NQR6

Providers must operate a complaints procedure that is consistent with the principles of the NHS complaints procedure


NQR7

Providers must demonstrate their ability to match their capacity to meet predictable fluctuations in demand for their contracted service


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NQR Number




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NQR8a

No more than 0.1% of calls engaged

Target no longer applicable: This element of the service is now delivered by

NHS 111, with appropriate calls being transferred to the Out-of-Hours service.

No more than 5% of calls abandoned

NQR8b

Calls to be answered within 60 seconds of the end of the introductory message

Target no longer applicable: This element of the service is now delivered by

NHS 111, with appropriate calls being transferred to the Out-of-Hours service.

NQR9a

All immediately life threatening conditions to be passed to the ambulance service within 3 minutes

Target no longer applicable: This service is now run by NHS 111, with appropriate calls being transferred to the

ambulance services and Out-of Hours service.

NQR9b

Definitive clinical assessment for urgent calls started within 20 minutes

Target no longer applicable: Calls are now routed through the NHS 111

service.

Definitive clinical assessment for all other calls started within 60 minutes

Target no longer applicable: Calls are now routed through the NHS 111

service.

NQR10a (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.

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NQR Number




Do

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NQR10b (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. All definitive clinical assessment for less urgent cases presenting at treatment location started within 60 minutes

NQR10d

At the end of the assessment, the patient must be clear of the outcome


NQR11

Providers must ensure that patients are treated by the clinician best equipped to meet their needs in the most appropriate location


NQR12 (presenti

ng at base)

Emergency consultation started within an hour

Red N/A Green Red Green Green

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NQR Number




Do

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Urgent consultations started within two hours

Amber Amber Green Amber Amber Green

Less urgent consultations started within six hours.


NQR12 (home visit)

Emergency consultations started within one hour

Red Red Green Red Green Green

Urgent consultations started within two hours

Red Red Green Amber Amber Amber

Less urgent consultations started within six hours

Amber Green Green Green Green Green

NQR13

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


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NQR Number




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patients with impaired hearing or impaired sight

Urgent Care Services – NHS 111 Quality Requirements

The NHS 111 service in England was established in February 2013. Tendered in seven ‘lots’ within the South West region, the ‘go live’ of local services has been staggered over the period February 2013 to February 2014. SWASFT delivers four of the NHS 111 services across the counties of Cornwall and the Isles of Scilly, Devon, Dorset and Somerset:

Cornwall and the Isles of Scilly: The Trust has delivered the NHS 111 service from its initial launch in February 2014;

Devon: The Trust has delivered the NHS 111 service from its initial launch in September 2013;

Dorset: The Trust has delivered the NHS 111 service from its initial launch in February 2013;

Somerset: The Trust took on responsibility for the NHS 111 service in the county in November 2013.

As with Out of Hours services, national quality targets are set out by the Department of Health for NHS 111 services and are applicable to every service in England. There are 12 quality requirements that specifically relate to the NHS 111 service. The main challenges for the NHS 111 service have been the achievement of the targets relating to the percentage of calls being answered within 60 seconds and the percentage of abandoned calls. These targets have not been achieved due primarily to high levels of call volumes at peak periods. These demand patterns require very large numbers of NHS 111 call advisors to be employed for peak times at weekends over short shift durations; i.e. between 08:00 and 13:00 hours and between 16:00 and 20:00 hours on Saturdays and Sundays. Whilst the Trust has achieved a large volume of recruitment and training of call advisors for weekend working, these staff are difficult to retain. High attrition rates

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lead to significant challenges in achieving call answering and call abandonment target The tables overleaf set out each of the quality requirements, with performance stated for the Dorset service only in 2012/13, and for each of the four services for 201314. These have also been ‘RAG’ rated (see above for explanation)

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NQR Number National Quality Requirement (NQR)

RAG Rating for 2013/14

RAG Rating for 2014/15

Cornwall Devon Dorset Somerset

NQR8a No more than 0.1% of calls engaged.

Green Green Green Green Green

NQR8b No more than 5% of calls abandoned.

Green Red Red Red Red

NQR8c

Calls to be answered within 60 seconds of the end of the introductory message.

Amber Red Red Red Red

NQR9

All immediately life-threatening conditions to be passed to the ambulance service within three minutes.


NQR13

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


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Urgent Care Services – NHS 111 Quality Requirements

NQR Number


RAG Rating for 2013/14 RAG Rating for 2014/15

Cornwall Devon Somerset Dorset Cornwall Devon Somerset Dorset

NQR1

Providers must regularly report to NHS commissioners on their compliance with the Quality Requirements.

Green Green Green Green Green Green Green Green

NQR2

Providers must send details of all consultations (including appropriate clinical information) to the practice where the patient is registered by 08:00 hours the next working day.

Green Green Green Green Green Green Green Red

NQR3

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.


patients with impaired hearing or impaired sight.

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NQR Number




NQR4

Providers must regularly audit a random sample of patient contacts (audit should provide sufficient data to review the clinical performance of each individual working within the service).


NQR5

Providers must regularly audit a random sample of patient experiences of the service (e.g. 1% per quarter).

Green Green Green Green Red Red Red Red

NQR6

Providers must operate a complaints procedure that is consistent with the principles of the NHS complaints procedure.


NQR7

Providers must demonstrate their ability to match their capacity to meet predictable fluctuations in demand for their contracted service.

Green Green Green Green Red Red Red Red

NQR8a No more than 0.1% of calls engaged.


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NQR Number




No more than 5% of calls abandoned.

Green Green Green Green Amber Amber Amber Green

NQR8b Calls to be answered within 60 seconds of the end of the introductory message.

Amber Amber Amber Amber Red Red Red Red

NQR9a

All immediately life-threatening conditions to be passed to the ambulance service within three minutes.

Red Red Red Red Green Green Amber Amber

NQR9b Patient call-backs must be achieved within 10 minutes.

Red Red Red Red Red Red Red Red

NQR13

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.


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NQR Number




NQR14

Providers must demonstrate the online completion of the Information Governance Toolkit at Level 2 or above and that this is audited on an annual basis by Internal Auditors using the national framework.


NQR15

Providers must demonstrate that they are complying with the Department of Health Information Governance SUI Guidance on reporting of Information Governance incidents appropriately.


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Patient Transport Service (PTS) PTS provides non-urgent transport for patients who have a medical need. These services include:

Attending outpatient appointments;

Admission to or discharge from hospital;

Transfers between hospitals. The Trust delivered in excess of 99,900 patient journeys in 2014/15 in Bristol, North Somerset and South Gloucestershire, as well as activity as part of a smaller contract for PTS on the Isles of Scilly. Feedback from patients continued to be overwhelmingly favourable and formed a valuable and crucial measure of how well our organisation performed. Our recent patient surveys have demonstrated a 98% patient satisfaction rate. During 2014/15, the Trust focussed on improving the timeliness of the service delivered to patients and invested in new ways of working to drive efficiencies and better utilisation of available resources. This approach, together with a rigorous focus on value for money, ensures that resources are used wisely to deliver a high quality PTS service to our patients and commissioners. The tables below set out performance for 2013/14 and 2014/15 against the locally agreed PTS targets. Key Performance Indicators – North Division

Key Performance Indicators – Bristol, North Somerset and South Gloucestershire

Locally agreed

Target %

Actual Performance

2013/14 %

Actual Performance

2014/15 %

1a. Patients living up to 10 miles away from

the treatment centre (Band A) should not

spend more than 60 minutes on the vehicle

on either an outward or return journey.

(Green >90%, Amber 80-90%, Red <80%)

90% 95.73% 91.99%

1b. Patients living over 10 miles and up to 35

miles away from the treatment centre (Band

B) should not spend more than 90 minutes on

the vehicle on either an outward or return

journey.

(Green >90%, Amber 80-90%, Red <80%)

90% 95.76% 93.20%

1c. Patients living over 35 miles away from 90% 97.38% 97.50%

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Locally agreed

Target %

Actual Performance

2013/14 %

Actual Performance

2014/15 %

the treatment centre (Band C) should not

spend more than 120 minutes on the vehicle

on either an outward or return journey.

(Green >90%, Amber 80-90%, Red <80%)

2a. Patients should not arrive more than 45

minutes before their booked arrival time.

(Green >90%, Amber 80-90%, Red <80%)

90% 83.79% 87.64%

2b. Patients should not arrive after their

booked arrival time.

(Green >97%, Amber 87-97%, Red <87%)

97% 87.24% 89.78%

3a. The Trust is to arrive to collect patients

from the agreed location within 45 minutes of

the outward journey time.

(Green >90%, Amber 80-90%, Red <80%)

90% 84.51% 87.76%

3a. The Trust is to arrive to collect patients

from the agreed location within 75 minutes of

the outward journey time.

(Green >90%, Amber 80-90%, Red <80%)

90% 92.47% 94.95%

3b. A summary of reasons and actions to be provided, for each month, for all cases where collection was outside of the KPI limits. This may include case by case analysis as deemed necessary.

Green Green Green

8c. Pick-up time to be confirmed by text,

email or phone call to the patient within a

week of the appointment (phone call being

the preferred method).

(Assessed quarterly)

100% 100% 100%

9a. Patient satisfaction with the level of

service received from the provider. This is 85% 97.80% 97.80%

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Locally agreed

Target %

Actual Performance

2013/14 %

Actual Performance

2014/15 %

assessed through the annual patient

satisfaction survey.

(Green >85%, Amber 75-85%, Red <75%)

9b. NHS commissioners to be satisfied with

the level of service.

(Green = no issues or minor concerns

resolved within 1 month)

(Amber = minor issues and not resolved

within 1 month or major issues resolved

within 1 month)

(Red = major issues not resolved within 1 month)

Green Green Green

9f. Telephone answering.

(Green >95%, Amber 85-95%, Red <85%) 95% 93.16% 95.12%

10a. Agreed activity performance report received in correct format and on time within 10 working days of the start of the following month.

100% 100% 100%

10b. Activity and finance queries are acknowledged within 3 days of receipt and resolved within 28 days from the date of the query.

100% 100% 100%

12d. Compliance with the agreed Trust

complaints procedure – full response made in

a timely manner agreed with the complainant.

(Assessed quarterly)

100% 100% 100%

12h. Nil Serious Untoward Incidents (SUIs).

Any SUIs are to be reported and action plans

put in place, in line with NHS Bristol

standards and timeframes (reported

immediately; investigated within 24 hours and

lessons learnt shared, then closed within 60

100% 100% 100%

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Locally agreed

Target %

Actual Performance

2013/14 %

Actual Performance

2014/15 %

working days of the incident).

(Green - No SUIs, Amber – SUIs reported but resolved within timeframe, Red SUIs reported but not resolved within timeframe)

Ambulance Clinical Quality Indicators (ACQIs)

Ambulance trusts are required to publish all data in relation to Ambulance Quality Indicators (ACQIs) on a monthly basis, both locally (on the Trust’s website) and nationally (by the Department of Health). ACQIs 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 response provided to patients. Ambulance service providers use ACQIs to stimulate continuous improvements in the care they provide for patients. ACQIs 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, ACQIs provide a much fuller picture of how ambulance services are performing. ACQIs are designed to be consistent with measures in other parts of the NHS, most notably those in hospital emergency departments. Our ACQIs are reported in the Quality Report on page 150.

Commissioning for Quality and Innovation (CQUIN) 2014/15

Lord Ara Darzi introduced the ‘High Quality Care for All’ NHS reforms 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 set out the Trust’s CQUIN targets for each service for 2014/15. For emergency 999 (A&E) services, nine CQUINs were agreed with commissioners for 2014/15, representing 1.5% (£2.625 million) of our block contract. The Dorset and Somerset Out of Hours contracts included local CQUIN schemes totalling 2.5% of the contract value, as presented below. CQUIN did not form part of the NHS 111 contracts, Gloucestershire Out of Hours contract or the Patient Transport Service contract. For 2014/15, the Trust achieved all of its CQUIN targets for emergency 999 (A&E) services and Out of Hours service in Dorset, therefore is receiving the full contracted value for each of these CQUINs. In Somerset the 2014/15 CQUIN schemes have been extended into 2015/16, thereby covering the last three months of this contract. The Trust is forecasting achievement of these schemes, and therefore to receive the full contract value, shown below, in Quarter One of 2015/16.

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Emergency 999 Ambulance Services (A&E) CQUIN 2014/15

CQUIN Target Description Indicator Name

Contracted Value £

Actual Value £

In England, more than 15 million people have a long term condition (LTC), a figure which is set to increase over the next 10 years, particularly those people with three or more conditions. The CQUIN focused on improving pathways for patients with a LTC, and where possible, reducing inappropriate admissions to hospital emergency departments.

Frailty/LTCs in the elderly

393,850 393,850

The Trust worked to ensure effective assessment by the ambulance service of mental health patients and appropriate onward referral or transfer of patients to the relevant services.

Mental health conveyance

393,850 393,850

Sepsis is a life threatening condition that arises when the body’s response to an infection injures its own tissues and organs. Sepsis can affect anyone at any time but it does tend to strike more often people at the extremes of life; the very old and the very young. As a result, children, particularly premature babies and infants, can be more susceptible to developing sepsis. The CQUIN aimed to improve the recognition, assessment and management of sepsis in children.

Sepsis 393,850 393,850

The CQUIN focused on improving the experience of patients in line with Domain 4 of the NHS Outcomes Framework. The Friends and Family Test will provide timely feedback from patients about their experience.

Friends and Family Test

393,850 393,850

The Trust aspires to 'work better together' with partner agencies, contributing to a whole system approach to improve healthcare services in Cornwall. A priority for the Trust and NHS Kernow CCG was to improve the service provided to patients who are frail and have long term conditions (in Kernow).

Integrated services

210,054 210,054

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Contracted Value £

Actual Value £

The CQUIN involved ambitious plans to further reduce inappropriate admissions across the Trust, which are set out in Right Care

23. This CQUIN aimed to provide more

local deliverables, utilising opportunities across the New Devon CCG area.

Exceeding Right Care

2

210,054 210,054

Early detection, timeliness and competency of clinical response are a triad of determinants of clinical outcome in people with acute illness. The National Early Warning System (NEWS) is a simple scoring system which uses six physiological parameters to identify acutely unwell patients. Although widely used in hospitals, NEWS has not yet been implemented by an ambulance service. The indicator explored the potential for the score to be implemented within the pre-hospital environment.

Patient safety

210,054 210,054

For agreed local areas within Dorset and Somerset, the CQUIN focused on enhancing the initial response to patients triaged as RED 1 by working in partnership with the CCG to engage health professionals already within the area to respond to calls and increasing the number of community public access defibrillators and static defibrillator sites (in Dorset and Somerset).

Community engagement

210,054 210,054

To complete a root cause analysis of the call to balloon (CTB) time breaches in patients with ST-elevation Myocardial Infarction (STEMI) and devise an action plan to improve performance (in Wiltshire, Bath and North East Somerset and Gloucestershire).

Angioplasty 210,054 210,054

Total 2,625,670 2,625,670

3 Further information about Right Care

2 can be found on page 45 of this document.

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Out of Hours Service CQUIN Dorset 2014/15

Target Description Indicator Name Contracted

Value £

Actual Value £

The Trust has already highlighted the

importance of early Deep Vein

Thrombosis (DVT) diagnosis through its

2012/2013 CQUIN in delivering training

to its staff in Venous Thromboembolism.

In order to provide early diagnosis and

to rule out DVT, NICE guidance advises

the use of D-Dimer testing along with

the 'Wells' scoring method. The

introduction of 'Point of Care' Near

testing for D-Dimers by Out of Hours

clinical staff would ensure appropriate

referral during both In Hours and Out of

Hours care.

Venous

Thromboembolism

Training

29,545 29,545

To undertake patient contact surveys of

the Out of Hours service. A sample

survey to be sent every month to those

who had used the service the previous

month. This will be reported on every

quarter. A target of 23% response rate is

set. To introduce a Staff Friends and

Family test to run alongside the Patient

Friends and Family test. Introduce

surveys in the treatment centres and for

home visits.

Patient surveys

and Friends and

Family test

29,545 29,545

To contribute to the reduction in the

number of emergency supplies provided

during Out of Hours.

Prescriptions 29,545 29,545

Triage is a major part of our service. It

allows for effective use of our resources

whilst being able to have contact with

our patients. Home visits also form a

major part of our service and are a key

Remote triage and

ad hoc on call

remote home

visits

29,545 29,545

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Target Description Indicator Name Contracted

Value £

Actual Value £

contact between GPs and patients. It is

important that home visits are made in a

timely manner whilst not jeopardising

other resources.

To ensure that the management of

patient records - Special Patient Notes

(SPN) and Summary Care Records

(SCR) - is carried out effectively and

consistently, to the benefit of the patient.

Special Patient

Notes and

Summary Care

Records

29,545 29,545

To introduce an electronic management

system for the drugs used in the Out of

Hours service.

Medicines

Management 29,545 29,545

Total 177,270 177,270

Out of Hours Service CQUIN Somerset 2014/15

Target Description* Indicator

Name

Contracted

value £

Actual

Value £

To provide training and development to clinicians working in Somerset.

Education

and

Development

125,000 tbc

Total 125,000 tbc

*Please note that these schemes are running until June 2015.

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Commissioning for Quality and Innovation (CQUIN) 2015/16

For emergency 999 (A&E) services, eight CQUINs have been agreed with our

commissioners for 2015/16, representing 1.5% of the Trust’s block contract. CQUINs

for the Dorset Out of Hours contract totals 2.5% of the 2015/16 contract value.

CQUIN is not applicable to the NHS 111 contracts, Tiverton Urgent Care Centre

contract, or the Patient Transport Service contract. CQUINs are also not applicable

for the first year of the Gloucestershire Out of Hours contract, but will be introduced

in 2016/17.

Emergency 999 Ambulance Services (A&E) CQUIN 2015/16


Contracted Value £

Promote evidence-based assessment and management of unwell children and young people for the six most common conditions when accessing 999 ambulance services.

Paediatric Big 6

485,460

Explore the potential for paramedics to practice enhanced wound care skills, traditionally practiced by specialist paramedics in urgent and emergency care. This would enable the paramedic to treat patients more effectively on scene, potentially reducing the need for hospital admission. The CQUIN would also explore other clinical skills which may be included under the enhanced care umbrella.

Enhanced skills

485,460

Improve the management of frequent callers who present to the ambulance service and across multiple patient-facing organisations.

Frequent callers

485,460

Develop a more consistent approach to transfers of care between urgent and emergency care providers. Improve understanding of patient safety concerns resulting from delays in handover and subsequent delays in ambulance response to 999 calls. Identify opportunities to better meet demand from other healthcare professionals (HCP) for ambulance conveyance to hospital.

Clinical handovers

512,430

Review the provision of the new Alcohol Recovery Centre (ARC) in Bristol to assess for a wide range of potential opportunities for the Trust to support initiatives aimed at mitigating the impact that alcohol has on the wider health economy. Determine how an

Alcohol 242,730

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Contracted Value £

Alcohol Recovery Unit (smaller scale support in same context as an ARC for town centres) could be developed and utilised.

Increase focus on healthcare professional (HCP) calls in order to identify patients who may be more appropriately conveyed by PTS level resources operated by the private provider. The CQUIN will foster a closer working relationship between SWASFT, NEW Devon CCG, South Devon and Torbay CCG and the private PTS provider.

Integrating transport

242,730

Optimise use of specialist paramedics in urgent care cars to increase the number of people SWASFT see and treat, reduce the number of patients conveyed to Treliske’s Emergency Department (ED) and reduce SWASFTs overall conveyance rate to Treliske ED.

Increasing utilisation of specialist paramedics

242,730

Total 2,697,000

Description

Out of Hours Service CQUIN Dorset 2015/16 £

The Trust is working with Dorset CCG to identify and agree suitable CQUIN

schemes for the Out of Hours Contract for 2015/16. The proposed overall value of

these CQUINs is £189,330 and the indicators being considered are:

Antibiotic Stewardship; this is in line with the draft clinical Guideline on antibiotic stewardship from NICE and local initiatives within NHS England and the AHSN;

Repeat Prescriptions; this is aimed at reducing inappropriate contacts with UCS and to encourage practices and patients in the appropriate management of repeat medications;

Sepsis; This aims to improve the recognition assessment and management of patients with sepsis, by utilising recognition tools for clinicians, educational material clinical and call taking staff and audit. Sepsis is recognised as a significant cause of mortality and morbidity in the NHS, with around 37,000 deaths attributed to sepsis annually. Of these some estimates suggest 12,500 could have been prevented;

111 Staff Engagement.

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Out of Hours Service CQUIN Somerset 2015/16

Please refer to the table showing the 2014/15 Somerset CQUIN information as this

scheme will be continued until 30 June 2015

Improvements in services

Right Care2

In 2010, SWASFT developed the Right Care, Right Place, Right Time initiative, a

five-year commissioner-funded agreement that committed us to reducing

unnecessary admissions to emergency departments (ED) by 10% through managing

patients using alternative pathways. Many of the patients that call 999 for an

ambulance can be managed safely and effectively without sending an emergency

ambulance to convey them to an ED. An increasing proportion can be managed

through telephone assessment and sometimes by referral to another service, such

as making their own way to a minor injuries unit (MIU). Over half of our patients can

be treated by highly skilled ambulance clinicians in their own home, practicing skills

that have historically only been delivered within a hospital. An example of this is

suturing (stitching) a wound.

Delivering the right care for patients, outside of an ED wherever possible and at the

time of the call has three significant advantages. Patients receive care without

having to leave their home, EDs have greater capacity to deal with true emergencies

and emergency ambulances can be better utilised to attend patients who most need

a rapid response.

This successful initiative has resulted in an increase in the proportion of 999 calls

that were managed without attending an ED (from 50.84% in 2010/11 to 57.45% in

2013/14). In reality, this means that the Trust annually conveyed 83,517 fewer

patients to EDs than the UK average for ambulance services. This is 15% above the

national average and 24.8% better than the worst performing ambulance trust.

Following this success, the Trust was commissioned in 2014/15 to deliver the Right

Care2 programme.

What has been achieved?

The Right Care2 programme has built on this initial success to ensure that even

more patients are able to be safely managed within in the community. During

2014/15 over 12,000 fewer patients were conveyed to EDs than the previous year,

despite an 9.75% increase in the number of emergency 999 incidents received. We

estimate that managing patient’s more effectively in the community has led to

savings of around £9,000,000 for the wider South West health economy.

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This improvement has been achieved through the introduction of a system to enable

ambulance and ED clinicians to provide feedback on issues which prevent the

delivery of the right care to a patient. Over 1,000 incidents have been submitted

through the Right Care feedback routes during 2014/15, with many shared with local

Clinical Commissioning Groups (CCGs) to help identify service improvements. A

wide range of projects have been completed to improve access to alternative care

pathways, which include:

Producing the first South West wide list of the acceptance criteria for every minor injuries unit (MIU);

Developing a wide range of alternative hospital pathways;

Better publicising of local services;

Recruiting and training a pool of GPs in the 999 clinical hubs;

Auditing the management of healthcare professional 999 calls;

Managing frequent callers through a recognised trust-wide process;

Launching the Appropriate Care Pathways policy providing guidance and support to clinicians in particular when managing patients who insist on conveyance, those who decline it, and those requiring a bypass to a specialist centre;

Launching the Right Care education award;

Specialist paramedic review to develop a strategy to better utilise our most clinically skilled staff;

Pilot to link with community pharmacies;

Holding Right Care2 roadshows at every acute hospital across the South West to bring commissioners, hospital, community and ambulance clinicians together;

Local operational champions acting as local Right Care ambassadors between the central team and local operational teams across all stations, 999 and urgent care hubs;

Better use of social media to promote the initiative and communicate with operational staff;

Local plans agreed by commissioners, trust clinical and operational managers.

Clinical Focus

We have a proven track record of delivering a clinically-focused service and continue

to maintain a strong reputation for being one of the first UK ambulance services to

implement a wide range of innovative cutting edge treatments. The introduction of

clinical commissioning groups continues to lead to a significant increase in demand

for senior clinical representatives from the Trust to attend meetings to support the

development of care pathways within local areas.

Every day our clinicians work to deliver the very best possible care to patients.

During 2012/13, the Trust introduced 24 award-winning new local clinical guidelines,

to provide additional support to ambulance clinicians managing the more complex

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conditions. As part of the planned two year cycle, all guidelines were reviewed during

early 2014 to ensure that they continued to reflect the latest evidence base. Ten of

the existing 24 guidelines were revised to incorporate further learning from internal

incidents and the latest published evidence. Following positive feedback from

ambulance clinicians, seven additional guidelines (catheterisation, croup, headache,

mental health and mental capacity, palliative care, pain management and spinal

management) were also published.

Other notable initiatives from the reporting period which demonstrate the Trust’s

continued clinical focus include:

Dedicated day of clinical input was delivered by the Medical Directorate to all

of the newly appointed Operational Officers. The day focused on equipping

individuals with the skills needed to support staff with clinical issues and to

manage clinical performance;

In line with the introduction of the mental health Crisis Care Concordat, we

have been working with partners to develop a greater understanding of the

patient pathway and how the NHS and its partners respond to those in mental

health crisis. We have signed up to the principles of the Concordat in all CCG

areas and provided input into local action plans across the South West;

SWASFT achieved representation on the national group developing the new

National Institute for Health and Care Excellence (NICE) clinical guideline for

sepsis as well as on national ambulance groups developing sepsis, end of life

and mental health guidelines;

Vascular bypasses launched in a number of areas to improve the care of

patients experiencing a vascular emergency;

Continued to support the clinical hubs to better manage inter-hospital

transfers, by liaising with hospitals and challenging inappropriate calls;

Lead site and sponsor of National Institute for Health Research (NIHR) Health

Technology Assessment (HTA) funded study - AIRWAYS-2 (first ambulance

trust to sponsor an HTA funded study);

Collaborated with colleagues at the Peninsula Collaboration for Health and

Operational Research and Development (PenCHORD) on a project assessing

the factors that influence the level of ambulance service demand;

Additional opportunities provided for Research Paramedics;

Completed the national Red 1 call clinical evaluation to demonstrate the

clinical benefit of responding quickly to peri-arrest patients;

Used comprehensive trauma database to model the implementation of the

new pelvic immobilisation guidelines;

Continuous programme of clinical audit activity to inform service delivery.

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Electronic Care System (ECS)

The Electronic Care System (ECS), incorporating the electronic Patient Clinical Record (ePCR), has been created in partnership with Ortivus, a leading supplier of mobile solutions for modern emergency medical care. The solution aims to eradicate paper-based data collection, enhance the clinical decision making process and support the provision of the right care, in the right place at the right time. The project was initially part of four work programmes led by Connecting for Health and aimed to provide an electronic solution across the South of England. Although looking in particular at an ambulance-based solution, functionality to support further integration at a later stage has been a consideration throughout. On initial review of the available solutions, central to the decision to identify Ortivus and MobiMed Smart, was to find a system that is highly configurable by the ambulance service and a solution that is focused on the needs of a modern ambulance service. A service that is driven by the provision of high quality care and the desire to ensure that the patient outcomes meet the needs of the individual patient, but are also focused on supporting the clinician in determining the most appropriate pathway and providing care that meets the objectives of the wider urgent care agenda. A system which is highly adaptable and can be configured to meet the specific needs of the service, provides a huge potential benefit to patient care and the wider health economy, but does require far greater input from the clinical team in SWASFT to develop the product and ensure that all potential requirements are considered. The ePCR has been configured by a small but dedicated project team in SWASFT. Using a structured model of examination and assessment, the software is configured to take the clinician through a structured process, capturing any and all clinical interventions and, where possible and appropriate, incorporating validated assessment tools to enhance the clinical decision making process and support the clinician in making the most appropriate decisions regarding the patients definitive care needs. ECS aims to:

Deliver more appropriate clinical outcomes for patients, through better pathway management, data sharing and informed decision making;

Reduce the number of patients taken to emergency departments unnecessarily;

Improve the communication of appropriate and essential patient information across the healthcare community; including receiving units, GPs and other parties involved with patient care. All acute hospitals will be able to monitor a patient’s clinical presentation prior to arrival;

Deliver improved support for Trust staff resulting in improved job satisfaction – ECS empowers clinicians, supporting them to make appropriate clinical decisions confidently.

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Following a pilot in Taunton, Somerset, the ECS system was introduced in Taunton and Plymouth, Devon, during 2014/15, with an ambitious roll-out planned for 2015/16.

Air Ambulance

During 2014/15, SWASFT continued to work in close partnership with the five air ambulance charities that provide this invaluable service across the South West. We continue to provide the clinical teams for six air ambulances (two in Devon, one in Cornwall and the Isles of Scilly, one shared across Dorset and Somerset, one in Wiltshire and one based near Bristol). The main output of the Air Ambulance Clinical Group has been the creation of a draft five year strategy to deliver 24/7 enhanced and critical care across the South West. Work will continue in early 2015/16 to finalise the strategy and translate it into practice. The group also focused on supporting Specialist Paramedics - Critical Care (formerly known as Critical Care Paramedics) to gain additional skills as well as reviewing clinical guidance.

Infection control

In line with the NHS nationally, infection prevention and control continues to be a

high priority for the Trust. During 2014/15, we built on the newly aligned policies and

procedures to harmonise frontline practice across the organisation. The Trust aims

to ensure that patients are cared for in a clean, safe environment; one that we would

be proud for our relatives to experience.

As part of the comprehensive 2014/15 Annual Infection Prevention and Control

Programme, a wide range of initiates were completed including:

Infection prevention and control commitment to the public published on the

Trust’s website;

Focus on the use of social media to raise awareness of infections and

preventative measures;

‘Bare below the elbows’ campaign launched;

Appropriate personal protective equipment (PPE) campaign launched;

Unannounced inspections of a range of sites to confirm compliance with

policies and procedures and to ensure consistency of the monthly audits;

Hand hygiene audits undertaken;

Influenza vaccination delivered to 44% of staff.

During 2014/15, the Trust responded to the national threat of Ebola, investing in

additional PPE, dedicated ambulances and providing staff with comprehensive

guidance. During the outbreak we managed around 20 incidents involving patients

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who were at risk of potentially having Ebola; thankfully all tested negative for the

disease.

Make-Ready Operatives

The Trust’s Make Ready Operatives are responsible for the deep cleaning of vehicles for infection control purposes. The Trust sets a target that 95% of the vehicles should undergo a deep clean every 42 days. In 2014/15, in excess of 5,000 deep cleans were undertaken.

Logistics Desk

There are two logistics desks within the Trust, one in Trust Headquarters in Exeter, the other in Acuma House in Bristol. The desks are staffed by 11 administrators providing 24/7 cover to SWASFT staff.

The role of the desk is to provide support on a wide range of issues. The key priority for the desk is to closely monitor hospital delays for escalation to Operational Commanders.

Community and Social Issues

Responders

Responders are invaluable and highly regarded volunteers who have been trained to attend certain medical emergencies and deliver basic life support, oxygen therapy and defibrillation. We have 5,203 individual responders across the operational area including 770 Community First Responders (CFR), who are trained volunteers who provide support to their local communities by attending certain emergency calls (especially time critical ones like cardiac arrests) whilst an ambulance is on its way.

CFRs provide an invaluable service, both to the ambulance service and local communities within which they work. Additionally, there are members of SWASFT staff who voluntarily respond to incidents whilst off-duty. The Trust is also provided with greatly valued support and assistance from colleagues working in other organisations including the RNLI, St John Ambulance CFRs, Fire Co-Responders and BASICS Doctors (members of the British Association for Immediate Care) who volunteer to attend emergencies, supporting ambulance clinicians and providing enhanced care for patients.

An increase in coverage and availability of volunteer responders during the past year has resulted in a 10.5% increase in allocations to life threatening emergency calls attended ahead of an ambulance arriving on scene. Community initiatives contributed 8.5% to Red performance, responding to over 60,000 patients.

The placement of defibrillators within communities for public access has also significantly increased this year. There are now 630 public access defibrillators supported by SWASFT, which can be accessed by anyone around the clock.

Defibrillator initiatives help improve cardiac arrest survival rates by being available at the time of need. These additional resources mean that we now have a total of 2,038

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defibrillators across our operational area, which can be used ahead of an ambulance arriving at the scene of a 999 call.

Safeguarding

Safeguarding is the protection of members of society who may be more vulnerable due to age, illness, capacity or position. The Trust has a statutory duty of care to protect its patients.

The past year has been a significant one for safeguarding nationally. There are two new statutory influences on safeguarding practice; The Care Act 2015 and the Counter–Terrorism and Security Bill 2015. There have also been a number of high profile cases covered by the media, including that of Jimmy Savile, as well as Child Sexual Exploitation cases in Rotherham and Oxford. There is also a continued focus on preventing young people from being radicalised, putting Safeguarding even higher up the agenda. This means that safeguarding departments are subject to an increased level of scrutiny and it is imperative to be aware of and adhere to the latest recommendations arising from each national or local case. The increase in safeguarding activity has been recognised by the Trust’s Board of Directors and, as a result, the safeguarding service has increased by two whole time equivalent (WTE) clinical members of staff – a clinical triage post and a Named Safeguarding Professional. SWASFT referrals have risen from 5,814 in 2013/14 to 7,722 this year. This is an

increase of almost 33%.

The following table shows the total number of referrals for both adults and children

during the reporting period:

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April 2014

May 2014

June 2014

July 2014

August 2014

September 2014

October 2014

November 2014

December 2014

January 2015

February 2015

March 2015

Adults 414 409 362 409 402 378 377 443 471 504 498 525

Children 192 193 204 213 209 218 222 241 174 238 150 276

Total 606 602 566 622 611 596 599 684 645 742 648 801

The referrals are mainly submitted by clinicians and staff working in the clinical hub, although any staff member who thinks that a

patient has been or is at risk of abuse or neglect can make a referral. These are then shared with other agencies as appropriate, for

example colleagues working in the police, Care Quality Commission (CQC), social care and primary care.

As well as referrals, the focus of the safeguarding function is in the oversight and delivery of training.

A safeguarding training strategy is now in place. All staff and managers are aware of the level of training that is required and the

Trust’s performance is scrutinised by commissioners and Safeguarding Boards to ensure compliance.The safeguarding team also

contributes to serious incident (SI) panels, allegations, frequent caller and other meetings as appropriate.

SWASFT is aligned to 28 Adult and Child Safeguarding Boards within its operational area and has supplied information and/or

attended all panels focussing on serious case and mental health reviews, complex cases, domestic homicide reviews and case

audits as required.

It is a statutory requirement to produce an Annual Report4 showing how the Trust has met its safeguarding responsibilities in line

with Working Together to Safeguard Children (H.M. Government 2013) and the Care Act 2015. This provides a more detailed

report on safeguarding activity.

4 For further information about safeguarding and to obtain a copy visit www.swast.nhs.uk


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Patient Experience and Stakeholder Engagement

Consultation and engagement with local groups and organisations

We were not required to undertake any statutory consultations during 2014/15, but carried out a series of activities to engage key stakeholders and have continued to place a great deal of emphasis on our Patient and Public Involvement (PPI) activity. Patient and Public Involvement (PPI) and health checks

During 2014/15, the Trust supported 148 patient and public involvement events. These were attended and staffed predominantly by volunteers from a variety of roles across the organisation including clinicians, managers, administrators, governors and community first responders.

Examples of the types of events supported by the Trust include the county shows, community fetes and fairs, school and college visits and public health awareness days.

These events provide a fantastic opportunity to engage with the public and people who have accessed emergency and urgent care services provided by SWASFT. During these events they are informed about the services that the Trust provides and their views on a variety of topics related to these are also sought.

The events also provide an opportunity to deliver proactive health checks. A total of 1,262 members of the public had their blood pressure checked during the reporting period and a further 48 people received a free NHS Health Check, covering blood pressure, body mass index, blood glucose and cholesterol levels. The results are provided immediately and where necessary recommendations about further medical care, such as attending their own GP, are made.

We have improved our links with our Road Safety Partnerships across the area we serve and paramedics continue to give presentations to young people aged 19 to 24 under the ‘Learn to Live’ initiative.

Other achievements include;

Providing public health messages to the public by working with our CCG partners and other health and care organisations;

Establishing links with our local armed forces and supplying NHS health checks to serving Royal Marines;

Joining forces with Avon & Somerset Constabulary’s festive Drink Drive Campaign, working with them at the roadside to deliver safety messages;

Continued partnership working with colleagues from the police, street pastors and town centre managers – operating the mobile treatment centre (MTC) in densely populated locations allowing immediate access to healthcare, reducing unnecessary admissions to EDs and ensuring that patients get the right care, in the right place at the right time;

Working with other emergency service partners on the Hinkley Point C project, including the provision of an education session to the local school on the dangers of large vehicles on the road during the construction phase;

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Raising the profile of SWASFT’s Bristol Bike Unit by ensuring that they have a presence at high profile events across the Trust area.

Below is a table showing a summary of the PPI activity during the reporting period:

Political Engagement

The Trust operates in a complex political environment. In order to function effectively

it is important that we develop productive relationships with a wide range of key

external stakeholders and bodies or individuals that have an interest in and/or

influence our work.

In August 2014, a part-time MP and Stakeholder Engagement Business Manager

was appointed and began to further develop the relationships with SWASFT’s

political stakeholders and those that influence policy and legislation, both in

Parliament and within local government across the South West.

Within the Trust area there are currently 55 Members of Parliament representing

their local areas, many of whom regularly contact the Trust on behalf of their

constituents with a wide range of questions and requests. There are also 13 upper

tier or unitary local authorities within the region, each of which examines the work of

the Trust through their local Health Overview and Scrutiny Committees and Health

and Well-being Boards.

A programme of work has been undertaken with this stakeholder group to cultivate a

greater understanding of, and support for, Trust strategy and to raise awareness of

the current and future challenges that we face has already begun. Many meetings

have taken place at MPs’ constituency offices as well as at various local Council and

SWASFT sites throughout the region.

A number of key stakeholders, including MPs, Governors and Councillors have

visited Trust premises in their locality to spend time either in one of the clinical hubs

or operationally with a crew on the road to find out more about the ambulance

service first hand.

The success of this programme of engagement will be built upon and further

developed during the 2015/16 financial year.

Further information about stakeholder engagement can be found within the Annual

Governance Statement on page 229.

Total events

Blood pressure checks

Full NHS health checks

New members

Have Your Say leaflets

Response to running Red calls

148 1262 48 99 25 71

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Human Rights

SWASFT takes equality, diversity and human rights very seriously and is committed to promoting equality of opportunity in its employment practices and in its provision of care. Our ambition is to be an excellent organisation in terms of service provision and to be an employer of choice for our existing and potential employees. Human rights issues are covered by our Single Equality Scheme, which aims to make ‘Diversity, Equal Opportunities and Human Rights a Reality’. Through the implementation of the Single Equality Scheme and in addition to furthering equality and celebrating diversity, the Trust aims to ensure that human rights are at the centre of our work and are integral to all our functions, policies, strategies and procedures as a means of eliminating institutional and individual discrimination. See more in our Equality and Diversity section on page 65.

Learning from Experience During 2014/15, the Trust’s Learning From Experience Group was re-launched to become the Experiential Learning Forum (ELF). This group brings together Trust experts to discuss and review safety and quality related themes to identify lessons to be learned, to promote good practice and to ensure these are disseminated throughout the organisation. The specific duty of the group is to undertake focused reviews from trends identified or concerns raised, which are informed by internal and external feedback including adverse incidents, complaints and claims, and investigations including those for serious or moderate harm incidents. The focused reviews undertaken during the year include mental health and capacity, health and well-being and the non-conveyance of patients. In addition to ELF, the Trust also learns from investigations into serious and moderate harm incidents and complaints. Each serious incident investigation is reviewed at a dedicated Serious Incident Review meeting chaired by a clinical director or deputy director. All staff involved in the incident are invited to attend and contribute towards identifying learning from the investigation. In addition to the provision of feedback and completion of reflective practices by those involved in incidents, examples of recommendations for improvement arising from investigations and the activity of ELF are set out below:

A review of vascular guidelines;

The dissemination of guidance on the use of social media;

The issue of a new Standard Operating Protocol regarding back up management to include a defined escalation process;

Feedback nationally to NHS Pathways regarding a particular question relating to timing of pain;

A change to the order of the opening script for third party callers contacting NHS 111;

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Feedback to the Medical Priority Dispatch System User Group (who produce the triaging tool used by our North Clinical Hub) raising a reconfiguration requirement;

A systematic review of the Trust’s business critical and back up services;

The development and dissemination of an updated aide memoire regarding the triaging of symptoms within NHS Pathways;

Additional focus on training within NHS 111 on the management of emergency calls;

The publication of a bruising protocol for all clinicians including those working within urgent care services;

Review and circulation of a new spinal care clinical guideline;

A review of the Trust’s Driving Policy to ensure that it included guidance on management of road traffic collisions involving Trust staff;

The implementation of a process within the clinical hub to look at patterns of staff errors, identify issues and address them with additional support and training;

A review of the Trust guidelines in relation to the assessment of paediatrics and adolescents presenting with meningitis symptoms;

Distribution of the Trust’s new headache clinical guideline;

The development and provision of a two day investigations course for new Operational Officers to improve the quality and standard of investigations.

Patient Experience – Complaints Handling Comments, concerns and complaints are an invaluable source of information about the patient experience. The management of comments, concerns and complaints provides the Trust with valuable opportunities to learn and to improve future services. If we do not know about an issue, we do not get the opportunity to turn the situation around. As an organisation, the Trust encourages patients and their families to get in touch when they believe that our service has not been as it should. The Trust’s Complaints Policy reflects the requirements of the 2009 Local Authority Social Services and National Health Service Complaints (England) Regulations.

Each month, we monitor the patient feedback received and review any emerging themes. Lessons learned and actions taken to embed improvements are reported to the Board of Directors and commissioners through the Patient Experience and Safety report. Clinical development and Trust-wide learning is encouraged through the publication of clinical articles and the Reflect newsletter. In addition, key learning is reflected in our statutory, mandatory and essential training programme. In 2014/15, SWASFT received a total of 1,268 comments, concerns and complaints. We also received 2,055 compliments. In addition, we received 857 general enquiries including issues such as lost property and signposting patients to other organisations.

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Ombudsman Principles We have adopted three Ombudsman’s Principles which are: Principles of Good Administration; Principles for Remedy; and Principles of Good Complaint Handling. This has resulted in the Trust operating a complaints service committed to:

Getting it right;

Being customer focused;

Being open and accountable;

Acting fairly and proportionately;

Putting things right;

Seeking continuous improvement. We provided recompense in accordance with, and appropriate to, these principles on one occasion in 2014/15. This action supports the wider health economy by preventing future and potentially costly claims because swift local action prevents litigation which is a huge cost to the taxpayer. We sent 10 files to the Ombudsman’s Office during 2014/2015 relating to comments, concerns and complaints received by the patient experience team. Of these files, the Ombudsman carried out independent reviews on all files and considered one of these to be upheld; five of these not to be upheld and four are currently under review.

Information Management and Technology (IM&T) involving personal data as

reported to the

The IM&T team has led a number of projects throughout the year, including:

The creation of a NHS 111 hub in Cornwall, which was completed within four weeks;

Refurbishment of the 999 clinical hub in Exeter, which was undertaken without any impact on 999 performance;

Replacement/standardisation of the Trust’s Command and Dispatch System (CAD), station WiFi, telephony and voice recording which incorporates NHS 111, 999 and all admin service lines.

Station WiFi

In 2014 the Trust secured one off funding from the NHS Technology Fund initiative

to assist the Trust and the wider NHS in moving towards a more sustainable

(paperless) ways of working.

Procurement of all the required equipment and services to facilitate the project was

completed in March 2015, with a progressive Trust-wide roll-out commencing in May

2015 and finishing at the end of the year.

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Hub Virtualisation

To allow us to operate within a virtual clinical hub across our area, the Trust awarded

the Computer Aided Dispatch (CAD) system contract to MIS Emergency via a formal

tendering process. There is currently a significant system build and training activity

underway. The Trust should be using a single instance of the MIS CAD by October

2015.

Gloucestershire Out of Hours Service

The Trust bid for, and successfully won, the contract to deliver the Gloucestershire

Out Of Hours Service in November 2014 and ‘went live’ on 1 April 2015.

The service specification required, in partnership with the Gloucestershire GP

Provider Company (GGPPC), the operation of six Primary Care Centres (PCCs)

across Gloucestershire for patients to be seen by a GP or Advanced Nurse

Practitioner, seven mobile clinicians in vehicles offering home visits, and a co-

ordinating clinical hub where patients can be triaged and booked into appointments.

As with all modern service models, sophisticated IT has been at the heart of making

the patient experience as streamlined as possible. This has involved interfaces with

the NHS 111 service, the community care provider (Gloucestershire Care Services)

and GP surgeries to ensure joined up care. The service has been well supported by

the local GP community and commenced on schedule on 1 April 2015 and

successfully delivered care over a busy Easter Holiday.

Valuing staff As at 31 March 2015, we employed a workforce of 4,285. The majority of our staff are frontline A&E staff covering the following roles:

Critical care paramedics;

Clinical hub staff;

Clinical operational tutors;

Clinical support officers;

Clinical team leaders;

Emergency care assistants (ECA);

Hazardous Area Response Team (HART) paramedics;

Lead paramedics;

Paramedics;

Specialist paramedics;

Technicians, advanced technicians and ambulance practitioners.

We also have access to 177 student paramedics, 602 bank staff, 400 sessional and 7 employed GPs who support the delivery of the Out of Hours service, and over 3,200 responders, who support delivery of the emergency 999 service.

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Staff engagement and consultation SWASFT takes staff engagement very seriously. It is fundamental to delivering high-quality clinical services and transformational change and is regarded as a valuable indicator of organisational health and well-being. A range of two-way feedback mechanisms, both formal and informal, are in place to encourage and enable the provision of information to and consultation with employees. The Trust faces significant challenges in developing its communications systems because of the 24/7 nature of the service against the context of a dynamic operating environment spanning a very wide geographical area. A selection of the tools and methods developed to communicate and encourage meaningful, two-way dialogue with staff includes:

Chief Executive’s weekly bulletin and other newsletters;

Corporate website and intranet;

Email facilities which include 24/7 and remote access;

Annual staff survey;

Electronic chat room sessions;

Face-to-face station meetings;

Union and executive director team meetings;

Local Consultation Committee, providing a union and management forum for each locality area designed to represent the staff within that locality. This in turn feeds into the Joint Negotiation and Consultative Committee (JNCC), which is our corporate committee for staff engagement and consultation. This ensures local input in corporate and strategic policy making;

Focus groups;

Staff Suggestion Scheme;

Staff Facebook page;

Video blogs.

NHS Staff Survey

The annual NHS Staff Survey is a mandatory requirement as part of the Trust’s registration with the CQC. It is designed to support and develop priority actions that deliver on the staff pledges contained within the NHS Constitution. These four pledges are:

Staff Pledge 1 – the NHS commits to provide all staff with clear roles and responsibilities and rewarding jobs for teams and individuals that make a difference to patients, their families and carers and communities;

Staff Pledge 2 – the NHS commits to provide all staff with personal development, access to appropriate training for their jobs and line management;

Staff Pledge 3 – the NHS commits to provide support and opportunities for staff to maintain their health, well-being and safety;

Staff Pledge 4 – the NHS commits to engage staff in decisions that affect them and the services they provide, individually, through representative organisations and through local partnership working arrangements. All staff will be empowered

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to put forward ways to deliver better and safer services for patients and their families.

We value the feedback and information provided by the annual independent NHS Staff Survey. It supports dialogue and engagement and provides a mechanism for identifying priority interventions to enhance staff health and well-being and organisational performance. Unlike the majority of other NHS Trusts, SWASFT surveys the whole of its workforce each year, not just a percentage. This demonstrates our commitment to staff engagement which supports our ambition to become a model employer. We also have a staff suggestion scheme, which is used by staff across the organisation to suggest local improvements to patient care.

Results from the NHS Staff Survey

A total of 1,691 staff participated in the 2014 survey; this represents a response rate of 42.3%, which is above average for ambulance trusts in England.

2013 2014 SWASFT improvement/deterioration

SWASFT National Average

SWASFT National Average

Improvement of 2% when compared with last year’s

results. Response Rate

40% 40% 42% 36%

Staff Engagement The overall indicator of staff engagement has been calculated using the questions that make up key findings 22, 24 and 25 respectively. These key findings relate to the following aspects of staff engagement:

Key Finding 22: Staff members’ perceived ability to contribute to improvements at work;

Key Finding 24: Their willingness to recommend the Trust as a place to work or receive treatment;

Key Finding 25: The extent to which they feel motivated and engaged with their work.

The employment engagement score for SWASFT is 3.37, above (better than) average, when compared to other ambulance trusts in England, which is 3.28. The following table highlights the key findings for which the Trust compares most favourably with other ambulance trusts in England:

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Key Findings SWASFT Score 2013

SWASFT Score 2014

Ambulance Average 2014

KF12 Percentage of staff witnessing potentially harmful errors or near misses in last month

36% 37% 41%

KF14 Reporting incident procedures are fair and effective

3.23 3.31 3.18

KF22 Percentage of staff who feel able to contribute to improvements at work

51% 51% 43%

KF25 Motivation at work

3.62 3.55 3.48

KF28 Percentage of staff experiencing discrimination at work in last 12 months

16% 17% 20%

The following table highlights the key findings for which the Trust compares least favourably with other ambulance trusts in England:

Bottom Key Findings SWASFT 2013 Score

SWASFT 2014 Score

Ambulance Average 2014

KF5 Percentage of staff working extra hours

87% 88% 85%

KF6 Percentage of staff receiving job-relevant training, learning or development in last 12

75% 72% 74%

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months

KF8 Percentage of staff having well-structured appraisals in last 12 months

15% 18% 22%

KF13 Percentage of staff reporting errors, near misses or incidents witnessed in last month

78% 77% 80%

KF26 Percentage of staff having equality and diversity training in last 12 months

47% 40% 49%

During the fieldwork period for the 2014 NHS Staff Survey, the Trust’s HR department conducted station visits to ensure that any queries or concerns regarding the survey were addressed. Following the results being published, action plans are being formed in each locality and hub to address the problem scores listed above in addition to their local themes. Progress on these action plans will be reported through the Quality and Governance Committee. In addition to setting localised action plans, the Trust has recently introduced local forums to address some of the concerns around the 2014 scores. These are held in each locality and hub and include relevant senior management. The forums are an opportunity for staff to engage and present their concerns or suggestions to local management.

Future priorities Improving the response rate for the NHS Staff Survey remains a key priority for the Trust; to ensure a representative reflection of the workforce is presented. Better communication of the survey in partnership with UNISON and continuing the station visits should help achieve this. In addition to the survey, the Trust will continue to promote participation in the Staff Friends and Family Test, to provide management with a rich source of data to highlight and address concerns much faster than traditional survey methods.

Education, Training and Professional Development

SWASFT continues to drive forward professional standards by ensuring the delivery of high quality teaching, research and clinical services. We aim to:

Develop staff and improve skill sets to ensure that first class patient care remains at the heart of our services;

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Identify and develop staff in a consistent manner based on the principles of merit and performance to improve individual skills, ability and organisational capacity;

Identify future leaders and subject matter experts;

Ensure that the Trust’s investment in workforce development is aligned to our strategic goals;

Support and develop the recruitment and retention of key clinical skills and behaviours to ensure a competitive advantage;

Deliver effective clinical leadership at all levels. Our Talent and Clinical Workforce Development Strategy 2014 - 2017 sets out our strategic aims relating to staff development. Specifically the strategy aims to improve care by continuing to develop the considerable talents of our frontline staff. The strategy provides a three year plan to create clear clinical career pathways and improve leadership capacity. It provides detail as to how we will develop and maximise future talent. SWASFT has three well-established training colleges, one in each of the three Divisions; with several additional small training venues located at stations across the Trust. We work closely with our three regional university partners: Bournemouth; Plymouth and the University of the West of England (UWE), who provide undergraduate development and post-registration paramedics.

This year we have enjoyed a much closer relationship with external organisations including: Local Education and Training Boards (LETBs) and Academic Health Science Networks (AHSNs). We have been fortunate to receive major financial support for several key innovation and workforce projects this year from the two LETBs in our region. In addition, Macmillan Cancer Support has agreed to work with SWASFT on a £650,000 pioneering collaboration project for cancer patients. We will be the first ambulance trust to offer such a scheme.

Our team of highly-skilled Learning and Development Officers (LDOs) are registered paramedics and organisational development experts educated to a minimum of degree level, with additional teaching qualifications. They offer learning opportunities in both the classroom and in the workplace. They also carry out assessments, core and clinical induction and remedial training. The Learning and Development department works closely with our Clinical Directorate and research colleagues to provide in-house clinical and educational expertise.

To support this, the Department has been working on the design and delivery of a number of development pathways over the last few months, in addition to the annual core training provision. The educational provision includes:

Statutory Mandatory and Essential (SME) training for clinical staff;

Declaration of the SME training against the Skills for Health UK Core Competencies (2013);

Management and Leadership programmes including Chartered Management Institute (CMI) accredited courses to meet the requirements of the NHS Leadership Framework (2014);

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Basic and Advanced Driver training for frontline operational crews and Out of Hours Doctors;

Bespoke courses in areas such as trauma, obstetrics, paediatric and educational training packages;

E-learning packages such as stroke care; with other resources in development;

The development of an internal CPPD Website in addition to the Learning4Health Training Platform where staff are able to find a variety CPPD opportunities programmes to support their development;

The development of the Right Care Award to develop clinical staff in the skills and competencies required to support the Right Care initiative;

The development of a Specialist Paramedic (Urgent Care) programme to support the development of the skills and competencies to ensure the right care, at the right time and in the right place;

The delivery of Quality and Credit Framework (QCF) Level 3 and 4 Development Pathways for Emergency Care Assistants (ECAs) as part of a development pathway;

The development of Apprenticeships and Higher Apprenticeship for Bands 1 to 4 staff;

The delivery of ECA/Tech Conversion courses to support the up skilling of ECA and Technician staff to Paramedic using a Foundation Degree programme to support the Trust Workforce needs;

A level 6 BSc course for IHCD and Foundation Degree Paramedics to uplift their skills and competencies;

Training for Hazardous Area Response Team (HART) members

Courses for clinical hub staff and clinicians linked to the new ambulance clinical quality indicator (ACQI) reporting;

Bespoke training courses at Level 3, 4 and 5 for 111/Clinical Hub Call Advisors, Supervisors and Managers development;

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Equality and Diversity We are committed to ensuring full equality of access for patients who require our services. Additionally, we aim to provide an environment in which all staff are engaged, supported and developed throughout their employment, with none disadvantaged by virtue of any personal protected characteristic. To ensure the duties of the Equality Act 2010 and the requirements of the Public Sector Equality Duty (PSED) are met, we have adopted the NHS Equality Delivery System (EDS2) as a tool to enable analysis, review and assessment of performance against 18 evidence based outcomes. These outcomes are incorporated within four goals:

Better health outcomes for all;

Improved patient access and experience;

Empowered, engaged and inclusive staff;

Inclusive leadership.

A summary of the Trust’s EDS2 grades is available on the Trust’s website:

http://www.swast.nhs.uk/What%20We%20Do/equality-and-diversity.htm


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Workforce Statistics A full breakdown of the workforce by protected characteristics is available on the Trust’s website: http://www.swast.nhs.uk/What%20We%20Do/equality-and-diversity.htm The following WTE figure is different from that given in the annual accounts on page 269 because outlined below is the total number of people employed by the Trust on 31 March 2015 and the number given within the accounts is an average during the year.

2014/15 2013/14

Headcount WTE Headcount

%

WTE % Headcount WTE Headcount

%

WTE %

Age

16-25

26-35

36-45

46-55

56-65

66+

332.16

951.73

1197.98

1011.27

330.25

16.75

353

1035

1345

1123

401

28

8.65

24.78

31.20

26.33

8.60

0.44

8.24

24.15

31.39

26.21

9.36

0.65

270.85

910.20

1204.73

989.37

313.47

15.06

280

983

1351

1084

371

25

7.31

24.58

32.53

26.71

8.46

0.41

6.84

24.01

33.00

26.48

9.06

0.61

Ethnicity

White

3764.88

4197

98.04

97.95

3635.85

4016

98.17

98.09


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Mixed

Asian or Asian

British

Black or Black

British

Chinese

Other

31.82

6.37

10.50

1.25

1.00

24.32

35

10

11

2

1

29

0.83

0.17

0.27

0.03

0.03

0.63

0.82

0.23

0.26

0.05

0.02

0.68

30.45

10.10

8.50

1.33

2.00

15.45

33

13

9

3

2

18

0.82

0.27

0.23

0.04

0.05

0.42

0.81

0.32

0.22

0.07

0.05

0.44

Gender

Male

Female

Transgender

2223.50

1616.64

0

2349

1936

0

57.90

42.10

0

54.82

45.18

0

2178.54

1525.15

0

2281

1813

0

58.82

41.18

0

55.72

44.28

0

Recorded

Disability

Yes

No

Not Declared

81.75

3061.64

696.75

94

3421

770

2.13

79.73

18.14

2.19

79.84

17.97

89.74

2860.36

753.59

98

3164

832

2.42

77.23

20.35

2.39

77.28

20.32

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Occupational Health Services In December 2014, the Trust moved to a new Occupational Health Provider, Optima Health. As part of this contract, Optima Health issue infection control advice, offer pre-employment health screening, rehabilitation advice following absence or injury and sickness absence management. Staff have access to a 24-hour confidential consultancy which provides advice and support on health and well-being issues. The Trust also offers specialist trauma support for staff through Red Poppy, who specialise in supporting staff working for the emergency services.

Sickness Absence The overall sickness absence rate for 2014/15 was 6.18%, which equates to 50,677 days and 13.55 days per person. (Refer to note 5.3 to the accounts on page 270.) The Trust’s target is to reduce sickness levels to 4%. Every 1% of sickness absence costs the organisation £869,000. The management of sickness remains a priority for the HR team. In order to achieve the 4% target, a detailed sickness action plan has been formulated and was presented to Directors during April 2015. Ultimately, the plan seeks to change the culture of how line managers approach sickness absence through offering them better support and training, to ensure they have greater autonomy and ownership within their role to enable a more individualised approach to all staff who are managed under the Sickness Absence Policy. The proposals outlined in the sickness action plan, together with the continued strong leadership and overview from the senior HR management team, will ensure a focus on both sickness and the wider health and well-being strategy. There is currently a centralised system to record all sickness, which is linked to the Global Rostering System (GRS) allowing reporting at multiple levels. This in turn, enables the HR business managers and HR business partners to discuss and review sickness absence during weekly Resource Management Group conference calls, chaired by the Divisional Head of Operations. As part of the Sickness Action Plan, it has been recognised that sickness absence management now requires a two-step process to enable the initial data to be captured through GRS, followed up by a detailed management discussion when an employee either books sick or returns to work. Sickness absence reporting is currently being developed through the GRS system for October 2015. These developments will allow further reviews of sickness absence against local management to review what action is being taken at

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operational management level. Targeted action can then be taken to assist managers in the management of sickness absence in accordance with Trust policy. The HR Department's dedicated health and well-being lead has undertaken a number of initiatives to improve the health services available across the Trust. Of particular note are the Health and Well-being Forums that have been arranged, during which staff have been invited to provide feedback with regard to their health and well-being. This valuable information has enabled the HR department to formulate a detailed report to recommend proposals and targeted interventions to improve the health and well-being of Trust employees. A new occupational health provider has also been announced and they are providing quality reports within the service line agreements. Individual case management is also monitored on an on-going basis to ensure that staff are supported with appropriate management and, where necessary, referral to the Trust’s occupational health provider. Review of and changes to systems will result in more rigorous decision making to support reasonable adjustments to roles and/or suitable alternative options. This gives staff greater opportunity to return to their existing role after ill-health, or where appropriate, learn new skills to enable them to retain employment in an alternative capacity.

Countering Fraud

The Trust has a responsibility to ensure that public money is spent appropriately and, in relation to this, we have policies in place to counter fraud and corruption. These include detailed Standing Financial Instructions, a Counter Fraud Policy and an Anti-Bribery Policy. In addition, we raise awareness of fraud via staff inductions, staff communications and through displays in public and staff areas. Counter fraud arrangements are reviewed annually by the Local Counter Fraud Specialist, who is employed by Audit South West. During 2014/15, a total of 128 days were provided to the Trust. The majority of these were planned, with the others being carried out on an ad-hoc basis. The Audit Committee receives and approves the Counter Fraud Annual Work Plan and the Annual Report, monitors the adequacy of Counter Fraud arrangements and reports on progress to the Board of Directors.

Sustainability Report

The Trust acknowledges and takes responsibility for the impact of its activities and operations on the local, regional and global environment and is committed to reducing any adverse effects. We are committed to making continual improvements in all aspects of our environmental and sustainability performance and to preventing pollution. Everyone in the organisation is encouraged and expected to take responsibility for environmental measures such as reducing energy consumption, fuel saving and waste reduction. We use environmental monitoring and reporting to quantify the environmental and

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social effects of our service delivery; to improve the management of any associated adverse environmental and social impacts; to improve our overall environmental performance; and to work towards the goals set out in the NHS Sustainable Development Strategy.

Sustainability Strategy

The Trust’s sustainability aims are set out in our Environmental Policy and in the Environment and Sustainability Strategy. These documents are intended to ensure environmental awareness and understanding is embedded in all our activities and operations. By developing this approach, we are creating a culture that supports improvements in environmental performance and the efficiency of the service whilst minimising waste and pollution and other environmental impacts by:

Ensuring the Environment and Sustainability Strategy is embedded into our core business strategies, raising staff awareness at all levels in the organisation and providing appropriate staff training;

Identifying and managing factors that impact on the environment;

Minimising the use of energy, water and other finite resources;

Working to ensure continual improvements in environmental performance;

Promoting and supporting green travel, encouraging staff to drive in an energy- efficient way and identifying measures to reduce our fleet carbon emissions;

Applying a sustainable procurement policy with specific focus on low carbon goods and services and building greater resilience into supply chains;

Complying with relevant legislation and guidance;

Minimising waste and increasing the re-use, recycling and recovery of waste material;

Avoiding environmental pollution and minimising emissions to land, sea and air;

Identifying climate adaptation impacts and measures to minimise the effect of climate change on operations, service delivery, staff and estate.

Sustainability Governance

The Trust’s Environmental Management Group (EMG) is a multi-disciplinary group responsible for championing our green agenda and for reviewing and monitoring progress against our environmental objectives. This group updates the Board of Directors annually on environmental matters and provides advice, guidance and support. The Board of Directors also has a Non-Executive Director lead for sustainability. For 2014/15 this was Christopher Kinsella.

Summary of Performance

Over the past few years the Trust has worked consistently to identify and implement improvements in its environmental performance in the following areas:

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Energy and carbon management;

Travel and transport including vehicle design, new build concepts and efficiency technologies;

Water and waste;

Built environment and workforce development;

Partnership and networks;

Governance and finance. The Trust has carried out an assessment of its overall carbon footprint for 2013/14, the last year for which full data is currently available, and this compares with the overall NHS carbon footprint as follows:

Trust

tCO₂e

Trust %

(2013/14)

NHS %

(2012 data)

Procurement 20,656 44% 61%

Estate energy and utilities 3,668 8% 17%

Travel and transport 22,353 48% 13%

Commissioning N/A N/A 9%

Total 46,677 100% 100%

The carbon footprint assessment for 2013/14 is based on estimated Estates Return Information Collection (ERIC) data for estates energy and utilities, fleet fuel consumption and annual expenditure for various fleet and procurement commodity groups. The carbon footprint assessment will be reviewed and updated as further information is received. The carbon footprint of the Trust varies from that of the NHS as a whole. This is due mainly to the nature of our core services and use of vehicles to provide those services. The fleet includes emergency 999 ambulances, rapid response vehicles and Patient Transport Service vehicles, and we operate across a very large geographical area. There are also other influences such as well-established cost effective purchasing practices, the relatively small size of our estate and continuing investment in estate energy efficiency and low carbon measures.

The 2013/14 figures indicate that carbon emissions arising from the use of energy in our estate have fallen by an estimated 382 tonnes of carbon dioxide equivalent (tCO2e) from 2012/13 levels. Since 2006/7 the overall total reduction in carbon emissions due to estates energy usage is estimated at 253 tCO2e which equates to 6.9% since 2006/7. It should be noted that over the same period the total gross internal area of the Trust estate has grown by 13.9%.

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The Trust calculates that to achieve a cumulative ten per cent reduction in carbon emissions due to the use of energy in the Trust estate over the period 2006/7 to 2014/15, we need to reduce our estate energy carbon emissions in 2014/15 by a further 116 tCO2e.

The table below shows the Trust’s Environmental Impact Performance Indicators:

Area

Non-

Financial

Data

2014/15

Non-

Financial

Data

2013/14

Financial

Data

2014/15

Financial

Data

2013/14

Waste

minimisation

and

management

Incinerated

waste (tonnes) 67 34 Incinerated

waste cost £133,974 £106,922

Landfill waste

(tonnes) 190 556 Landfill waste

cost £185,280 £145,008

Recycled waste

(tonnes) 69 43 Recycled waste

cost £71,028 £61,811

Finite

Resources

Water

(cubic metres) 98,467 72,341 Water cost £66,998 £49,154

Electricity

(MWh) 5,183 4,182 Electricity cost £934,582 £754,070

Gas

(MWh) 5,340 6,204 Gas cost £247,712 £287,768

Oil (MWh)

29 63 Oil cost

£2,860 £6,199

* The data for 2014/15 is estimated as energy, utility and waste information is provisional at this time.

Future Priorities and Targets

Other future environmental priorities include:

Developing an environmental management system;

Ensuring major new developments employ low energy solutions, sustainable design and construction methods, waste minimisation measures and, where viable, renewable and sustainable energy sources;

Ensuring a set of minimum environmental requirements are incorporated into office refurbishments;

Continuing investment in energy conservation to reduce carbon emissions from the use of energy in our estate;

Reducing waste, improving recycling rates and decreasing the amount of waste sent to landfill;

Investment to reduce water consumption;

Continuing to raise environmental awareness amongst staff;

Developing a sustainable procurement programme, including reviewing

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procurement arrangements to achieve value for money on a whole life basis;

Rationalising waste contract arrangements across the Trust;

Reviewing and updating the our NHS Good Corporate Citizenship Assessment;

Working with suppliers to minimise waste and identify opportunities for carbon reduction;

Identifying further opportunities for reducing carbon emissions arising from travel and transport, including vehicle emissions from our fleet.

Ken Wenman Chief Executive Officer 20 May 2015

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Directors’ Report

Board of Directors

Role The Board of Directors is responsible for ensuring the Trust provides high quality, safe care delivered within an effective, efficient and economic environment in accordance with its Standing Orders and Financial Instructions. A comprehensive framework ensures the organisation is properly governed, and that membership of the Board of Directors meets statutory requirements and appropriately reflects the direction and culture of the Trust. The Board of Directors undertakes the strategic and operational management of the Trust, and its primary responsibilities are to:

Ensure the quality and safety of all patient services;

Ensure the Trust complies with its terms of authorisation;

Ensure the Trust is compliant with the NHS Foundation Trust Code of Governance;

Ensure the Trust meets its Care Quality Commission registration requirements;

Set the Trust’s strategic direction;

Ensure the Trust operates efficiently, effectively and economically;

Manage the Trust’s performance against objectives;

Ensure high standards of corporate governance and personal conduct;

Engage effectively with the Council of Governors and the membership;

Promote effective dialogue between the Trust and local communities. The Board of Directors provides a high-level of expertise which has been enhanced through development sessions throughout the year so that its members have the range of skills and experience to ensure that it has the right balance and completeness necessary to meet the requirements of the Trust. In 2014/15, the Board of Directors consisted of the Chairman, six Executive Directors and six Non-Executive Directors: Non-Executive Chairman

Mrs Heather Strawbridge Executive Directors

Mr Ken Wenman, Chief Executive;

Mrs Jennie Kingston, Deputy Chief Executive and Executive Director of Finance;

Dr Andy Smith, Executive Medical Director;

Mr Francis Gillen, Executive Director of IM&T;

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Mrs Jennifer Winslade, Executive Director of Nursing and Governance (permanent appointment from 1 June 2014, interim from 9 Dec 2013);

Mrs Judy Saunders, Interim Executive Director of Human Resources and Organisational Development (from 2 December 2013 to 30 April 2014);

Mrs Emma Wood Executive Director of Human Resources and Organisational Development (from 12 May 2014).

Non-Executive Directors

Professor Mary Watkins, Senior Independent Director;

Mr Robert Davies;

Mr Tony Fox;

Mr Hugh Hood;

Mrs Venessa James (appointed – 1 June 2014);

Mr Chris Kinsella. The Board of Directors is not aware of any relevant audit information that has been withheld from the Trust Auditors and takes all the necessary steps to make itself aware of relevant information and to ensure that this is passed to the external auditors as appropriate. The Board of Directors is not aware of any significant differences in any of the market values of its fixed assets as described in the Trust’s financial statements. The Trust Auditors have provided an opinion on the 2014/15 Financial Accounts with independent assurance from the Trust’s Internal Auditors, which appears within this Annual Report on page 237. The Board of Directors has an agreed Membership Strategy and a Policy of Engagement for the Council of Governors which sets out the steps taken to understand the views of Governors and members. These will be under review in 2015/16 in line with our policy framework. The Board of Directors considers the Trust to be fully compliant with the principles, pledges and rights set out in the NHS Constitution. It is also compliant with the Ombudsman principles for complaints handling to demonstrate clear leadership and commitment to listening and responding to patients’ concerns. The Trust is fully compliant with ‘declaration of interest’ and ‘salary disclosure’ principles. Performance evaluation of the Board of Directors is carried out in line with best practice guidance and appraisals of Non-Executive and Executive Directors are conducted by the Chairman and the Chief Executive respectively. The Board of Directors is responsible for providing strategic direction, leadership and being the final arbiter of organisational decision making. It reviews assurance on performance against the Annual Plan; considers medium and long term plans drafted by Directors’ Group; leads on the monitoring of the risk environment of the Trust; and seeks assurance that actions identified to address variance from plan are achieved. These responsibilities are set out in the Board terms of reference. The processes to be followed by the Board of Directors are clearly set out in the Standing Orders for the Practice and Procedure of the Board of Directors within the Trust Constitution.

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The Board of Directors delegates the discussion and development of key strategic and operational short and long term business, including review of items for future presentation to the Board or one of its committees, to the Directors’ Group. The Group will:

Review performance against the annual plan;

Develop medium and long term plans for consideration by the Board of Directors;

Monitor the risk environment of the Trust and advising the Board of changes;

Agree actions to address variance from plan.

The Council of Governors holds the Non-Executive Directors individually and collectively, to account for the performance of the Board and ensuring the views of members and the public are represented. The statutory duties of the Council of Governors are set out in guidance released in August 2013 called ‘Your Statutory Duties’, a reference guide for NHS Foundation Trust governors. This guidance has been adopted in the Standing Orders for the Practice and Procedure of the Council of Governors within the Trust Constitution. The Board, its committees and the Directors’ group complete an annual self-assessment to identify areas that have worked well and those that can be improved. These are then acted upon to ensure that the committees are as effective as possible. In addition, a wide range of input is sought from external sources and incorporated into the meetings. The Non-Executive Directors meet as a group, as do the Executive Directors, this is done before Board meetings, prior to away days and the Executive Directors also meet weekly. The Chief Executive reviews the performance of each individual Executive Director at regular one-to-one meetings, and the Chairman meets regularly with the Non-Executive Directors, both individually and as a group. The Trust complies with the requirements of the NHS Foundation Trust Code of Governance and has in place a comprehensive framework to ensure the Trust is properly managed and governed. The Board of Directors are satisfied with the balance, completeness and appropriateness of the membership of the Board.

Board of Directors biographies

Chairman, Mrs Heather Strawbridge

Heather has a wealth of experience and extensive understanding of large and complex organisations, particularly in the public sector. She has led organisations through significant change and brought together many successful partnerships. Heather was Chairman of the Board during the merger of Westcountry Ambulance Service and Dorset Ambulance Service in 2006, to form South Western Ambulance Service NHS Trust.

During her time as Chairman, the organisation became one of the first ambulance trusts to achieve Foundation Trust status and in 2013 she led the Board through the

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acquisition of the former Great Western Ambulance Service NHS Trust. Heather has been involved in many regional and national organisations.

Current Roles include:

Chairman of South Western Ambulance Service NHS Foundation Trust (2006 to date);

Chairman of the Urgent and Emergency Care Steering Group, NHS Confederation;

Trustee of NHS Confederation;

Chair, NED, Lay Person, Faculty Chair, HFMA.

Previous Roles include:

Chairman of Westcountry Ambulance Service NHS Trust (2004 to 2006);

Chairman of the Ambulance Service Network (2010 to March 2013);

Chairman of Connexions Somerset Limited (2002 to 2010);

Deputy Leader of a County Council;

Finance and development portfolio holder of a County Council;

Leader of a District Council.

Heather’s experience and working knowledge has been strengthened through her

involvement as a governor of Bridgwater College of Further Education, her time as a

Director of Business Link Somerset Ltd and the National Association of Connexions

Partnerships Ltd. She is also a Non-Executive Director for Somerset Care Ltd (a

care and training company) and works with many charitable and voluntary

organisations. Heather is Board champion for equality and diversity and

safeguarding.

Chief Executive, Mr Ken Wenman

Ken joined the NHS at the age of 21 and has undertaken many senior roles within

the ambulance service including operational management and training. Prior to his

appointment to the Trust on 1 July 2006 his accomplishments include:

Chief Executive of the Dorset Ambulance Service NHS Trust;

Deputy Chief Executive and Director of Operations for the former Westcountry Ambulance Services NHS Trust;

State Registered Paramedic;

First Chairman of the Council for Professions Supplementary to Medicine (the forerunner to the Health Professions Council);

Instrumental in establishing the paramedic register.

Ken leads the ambulance sector nationally on HR & Workforce and Operations for

the national ambulance groups and is a member of the Board of the Association of

Ambulances Chief Executives (AACE). Ken has a Masters in Management

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(Plymouth University) and is also the nominated individual for the Care Quality

Commission.

Non-Executive Directors

Mr Robert Davies

Robert is a Fellow of the Institute of Chartered Accountants (FCA) and holds a

Masters Degree in Business Administration (MBA) from Cranfield University. He has

held a variety of senior positions in the business and banking sectors and was

appointed as a Non-Executive Director of the Trust on 1 November 2009. His past

experience includes the following roles:

Management Consultant with Arthur Andersen & Co;

Manager of Corporate Finance at British Leyland, where he also represented the Company on the Boards of its Trade Investments;

Finance Director of two regional banks, one of which he helped bring to a full Stock Exchange listing;

Director of Finance and Corporate Services at Devon and Cornwall Training & Enterprise Council (DCTEC) from its inception, where he helped progress some important local economic initiatives, including the National Marine Aquarium, the Eden Project and the Tamar Science Park, of which he was a Non-Executive Director;

Past President of the South Western Society of Chartered Accountants and a member of the Institute of Chartered Accountants in England and Wales (ICAEW) Support Members Group providing confidential help and advice to Institute members facing difficulties.

Mr Tony Fox

Tony was appointed to the Board of Directors of South Western Ambulance Service NHS Foundation Trust (SWASFT) in February 2013.

Tony has over 30 years senior leader experience of managing large and complex operations and has held numerous senior positions within Royal Mail. Tony is a member of the Royal Mail Letters Executive team and reports to the Chief Operating Officer of Royal Mail. In November 2014 Tony joined the board for ‘Opportunity Now’, part of Business in the Community supporting the many challenges and opportunities for increasing awareness of diversity and in particular gender issues within UK businesses. His experience includes the following roles:

Operations Director running a daily operation leading over 45,000 colleagues whilst transforming the business through one of the largest modernisation programmes in the UK;

Group Logistics Director, where he was accountable and gained valuable experience of supply chain management, procurement, facilities

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management, national distribution network and fleet responsible for over 40,000 vehicles;

Leading strategic customer relationships with large clients;

Negotiations with national trade unions on a variety of issues;

Non-Executive Director of Great Western Ambulance Service;

Non-Executive Director of SWASFT;

Board member for Opportunity Now (BITC). Tony brings to the board a wealth of operational and strategic commercial experience with a track record of motivating and managing transformational change programmes and employee relations in highly unionised environments.

Mr Hugh Hood

Hugh was appointed to the Board of Directors of SWASFT in January 2010.

Hugh is a qualified Human Resources practitioner who has extensive business experience in both the public and private sectors where he has been instrumental in defining and delivering substantial change programmes. His key appointments include:

Director of Leadership for BT Plc (responsible for culture and approach, training, talent pipeline and succession);

Human Resources Director for BT Wholesale;

Group Human Resources Director for Transport for London and Director of the Pension Trustee Company;

Head of Human Resource Service Operations Barclays Bank PLC;

Programme Manager Avionics training design Royal Air Force.

Currently Hugh is a BT Group Director and is part of BT's Human Resources leadership team with key input on BT’s strategy for the future. He is also the Chairman of the Board of BT Lancashire Services Ltd. He holds an MSc in Digital Systems Engineering and BSc in Physics from the University of Manchester, and a Graduate Certificate in Organisation Development from the University of Sussex.

Professor Mary Watkins Mary was appointed to the Board of Directors at SWASFT in August 2006.

Mary has worked extensively in senior healthcare posts in both University and NHS settings. Her particular expertise is in the field of mental health and she has a wealth of experience working in partnership with social services and the voluntary sector.

Her accomplishments and appointments include:

Emeritus Professor (Health Care Leadership) at Plymouth University;

Deputy Vice-Chancellor at Plymouth University;

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Serving on a NICE Appraisal Committee as a Trustee for the Burdett Trust for Nursing;

Being a BUPA Foundation Board member (current);

Being a Registered Nurse.

Mary is Board champion for governance and patient safety, and has a keen interest in health economics. She has a Diploma in nursing, a General and Mental Health Diploma in nursing, Masters in Nursing (distinction), holds a Doctor of Philosophy (Science), King’s College London, and is a graduate of the Civil Service Top Management Programme.

Mr Christopher Kinsella

Chris was appointed to the Board of Directors of South Western Ambulance Service NHS Foundation Trust in October 2013.

Chris is a widely experienced and successful Finance Director and Chief Financial Officer from the private sector in businesses of significant scale and international reach. An experienced general manager and chief executive, with significant board service in executive and non-executive roles for a variety of complex organisations. He is a Chartered Management Accountant and his accomplishments and appointments include:

Leading the management buyout and serving as Group Finance Director and Chief Financial Officer of TI Automotive for eleven years, a complex manufacturing group with 22,000 people in 28 countries;

Chief Financial Officer - The British Council;

Serving as Group Finance Director for Dyson Group plc;

Audit Chair and Non-Executive Director, Dyson Group plc;

Divisional Finance Director for Meggitt plc, Invensys plc, and General Electric (USA);

Chief Executive of the Chartered Management Institute;

Trustee and Non-Executive Director, Chartered Management Institute;

Member of the Board of Governors, Sheffield Hallam University;

Member of the Industrial Development Advisory Board (Dept BIS).

Chris holds a business degree at Bachelor and Masters levels, Fellow membership of the Chartered Institute of Management Accountants, he is a Companion of the Chartered Management Institute, a Chartered Manager and an Honorary Teaching Fellow of Lancaster University.

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Mrs Venessa James

Venessa was appointed to the Board of Directors of South Western Ambulance

Service NHS Foundation Trust in June 2014

Venessa has a vocational background in general nursing, social work and teaching.

An experienced senior manager, she has held executive, board-level appointments

in the private education sector and the NHS. Her specific areas of expertise include

corporate governance and commissioning services for people with complex care

needs, from which she brings a wealth of experience in partnership, collaborative

and contractual working arrangements with NHS organisations, social services and

the independent care sector. Her experience includes:

Director of Communications & Corporate Affairs for NHS Devon; Programme Director of NHS Continuing Healthcare for NHS Devon; Head of Performance & Corporate Affairs for Mid Devon Primary Care Trust; Strategy Coordinator for North & East Devon Health Authority; Managing Director of International House Sabadell, Barcelona.

Venessa is board champion for social care and the Duty of Candour, and she has a

keen interest in applied health psychology research. She holds qualifications in

business management and teaching, including the Masters-equivalent DTEFLA, and

is currently studying for a Masters in Advanced Psychology at Plymouth University.

Executive Directors

Mrs Jennie Kingston, Deputy Chief Executive / Executive Director of Finance

Jennie joined the NHS in 1990 as a graduate finance trainee and qualified as a Chartered Certified Accountant in 1993. Prior to her appointment to the Trust in November 2008, her accomplishments, appointments and experience includes:

Attaining a BSC Hons (University of Birmingham);

Fellow of the Association of Chartered Certified Accountants;

Director of Finance of a Primary Care Trust;

Associate Director of Performance at a Strategic Health Authority;

Serving an eight year short service commission in the Royal Air Force;

Completing the Cass Business School, London, Strategic Financial Leadership Course 2008.

Jennie is also Chair of the National Ambulance Directors of Finance Group and a member of the Board of the Association of Ambulances Chief Executives (AACE).

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Mrs Jennifer Winslade, Executive Director of Nursing and Governance Jenny was appointed as the Executive Director of Nursing and Governance in June 2014. She has 25 years’ experience as a nurse and has worked within acute and primary and community care settings, spending the last six years at director level in NHS Commissioning. She qualified as a nurse in 1991, initially working in acute and intensive care services within the UK before leaving to spend two years living and working in the USA. She then returned to the UK and trained as a district nurse and health visitor and specialised in public health and children’s services in the community. Jenny most recently held the role of Chief Nursing Officer for NEW Devon CCG, the largest CCG in the country leading patient safety and quality with a special interest in commissioning services for vulnerable groups and the role of non-medical professionals within commissioning.

Jenny’s specialist areas of interest include primary and community urgent care, safeguarding and patient experience. She has also worked at a national level for the Department of Health, focusing on nursing and public health.

Mrs Emma Wood, Executive Director of HR and Organisational Development Emma has 19 years of experience working in human resources. Her specialisms include employee relations and engagement, organisational design and development, resourcing and talent development.

Her career started in the private sector with an IT software development company and she fulfilled managerial roles in the technology and food sector until she joined the Grafton Group, an international recruitment group, in 2002, as HR Account Manager and was later appointed Director of HR and MD for the recruitment outsourced and consultancy brand Grafton ESP (employment solutions portfolio). Grafton ESP’s client base featured organisations such as Police Service of Northern Ireland, Cisco and Microsoft and spanned 72 offices in 18 countries.

In 2009 Emma used her insights into policing to move to Avon and Somerset Constabulary as Strategic Director of Human Resources. Emma led many regional collaborations joining neighbouring forces together to improve interoperability and national projects, particularly in the specialism of resourcing.

Emma holds a BA in Psychology and Education and is finishing her MSc. She is a Chartered Fellow of the Chartered Institute of Personnel and Development.

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Dr Andy Smith, Executive Medical Director

Andy has been a GP in Devon since 1997 and has been actively involved in medical management. His interests have always included urgent and emergency care. He helped establish the ‘out of hours’ GP service in his area and was the Associate Director of Primary Care Services for the Trust (since April 2008).

He is also a member of the Royal College of General Practitioners, and responds to 999 calls as an ambulance doctor. Andy was appointed to the role of Executive Medical Director on 1 February 2010 and is joint Board Champion for Clinical Quality, as well as being the Trust’s Caldicott Guardian. He has a Bachelor of Science Honours in Microbiology (University of Bristol), a Bachelor of Medicine & Surgery MB Ch.B (University of Bristol), a Post Graduate Diploma of the Royal College of Obstetricians and Gynaecologists and a Diploma in Child Health.

Mr Francis Gillen, Executive Director of Information Management & Technology (IM&T)

Francis has been an IT professional for twenty five years with expertise gained from working in private, public and emergency services. He joined the ambulance service as Head of ICT for Westcountry Ambulance Service NHS Trust in 2005 and his accomplishments and experience includes:

Messaging Consultant for Digital Equipment (now HP) responsible for the design

and provision of national network and messaging solutions to private and public sector organisations;

Messaging Manager for Emirates Airline responsible for the development, implementation and support of airline, airport and international network and inter-airline services;

Client Services Manager for Devon and Cornwall Police overseeing the outsourced ICT delivery to the police;

Product Support Engineer for Racal in the areas of data communications technologies.

Francis is a qualified electrical engineer, has an ITIL Managers Certificate, is a

Prince II Practitioner and has an MBA (Edinburgh Business School). Previously an

Associate Director of the Trust for 4 Years, he was appointed to the role of Executive

Director in March 2013.

Mrs Judy Saunders, Interim Executive Director of HR & Workforce Development Judy has 25 years of experience working in the NHS in the field of human resources and organisational development. She has worked in all parts of the NHS system including acute, mental health, learning disabilities, strategic health authorities and ambulance services.

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Judy was recruited to this position as the Trust proceeded with the recruitment of a substantive Human Resources Director. Her accomplishments include:

Director of HR & OD at Winchester Hospital NHS Trust (acute);

Director of HR & OD Dorset Healthcare NHS Foundation Trust (mental health and learning disability);

Director of HR & OD Great Western Ambulance Service NHS Trust; Judy has a Master’s Degree in Human Resources from the University of Winchester and her dissertation was on ethical leadership. She is also a fellow of the CIPD (Chartered Institute of Personal Development). Pension and other retirement benefits Details about pension costs and other retirement benefits are set out on page 127 of the Remuneration report and pages 254 and 274 within the Notes to Accounts. Sickness and absence data Information pertaining to sickness and absence data can be found on page 68 of the Strategic Report. Cost allocation and charges for information

South Western Ambulance Service NHS Foundation Trust has complied with HM Treasury’s guidance on setting charges for information. Better payment practice code Details of compliance with the code are given in the Operational and Financial Review on page 119 and within the Annual Accounts on page 282. Prompt payment code South Western Ambulance Service NHS Foundation Trust is signed up to the Prompt payment code. Principles for remedy Further details about the ‘principles for remedy’ can be found in the ‘ombudsman principles’ section of the Strategic Report. This can be found on page 57. Off-payroll engagements There are no Executive off-payroll engagements (as noted on page 128 of the remuneration report). There are a total of 24 other off-payroll engagements as presented in the notes to the accounts on page 273.

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Health, Safety and Security

The Health, Safety and Security team has six bases across our operational area to assist the various departments and stations with their health and safety responsibilities.

During the past year we continued to support staff and ensure that the Trust is compliant with health and safety legislation.

The health, safety and security agenda has been taken forward through an action plan, and key performance indicators are reported to the Board of Directors, Quality and Governance Committee and Health and Safety Group. We have completed our second NHS Protect Self-Assessment Tool looking at security issues within the Trust.

During 2014/15, the department has continued to maintain significant achievements including:

Providing the Specsavers Eye Sight Voucher scheme for staff;

Providing first aider and fire warden training to staff in key locations;

Identification and development of new health and safety policies, as well as a review of existing ones;

Developing and issuing online assessments accessible via the intranet about the control of substances hazardous to health (COSHH) for staff to access;

Completion of 68 fire risk assessments, 81 health and safety inspections and 65 security inspections;

On-going implementation and review of existing warning markers on patient addresses;

A total of 154 letters were sent to patients following an incident where they had directed either violence or aggression towards ambulance crews who had attended in order to help them;

Development of guidance notes and posters for staff on a variety of subjects.

During the 2014/15 financial year, the health, safety and security department received:

1,607 datix5 reports including 816 injury accidents (77 patient and 739 staff);

727 abuse incidents including 115 staff subjected to a physical assault and 64 security incidents.

During 2014/15, 854 datix reports were received detailing staff who had been subjected to an injury or physical assault. This compares to 956 datix reports received during 2013/14 and represents a 11% decrease in reported incidents during 2014/15.

5 Refer to page 228 for more information about the Datix system.

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Under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995, the health, safety and security department reported 141 over-seven-day injuries to the Health and Safety Executive during 2014/15 compared to 134 during 2013/14.

Staff consultation and engagement The action taken to maintain or develop the provision of information to, and consultation with, employees can be found on page 59 within the Strategic Report Disabled Employees

As of 27 March 2015, SWASFT employed 122 staff who have declared a disability. Staff with a disability are covered by our approach to equality and diversity as set out above. Recruitment processes bear the two-tick symbol, which guarantees an interview to candidates who declare a disability and meet the essential criteria. When employees develop a disability whilst in employment, the Trust will seek alternative roles or duties where applicable to meet their needs and comply with occupational health advice and guidance.

Register of Interests

The Board of Directors has approved and signed up to a Code of Conduct which sets out a requirement for all Board members to declare any interests which may compromise their role. In May 2015 the Register of Interests was updated and each Non-Executive Director and the Chairman also reconfirmed their declaration of independence against the criteria set out in Monitor’s NHS Foundation Code of Governance. The Register of Directors’ Interests is published on the Trust website, www.swast.nhs.uk, or may be obtained by application to the Trust’s Secretary, Trust Headquarters, Abbey Court, Eagle Way, Exeter, Devon, EX2 7HY or 01392 261500. Board Meetings

The Board of Directors holds a series of public meetings and private seminars throughout the year, with additional strategy away days to support strategic planning and development. Advance notice of all public meetings is published on the Trust website (including the Annual General Meeting held each September) to actively encourage members of the public to attend.

All Board committees complete a self-assessment against their terms of reference on an annual basis. All improvements to working practices are included in the annual revision of each committee’s terms of reference.

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The following table sets out the attendance of the Board of Directors at Trust Board of Directors meetings from 1 April 2014 to 31 March 2015.

Name Position Attendance:

Actual/possible

Mrs Heather Strawbridge Trust Chairman 12/13

Professor Mary Watkins Non-Executive Director 12/13

Mr Hugh Hood Non-Executive Director 11/13

Mr Robert Davies Non-Executive Director 12/13

Mr Tony Fox Non-Executive Director 12/13

Mr Chris Kinsella Non-Executive Director 8/13

Mrs Venessa James Non-Executive Director 7/8

Mr Ken Wenman Chief Executive 13/13

Mrs Jennie Kingston Deputy Chief Executive and

Executive Director of Finance 12/13

Mrs Jennifer Winslade Executive Director of Nursing

& Governance 12/13

Mrs Emma Wood Executive Director of HR & OD 12/12

Mrs Judy Saunders Interim Executive Director of

HR & Workforce 1/1

Dr Andy Smith Executive Medical Director 9/13

Mr Francis Gillen Executive Director of IM&T 11/13

Board Committees

The Board has five committees, of which two – the Audit Committee and the Remuneration Committee – are statutory requirements. The following section identifies each committee, its membership and its responsibilities.

Audit Committee

The Audit Committee is a statutory committee of the Board whose Terms of Reference are aligned with those of the NHS Audit Committee Handbook. It comprises four Non-Executive Directors other than the Trust Chairman and is chaired by an experienced Chartered Accountant. Certain officers are regular attendees, including the Deputy Chief Executive/Executive Director of Finance and the Trust Secretary, as are representatives of Internal Audit and the Local Counter Fraud Team and the External Auditors; other board members, including the Chairman and the Chief Executive, and senior managers, attend as appropriate.

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Minutes of the Committee’s meetings are provided to the Board.

The Audit Committee’s responsibilities are to:

Review and seek assurance on the effectiveness of processes in place for the management of arrangements for Governance, Risk Management, Clinical Assurance, Internal Control, and Financial Reporting;

Ensure the Trust and its auditor remain compliant with Monitor's Audit Code for NHS Foundation Trusts and conditions of license;

Conclude upon the adequacy and effective operation of the trust's overall internal control system, predominantly focusing on the framework of risks, controls and related assurances underpinning the delivery of the trust's objectives;

Have a pivotal role in reviewing the trust's assurance processes.

In seeking to discharge its responsibilities, the Committee reviews and takes into account the Board Assurance Framework, the Trust’s Risk Registers and the work of other Board Committees, including the Quality & Governance Committee and the Finance & Investment Committee, as well as the findings of Internal Audit and the Counter Fraud Specialist, the External Auditors and feedback received from external bodies such as Monitor, CQC, and Commissioners and from users of the Trust’s services.

The Audit Committee met formally on five occasions during 2014/15 financial year. The following table shows members’ attendance at these meetings.


Actual/possible

Mr Robert Davies Chairman* of Committee and

Non-Executive Director 3/3

Mr Chris Kinsella Chairman** of Committee and Non-Executive Director

5/5



Mrs Venessa James Non-Executive Director 2/2 **Chris became Chair in September 2014

During the year the committee considered a number of matters relating to the Annual

Accounts for the year 31 March 2015; the significant issues included the following:

Workforce integration

The Audit Committee agreed that the provision for the outstanding workforce integration issue was based on the management best estimate and legal advice

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received in year. The Committee were assured that the provision was agreed to be rolled over from 2013/14 by the Trust Board at its Seminar in October 2014, following extensive discussion and external advice and this position has not changed. Impairment

The Audit Committee noted in month 12 of 2014/15 SWASFT, the impairment of the St Leonards Hub. The current St Leonards hub site is a shared facility between A&E, 111 and Somerset and Dorset Out of Hours. The main cause of the impairment are the loss of 111 and Out of Hours contracts. Accruals The Audit Committee has recognised that due to the introduction of the Red One Performance Recovery plan during March 2015, the overtime accrual will be estimated on the previous month, coupled with intelligence from the global rostering system. The Committee were assured by the rationale. ECS funding and winter pressures funding SWASFT received unplanned income relating to the Electronic Care System project and Winter Pressures. This income was matched by expenditure relating to these items that was included in the Trust operating expenses. Internal Audit Internal Audit services are outsourced to Audit South West, a consortium within the NHS that is the principal provider of Internal Audit and Counter Fraud services to NHS bodies in the region. Each year, a risk based plan is agreed that is reviewed and updated mid–year to ensure its continuing relevance. For 2014/15, a programme involving 292 planned days of internal audit activity (with 293 delivered) and a further 128 days of Counter Fraud work was agreed. Audit South West attend every committee meeting, report on progress and discuss the outcome of work undertaken. Copies of the Executive Summaries of each Internal Audit Report, including all key findings and recommendations, are circulated to committee members. External Audit PricewaterhouseCoopers (PwC) were appointed Auditors of the Trust in 2012/13 and this is the third audit they have undertaken. PwC attend every committee meeting to report on progress and developments likely to affect the year-end audit and accounts. They have also provided some relevant training and advice to the Committee and the Finance Team during the year. One non-audit related service has been commissioned from them in 2014/15. This was for a commercial and charitable income review commissioned by the Board. The audit fee was £15,000.

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Council of Governors (CoG) Under the terms of the Trust’s Constitution, the Audit Committee is required to review the Auditor’s performance on an annual basis and make a recommendation to CoG regarding their re-appointment. In 2014/15 the appointment of PwC as our external auditors was compliant with Monitor guidance and the Trust Constitution. CoG has an Audit sub-group, whose Chair has attended Board of Directors meetings regularly and liaises closely with the Chairman of the Audit Committee. He is invited to the Audit Committee meeting at which the annual audit and accounts are considered. PwC meet with this sub-group on an annual basis.

Charitable Funds

The role of the Charitable Funds committee is to oversee the proper collection, accounting and distribution of the Trust's charitable funds, ensuring they are managed in accordance with the requirements of the Charity Commission.

Remuneration Committee The Remuneration Committee is responsible for determining the salaries, benefits and contracted terms of employment for Executive Directors. Details of the committee’s membership and work in 2014/15 form part of the Remuneration Report on page 122. Other Board committees Membership of the other Board committees is made up from Executive and Non-Executive Directors, frontline operational and support staff and union representatives. Committee meetings are aligned to the board cycle of business throughout the year and their outline Terms of Reference are set out below. Minutes are recorded for each meeting and presented regularly to the Board of Directors.

The following sets out a high-level description of each of the additional Board committees:

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Quality and Governance Committee

The membership of the Quality and Governance committee is Executive and Non-Executive Directors. They are supported by key officers and meetings are attended by Commissioners and Union representatives. The Quality and Governance Committee’s responsibilities are to:

Develop and implement effective quality and governance assurance systems and processes;

Ensure the establishment and maintenance of effective corporate and quality governance, risk management and quality assurance systems, and key patient safety and quality indicators;

Seek assurance from periodic deep dives into functional areas and a focus on receiving reports which include positive highlights but also identify trends and improvement plans and how these will be completed, reviewed and reported;

Support an organisational structure and philosophy promoting a positive and responsible culture and nurturing continuous quality improvement in the delivery of patient care and patient experience.

The following table sets out the attendance of the Quality and Governance Committee members at meetings from 1 April 2014 to 31 March 2015.


Actual/possible

Professor Mary Watkins Committee Chair and Non-

Executive Director 5/6





Mrs Jennifer Winslade Executive Director of Nursing

& Governance 5/6

Mrs Emma Wood Executive Director of HR &

OD 5/6

Dr Andy Smith Executive Medical Director 4/6

Finance and Investment Committee Membership comprises the Chief Executive, Deputy Chief Executive and Executive Director of Finance, three Non-Executive Directors including the Trust Chairman, and at least one other Director. The Finance and Investment Committee’s responsibilities are to:

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Scrutinise and provide assurance to the Board of Directors on financial planning, financial reporting, cost improvements and investments;

Provide assurance to the Audit Committee regarding the consistency of reporting to support the Annual Accounts and Annual report disclosure statements;

Conduct an independent and objective review of activities relating to financial planning, cost improvements, investments, disinvestments, financial performance and provide assurance to the Board of Directors;

Review monthly financial accounts and investigate and report on material variances against budget and forecast;

Review significant tenders and pricing information: - tenders where the Trust is provider - tenders where the Trust is procuring goods and services;

Operate under its scheme of delegation and consider partnership arrangements for tenders as appropriate;

review the Trust business plan and annual plan. The following table sets out the attendance of the Finance and Investment Committee members at meetings from 1 April 2014 to 31 March 2015.


Actual/possible

Mr Hugh Hood Committee Chairman & Non-Executive Director

5/5

Mrs Heather Strawbridge

Trust Chairman 3/5

Professor Mary Watkins

Non-Executive Director 4/5




Mrs Jennie Kingston Deputy Chief Executive

and Executive Director of Finance

5/5

Mr Francis Gillen Executive Director of IM&T 4/5

Trust & Charitable Funds Committee

Membership comprises the Chief Executive (Committee Chairman), and at least two Executive and/or Non- executive Directors, to include the Deputy Chief Executive and Executive Director of Finance, and the Trust Chairman.

Responsibilities include:

Reporting on the receipt and distribution of all charitable funds;

Undertaking the management of the Trust & Charitable Funds

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Overseeing the proper collection, accounting and distribution of Trust charitable funds, ensuring these are managed in accordance with the requirements of the Charities Commission

Administration of all existing charitable funds;

Identifying any new charity that may be created (of which the Trust is a trustee) and dealing with any legal steps that may be required to formalise the trusts of any such charity;

Providing guidelines in respect of donations, legacies and bequests, fundraising and trading income;

Responsibility for management of investment of funds held on trust, where they exist;

Ensuring appropriate banking services are available to the Trust Preparing reports to the Board of Directors, including the annual account;

Ensuring that, under the powers of delegation, the appropriate procedures for dispensation shall include an Executive Director and not a member of the Committee.

The following table sets out the attendance of the Trust and Charitable Funds Committee members at meetings from 1 April 2014 to 31 March 2015.


Actual/possible

Mrs Heather Strawbridge

Trust Chairman 1/2


Mrs Jennie Kingston Deputy Chief Executive

and Executive Director of Finance and Performance

2/2

Emergency Preparedness, Resilience and Response (EPRR)

The Emergency Preparedness Resilience and Response (EPRR) Department has focussed core activities into four areas in order to achieve compliance with the legislative requirements of the Civil Contingencies Act (2004) and the Health and Social Care Act (2012).

Special Operations

The Trust’s Hazardous Area Response Teams (HART) at Exeter (HART South) and Bristol (HART North) provide a specialist capability which delivers paramedic medical care to patients in difficult locations or situations. Over the past 12 months these emergencies have included assisting with the rescue and treatment of climbers, providing medical support to police firearms teams and fire and rescue specialist units, as well as responding to significant incidents such as major fires, road traffic collisions and floods.

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The team has led the enhancement of our response to terrorist attacks, providing training to a large number of operational paramedics and officers in areas such as ballistic threats and Chemical, Biological, Radiological, Nuclear (CBRN) (explosive) environments.

In February, Her Royal Highness the Princess Royal officially opened the new Ambulance Special Operations Centre (ASOC) near Exeter, providing a permanent bespoke facility for the EPRR team and HART South.

Emergency Preparedness

SWASFT’s Resilience Officers provide expert support to Trust commanders and staff as well as engaging in multi-agency civil protection. Over the past year, this activity has focussed on challenges as diverse as flooding and Ebola. The team has been central to the development of commander training and the introduction of the Joint Emergency Services Interoperability Programme (JESIP), which is a two year project that has been established to address the recommendations and findings from a number of major incident reports, in order to improve the ways in which police, fire and ambulance services work together at major and complex incidents.

Operational Resilience and Capacity Planning (ORCP)

The introduction of ORCP during the reporting period has enabled the expansion of Trust’s capacity to manage the increased surge in demand for pre-hospital healthcare. The coordination of a number of central and local schemes has made a significant operational contribution to patient care. ORCP schemes have included the provision of GPs and mental health nurses in the clinical hubs, as well as Advanced Practitioners and GPs responding in 999 response cars to support admission avoidance schemes.

Event Management

The Trust has increased its capacity to engage with major public events. This has been beneficial in a number of areas:

Income generation – providing a direct income that can be reinvested into patient care;

Reputation and public engagement – providing a positive message to members of the public;

Improved patient care at events – often enabling patients to be treated and discharged at the scene;

Reduced hospital attendances – through direct intervention with high quality patient care.

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Freedom of Information Act and Data Protect Act (Subject Access Requests)

We received a total of 2,331 external requests during the 2014/15 period. Of these 219 were requests for corporate information made under the Freedom of Information Act and 2,012 were requests for personal or patient data under the Data Protection Act.

Freedom of Information requests were down by 47 requests (17.7%) compared with the previous year. Of those requiring a response 97.2% were responded to within the statutory 20 working day deadline.

Data Protection requests were up by 107 requests (5.6%) compared with the previous year. Of those requiring a response 99.2% were responded to within the statutory 40 day deadline.

Incidents involving Data Loss or Breach

The Trust is required to monitor and report information risks and data losses in a standard format specified by the regulator.

Summary of Personal Data Related Incidents in 2014/15

Category Breach Type Total

A Corruption or inability to recover electronic data 0

B Disclosed in Error 30

C Lost in Transit 3

D Lost or Stolen hardware 0

E* Lost or Stolen Paperwork 155

F Non-Secure Disposal 0

G Non-Secure Disposal Paperwork 2

H Uploaded to website in error 0

I Technical Security Failing (including hacking) 2

J Unauthorised Access/Disclosure 1

K Other 26 *Please note this usually relates to paperwork which can’t be sourced, but is not confirmed lost or stolen.

During 2014/15 there were no serious incidents attracting a severity rating of 2 or more which required reporting at the national level.

The data breach identified in the 2013/14 annual report resulted in an undertaking being signed by the Trust in August 2014. In a follow-up report in February 2015 the regulator identified that the Trust had appropriately addressed the actions agreed in the undertaking.

Information Governance Training

Completing information governance (IG) training has always been a challenging area with a largely mobile workforce. Historically the Trust has used e-learning through the Health and Social Care Information Centre (HSCIC) to complete mandatory IG training on an annual basis.

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This year the IG Team hope to develop an in-house e-learning package incorporating material and examples more relevant to the ambulance service, this with a view to implementation in 2016/17. In addition the department is utilising other Trust wide projects such as the introduction of the electronic patient record to augment IG training.

Council of Governors

Structure and role As an NHS Foundation Trust, we have a Council of Governors. The Council forms a vital link between its members, staff, stakeholders and wider public, ensuring that their interests are represented. The Council of Governors hold the Non-Executive Directors, individually and collectively, to account for the performance of the board of directors.

Statutory roles and responsibilities of the Council of Governors

Appoint and, if appropriate, remove the other Non-Executive Directors;

Decide the remuneration and allowances and other terms and conditions of office of the chair and the other Non-Executive Directors;

Approve (or not) any new appointment of a chief executive;

Appoint and, if appropriate, remove the NHS Foundation Trust’s auditor; and Receive the NHS Foundation Trust’s annual accounts, any report of the auditor on them, and the annual report at a general meeting of the Council of Governors;

Hold the Non-Executive Directors, individually and collectively, to account for the performance of the board of directors;

Represent the interests of the members of the Trust as a whole and the interests of the public;

Approve ‘significant transactions’;

Approve any application by the Trust to enter into a merger, acquisition, separation or dissolution;

Decide whether the Trust’s non-NHS work would significantly interfere with its principal purpose, which is to provide goods and services for the health service in England, or performing its other services;

Approve amendments to the Trust’s constitution.

Additional Powers In preparing the NHS Foundation Trust’s forward plan, the Board of Directors must have regard to the views of the Council of Governors. The Council of Governors has a forward planning sub-group which receives regular presentations throughout the year on the Trust’s objectives, priorities and strategic aims. This is also the forum through which views of the governors and members are fed back to the Board of Directors. The Council of Governors, in turn, has a duty to canvass the views of

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members and the public on the Trust’s future plans. The Governor’s plan their own engagement activities to engage with the public as well as attend SWAST organised events. The Council of Governors may require one or more of the directors to attend a governors’ meeting to obtain information about performance of the Trust’s functions or the directors’ performance of their duties, and to help the Council of Governors to decide whether to propose a vote on the trust’s or directors’ performance.

Public, staff and appointed Governors

For the period 1 April 2014 to 31 March 2015, the Council was reduced made up of 34 governors, with 19 being elected by public members, six by the staff members, one local authority appointed governor and the remaining eight being appointed by partner organisations.

Constituency

Area

Minimum Number of members

Number of Governors

Bristol and Bath & North East Somerset

The electoral ward areas comprising the areas covered by Bristol City Council and Bath and North East Somerset Council, and, for the avoidance of doubt, any successor authority of Bristol City Council or Bath and North East Somerset Council.

320 2

Cornwall The electoral ward areas comprising the area covered by Cornwall Council and, for the avoidance of doubt, any successor authority of Cornwall Council.

272 2

Devon The electoral ward areas

comprising the area

covered by Devon County

Council, East Devon

District Council, Exeter

City Council, Mid Devon

District Council, North

Devon District Council,

South Hams District

Council, Teignbridge

District Council, Torridge

District Council, West

Devon Borough Council,

Plymouth City Council

580 4

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and Torbay Council and,

for the avoidance of

doubt, any successor

authority of Devon County

Council, East Devon

District Council, Exeter

City Council, Mid Devon

District Council, North

Devon District Council,

South Hams District

Council, Teignbridge

District Council, Torridge

District Council, West

Devon Borough Council,

Plymouth City Council

and Torbay Council.

Dorset The electoral ward areas

comprising the area

covered by Christchurch

Borough Council, Dorset

County Council, East

Dorset District Council,

North Dorset District

Council, Purbeck District

Council, West Dorset

District Council,

Weymouth and Portland

Borough Council,

Borough of Poole Council

and

Bournemouth Borough Council and, for the avoidance of doubt, any successor authority of Christchurch Borough Council, Dorset County Council, East Dorset District Council, North Dorset District Council, Purbeck District Council, West Dorset District Council, Weymouth and Portland Borough Council, Borough of Poole Council and Bournemouth Borough Council.

360 2

Gloucestershire and

South

Gloucestershire

The electoral ward areas comprising the areas covered by Gloucestershire County Council and South Gloucestershire Council and, for the avoidance of

436

3

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doubt, any successor authority of Gloucestershire County Council of South Gloucestershire Council.

Isles of Scilly

The electoral areas comprising the areas covered by the parishes of the Council of the Isles of Scilly:

St Mary's;

Bryher;

St Martin's;

St Agnes; and

Tresco, And, for the avoidance of

doubt, any successor

parishes or any successor

authority of the Council of

the Isles of Scilly.

25 1

Somerset and North Somerset

The electoral ward areas comprising the areas covered by Mendip District Council, Sedgemoor District Council, Somerset County Council, South Somerset District Council, Taunton Deane Borough Council, West Somerset District Council and North Somerset Council, and, for the avoidance of doubt, any successor authorities to Bath and North East Somerset Council, North Somerset District Council, Mendip District Council, Sedgemoor District Council, Somerset County Council, South Somerset District Council, Taunton Deane Borough Council, West Somerset District Council, or North Somerset Council.

375 3

Wiltshire and Swindon

The electoral ward areas comprising the areas covered by Wiltshire Council and Swindon Borough Council, and, for the avoidance of doubt, any

336 2

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successor authority of Wiltshire Council or Swindon Borough Council.

Staff classes Name of staff class Number of governors

Accident and Emergency (North Division) Staff Class

1

Accident and Emergency (East Division) Staff Class

1

Accident and Emergency (West Division) Staff Class

1

Urgent Care Services Staff Class 1

Volunteers Staff Class 1

Administration, Support and Other Services Staff Class

1

Appointed Governors

Local Authority

Cornwall Council, the Council of the Isles of Scilly, Devon County Council, East Devon District Council, Exeter City Council, Mid Devon District Council, North Devon District Council, South Hams District Council, Teignbridge District Council, Torridge District Council, West Devon Borough Council, Plymouth City Council, Torbay Council, Christchurch Borough Council, Dorset County Council, East Dorset District Council, North Dorset District Council, Purbeck District Council, West Dorset District Council, Weymouth and Portland Borough Council, Borough of Poole Council, Bournemouth Borough Council, Mendip District Council, Sedgemoor District Council, Somerset County Council, South Somerset District Council, Taunton

1

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Deane Borough Council, West Somerset District Council, Bristol County Council, Cheltenham Borough Council, Cotswold District Council, Forest of Dean District Council, Gloucester City Council, Gloucestershire County Council, South Gloucestershire Council, Stroud District Council, Tewkesbury Borough Council, Bath and North East Somerset Council, North Somerset District Council, Swindon Borough Council and Wiltshire Council

CCG Bristol Clinical Commissioning Group, South Gloucestershire Clinical Commissioning Group, Gloucestershire Clinical Commissioning Group, Swindon Clinical Commissioning Group, Wiltshire Clinical Commissioning Group, Bath and North East Somerset Clinical Commissioning Group and North Somerset Clinical Commissioning Group

1

CCG Kernow Clinical Commissioning Group, Northern, Eastern and Western (NEW) Devon Clinical Commissioning Group, South Devon and Torbay Clinical Commissioning Group, Dorset Clinical Commissioning Group and Somerset Clinical Commissioning Group

2

Fire Avon Fire and Rescue Service, Devon and Somerset Fire and Rescue Service, Cornwall Fire and Rescue Authority, Dorset Fire and Rescue Service and Isles of Scilly Fire and

1

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Rescue Service, Gloucestershire Fire & Rescue Service, Wiltshire Fire & Rescue Services

Police Avon and Somerset Constabulary, Dorset Police and Devon and Cornwall Constabulary, Gloucestershire Constabulary, Wiltshire Police

1

Air ambulance Cornwall Air Ambulance Trust, Devon Air Ambulance Trust, Dorset and Somerset Air Ambulance, Great Western Air Ambulance Charity and Wiltshire Air Ambulance Charitable Trust

1

Acute Dorset County Hospital NHS Foundation Trust; Northern Devon Healthcare NHS Trust; Plymouth Hospitals NHS Trust, Poole Hospital NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust; Royal Devon and Exeter NHS Foundation Trust, the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, South Devon Healthcare NHS Foundation Trust, Taunton and Somerset NHS Foundation Trust, Weston Area Health NHS Trust and Yeovil District Hospital NHS Foundation Trust, Gloucestershire Hospitals NHS Foundation Trust, Salisbury Hospital NHS Foundation Trust, Weston Area Health NHS Trust, Royal United Hospital Bath NHS Trust, North Bristol NHS Trust, University Hospitals Bristol NHS Foundation Trust, Great Western Hospitals NHS Foundation Trust, Torbay

1

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and Southern Devon Health and Care NHS Trust

Mental Health Avon & Wiltshire Mental Health Partnership, 2gether NHS Foundation Trust, Cornwall Partnership NHS Foundation Trust, Devon Partnership NHS Trust, Dorset Healthcare NHS Foundation Trust and Somerset Partnership NHS Foundation Trust

1

Governors

Governor Constituency

Elected/

Appointed

Rae Care

Public - Bristol and

Bath & North East

Somerset

Uncontested 1 March 2014

Harriet Lupton

Public - Bristol and

Bath & North East

Somerset


David Clare Public - Cornwall Elected 1 March 2014

William Thomas Public - Cornwall Elected 1 March 2014

Iris Cristoforo

Public – Devon

Left and

replaced by

Bob Deed

Elected 1 March 2014

Stephen Moakes

Public – Devon

Left and

replaced by

Phil Ford


Adrian Rutter Public - Devon Elected 1 March 2014

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Paul Young Public - Devon Elected 1 March 2014

Phil Ford Public Devon

Elected (2nd

on list)

14 November 2014

Robert Day Public - Dorset Elected 1 March 2014

Jim Duffie Public - Dorset Elected 1 March 2014

Andrew Gravells

Public -

Gloucestershire


Craig Holmes

Public -

Gloucestershire


Paul Richardson

Public -

Gloucestershire


Christopher Mills

Public - Isles of

Scilly


Terry Beale Public - Somerset Elected 1 March 2014

Anthony Leak Public - Somerset Elected 1 March 2014

Colin Thomas Public - Somerset Elected 1 March 2014

Torquil David MacInnes Public - Wiltshire Uncontested 1 March 2014

Dee Nix Public - Wiltshire Uncontested 1 March 2014

David Shephard Staff - A&E (East) Uncontested 17 September 2014

Alan Peak Staff - A&E (North) Elected 1 March 2014

Mark Bradford

Staff - A&E (West)

Vacancy

following

resignation


Neil Hunt

Staff - Admin,

Support & Other

Services


Andrea Henley

Staff - UCS (inc

NHS 111)

Vacancy

following


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resignation

Mark Norbury Staff - Volunteers Elected 15 March 2014

Bob Deed

Appointed - Local

Authorities

Moved to

public and

replaced by

Cllr Brian

Mattock

Appointed

Elected (2nd

on list)

1 March 2014

4 July 2014

Brian Mattock

Appointed – Local

authorities

Appointed 14 November 2014

Kay Haughton

Appointed - CCGs

(North Division)

Appointed 1 March 2014

Steve Wallwork

1 x vacancy

Appointed - CCGs

(East and West)

Vacancy to be filled

following

resignation


Steve Brown

Appointed - Fire

Services


Iain Tulley

Appointed - Mental

Health Partnerships


Juliet Cross

Appointed - Acute

Trusts

Juliet Cross

appointed


Assistant Chief Constable Sally

Crook

Appointed - Police

Forces


John Christensen

Appointed - Air

Ambulance

Charities


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Lead Governor

Governors are invited to nominate themselves for the posts of Lead and Deputy Lead Governor annually. Following election by their peers at the Council of Governors Meeting in April 2014, the Lead Governor is Adrian Rutter, Public Governor – Devon, and the Deputy Lead Governor is William Thomas, Public Governor – Cornwall. Their terms of office ran until the Annual General Meeting on 11 September 2014. At the Annual General Meeting (AGM) Adrian Rutter was reappointed as Lead Governor and William Thomas was reappointed as Deputy Lead Governor. Their terms of office will run until the AGM on 17 September 2015.

Register of Interests

Governors have signed the Trust’s Code of Conduct and are required to declare any interests which may compromise their objectivity in carrying out their duties. A Register of the Interests for all members of the Council of Governors is published on the Trust website at www.swast.nhs.uk or may be obtained by a request to the Secretary to the Council of Governors, South Western Ambulance Service NHS Foundation Trust, Abbey Court, Eagle Way, Exeter, EX2 7HY.

Contacting Governors Members who wish to contact the Council of Governors may do so by contacting the Trust Secretary, South Western Ambulance Service NHS Foundation Trust, Abbey Court, Eagle Way, Exeter, EX2 7HY or via email at [email protected].

Meetings

The Council of Governors met formally on 7 occasions during 2014-15, as well as other events and meetings. The following table details attendance at these meetings. Reference has not been made to the vacant seats which are as a result of the election process not having been completed within the 2013-14 year.

Name Position Attendance: Actual/Possible


Terry Beale Public Governor - Somerset 4/7

Steve Brown Appointed Governor – Fire & Rescue Services

0/7

Rae Care Public Governor – Bristol and Bath & North East Somerset

5/7

John Christensen Appointed Governor – Air Ambulances Charities

4/7

David Clare Public Governor - Cornwall 6/7


mailto:[email protected]

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Juliet Cross Appointed Governor – Acute Trusts

2/2

Sally Crook Appointed Governor – Police Forces

4/7

Robert Day Public Governor - Dorset 7/7

Bob Deed Appointed Governor – Local Authorities

2/2

Bob Deed Public Governor - Devon 5/5

Jim Duffie Public Governor - Dorset 5/7

Phil Ford Public Governor - Devon 1/2

Andrew Gravells Public Governor - Gloucestershire 2/7

Kay Haughton CCGs (North) 5/7

Andrea Henley Staff Governor – Urgent Care Services

5/7

Craig Holmes Public Governor - Gloucestershire 7/7

Neil Hunt Staff Governor – Admin, Support & other services

4/7

Anthony Leak Public Governor - Somerset 6/7

Harriet Lupton Public Governor – Bristol and Bath & North East Somerset

6/7

Torquil MacInnes Public Governor - Wiltshire 4/7

Brian Mattock Appointed Governor – Local Authorities

1/2

Chris Mills Public Governor – Isles of Scilly 5/7

Stephen Moakes Public Governor - Devon 1/3

Dee Nix Public Governor - Wiltshire 7/7

Mark Norbury Staff Governor - Volunteers 4/7

Alan Peak Staff Governor – A&E (North Division)

7/7

Paul Richardson Public Governor - Gloucestershire 6/7

Adrian Rutter Public Governor - Devon 7/7

David Shephard Staff Governor – A&E (East Division)

1/2

William Thomas Public Governor - Cornwall 7/7

Colin Thomas Public Governor - Somerset 2/7

Iain Tulley Appointed Governor – NHS Mental Health Trusts

3/7

Paul Young Public Governor – Public 6/7

Mark Bradford Staff Governor – A&E (West 3/7

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Division)

Iris Cristoforo Public Governor - Devon 3/3

Steve Wallwork CCG’s (East & West) 2/3

The Council of Governor meetings and workshops are regularly attended by

members and non-members. Non-members include senior managers and Directors.

The Chairman of the Trust chairs both the Board of Directors and the Council of

Governors and therefore plays a significant role in ensuring effective and sound

working relationships.

To support the Chairman in this respect, we have developed a Policy of Engagement for the Council of Governors and the Board of Directors to ensure the smooth operation of both forums and the Trust’s governance arrangements.

Details of staff eligibility are detailed in our Constitution, which is available on the public website at www.swast.nhs.uk.

Sub Groups of CoG

The Council of Governors has a number of sub-groups which enable governors to contribute in the follow specific areas:

Remuneration and Recommendations Panel;

Audit and Planning;

Communications, Membership and Patient Experience. Over the past year, the work programme for CoG at its meetings included:

Receiving updates on the corporate committees of the trust;

Induction and training from the Trust Secretary, solicitor and NHS Providers;

Agreeing a recruitment process for Non-Executive Directors;

Reviewing the working arrangements of the council of governors;

Succession planning arrangements for Non-Executive Directors;

Engaging with the public through a range of events;

Contributing to the forward plan.


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Remuneration and Recommendation Panel The Remuneration and Recommendation Panel is comprised of four Governors and the Chairman of the Council of Governors. The responsibilities of the Remuneration and Recommendation Panel include:

To consider the remuneration, appointments, allowances and terms and conditions of the Chairman and Non-Executive Directors;

To undertake the short listing and interview of any future Chairman or Non-Executive Directors;

To assist the Council of Governors in these responsibilities the Panel shall: i. Determine and agree with the Council of Governors, in liaison with the Board of

Directors, the framework, (i.e. these terms of reference), for the remuneration, appointments, allowances and terms and conditions of the NHS Foundation Trust’s Non-Executive Directors;

ii. In determining such a framework, take into account all factors which it deems necessary. The objective of such a framework shall be to ensure that the Chairman and Non-Executive Directors of the NHS Foundation Trust are provided with appropriate incentives to retain and recruit high quality individuals, encourage enhanced performance and that they are, in a fair and responsible manner, rewarded for their individual contributions to the success of the Trust;

iii. Review the ongoing appropriateness and relevance of the Remuneration and Recommendation Panel Terms of Reference;

iv. Recommend the design of, determine targets for, and set upper limits of any performance related pay schemes where operated by the NHS Foundation Trust and recommend the total annual payments made under such schemes. Any performance related pay scheme should be aligned with the interests of the NHS Foundation Trust, patients and taxpayers and ensures that targets are challenging and contribute to the overall benefit of the organisation. Full disclosure will be made for any performance related pay and bonuses agreed by the Council of Governors;

v. Ensure that contractual terms on termination, and any payments made, are fair to the individual, and the NHS Foundation Trust, aligned with the interests of the patients, that failure is not rewarded and that the duty to mitigate loss is fully recognised;

vi. Within the terms of the agreed framework and in consultation with the Chairman and/or Chief Executive as appropriate, determine the total individual remuneration package of the Chairman and each Non-Executive Director including bonuses, incentive payments and other awards;

vii. Recommend to the Council of Governors the policy for authorising claims for expenses from the Non-Executive Directors;

viii. Be exclusively responsible for establishing the selection criteria, short listing, appointing and setting the terms of reference for any remuneration consultants who advise the Panel, which should be at least every three years or when considering making large changes: and to obtain reliable, up-to-date information about remuneration in other NHS Foundation Trusts;

ix. Oversee any investigation of activities which are within its terms of reference, and at least once a year, review its own performance and terms of reference

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to ensure it is operating at maximum effectiveness and recommend any changes it considers necessary to the Council of Governors for approval.

The following table shows members’ attendance at Remuneration and Recommendation Panel Committee meetings for the 2014-15 financial year.


Actual/Possible

Mrs Heather Strawbridge Trust Chairman 3/3

Mr Adrian Rutter Public Governor - Cornwall 3/3

Mr Paul Young Public Governor - Devon 3/3

Mr Paul Richardson Public Governor -

Gloucestershire

1/3

Mr John Christensen Appointed Governor – Air

Ambulance Charities

3/3

Mr Alan Peak Staff Governor - A&E North Division

3/3

Mr Rae Care Public Governor Bristol and Bath & North East Somerset

3/3

In addition, the Chief Executive, Ken Wenman and Marty Mcauley, Trust Secretary, have been regular attendees to support and advise the panel.

Our membership We welcome members from all walks of life and public membership is open to people aged 16 years or over who live within our operating area. We have a membership strategy which sets out how we continue to build a membership that is representative of its operational area, using the analysis of socio-economic demographics. The strategy defines our membership community and eligibility criteria and sets out targets for membership, as well as defining differing levels of membership and the engagement opportunities offered at each level. In terms of membership growth, the Membership Strategy includes a membership recruitment, retention and engagement plan and recruitment trajectory. In accordance with this plan, we have predominantly focussed membership recruitment in the new public constituencies created as a result of the acquisition of GWAS. We have used various methods to recruit new members. These have included raising awareness through the media, attending various public and community events, as well as the use of our public website and social media. Our membership engagement activity has included all members being sent editions of the Trust’s

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newsletter, widely publicising information about forthcoming Governor elections and consulting members on our annual plan. At 31 March 2015, the main demographic imbalance within our membership was the under representation of men, who form 43 per cent of the membership as compared with 49 per cent of the total population within our operating area. In addition, there is an under-representation of members who classify themselves from a “white” ethnic background. They make up 87 per cent of the membership compared with 92 per cent of the total population. However, it should be noted that just fewer than nine per cent of the membership declined to provide their ethnic classification when they signed up to become a member. We are continuing to address previously identified demographic imbalances: which are an underrepresentation of men and of all public members under the age of 40. We have also identified a further area of under-representation in the Volunteer Staff Class. We plan to address these representational issues through increased communication with volunteers and targeted recruitment exercises across the north of the region, with staff and governors attending local events. We will also focus on improving linkages with sporting organisations such as rugby and football clubs and health networks, which provide support to men. The Council of Governors has established a Communications and Membership Sub Group, which is charged with reviewing the effectiveness of the Membership Strategy and working with the Membership Manager to target demographic imbalances within the our membership. The Board of Directors monitors how representative the membership is and the level and effectiveness of membership engagement through annual reporting and by individual directors attending membership events throughout the year. These arrangements will form part of the review of the membership strategy which will be reviewed in 2015. It is proposed that they will form part of a quarterly report presented to the Board of Directors. Our public membership at 31 March 2015, numbered 14,339 members – exceeding the 0.22 per cent of total population target contained within the membership strategy – and 4,448 staff members. The following table provides a breakdown of our membership by constituency, and also provides details of the eligibility criteria for each constituency.

Public Constituency

Target Membership 31.03.2015 (0.22% of

population)

Actual Membership 31.03.2015

Number of Governors

Eligibility

Bristol and Bath & North East Somerset

1,363 1,222 2 Age 16 and above residing in the electoral ward areas comprising the areas covered by Bristol City

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Public Constituency


population)


Number of Governors

Eligibility

Council and Bath and North East Somerset Council, and, for the avoidance of doubt, any successor authority of those listed above.

Cornwall 1,201 3,130 2

Age 16 and above residing in the electoral ward areas comprising the area covered by Cornwall Council and, for the avoidance of doubt, any successor authority of Cornwall Council

Devon 2,536 3230 4

Age 16 and above residing in the electoral ward areas comprising the area covered by Devon County Council, East Devon District Council, Exeter City Council, Mid Devon District Council, North Devon District Council, South Hams District Council, Teignbridge District Council, Torridge District Council, West Devon Borough Council, Plymouth City Council and Torbay Council and, for the avoidance of doubt, any successor authority of those listed above. .

Dorset 1,669 1,615

Age 16 and above residing in the electoral ward areas comprising the area covered by Christchurch Borough Council, Dorset County Council, East Dorset District Council, North Dorset District Council, Purbeck District Council, West Dorset District Council, Weymouth and Portland Borough Council, Borough of Poole Council and Bournemouth Borough Council and, for the avoidance of doubt, any successor authority of those listed above.

Gloucestershire and South Gloucestershire

1,934 1,483 3

Age 16 and above and residing in the electoral ward areas comprising the areas covered by Gloucestershire County Council and South Gloucestershire Council, and, for the avoidance of doubt, any successor authority of Gloucestershire County Council or South Gloucestershire Council.

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Public Constituency


population)


Number of Governors

Eligibility

Isles of Scilly 5 74 1

Age 16 and above residing in the electoral areas comprising the areas of the Isles of Scilly – St Mary’s, Bryher, St Martin’s, St Agnes and Tresco and, for the avoidance of doubt, any successor authority of St Mary’s, Bryher, St Martin’s, St Agnes and Tresco

Somerset and North Somerset

1,648 2,548 3

Age 16 and above residing in the electoral ward areas comprising the areas covered by Mendip District Council, Sedgemoor District Council, Somerset County Council, South Somerset District Council, Taunton Deane Borough Council, West Somerset District Council and North Somerset Council, and, for the avoidance of doubt, any successor authorities of those listed above.

Wiltshire and Swindon

1,535 1,025 2

Age 16 and above residing in the electoral ward areas comprising the areas covered by Wiltshire Council and Swindon Borough Council, and, for the avoidance of doubt, any successor authority of Wiltshire Council or Swindon Borough Council.

The current Membership Strategy contains a target of increasing staff membership

by 3 per cent year on year. The structure of the Staff Constituency was completely

re-configured from 1 March 2014 to recognise the integration of staff formerly

employed by GWAS and of the change in service provisions with regard to NHS 111

and Patient Transport Services.

Staff Constituency


No of Governors

Eligibility

Accident & Emergency: East Division Staff Class

669 1

Those individuals who are employed by the Trust or a Designated Organisation in the eastern operating region of the Trust and who are accident and emergency clinical hub staff; accident

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and emergency clinical staff (other than senior managers); Hazardous Area Response Team staff; training staff; community support responders; patient transport service control staff and managers, patient transport service clinical staff, dedicated patient transport service support staff and managers.

Accident & Emergency: North Division Staff Class

1,415 1

Those individuals who are employed by the Trust or a Designated Organisation in the northern operating region of the Trust and who are accident and emergency clinical hub staff; accident and emergency clinical staff (other than senior managers); Hazardous Area Response Team staff; training staff; community support responders; patient transport service control staff and managers, patient transport service clinical staff, dedicated patient transport service support staff and managers.

Accident & Emergency: West Division Staff Class

1,109 1

Those individuals who are employed by the Trust or a Designated Organisation in the western operating region of the Trust and who are accident and emergency clinical hub staff; accident and emergency clinical staff (other than senior managers); Hazardous Area Response Team staff; training staff; community support responders; patient transport service control staff and managers, patient transport service clinical staff, dedicated patient transport service support staff and managers.

Urgent Care Services Staff Class

530 1

Those individuals who are employed by the Trust or a Designated Organisation and who are Out of Hours service and NHS 111 clinical hub staff and managers, Out of Hours service and NHS 111 clinical staff including general practitioners and Registered Nurses, Out of Hours service and NHS 111 bank staff, and dedicated Out of Hours service and NHS 111 support staff.

Volunteers Staff Class

155 1

Those individuals who are either employed or engaged by a Designated Organisation and who are Volunteers trained to provide designated services on behalf of the Trust.

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Administration, Support and Other Services Staff Class

567 1

All other individuals who are employed by the Trust or a Designated Organisation and who do not fall within the preceding five staff classes set out above.

TOTAL 6

Details of staff eligibility are detailed in our Constitution, which is available on the public website at www.swast.nhs.uk. Our members receive communications and are invited to events including the Council of Governor Meetings and Annual Members’ Meeting as well as PPI events. Members wishing to know more about membership, should contact us on 01392 261502 or via [email protected].

Operating and Financial Review

Summary of Financial Performance Key highlights of SWASFT’S financial performance for 2014/15 are as follows:

Income of £229.4million, this is above plan but includes the loss of PTS contracts and additional income and costs associated with 111, A&E Activity and Winter Pressures funding;

A surplus of £0.159million, this was lower than the plan of £0.6million due to the Red 1 recovery plan in March 2015;

Earnings Before Interest, Tax, Depreciation and Amortisation (EBITDA) of £14.0million representing 6.1% of income compared to a plan of 6.4%;

A year-end cash balance of £34.1million (2014: £30.4million). The Trust’s strong cash position is due to the recognition of the impairments and slippage in the capital plan until 2015/16;

Net current assets of £10.4million (2014: £10.0million). This is driven by the improvement in the Trust cash balance;

Delivered a Continuity of Service risk rating of 4 (as set by Monitor) (where 4 is the best and 1 is the worst).

2014/15 was a challenging year for SWASFT as set out in the following:

Significant increase in activity above contract levels for the A&E service line (9.75% increase in A&E incidents);

Delivery of the Red 1 Recovery Plan to support the A&E service contract (75.20%);

Workforce challenges including increased Paramedic vacancies (8.51%);

Rollout of the Trust strategic programmes including the new Bristol Ambulance Station and Electronic Care System project;


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Tender activity in relation to Urgent Care with success for Gloucestershire OOH commencing 01 April 2015 but the loss of Somerset OOH and 111 which will terminate from 30 June 2015.

The focus of the Operating and Financial Review is how these matters have impacted on the financial health of the organisation, with a particular focus on the Statement of Comprehensive Income.

Analysis of income SWASFT recognised income of £229.4 in 2014/15. This has increased by 1.7% from £225.6million in 2013/14. The table below provides a summary of the key movements. Income Movements 2013/14 to 2014/15

£'m

Income 2013/14 225.6

Additional A&E income 4.5

Loss of PTS & VACs income (7.6)

Additional 111 income 2.7

Other income movements 4.2

Total income 2014/15 229.4

Total Income 2013/14 The Trust’s principal source of income is from local NHS commissioning contracts for the provision of A&E Services. This income totalled £177.2 million (2014: £174.8 million) which represented 77.2% of the Trust’s 2014/15 turnover (2014: 77.5%). The table below provides a summary of the key movements. Trust income 2014/15 to 2013/14

2014/15

2013/14

£'m % £'m %

A&E income 177.2 77.2% 174.8 77.5%

PTS income 3.9 1.7% 10.4 4.6%

UCS income 24.5 10.7% 22.4 9.9%

Other income 23.8 10.4% 18.0 8.0%

229.4 100% 225.6 100%

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Analysis of Expenditure

The operating expenditure for 2014/15 was £227.6 million. This has increased by 1.9% from £223.3 million in 2013/14. The following table provides a summary of the key movements.

Operating expenditure in 2013/14 and 2014/15

2014/15 2013/14

£'m % £'m %

Staff Costs 164.2 72.1% 158.9 71.2%

Supply and Services 9.1 4.0% 8.3 3.7%

Establishment 4.7 2.1% 4.7 2.1%

Transport 17.5 7.7% 19.7 8.8%

Premises 11.7 5.1% 8.3 3.7%

Depreciation 10.2 4.5% 12.1 5.4%

Impairment 2.0 0.9% 3.5 1.6%

Other 8.2 3.6% 7.8 3.5%

227.6 100% 223.3 100%

These movements reflect:

The reduction in staff costs for PTS following their transfer under TUPE to the successful providers in 2013/14;

The increase in staff costs relating to the Trust rollout of the 111 contracts;

The use of external third parties arising from vacancies (included in the Transport section) to support the frontline operations of A&E;

The transactions relating to the Electronic Care System project which is matched by other income;

The increase in supply and services relating to the procurement of additional medical equipment in support delivery of the Red 1 Recovery Plan;

Estates movements including sale of Marybush Ambulance Station, the impairment for the St Leonards hub and the impact of the annual revaluation of the estate by the District Valuer;

The reduction in the depreciation due to loss of the PTS vehicles and slippage in Service Developments during 2014/15;

It should be noted that the Trust charitable accounts of £0.2 million are not consolidated.

Cost Improvement Strategy The delivery of internal efficiencies is vital to the ability of the Trust to deliver its Business Plan. SWASFT has a strong track record of delivering recurrent efficiencies that underpin its financial plan. The delivery of the cost improvement programme is one of the most significant factors in delivering the Trust financial position and maintaining the ability to reinvest surpluses and maintain the financial health of the

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organisation. The Trust has in place an approved five year Cost Improvement Strategy. During 2014/15, SWASFT faced a number of challenges in relation to the delivery of the £9.0 million cost improvement plan. The Trust delivered a recurrent cost improvement programme of £8.2 million through the implementation of recurrent schemes with a further £0.8 million delivered non-recurrently. The 2015/16 cost improvement plan is £8.0million. The cost improvement plan has been fully identified on a recurrent basis and extracted from budgets. The plan includes schemes such A&E modernisation, review of non-pay, Urgent Care Service modernisation and a fuel reduction action plan. The continued delivery of cost improvements is critical to the on-going financial health of the Trust.

Capital Investment The Trust continues to manage its capital spend in line with the Trust’s Fleet, Information Communication and Technology and Estate enabling strategies. The total investment in capital for the year to 31 March 2015 was £14.3million (2014: £13.4million). Details of key elements of spend during the year is detailed below.

Capital programme 2013/14 and 2012/13

2014/15 2013/14

£'m % £'m %

Fleet 6.1 43% 7.8 58%

Information Communication and Technology 3.2 22% 1.0 7%

Estates 3.7 26% 1.6 12%

Hazardous Area Response Team Estate 0.9 6% 3.0 22%

Other including Medical Devices 0.4 3% 0.0 0%

14.3 100% 13.4 100%

The main movements in capital expenditure include:

The fleet replacement programme;

The ICT costs which related to the new Computer Aided Dispatch system in the Clinical Hub;

Estate costs relating to the new Bristol Ambulance Station and the completion of the HART estate in Exeter;

Medical device replacement relates to the vital signs equipment and has been delayed to 2015/16 to be aligned to the introduction of the Electronic Care System project.

Financing and Investment

For the majority of 2014/15 the Trust had a working capital facility of £16million. From January 2015 the Trust has in place an overdraft facility of £5 million. The Trust had no requirement to access either facility during 2014/15, maintaining healthy cash balances throughout the year. The Trust continues to forecast its cash

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requirements on a rolling 12-month basis and has no plans to use the facility over the period.

Better Payment Practice Code The Trust has an excellent record delivering against requirements set out by the Better Payment Practice Code. Although not a financial target, the Trust monitors compliance to ensure that suppliers are paid within 30 days. The table below provides a summary of the number and value of the invoices paid within this target.

Better Payment Practice Code Performance

2014/15 2013/14

Number £'m Number £'m

Total Non-NHS trade invoices paid in year 46,352 63.5 48,088 55.5

Total Non-NHS trade invoices paid within target 44,720 60.6 46,857 54.5

Percentage of Non-NHS trade invoices paid within target 96% 95% 97% 98%

Total NHS trade invoices paid in year 1,130 2.8 931 6.2

Total NHS trade invoices paid within target 1,096 2.8 884 6.1

Percentage of NHS trade invoices paid within target 97% 97% 95% 98%

Public Dividend Capital The Trust is required to pay a dividend to the Department of Health based on 3.5% of average relevant net assets. During 2014/15, the Trust recognised a dividend payable of £1.6 million within the Statement of Comprehensive Income based on an average relevant net assets of £52.8 million.

Monitor’s Continuity of Services Risk Rating

The COSRR calculation incorporates two metrics to assess the financial strength of the Foundation Trust:

Liquidity - calculated as a measure of days operating costs held in cash or cash equivalent form, including wholly committed lines of credit available (excludes the Trust’s Working Capital Facility due to the conditional nature of this facility)

Capital Servicing Capacity - the degree to which the Trust’s generated income covers its financing obligations. The ratio is calculated by dividing revenue available (EBITDA plus interest received) by capital servicing costs.

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The Trust has a risk rating of four (where 4 is the best and 1 is the worst) This means that the Trust is considered by Monitor, the independent regulator of NHS Foundation Trusts, to be low risk in financial terms. This is evidence of the strong financial discipline and cost control embedded across the Trust.

Financial Outlook The sound financial performance of the Trust in 2014/15 secures a strong starting point for 2015/16. The Trust has an approved Financial Plan for 2015/16 and an Integrated Business Plan for the period 2014/15 to 2018/19 including financials. The Trust has a history of achieving its key financial targets and financial plans. The Directors of the Trust have confidence in the future plans of the Trust to ensure its on-going success as demonstrated by:

Agreement of the A&E contract;

Signed contracts in place for all other services;

Approved financial plans for 2015/16 including identified cost improvement plan;

The Trust cash flow forecast.

General Economic Climate The Trust has been delivering services against the backdrop of the on-going financial challenges and this is expected to continue over the medium term.

Other Developments

The Trust continues to operate in competitive markets under the Government policy of Any Willing Provider.

As part of the A&E contract the Right Care2 service development investment is profiled within the Trust Financial plan for 2015/16.

The Trust has a number of service developments continuing into 2015/16 the most significant of which are the rollout of the Electronic Care System project and the rationalisation of A&E clinical hubs with the provision a single Computer Aided Dispatch, Triage and Telephony system.

Any investments are assessed using the Trust’s investment strategy, ensuring that there is minimal impact of the current levels of service delivery or the Trust’s underlying financial stability.

Planning

As a Foundation Trust, the organisation has a rigorous process to review its financial position and projections including the identification of the risks to which it is likely to be exposed. This process includes the reconciliation between the financial plan and the operational plan of the organisation. The Trust has developed a Mitigation

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Escalatory Action Plan (MEAP) to allow the Trust to manage these risks should they materialie.

Auditors The Trust’s appointed external auditors are PricewaterhouseCoopers (PwC). The auditors carry out the statutory audit of the Trust’s annual accounts. The cost of this audit service in 2014/15 was £0.058 million (2013/14: £0.056 million).

Disclosure of Information to Auditors As far as each of the Directors is aware, there is no relevant audit information of which the auditors are unaware. Each Director has taken all the steps required to make themselves aware of any relevant audit information and to establish that the auditors are aware of such information.

Political and Charitable Donations The Trust has not made any political or charitable donations this year (2014: £nil).

Governor Expenses The total amount of expenses claimed by Governors is contained in the Remuneration Report on page 124.

Medical Devices

The Trust’s Medical Device and Equipment team has been increased to eight members of staff across the Trust area, servicing, maintaining and repairing medical equipment. Due to the increasing numbers of devices a team leader post has been created to manage and oversee all new device inputs and replacement programmes. With a responsibility trust wide they also coordinate all device servicing activities & the ePCR Mobimed programme alongside the Logistics Helpdesk.

The total spend of the Medical Device replacement programme for 2014-15 was £1,204,842. For the first time in SWASFT history this ensured that all vehicles were fully equipped for responding at the start of the year.

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Remuneration Report

Remuneration for the Trust’s most senior managers (Executive Directors who are members of the Board of Directors) is determined by the Remuneration Committee, which is a statutory committee of the Board of Directors. The members of the Remuneration Committee, all Non-Executive Directors, are:

Mrs Heather Strawbridge (Chairman of the Committee)

Mr Hugh Hood

Mr Robert Davies

Professor Mary Watkins

Mr Tony Fox

Mr Chris Kinsella

Mrs Venessa James The Chief Executive, any other directors, or the Trust Secretary may be asked to attend by the Chairman. The Committee met once during 2014/15. Confirmation of attendance at these meetings is provided in the following table:


Mrs Heather Strawbridge Chairman (Non-Executive Director) 1/1

Professor Mary Watkins Non-Executive Director 1/1






In addition, the following non-members attended:



Mr Marty McAuley Trust Secretary 1/1

The purpose of the Committee is to develop and apply policy on terms and conditions, and remuneration, which results in a robust and transparent process for determining pay for the Chief Executive and other Executive Directors.

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The responsibilities covers salary (including any performance related elements/bonuses or additional payments), benefits (lease cars, pensions) and contracted terms of employment (service contracts, termination). We do not have any performance bonuses in place. The remuneration and expenses for the Trust Chairman and Non-Executive Directors are determined by the Council of Governors (please see page 109 for more details about the Remuneration and Recommendations Panel). The Remuneration Committee determines the remuneration and expenses for the executive directors. In fulfilling their duties, guidance is considered from organisations such as Monitor (the independent regulator), the NHS Confederation and NHS Providers. Pay levels are informed by executive salary surveys conducted by independent management consultants and by the salary levels in the wider market place. Affordability, determined by corporate performance and individual performance, are also taken into account. Where appropriate, terms and conditions are consistent with NHS pay arrangements such as Agenda for Change and Very Senior Management Pay framework. The Trust strategy and business planning process sets key business objectives which in turn inform individual objectives for Directors. All Executive Director remuneration is subject to performance. Performance is closely monitored and discussed through both annual and on-going appraisal processes. This ensures that quality and performance are at the forefront of the work we do. Executive directors are employed on contracts of service and are substantive employees of the Trust. Their contracts are open-ended employment contracts which can be terminated by either party with six months’ notice, or 12 months in the case of the Chief Executive. The Trust’s normal disciplinary policies apply to all substantive executive directors, including the sanction of instant dismissal for gross misconduct. The Trust redundancy policy is consistent with NHS redundancy terms for all staff. These arrangements do not apply to interim Executive Directors, who are engaged on fixed-term contracts. There were two such appointments for the reporting period:

Mrs Judy Saunders joined the Trust as an Interim Executive Director of Human Resources and Organisational Development from 2 December 2013 to 30 April 2014;

Mrs Jennifer Winslade joined the Trust as an Interim Executive Director of Nursing and Governance from 9 December 2013 until 31 May 2014. Jennifer took up the permanent post on 1 June 2014.

There is no compensation for early termination of contracts, other than payment in lieu of notice.

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There have been no significant awards made to past senior managers. There were 14 Directors of the Board during the reporting period. The two interim Directors did not claim expenses. The total annual expenses claim of the Board of Directors was £20,232.11. In 2014/15 the Council of Governors was made up of 34 Governors. A total of 21 Governors claimed expenses which came to a total of £8,099.82 Non-Executive Director Payment Table

Director Payment Table

Name and Title

Sala

ry (

ban

ds o

f

£5,0

00)

£000

Ben

efits

in K

ind

Roun

ded t

o t

he

Neare

st £

100

Com

menta

ry

Mrs Heather Strawbridge (Chairman) 40-45 0 The role of the Non-Executive is to provide oversight,

governance and leadership to the Trust in the pursuit of its

strategies.

The Non-Executive Directors are held to account by the Council of Governors who

also set their remuneration.

No bonus payments are made to Non-Executive

Directors.

Mrs Charlotte Russell (Non-Executive Director) 0

Mr Trevor Ware (Non-Executive Director) 0

Professor Mary Watkins (Non-Executive Director) 15-20 0

Mr Hugh Hood (Non-Executive Director) 10-15 0

Mr Robert Davies (Non-Executive Director) 15-20 0

Mr Tony Fox (Non-Executive Director) 10-15 0

Mr Chris Kinsella (Non-Executive Director) 10-15 0

Mrs Venessa James (Non-Executive Director) 10-15 0

Name and Title

Sala

ry (

ban

ds o

f

£5,0

00)

£000

Ben

efits

in K

ind

Roun

ded t

o t

he

Neare

st £

100

Com

menta

ry

Mr Ken Wenman (Chief Executive) 170-175 4300

The role of the Executive Director is to manage the organisation and provide leadership.

The Executive Directors are held to account by Non-Executive Directors who also set their remuneration.

Payments consist of salary and benefits in kind. No bonus payments are made to Executive Directors.

Mrs Jennie Kingston (Deputy Chief Executive / Executive Director of Finance)

125-130 3100

Dr Andy Smith (Executive Medical Director) 60-65 1600

Mr Francis Gillen (Executive Director of Information Management and Technology)

110-115 5000

Mrs Emma Wood (Executive Director of Human Resources and Workforce Development) 95-100 2900

Mrs Jenny Winslade (Executive Director of Nursing and Governance) 90-95 0

Mrs Norma Lane (Executive Director of Delivery) 0

Mrs Sue Steen (Executive Director of Human Resources and Workforce Development) 0

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Remuneration Report for the Year Ended 31 March 2015 (Audited) 2014-15 2013-14

Name and Title

Sala

ry

(bands o

f £5,0

00)

£000

Ben

efits

in K

ind

Roun

ded t

o t

he

Neare

st £

100

Sala

ry

(bands o

f £5,0

00)

£000

Ben

efits

in K

ind

Roun

ded t

o t

he

Neare

st £

100

Mrs Heather Strawbridge (Chairman) 40-45 0 40-45 0

Mrs Charlotte Russell (Non-Executive Director) 0 5-10 0

Mr Trevor Ware (Non-Executive Director) 0 5-10 0

Professor Mary Watkins (Non-Executive Director) 15-20 0 15-20 0

Mr Hugh Hood (Non-Executive Director) 10-15 0 10-15 0

Mr Robert Davies (Non-Executive Director) 15-20 0 15-20 0

Mr Tony Fox (Non-Executive Director) 10-15 0 10-15 0

Mr Chris Kinsella (Non-Executive Director) 10-15 0 5-10 0

Mrs Venessa James (Non-Executive Director) 10-15 0 0 0

Mr Ken Wenman (Chief Executive) 170-175 4300 170-175 1600

Mrs Jennie Kingston (Deputy Chief Executive / Executive Director of Finance) 125-130 3100 125-130 4100

Dr Andy Smith (Executive Medical Director) 60-65 1600 50-55 5100

Mr Francis Gillen (Executive Director of Information Management and Technology) 110-115 5000 95-100 5000

Mrs Emma Wood (Executive Director of Human Resources and Workforce Development) 95-100 2900

Mrs Jenny Winslade (Executive Director of Nursing and Governance) 90-95 0

Mrs Norma Lane (Executive Director of Delivery) 0 30-35 1000

Mrs Sue Steen (Executive Director of Human Resources and Workforce Development) 0 75-80 3400

Band of highest paid Director's Total

Remuneration (£'000) 170-175 170-175

Median Total Remuneration (£'000) 30 30

Ratio 5.6 5.6

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Remuneration Report for the year ended 31 March 2015

Trevor Ware, Charlotte Russell, Norma Lane and Sue Steen left the Trust during 2013-14 and so there is no comparison with 2014-15.

Emma Wood, Jenny Winslade and Venessa James joined the Trust during 2014-15 and so there is no comparison with 2013-14.

Chris Kinsella joined the Trust during 2013-14 and so his salary was only for part of the year. The 2014-15 figure is for the whole year.

Dr Andy Smith’s salary was increased based on the remuneration committees decision to ensure that his salary is commensurate with his work as a GP.

Mr Francis Gillen had a salary review in 2014. Based on the experience that Francis Gillen had developed, the successful management of a number of key projects for the Trust, and a benchmark of pay against the sector, locality and other directors, the Remuneration Committee agreed to a salary uplift.

As Non-Executive Directors do not receive pensionable remuneration, there will be no entries in respect of pension for non-executive members. There has also been no increase in their remuneration since the Trust received its Foundation Trust status.

Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation's workforce. The banded remuneration of the highest-paid director in South Western Ambulance Service NHS Foundation Trust in the financial year 2014-15 was £170-175k. This was 5.6 times the median remuneration of the workforce, which is £30,452.

Total remuneration includes salary, non-consolidated performance-related pay, benefits in kind as well as severance payments. It does not include employer pension contributions, the cash equivalent transfer value of pensions or overtime as directors believe this reflects the median salary.

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Pensions for the year ended 31 March 2015 (Audited)

Name and Title

Real in

cre

ase in p

ensio

n a

t age 6

0

(bands o

f £2,5

00)

Real in

cre

ase in p

ensio

n lu

mp s

um

at ag

e 6

0 (

ba

nds o

f £2,5

00

)

Tota

l accru

ed p

ensio

n a

t a

ge 6

0 a

t

31 M

arc

h 2

015 (

bands o

f £

5,0

00)

Lum

p s

um

at a

ged 6

0 r

ela

ted to

accru

ed p

ensio

n a

t 31 M

arc

h 2

01

5

(bands o

f £5,0

00)

Cash E

qu

ivale

nt T

ransfe

r V

alu

e a

t

31 M

arc

h 2

015

Cash E

qu

ivale

nt T

ransfe

r V

alu

e a

t

31 M

arc

h 2

014

Real In

cre

ase in C

ash E

qu

ivale

nt

Tra

nsfe

r V

alu

e 3

1 M

arc

h 2

015

£000 £000 £000 £000 £000 £000 £000

Mr Ken Wenman (Chief Executive) 0 to 2.5 0 to 2.5 75 to 80 230 to 235 1769 1716 52

Mrs Jennie Kingston (Deputy Chief Executive / Executive Director of Finance ) 0 to 2.5 0 to 2.5 35 to 40 115 to 120 799 765 34

Dr Andy Smith (Executive Medical Director) 0 to 2.5 2.5 to 5 15 to 20 50 to 55 298 270 28

Mr Francis Gillen (Executive Director of Information Management and Technology) 0 to 2.5 5 to 7.5 10 to 15 35 to 40 232 188 44

Mrs Emma Wood (Executive Director of Human Resources and Workforce Development) 0 to 2.5 0 to 2.5 0 to 5 0 to 5 15 0 15

Mrs Jennifer Winslade (Executive Director of Nursing and Governance) 0 to 2.5 5 to 7.5 30 to 35 95 to 100 519 474 45

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The accounting policies for pensions and other retirement benefits are set out in note 1 of the financial statements.

Our executive team do not have any off-payroll engagements. Please refer to page 84 of the Directors Report.

Cash Equivalent Transfer Values (CETV) A CETV is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the members’ accrued benefits and any contingent spouse’s pension payable from the scheme.

A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefit accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies.

The CETV figure and other pension details, include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

Real Increase in Cash Equivalent Transfer Values This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of period. Pension benefits shown in the table relate to membership of the NHS Pension Scheme, which is available to all employees within the Trust. No additional pension payments are made by the Trust in relation to Executive Directors.

The Government Actuary Department (“GAD”) factors for the calculation of Cash Equivalent Transfer Factors (“CETVs”) assume that benefits are indexed in line with CPI which is expected to be lower than RPI which was used previously and hence will tend to produce lower transfer values.

Signed:

Chief Executive and Accounting Officer Date: 20 May 2015

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Quality Report

Part 1 -A statement on quality from the Chief Executive

As we enter a new financial year, I am pleased to have this opportunity to reflect on the quality of care and services we have delivered and to look forward to the developments and initiatives planned going forward. Last year was challenging for the NHS in general and the Trust specifically. Evolving healthcare needs and higher expectations have combined with increasing demand to test the NHS. A clear example of this was over the Christmas period where, in common with the rest of the healthcare community, we saw an unprecedented demand on our services. I am proud to report that our staff once again demonstrated their ability to rise to any challenge and maintain the delivery of high quality patient care in very difficult circumstances. Despite the ever increasing daily demand on the Trust’s services we still maintain our drive for quality and innovation for the benefit of our patients. Developments this year have included the phased introduction of the Electronic Patient Clinical Record, which enables our clinicians to electronically capture and report quality patient information; whilst successful partnership working has enabled us to operate a mobile Alcohol Recovery Centre in Bristol, providing a place of safety where clinicians can assess and monitor these vulnerable patients without the need for a visit to the hospital emergency department. The Trust’s Right Care2 initiative goes from strength to strength with our clinicians working to ensure that patients receive the best possible care, in the right place, at the right time. This initiative has resulted in more patients in the South West receiving the appropriate treatment without the need to be conveyed to an emergency department than in any other area within England. This not only improves patient experience, but has a positive impact on the rest of the healthcare economy across the South West. The success of Right Care2 is dependent upon effective partnership working across the health and social care community and I would like to take this opportunity to thank our partners for their support. Throughout the year the Trust continued to develop its delivery of urgent care services. In July we took over the management of Tiverton Urgent Care Centre which provides a seven day a week GP and nursing service for Tiverton and surrounding areas. Our provision of Out-of-Hours GP services during the year extended across Dorset, Somerset and Gloucester whilst our NHS 111 service continued across Devon, Dorset, Somerset and Cornwall. The next financial year will see us deliver a new Out-of-Hours GP service across Gloucestershire, which will not only provide visiting and hub-based triage doctors, but also visiting specialist paramedics and treatment centre based nurse practitioners. Whilst we are keen to embrace development opportunities, it is important, as our services change and evolve, that we take patients and staff with us and that they feel

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comfortable and confident in the care we deliver. I am assured of our success in this ambition by the results of the Care Quality Commission’s ‘Hear & Treat Survey’ in June 2014, which found that 90% of respondents who called our 999 service and didn’t receive an ambulance response considered that they were listened to and treated with dignity and respect by the first person they spoke to; whilst over 90% understood the advice given to them at the end of the call and that this advice was possible to follow. This outcome is a credit to our call handlers and clinicians and justifies our clinical hub in the North once again maintaining its accreditation as a Centre of Excellence. In addition to its development of urgent care activities, the Trust maintains its national position as an innovator in the provision of emergency care. In February we commenced the national ‘Dispatch on Disposition’ pilot. This project has enabled us to amend our 999 call handling procedure for the benefit of patients who need our help. Throughout the pilot, instead of allocating a resource to an incident as soon as the address of the incident in question is available, we are able to fully triage the call to enable us to identify the most appropriate resource to deploy. Whilst the outcome of the pilot is awaited, initial findings are positive with us seeing an increased level of ‘Hear and Treat’ cases and the number of vehicles being unnecessarily dispatched decreasing and so available for the ever increasing number of incidents we are required to attend. Throughout this busy year the Board of Directors and I have made time to meet and speak with our dedicated staff across the Trust. As ever, when I meet with staff, I am impressed by their attitude, commitment and sense of pride in the quality of the care they provide to our service users. This willingness to go the extra mile is reflected in the messages of thanks that we receive from patients and their families. It is always gratifying to read these plaudits and I congratulate and applaud the Trust’s staff and volunteers for their collective efforts and achievements over what has been a challenging year. It is important to recognise the pressure that our staff are under, given the ever increasing demands placed on them; therefore to have done so well achieving many of the Ambulance Care Quality Indicator standards for the year is testament once again to their professionalism and commitment. 2015/16 will see us continuing to focus on the integration of our emergency and urgent care services for the benefit of patients and the wider health community. I look forward to reporting developments in this area to you in future Quality Accounts.

I confirm that, to the best of my knowledge, the information in this quality report is accurate and reflects a balanced view of the Trust, its achievements and future ambitions.

Ken Wenman Chief Executive

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Part 2 Priorities for Improvement and Statements of

Assurance from the Board of Directors

A Review of Quality Improvement Priorities made within SWASFT in 2014/15

Providing quality services to its patients remained the top priority for the Trust during 2014/15, with this priority being evidenced through its vision, values and strategic goals. The Trust’s vision statement is ‘To be an organisation that is committed to delivering high quality services to patients and continues to develop ways of working to ensure patients receive the right care, in the right place at the right time.’ This reflects the vision for emergency and urgent care set out by Sir Bruce Keogh: “for those people with urgent but non-life threatening needs we (the NHS) must provide highly responsive, effective and personalised services outside of hospital.”

This vision is communicated and promoted through the following:

From Prevention to Intervention: this phrase summarises the Trust’s ambition to support a safer, more efficient and sustainable urgent and emergency care system for the future. It recognises the integral part ambulance services can play in working alongside health partners to prevent disease and identify effective ways of influencing people’s behaviours and lifestyles and in playing an increasingly significant role in urgent and emergency care provision.

Right Care, Right Place, Right Time: captures one of the Trust’s key initiatives that focuses on ensuring patients receive the best possible care, in the most appropriate place and at the right time. This is alongside a drive to safely reduce the number of inappropriate A&E attendances at acute hospitals and deliver a wide range of developments to improve the appropriateness of the care delivered to patients.

1 Number, 1 Referral, 1 Outcome: captures the value added by the Trust as a provider of NHS 111 services that are integrated with GP Out-of-Hours and 999 services.

Local Service, Regional Resilience: recognises the dual role of the ambulance service in delivering a local service providing individual and personalised care to patients balanced with system wide coverage and capacity for resilience.

The values agreed by the Board of Directors demonstrate the emphasis that the Trust places on the individuality of patients and staff, and the commitment the Trust has to delivering high quality services.

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Values

Respect and dignity: We value each person as an individual, respect their aspirations and commitments in life, and seek to understand their priorities, needs, abilities and limits.

Commitment to quality of care: We earn the trust placed in us by insisting on quality and striving to get the basics of quality of care – safety, effectiveness and patient experience – right every time.

Compassion: We ensure that compassion is central to the care we provide and we respond with humanity and kindness to each person’s pain, distress, anxiety or need.

Improving lives: We strive to improve health and well-being and people’s experiences of the NHS.

Working together for patients: We put patients first in everything we do, by reaching out to staff, patients, carers, families, communities, and professionals inside and outside the NHS.

The Trust’s long term strategic goals and corporate objectives reflect its quality priorities. These include national priorities for ambulance trusts and local commitments agreed with the Clinical Commissioning Groups (responsible for commissioning services) and our Council of Governors. The corporate objectives are aligned to the strategic goals set out below and show the recurrence of quality throughout the strategic approach.

Strategic Goals and Corporate Objectives

Safe, Clinically Appropriate Responses: Delivering high quality and compassionate care to patients in the most clinically appropriate, safe and effective way.

Right People, Right Skills, Right Values: Supporting and enabling greater local responsibility and accountability for decision making; building a workforce of competent, capable staff who are flexible and responsive to change and innovation.

24/7 Emergency and Urgent Care: Influencing local health and social care systems in managing demand pressures and developing new care models, leading emergency and urgent care systems and providing high quality services 24 hours a day, seven days a week.

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Creating Organisational Strength: Continuing to ensure the Trust is sustainable, maintaining and enhancing financial stability. In this way the Trust will be capable of continuous development and transformational change by strengthening resilience, capacity and capability.

Performance and progress against these are all reported within the Trust’s Integrated Corporate Performance Report, which is presented to the Board of Directors at each publicly held meeting and is available on our website.

Quality Strategy

In September 2014, the Executive Medical Director undertook a high level review of the Trust’s Quality Strategy and its Clinical Effectiveness Strategy to establish whether the latter remained relevant. On review, it was found that the Quality Strategy fulfils the requirements of the Clinical Effectiveness Strategy and so it was recommended that the latter was no longer required. The Quality and Governance Committee approved this decision. The Quality Strategy will be reviewed in full and updated in quarter two of 2015/16. This important document ultimately aims to ensure delivery of high quality, cost effective emergency and urgent healthcare services to people in the Trust area.

The strategy demonstrates that the Trust’s approach to the delivery of high quality

care is patient centred and partnership-based, whilst engaging staff. It builds upon

the already established integrated approach to service planning and delivery, which

will:

Achieve the highest standards of patient safety;

Achieve the highest standards of staff safety;

Ensure quality remains at the top of the Trust’s agenda;

Support staff to achieve the highest standards of professional clinical practice and effectiveness;

Promote the right behaviours and visible leadership from all staff from board to frontline;

Continuously improve the quality of patient experience;

Continuously improve the quality of staff experience;

Achieve the highest standards of quality governance;

Ensure early warning alerts are in place to inform the Board of any issues affecting quality;

Ensure clear accountability and responsibility for quality;

Foster a ‘quality culture’ encouraging staff to speak out when quality could be further improved.

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2014/15 Quality Priorities

In 2014 the Trust published a Quality Account which illustrated its continuous quality improvement journey and set out its priorities for the year ahead. These priorities (listed under the three categories of patient safety, clinical ef2fectiveness and patient experience) are restated below as they appeared at that time, along with an overview of the Trust’s performance:

Patient Safety Priority 1 – Sepsis - why a priority?

Sepsis is a life-threatening condition that is caused when the body over-reacts to an infection; it results in the body injuring its own tissues and organs. There are 100,000 cases of sepsis each year in the UK, with an estimated 37,000 deaths. Sepsis can arise from infection in a huge variety of sources, including minor cuts and bladder and chest infections. Sepsis can lead to shock, multiple organ failure and death especially if not recognised early and treated promptly. Although anybody can develop sepsis, some people are more vulnerable, such as those at the extremes of life, the very old and the very young. As a result, children, particularly premature babies and infants, can be more susceptible to developing sepsis. The key to saving lives lies in early recognition and immediate treatment.

Aims

Increase the proportion of child (paediatric) patients with sepsis who are rapidly identified and treated by ambulance clinicians;

Embed current guidelines into practice, ensuring clinicians use common; terminology (NICE traffic light system) when communicating with other health care professionals and when documenting their findings;

Reduce the number of adverse incidents and serious incidents relating to the treatment of children with fever/sepsis by 50% from the 2013/14 baseline by 31 March 2015.

Initiatives

Audit the management of paediatric patients with fever and sepsis;

Increase awareness amongst clinicians regarding the difference between fever and sepsis in children;

Adopt a common paediatric recognition tool within SWASFT for face to face use;

Appoint paediatric sepsis champions in each of the Trust operating areas to help promote this key work stream.

Did we achieve this priority?

We partially achieved this priority. The Trust increased clinical awareness; developed guidance and a screening tool; and appointed paediatric sepsis champions. However, this raised awareness of sepsis in children may have in turn led to increased incident reporting with 10 adverse and serious incidents being reported in 2014/15 compared with 6 in the previous year, equating to an increase of 67%.

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It is important to note that despite an apparent increase in the number of reported incidents, clinical care for patients with sepsis continues to improve. Mitigating circumstances may include the following:

The Trust has completed a number of quality improvement initiatives aimed at educating clinicians in the awareness and recognition of sepsis, which may have resulted in an increase in the reporting of adverse and serious incidents. This might be seen as a positive effect, as it is likely that the incidents existed last year however went unreported;

Sepsis remains a national priority with all providers of healthcare delivering quality improvement for this cohort of patients, which may have resulted in other HCPs identifying adverse and serious incidents and completing adverse or serious incident reports;

Demand on the Trust continues to increase year on year, which has been mirrored in the number of reports by an increase of 10%.

During 2014/15 the Trust performed two audits into the management of fever and sepsis in paediatric patients. The purpose of the audits was to benchmark current practice, with the aim of improving the recognition and management of fever and sepsis and the communication between healthcare professionals when transferring clinical responsibility for the patient.

Following the initial audit, guidance was produced as well as a face-to-face screening tool for clinicians to use. The tool was largely based on the National Institute for Clinical Excellence (NICE) traffic light fever guidelines and was disseminated across the Trust. Anecdotal feedback so far has been positive, with clinicians finding the tool helpful not only for paediatric patients with a fever, but also for those who appear generally unwell.

Alongside the sepsis guideline and screening tool, the Trust was also involved in developing patient information leaflets for parents and carers. We worked with NHS England to develop the Sepsis Assessment and Management (SAM) leaflet, which aims to support parents when there are escalating concerns or deterioration in their child’s condition. All vehicles within the Trust now carry the SAM leaflet, with clinicians mandated to leave a copy with the patient and their family when treating them at home or in the community.

In 2014/15 the Trust’s Sepsis Group went from strength to strength, with membership growing every month. The group reviewed all adverse and serious incidents relating to sepsis. The group’s perception is that due to an increase in awareness, reporting continues to grow. However, this is not felt to be reflective of an increase in incidents relating to sepsis, rather that they were not reported effectively when awareness was poor. The members of the Sepsis Group have become paediatric sepsis champions for their respective areas and continue to promote key work streams.

The Trust’s Clinical Development Manager (West) continues to lead this key work stream on a regional and national level, contributing to the development of NICE and Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines, and is also speaking at national conferences during 2015.

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Clinical Effectiveness

Priority 2 – Electronic Care System (ECS) - Why a priority?

The implementation of the Electronic Care System is an exciting innovation, which will be used in the pre-hospital arena to better manage patient care and which will also have the technical ability to integrate with hospital and other wider health community systems.

A fully managed service will be delivered that allows the Trust to electronically capture, exchange and report on better quality patient information. ECS will support the Trust in delivering benefits throughout the wider health and social care community and assist the Trust to better meet the needs of patients and support the urgent care agenda. The outcomes that will enable these benefits across the emergency care pathway cover include:

Aims

Deliver better clinical outcomes for patients, through better pathway management, data sharing and informed decision making;

Reduce the number of patients taken to Emergency Departments unnecessarily;

Improve the communication of appropriate and essential patient information across the healthcare community; including receiving units, GPs and other parties involved with patient care;

Deliver improved support for Trust staff resulting in improved job satisfaction.

Initiatives

Implementation of the Electronic Care System.


We partially met this priority.

The ECS, incorporating the electronic Patient Clinical Record (ePCR), has been created in partnership with a leading supplier of mobile solutions for modern emergency medical care and developed by a dedicated Trust project team.

Using a structured model of examination and assessment the software has been configured so as to take clinicians through a methodical process of capturing clinical interventions and, where possible and appropriate, incorporating validated assessment tools. This enhances the clinical decision making process and supports the clinician in making the most appropriate decisions regarding a patient’s care needs.

Although the initiative focussed on an ambulance based solution, the ability for it to be further integrated across the wider healthcare community at a later stage has been a consideration throughout. The high level of clinical input to develop the system in a way that ensures that future, wider requirements are met has delayed its implementation. However, the ECS has been introduced across West Somerset (incorporating Musgrove Hospital, Taunton) and at Derriford Ambulance Station

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which feeds into Derriford Hospital in Plymouth. Further implementation is scheduled across the Trust’s operating area during 2015 and early 2016.

It is too soon to provide definitive quantitative data to demonstrate that the ePCR has reduced the number of patients being taken to Emergency Departments (ED) unnecessarily or that the incorporation of validated assessment tools within the system has resulted in more appropriate clinical outcomes for patients. However, initial data and feedback indicates that these aims are achievable in the longer term.

Feedback received suggests that staff are more confident in making clinical decisions as the system captures clinical data which supports the decisions that they are making. This is particularly important when they are with patients who they believe can be treated outside of the ED setting, as they are confident in selecting other more appropriate care pathways. The ECS is already improving the communication of essential patient information with staff, for example, being able to make referrals electronically through the system immediately rather than having to return to the ambulance station to undertake this task. The hospitals currently using the system are also able to monitor the patient’s condition prior to their arrival.

Priority 3 – Primary Angioplasty - Why a priority?

When someone experiences a heart attack, the priority is to remove the blood clot obscuring the blood vessel as soon as possible to minimise the damage caused to the heart. Primary Angioplasty is the definitive treatment for a heart attack, which involves hospital specialists inserting a small tube through a vein, into the blocked blood vessel within the heart. A tiny balloon at the tip of the tube is then inflated to squash the blockage. A stent (small piece of wire mesh) expands with the balloon, and remains in the blood vessel to ensure that it remains open. The sooner patients reach a hospital that can deliver this specialist procedure, the better their outcome is likely to be.

The time that it takes from the initial emergency call to the balloon being inflated to relieve the clot during primary angioplasty is known as the call-to-balloon (CTB) time. The national target is to achieve a call-to-balloon time of under 150 minutes, which is reflected in the ambulance clinical quality indicator (ACQI) for patients who suffer from a heart attack. Local thresholds are set for the percentage of patients receiving such timely intervention.

Aim

Improve performance against the locally set threshold of 84% for the number of patients achieving a CTB time of 150 minutes for primary angioplasty.

Initiatives

Complete a root cause analysis of CTB breaches;

Develop and implement an action plan to enable achievement of the local CTB target of 84%.

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We partially met this priority.

As part of the Commissioning for Quality and Innovation (CQUIN) programme with the Clinical Commissioning Groups of Bath & North East Somerset, Bristol, Gloucestershire, North Somerset, South Gloucestershire, Swindon and Wiltshire the Trust focused on improving the local CTB time.

The cases of 142 patients who received primary Percutaneous Coronary Intervention (pPCI) during the period of 1 April 2014 - 30 June 2014 within the North Division were reviewed, establishing a baseline performance of 73%.

A root cause analysis of the breaches was completed to identify the common themes, which were addressed as part of an action plan to increase performance. A re-audit was conducted during 1 October 2014 - 31 December 2014 to review progress, and reported performance of 78%.

Despite an increase in operational demand, the Trust has made a significant improvement in the proportion of patients who receive primary angioplasty within 150 minutes of their call. The CQUIN demonstrated that a disproportionate proportion of cases (75%) missing the target, occurred during the out-of-hours period. The presence of just three facilities within the North Division providing 24/7 primary angioplasty limits the ability of the Trust to exceed current 78% performance.

Patient Experience Priority 4 – Friends and Family Test (FFT) - why a priority?

Quality Account guidance recommends that Trusts look at local and national indicators as sources for proven indicators where they overlap with local priorities. As a result, this year the Trust has included the Friends and Family Test as a priority for 2014/15. This test was introduced in other parts of the NHS in 2013, and asks patients whether they would recommend the hospital wards, emergency departments and maternity services to their friends and family if they need similar care and treatment. Asking all patients this question is aimed at giving hospitals a better understanding of the needs of their patients and enabling improvements.

Implementation of this is a key part of NHS England’s current business plan. The Trust does not underestimate the significance of the introduction of this indicator, and the local value of having a consistent indicator about how patients ‘rate’ our services. Due to its importance it has been included in the priorities for 2014/15.

Aim

The Trust has proactively encouraged feedback from its patients both positive and negative. We have worked on developing a range of feedback mechanisms to allow patients, their carers and families to tell us about their experiences. Patient feedback gives a rich source of insight into the overall patient experience and is used to help inform the refinement and development of our future services.

NHS England states that the FFT ‘aims to provide a simple headline metric which, when combined with follow-up questions, is a tool to ensure transparency, celebrate success and galvanise improved patient experience.’ SWASFT can use this

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measure, together with supporting questions to help understand the important elements that drive patient satisfaction across its various services.

Since April 2013, the FFT question has been asked in all NHS in-patient and A&E departments across England. From October 2013, all providers of NHS-funded maternity services have also been asking women the same question at different points throughout their care. The implementation of the FFT across all NHS services is an integral part of NHS England’s business plan for 2013/14 – 2015/16. As of 1 April 2014, all NHS trusts providing acute, community, ambulance and mental health services in England were required to implement the FFT for staff.

Initiatives

Implement the patient FFT in accordance with NHS England guidance;

Write to NHS England explaining our experience to date of eliciting patient feedback to help inform the detailed FFT guidance, so that it can account for the different approach that may be required for ambulance trusts (expected towards the end of June 2014);

Carry out segmentation analysis of our patient base in preparation for full implementation of patient FFT;

Undertake a feasibility study of how we might conduct the patient FFT;

Early implementation of FFT in one service line by 1 October 2014;

Full implementation of patient FFT;

Internal promotion and reporting of FFT scores as they become available.


Yes we did achieve this priority.

In readiness for the implementation of the patient FFT in October 2014, the Trust undertook an analysis of its patient base and a feasibility study of how the requirements of the FFT could best be carried out. It was agreed that the test needed to be as convenient as possible for patients and so they are offered three means of contact - text, telephone or an on-line survey.

The Trust devised a postcard which invites patients to respond to the FFT and is handed to 999 patients who are not conveyed to hospital, as well as those patients who use the Patient Transport Service. Patients who use the Trust’s GP Out of Hours Service and the Tiverton Urgent Care Centre (formally known as the Minor Injuries Unit) are provided with the postcard upon arrival.

The Trust staged a phased roll out of the FFT across its operating area and across the relevant service lines from 1 October 2014, with all areas and service lines having implemented the FFT as of 1 April 2015.

Whilst the number of patients choosing to take the opportunity to respond to the FFT is still low, with only 195 responses being received during 2014/15, the feedback that has been received has been overwhelmingly positive with 94% of those respondents indicating that they would recommend the service.

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“My experience following an emergency call out was excellent. The attending paramedic was efficient, professional and brilliant at explaining his actions whilst offering just the right level reassurance to put me at my ease. Thank you, I couldn't imagine how you could improve on the way the service was conducted.”

“111 call made at 9.00pm on Saturday 3 Jan, answered in less than 5 minutes. Paramedic dispatched and arrived at 9.20pm. Wonderful response time. Paramedic’s assessment and treatment of a 93 year old with severe breathing difficulties was calm, knowledgeable and cheerful - and spot on! He did thorough checks on all areas and stayed to ensure the patient was calm and able to breathe without apparatus. I couldn't have wished for better assistance in the circumstances and he saved a hospital bed for someone else.”

The scoring for the FFT is collated on a monthly basis and is reported to operational managers for dissemination to all their staff. The data is also provided to NHS England which, in turn, makes it publicly available.

Looking forward to 2015/16 the Trust will be making it easier for staff to hand patients an invitation to answer the question by including the details on patient safety leaflets for those patients left at home. The Trust will also be developing the way in which it makes the FFT data accessible to the public.

Quality Priorities for Improvement 2015/16

The Trust is accountable to its patients and service users and the Quality Account provides an ideal mechanism for addressing this. As a Foundation Trust, SWASFT has a Council of Governors (CoG) which is invaluable in representing the views of Governors, the Trust membership and the wider public, gained through engagement activities. The Trust liaised with its Council of Governors to obtain their opinion and input on the suggested priorities within this report and to encourage them to think about how they can engage with the Trust Membership and the wider public about these priorities.

In developing the priorities for the forthcoming year, the Trust has taken into account feedback provided by stakeholders, including commissioners, on the 2013/14 Quality Account. This feedback has also informed the inclusion of information within the quality overview in Part 3 of this report. The Trust’s commissioners have also been consulted on the priority areas proposed for 2015/16, to ensure the health community supports the areas identified.

When setting the priorities for 2015/16 consideration has been given to Quality Account priorities from previous years, the learning from these and the benefits in focusing further on these areas. During 2014/15 one quality priority related to sepsis in children. During 2015/16 the focus upon patients under the age of 15 will continue with the clinical effectiveness priority being in respect of the assessment and management of the six most common medical conditions which result in children requiring emergency or urgent care treatment. As these six conditions account for almost half of all emergency and urgent care admissions, better management will not only benefit children in the region but also the wider health community as unnecessary admissions are avoided.

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During 2014/15 the Implementation Leads for the agreed priorities were responsible for monitoring progress at the appropriate working groups, for example the Infection Prevention and Control Group. In addition, the Trust’s Quality and Governance Committee monitored the Quality Account priorities through exception reports at its bi-monthly meetings. These governance arrangements will be continued during the forthcoming year.

Patient Safety Priority 1 – Sign Up to Safety

Sign up to Safety is a national campaign, launched by NHS England, designed to strengthen patient safety in the NHS and make it the ‘safest healthcare system in the world’.6 By Signing up to Safety, we will align our patient safety improvement plans to the NHS-wide purpose, thereby strengthening our own activities. The campaign provides a robust structure on which we can pin our safety improvements, and this should help to make them clearer and more accessible to our service users.

Aims

To develop and implement a clear and measurable programme of safety improvement across all of the Trust’s services (A&E, Out of Hours, NHS 111 and Patient Transport Services), which is underpinned by a published set of principles supporting the five Sign up to Safety pledges, which are:

1. Put Safety First Commit to reducing avoidable harm in the NHS by half and make public our goals and plans developed locally.

2. Continually Learn Make our own organisation more resilient to risks, by acting on the feedback from patients and by constantly measuring and monitoring how safe our services are.

3. Honesty Be transparent with people about our progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong.

4. Collaborate Take a leading role in supporting local collaborative learning, so that improvements are made across all of the local services that patients use.

5. Support Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and celebrate the progress.

Initiatives

Develop a clear set of aims or principles to support the five Sign up to Safety pledges;

6 www.england.nhs.uk/signuptosafety

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Engage and consult with patients, staff, governors, and other stakeholders, to seek their feedback on what they see as priorities for patient safety;

Develop and implement a short/medium/long term programme of safety improvement using the feedback provided;

Support the work of the three Patient Safety Collaboratives covering our operational area, including encouraging managers to undertake the Institute of Healthcare Improvement (IHI) Accelerated Patient Safety Programme.

Board Sponsor: Jenny Winslade, Executive Director of Nursing and Governance Implementation Lead: Vanessa Williams, Head of Patient Safety and Risk How will we know if we have achieved this priority?

We will have a clear set of aims or principles supporting the five Sign up to Safety pledges signed off by our Chief Executive Officer and published on the Trust website.

Through engagement with staff and governors, we will have received: o Responses from a minimum 3% of staff (n129/4285), and at least 50% of

governors (n13/26), to a new engagement survey on safety, to be used to develop the programme of safety improvement.

We will have a measurable short/medium/long term programme of safety improvement based around feedback provided from stakeholders and signed off by the Trust Quality and Governance Committee.

We will have improved the completion of actions (within agreed target deadlines) developed through learning from serious/moderate harm incidents from the baseline (at April 2015) to 70%. This will be reported to and monitored by the Directors’ Group.

We will be able to demonstrate active involvement in the three Patient Safety Collaboratives covering our operational area, by ensuring a minimum of 3 Trust managers attend the Patient Safety Collaborative IHI training programme in 2015/16, and that at least one representative attends each meeting of the three Patient Safety Collaboratives

Implementation of the new programme will have commenced by quarter four of 2015/16. This will include development of a full plan for 2016/17.

Progress towards the Sign up to Safety campaign during 2015/16 will be reported by exception to the Quality and Governance Committee, including a deep dive into the first year’s work at year end.

Clinical Effectiveness Priority 2 – Paediatric Big Six

A recent study reported an increase of 28% in the admission rate for children under 15 years of age between 1999 and 2010 in England. In addition, a Kings Fund Review of the South of England in 2012 reported a 9% growth in general paediatric admissions over the previous four years. National data shows that the “big six”

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conditions accounted for 50% (2008/09) of all emergency and urgent care admissions. There is significant potential to better manage these conditions if there is the right distribution of services and a co-ordinated, systematic approach to the management, monitoring and recording of a patient’s care, known as the care pathway. The South West Strategic Clinical Network has identified scope to both reduce avoidable admissions and improve treatment and outcomes in the South West in relation to children, young people and their families, according with the Trust’s Right Care2 initiative.

Aims

To promote the evidence-based assessment and management of unwell children and young people for the six most common conditions when accessing 999 ambulance services. The six conditions are:

Fever

Croup

Abdominal pain

Diarrhoea (with or without vomiting)

Asthma

Head injury

Initiatives

Development of an overarching Trust document covering the Guideline for Paediatric Big Six;

Integration of the overarching document into the Electronic Patient Clinical Record;

Partnership working with Acute Trusts to identify ways in which direct admissions or advice can be achieved.

Board Sponsor

Executive Medical Director

Implementation Lead

Clinical Development Officer (East)

How will we know if we have achieved this priority?

Trust clinicians will be supported by the latest evidenced best guidance with support from the region’s providers, to reduce variation in the assessment and management of the six conditions and ensure patients are safe and have access to equitable care pathways;

The Big 6 Guideline will be published and uploaded to the intranet and electronic patient record;

75% of frontline clinicians (Specialist Paramedics, Operational Officers and Paramedics) will receive Big 6 training (excluding staff on secondment, maternity and long term sick leave).

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Patient Experience Priority 3 – Frequent Callers

Frequent callers are a small group of patients who access emergency healthcare on an abnormally high number of occasions. These patients, who often have specific social or healthcare needs, also have a significant impact on the ability of the NHS and emergency services to deliver a safe service to the wider community due to the level of resource required to deal with their requirements.

Improved partnership working is required to ensure that frequent callers are treated in an equitable manner and that care plans are developed and delivered, which meet their individual needs in line with the Trust’s Right Care2 initiative. This work will enable the Trust to manage demand from this small group by ensuring that resources are not used inappropriately and that their needs do not impact on the ability of the service to meet the requirements of other users.

Aim

To improve the management of Frequent Callers who present to the ambulance service and a range of health and social care providers.

Initiatives

Establish links with Frequent Caller Leads in external organisations including Acute Trusts, Mental Health Trusts and NHS 111 providers;

Review the top five Frequent Callers from private addresses, aged 18 years and over, for each CCG area. Establish the percentage which already has an individual action plan in place;

Work with partner organisations to develop individual action plans for any patients identified above where they are not already in place.

Board Sponsor

Director of Operations

Implementation Lead

Frequent Caller Lead

How will we know if we achieve this priority?

We will have produced a list of the key contacts within relevant external organisations.

We will increase the percentage of frequent callers, identified during each quarter, who have an action plan in place at the end of the following quarter, compared to the quarter in which they were identified.

A review of the progress against these priorities will be included in next year’s Quality Report and Account.

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Statements of Assurance from the Board

Statutory Statement This content is common to all healthcare providers which make Quality Accounts comparable between organisations and provides assurance that the Board has reviewed and engaged in cross-cutting initiatives which link strongly to quality improvement.

1. During 2014/15 the South Western Ambulance Service NHS Foundation Trust provided and/or sub-contracted three relevant health services:

Emergency (999) Ambulance Service;

Urgent Care Service (NHS 111; GP Out-of-Hours and Tiverton Urgent Care Centre);

Non-Emergency Patient Transport Service.

1.1 The South Western Ambulance Service NHS Foundation Trust has reviewed all the data available to them on the quality of care in three of these relevant health services.

1.2 The income generated by the relevant health services reviewed in 2014/15 represents 95.79 per cent of the total income generated from the provision of relevant health services by the South Western Ambulance Service NHS Foundation Trust for 2014/15.

2. During 2014/15, two national clinical audits and zero national confidential enquiries covered relevant health services that South Western Ambulance Service NHS Foundation Trust provides.

2.1 During 2014/15 South Western Ambulance Service NHS Foundation Trust participated in 100 per cent national clinical audits and 100 per cent national confidential enquiries of the national clinical audits and national confidential enquiries which it was eligible to participate in.

2.2 The national clinical audits and national confidential enquiries that South Western Ambulance Service NHS Foundation Trust was eligible to participate in during 2014/15 are as follows:

National Audit of Non-Conveyance

National Ambulance Clinical Quality Indicator Programme

2.3 The national clinical audits and national confidential enquiries that South Western Ambulance Service NHS Foundation Trust participated in during 2014/15 are as follows:

National Audit of Non-Conveyance

National Ambulance Clinical Quality Indicator Programme

2.4 The national clinical audits and national confidential enquiries that South Western Ambulance Service NHS Foundation Trust participated in, and for which data collection was completed during 2014/15, are listed below

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alongside the number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry:

National Audit of Non-Conveyance (91.5%)

National Ambulance Clinical Quality Indicator Programme (100%)

2.5 The reports of two national clinical audits were reviewed by the provider in 2014/15 and South Western Ambulance Service NHS Foundation Trust intends to take the following actions to improve the quality of healthcare provided:

Undertake a programme of Quality Improvement activity across the organisation to facilitate the delivery of high quality care.

2.6 The reports of ten local clinical audits were reviewed by the provider in 2014/15 and South Western Ambulance Service NHS Foundation Trust intends to take the following actions to improve the quality of healthcare provided:

Continue to reinforce the importance of good quality record keeping which underpins clinical quality reporting.

Work to ensure that all clinical audits cover the whole Trust area to inform service delivery across the region.

Ensure that the outputs of clinical audit are used to inform the work of the Quality Improvement Paramedics.

Undertake Quality Improvement activity to improve the assessment and management of pain.

Work with the Clinical Development team to improve the use of the Major Trauma Triage Tool.

Work with the resuscitation clinical sub group to develop a programme of work to improve the proportion of patients who are resuscitated gaining a return of spontaneous circulation on arrival at hospital.

Undertake a programme of re-audit following quality improvement activity.

3. The number of patients receiving relevant health services provided or sub-contracted by South Western Ambulance Service NHS Foundation Trust in 2014/15 that were recruited during that period to participate in research approved by a research ethics committee was 68.

4. A proportion of South Western Ambulance Service NHS Foundation Trust income in 2014/15 was conditional on achieving quality improvement and innovation goals agreed between South Western Ambulance Service NHS Foundation Trust and any person or body they entered into a contract, agreement or arrangement with for the provision of relevant health services, through the Commissioning for Quality and Innovation payment framework. Further details of the agreed goals for 2014/15 and for the following 12 month period are available electronically at www.swast.nhs.uk.


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4.1 The monetary total available for the Commissioning for Quality and Innovation payments, for all service lines, for 2014/15 was £2,927,940 and for 2013/14 was £3,564,833.

5. South Western Ambulance Service NHS Foundation Trust is required to register with the Care Quality Commission and its current registration status is ‘registered without compliance conditions’.

5.1 South Western Ambulance Service NHS Foundation Trust has the following conditions on registration:

None.

a. The Care Quality Commission has not taken enforcement action against South Western Ambulance Service NHS Foundation Trust during 2014/15.

5.3 South Western Ambulance Service NHS Foundation Trust has not participated in any special reviews or investigations by the Care Quality Commission during the reporting period.

6. South Western Ambulance Service NHS Foundation Trust did not submit records during 2014/15 to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published data.

7. South Western Ambulance Service NHS Foundation Trust Information Governance Assessment Report overall score for 2014/15 was 72% and green.

8. South Western Ambulance Service NHS Foundation Trust was not subject to the Payment by Results clinical coding audit during the reporting period by the Audit Commission.

9. South Western Ambulance Service NHS Foundation Trust will be taking the following action to improve data quality:

Continue to maintain and develop the existing data quality processes embedded within the Trust.

Hold regular meetings of the Information Assurance Group to continue to provide a focus on this area.

Ensure completion and return of the monthly Data Quality Service Line Reports and in particular strengthen reporting by its NHS 111 services.

Continue to provide Data Quality Assurance Reports to the Board of Directors.

Where external assurance of data quality is required, commission an independent review from Audit Southwest, the Trust’s internal audit provider.

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Key Performance Indicators This section includes the mandatory indicators which the Trust is required to include in this report. Further performance information, including Category A Performance by Clinical Commissioning Group, is shown in Part 3 of this report.

Category A Performance

Category A

Performance Target 2014/15 2013/14

National Average 2014/15*

Highest Trust

2014/15*

Lowest Trust

2014/15*

Red 1 75% 75.24% 73.15% 74.7% 77.4% 67.6%

Red 2 75% 71.42% 77.23% 69.1% 74.3% 59.7%

Category A

Performance Target

2014/15 2013/14 National Average 2014/15*

Highest Trust

2014/15*

Lowest Trust

2013/14*

19 Minute 95% 93.62% 95.76% 93.9% 96.8% 91.0%

*Highest/Lowest Trust reporting has been noted for each indicator independently, current information from YTD 2014/15 reported at the end of February 2015.

For clarification, Category A incidents are those involving patients with a presenting condition which may be immediately life threatening and who should receive an emergency response within 8 minutes irrespective of location, in 75% of cases. Red 1 calls are those requiring the most time critical response and cover cardiac arrest patients who are not breathing and do not have a pulse and other severe conditions such as airway obstruction. Red 2 calls are those which are serious but less immediately time critical and cover conditions such as stroke and fits. In addition, Category A patients should receive an ambulance response at the scene within 19 minutes in 95% of cases. A19 performance is based on the combination of both Red 1 and Red 2 categories of call.

The Trust is assessed against the delivery of the Red 1, Red 2 and A19 performance targets quarterly by Monitor. The Trust met all three targets for quarters one and two of 2014/15, but breached all three in quarter three. In quarter four the Red 1 target was achieved, but the other two targets were breached. Details of the breaches have been reported within the Annual Governance Statement, which forms part of the Annual Report and includes assurance of the action taken to improve the position. In accordance with the criteria contained in Monitor’s Risk Assessment Framework, the Trust maintained its Green Governance Rating throughout the year.

The South Western Ambulance Service NHS Foundation Trust considers that this data is as described for the following reasons:

The Trust has robust data quality processes in place to ensure the reporting of performance information is both accurate and timely.

Information is collated in accordance with the guidance for the Ambulance Clinical Quality Indicators.

This information is reported to the Board of Directors monthly in the Integrated Corporate Performance Report.

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The South Western Ambulance Service NHS Foundation Trust is taking the following actions to improve these percentages, and so the quality of its services, by:

The development and implementation of a red performance recovery plan. This is a comprehensive plan developed in conjunction with all directorates across the Trust to identify where and how improvements to performance can be achieved.

The implementation of a trial of ‘dispatch on disposition’, approved by Professor Keith Willett, National Director for Acute Episodes of Care at NHS England.

Dispatch on Disposition

In February 2015 the Trust was delighted to have been chosen, in partnership with London Ambulance Service, to pilot a new way for ambulance services to respond to 999 calls. The trial allows call-handlers a small amount of extra time to triage the patient over the telephone before dispatching an ambulance resource to respond.

This additional triage time does not apply to those incidents which are identified as immediately life-threatening (i.e. Red 1 incidents) where an ambulance resource continues to be dispatched immediately.

The limited extra assessment time ensures that call handlers are able to better deploy resources where they are most needed. The additional triage time also provides an opportunity to identify the most clinically appropriate response to meet the needs of the patient. In some cases this may not be an ambulance response, and patients may be better served by an immediate referral to another service (eg local GP, pharmacy or a walk-in centre).

The Trust is working with NHS England, the Association of Ambulance Chief Executives (AACE), the College of Paramedics and the London Ambulance Service during the trial period with strict oversight and monitoring of the results and impacts of these service changes, including patient safety. The trial is also subject to rigorous and independent external evaluation, the findings of which will be published in due course.

The trial commenced on 10 February 2015 and during the trial period (ie for the period 10 February 2015 to 31 March 2015) the Trust has been required to monitor against two sets of metrics for Red 1, Red 2 and A19 performance. In agreement with NHS England new calculation metrics for both Red 2 and A19 performance were introduced to take into account the additional telephone triage time before an ambulance resource is dispatched. The performance figures included within the Annual Report relate to the national ambulance performance target metrics. However, had the Trust been using the calculation metrics identified in the trial, this would have improved both Red 2 and A19 performance figures for the year as set out in the following table.

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Key Performance Indicators (Based on Trial Performance Metrics) Category A Performance

Target Actual Performance

2014/15

Red 17 75% 75.24%

Red 2 75% 72.30%

Category A19 95% 93.78%

Ambulance Clinical Quality Indicators (ACQIs)

ACQIs are designed to reflect best practice in the delivery of care for specific conditions and to stimulate continuous improvement in care. They were initially introduced in 2010/11, and since this time ambulance trusts have been working nationally to agree and improve the comparability of the datasets reported.

In February 2015 a national benchmarking day was led by the Trust’s Research and Audit Manager. The day aimed to build on the success of the 2013 workshop and improve comparative data quality through understanding. The results of the work will be shared with the National Ambulance Clinical Quality Group and the National Medical Directors Group during 2015/16.

Whilst there are currently no national performance targets for ACQIs, local thresholds have been agreed with the Trust’s commissioners and these are shown in the table below. In addition the data from the indicators is used to reduce any variation in performance across Trusts (where clinically appropriate) and drive continuous improvement in patient outcomes over time.

Further ACQI information is contained in Part 3 of this report and details of all ACQIs are contained in the Trust’s monthly Integrated Corporate Performance Report presented to the Trust Board of Directors and available on the Trust’s website.

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Outcome from Acute ST Elevation Myocardial Infarction (STEMI) - % of patients suffering a STEMI and who receive an appropriate care

85.0% 89.2% 89.6% 80.7% 89.5% 70.6%

7 The A8 Red 1 performance figure is identical in both performance tables because the way that life threatening emergency

calls are handled did not change during the trial.

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bundle.

Outcome from Stroke for Ambulance Patients - % of suspected stroke patients (assessed face to face) who receive an appropriate care bundle.

95.0% 97.4% 97.4% 97.1% 99.4% 93.5%

*Highest/Lowest Trust reporting has been noted for each indicator independently.

Data for these indicators is not currently available for information after October 2014. The longer timeframe for the production of this clinical data is due to the manual nature of the collection process and the delays experienced in collecting some of the data from third party sources.

The South Western Ambulance Service NHS Foundation Trust considers that this data is as described for the following reasons:

The Trust has robust data quality processes in place to ensure the reporting of performance information is both accurate and timely;

Information is collated in accordance with the technical guidance for the ACQIs.

The South Western Ambulance Service NHS Foundation Trust is taking the following actions to improve these percentages, and so the quality of its services, by:

Undertaking a programme of quality improvement activity across all regions, supported by Quality Improvement Paramedics.

Staff Survey One of the key findings in the 2014 national staff survey relates to staff recommending the Trust as a place to work or receive treatment. Staff were asked to rate their answer on a five point scale from “1” strongly disagree to “5” strongly agree. Staff responses were then converted into scores. The table below shows the Trust’s performance compared to last year, together with the performance of other ambulance trusts.

Staff Survey Indicator

Performance 2014

Performance 2013

National Ambulance

Average 2014

Highest Ambulance Trust 2014

Lowest Ambulance Trust 2014

Staff recommendation of the Trust as a place to work or receive treatment.

3.28 3.31 3.17 3.37 2.60

South Western Ambulance Service NHS Foundation Trust is taking the following actions to improve staff engagement, and so the quality of its services, by:

Reviewing the results of the 2014 staff survey with each of the locality managers to develop suitable targeted action plans for their individual areas aimed at improving response rates and performance across the Trust.

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Ensuring that staff have the opportunity to give feedback on this point through ongoing implementation of the Friends and Family Test for staff throughout 2015/16.

National Reporting and Learning System All Trusts are required to provide confidential and anonymised reports of patient safety incidents to the National Reporting and Learning System (NRLS). This information is analysed to identify common risks to patients and opportunities to improve patient safety. These incidents are identified through the Trust’s incident reporting processes, and of the 10,544 incidents reported during the 2014/15 year, 1,4868 have been identified as relating to patient safety.

The National Patient Safety Agency recognised that organisations that report more incidents usually have a better and more effective safety culture, stating ‘you can’t learn if you don’t know what the problems are’.

Indicator/Date

2014/15** 2013/14 National Average

Highest Trust*

Lowest Trust*

1 Oct to 31 Mar

01 Apr to 30 Sep

01 Oct to 31 Mar

01 Apr to 30 Sep

1 April to 30 Sept 2014

Total Incidents Reported to NRLS

1,252*** 234*** 699 730 434 843 196

Number of Incidents Reported as Severe Harm

27 5 2 21 9 29 0

Number of Incidents Reported as Death

2 1 0 0 3 13 0


**This information is sourced from the Trust’s incident reporting system based on the criteria used in NRLS reports. All other information in this table is published by the NRLS based on the data they received and collated from the Trust during their reporting periods. Information is published in arrears, and therefore the most recent information available from the NRLS relates to the period 1 April to 30 September 2014.

*** The apparent variation in these figures from previous reporting periods is as a result of changes to the staff involved in uploading incidents to NRLS rather than the actual number of incidents over the reporting period.

South Western Ambulance Service NHS Foundation Trust considers that this data is as described for the following reasons:

The Trust has a good culture for reporting adverse incidents.

Information is provided to the NRLS electronically through the upload of data taken from the Trust’s adverse incident reporting system.

8 This figure only includes incidents that were reported on the Datix system 2014/15. The table overleaf includes

incidents that were exported to NRLS in 2014/15.

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The Trust has taken the following actions to improve this number, and so the quality of its services, by:

o Continuing to encourage the reporting of adverse incidents by all members of staff so learning can occur at all levels of the Trust.

o Reviewing the mechanisms for learning from adverse incidents to ensure this is done quickly and effectively, and disseminated to staff so they have continued confidence in the reporting system.

o Reviewing the mapping of coding of patient safety incidents with the NRLS to ensure reporting is consistent with national requirements.

Part 3: Quality Overview 2014/15

This section provides an overview of other performance metrics for the Trust.

Additional Quality Achievements and Performance of Trust against selected

metrics

The indicators and information contained within this section of the report have been selected to describe the Trust’s continuous quality improvement journey. They build on the indicators reported in the previous Quality Reports and where possible historical and national benchmarked information has been provided to help contextualise the Trust’s performance.

Right Care

In 2010, the Trust developed the Right Care, Right Place, Right Time initiative. This five-year commissioner funded agreement that committed the Trust to reducing unnecessary admissions to Emergency Departments (EDs) by 10%, through managing patients using alternative pathways. Many of the patients that call 999 can be managed safely and effectively without the need for an emergency ambulance to take them to an ED. An increasing proportion can be managed through telephone assessment, and sometimes referral to another service, such as making their own way to a Minor Injuries Unit. Over half of the Trust’s patients can be managed by highly skilled ambulance clinicians in their own home, delivering care that has historically only been delivered within a hospital, for example suturing (stitching) a wound.

Delivering the right care for patients, outside of an ED wherever possible and at the time of the call has three significant advantages. Patients receive care without having to leave their home, ED have greater capacity to deal with true emergencies and precious emergency ambulances are better able to be utilised to attend patients who most need a rapid response.

This successful initiative resulted in the proportion of 999 calls that were managed without attending an ED increasing from 50.84% in 2010/11 to 57.45% in 2013/14. In reality, this means that the Trust annually conveyed 83,517 fewer patients to EDs than the UK average for ambulance services. Following the success of the initiative, the Trust was commissioned in 2014/15 to deliver the Right Care2 programme.

The Right Care2 programme has built on this initial success to ensure that even more patients are able to be safely managed within in the community. During

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2014/15 8,148 fewer patients were conveyed to EDs than in the previous year, despite an 8.9% increase in the number of emergency calls received. The Trust estimates that managing patients more effectively in the community has led to savings of around £6,192,000 for the region’s health economy.

This improvement has been achieved through the introduction of a system to enable ambulance and ED clinicians to provide feedback on issues which prevent the delivery of the right care to a patient. Over 800 feedbacks were received during 2014/15, with many then shared with local Clinical Commissioning Groups (CCGs) to help identify service improvements. A wide range of projects have been completed to improve access to alternative care pathways, which include:

Producing the first South West wide list of the acceptance criteria for every MIU.

Developing a wide range of alternative hospital pathways.

Better publicising local services.

Auditing the management of healthcare professional calls.

Launching the Right Care education award.

Specialist Paramedic (ECP) Review to develop a strategy to better utilise our most clinically skilled staff.

Pilot to link with community pharmacies.

Holding Right Care2 roadshows at every Acute Hospital across the South to bring commissioners, hospital, community and ambulance clinicians together.

Utilising frontline Right Care2 station champions to promote the programme.

Better utilising social media to promote the initiative.

Clinical Guidelines

During 2012 the Trust introduced 24 new local clinical guidelines, to provide additional support to ambulance clinicians managing the more complex of medical presentations thereby ensuring that all patients receive the same high standard of care. During 2013/14 these guidelines resulted in the Trust winning a Shared Learning award from the National Institute of Health and Clinical Excellence (NICE).

As part of the planned two year cycle, all 24 of the guidelines were reviewed during early 2014 to ensure that they continued to reflect the latest evidence base. Ten of the existing 24 guidelines were revised to incorporate further learning from internal incidents and the latest published evidence. In addition, following positive feedback from ambulance clinicians, the following seven additional guidelines were also published:

Catheterisation;

Croup;

Headache;

Mental health and mental capacity;

Palliative Care;

Pain management;

Spinal management.

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All Trust clinicians were issued with an individual printed copy of the guidelines during October 2014, with electronic versions also being available on the internet, intranet and electronic Patient Clinical Record.

Care Quality Commission (CQC)

The Trust maintains its registration with the CQC with no conditions.

The Trust is proactive in ensuring compliance with CQC regulations through the maintenance of a centralised evidence system; an annual review of processes; and an annual assessment of compliance across all service lines by way of an internal audit review. A “green” rated internal audit outcome was achieved for 2014/15 with the Trust robustly evidencing compliance against all three of the outcomes reviewed.

No inspections were undertaken by the CQC during 2014/15, with the last inspection being carried out in February 2014. That inspection, which was routine and not triggered as a response to any concern, resulted in a very positive outcome with the Trust being judged as fully compliant with the five outcomes assessed.

The CQC is changing the way in which it inspects health and social care organisations and a new regime was implemented for ambulance trusts during 2014/15. The Trust is not anticipating being inspected during the first half of 2015/16; however, it has commenced its preparation to ensure it maintains its unconditional registration.

Patient Safety Incident Reporting

As reported in Part 2 of this report, the Trust has a central reporting system for adverse incidents, including near misses, as well as moderate and Serious Incidents (SIs).

All three core service lines for the Trust: A&E; Patient Transport Service (PTS) and Urgent Care Service (UCS), are covered in the patient safety measures reported within this section, including the table below which sets out the categories and numbers of incidents managed by the Trust.

Other Patient Safety Measures 2014/15 2013/14

Adverse Incidents 1,450 1,2709

Moderate Harm Incidents 48 18

Serious Incidents 56 78

The Trust reports information relating to adverse incidents, moderate harm incidents and SIs to a variety of forums, in order for themes and trends to be identified. Having

9 A figure of 6,787 was reported in the 2013/14 Quality Account and Report. That figure, however,

related to all adverse incidents reported during 2013/14 rather than those which specifically related to patient safety.

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a centralised team monitoring the incoming incidents provides another mechanism to support trend analysis.

Working groups within the Trust receive reports on incidents relating to their remit. In addition the Trust has an Experiential Learning Forum (ELF) whose specific duty is to undertake focused reviews of themes identified from trends identified, or concerns raised as a result of feedback. The focused reviews that took place during 2014/15 included Mental Health and Capacity, Health and Wellbeing, and the non-conveyance of patients.

Recommendations resulting from incident investigations and the work of ELF during 2014/15 include:

Review and circulation of a new spinal care clinical guideline;

Development of a two day investigation course for new Operational Officers to improve the quality and standard of investigations;

A review of guidelines in relation to the assessment of paediatrics and adolescents presenting with the symptoms of meningitis;

Implementation of a process within the Clinical Hub to look at patterns of staff errors, identify issues and address them with additional support and training;

A change to the order of the opening script for third party callers contacting NHS 111;

An additional focus on training within NHS 111 on the management of emergency calls.

Serious Incidents

A fundamental part of the Trust’s risk management system is appropriately managing SIs to ensure lessons are learned. SIs are identified through a systematic review of both adverse incidents and patient feedback. All incidents that are believed to potentially meet the nationally set criteria for a SI are passed to the clinically qualified Patient Safety Manager for preliminary review, before being circulated to the Director led decision making group.

It is important to note that the proportion of SIs as a percentage of patient contact activity remains very low. In addition, the Trust has seen a decrease in SIs in 2014/15. Analysis of the 2014/15 SIs had identified that there is an equal split between those identified for the North and East/West divisions for the A&E service line. In addition, the majority of SIs which related to the Trust’s A&E Clinical Hubs took place within the North Division, with two of these incidents relating to cross border arrangements. As a result of these incidents work has taken place with neighbouring ambulance services to address the lessons learned.

SI investigations are considered within Serious Incident Review Meetings which are designed to identify organisational learning. These meetings are chaired by a Clinical Director or Deputy Director with a clinical background. All staff involved in the incident are invited to attend as this provides the best opportunity for the Trust to identify learning. Learning can either be at a local, Trust wide or at times national level, for example referring learning to NHS Pathways to help them improve the national Pathways system. A Serious Incident Action Plan is maintained to monitor progress against actions identified.

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The Trust has contributed to the National Ambulance Service Risk and Safety Forum (NASRAF) review of SIs reported by all Ambulance Trusts. This identified very similar themes to those being seen at this Trust.

Duty of Candour

On 1 April 2013, the contractual Duty of Candour was introduced for all NHS Trusts to report to patients or their next of kin where it is identified that moderate or severe harm has resulted from care provided by the Trust (where this has not already been identified as a serious incident). This duty became regulatory on 27 November 2014 and was included within the Health and Social Care Act 2008 (Regulated Activities) as Regulation 20.

The Trust has developed a process for the management of these incidents which has been agreed with commissioners.

The Trust supports an open culture and has introduced a ‘Proactive Apology Process’ which involves apologising to patients when the level of service that has been provided to them is below the standard that the Trust would expect. This process, which applies to incidents rated as being negligible or low, complements the Trust’s approach to the Duty of Candour.

Central Alert System

The Central Alert System (CAS) is an electronic web-based system developed by the Department of Health, the National Patient Safety Agency (NPSA), NHS Estates and the Medicines and Healthcare products Regulatory Agency (MHRA). This aims to improve the systems in NHS Trusts for assuring that safety alerts have been received and implemented. During 2014/15 the Trust acknowledged 100% of CAS notifications within 48 hours, thereby meeting the national requirement. The number of notifications received is set out in the following table.

Other Patient Safety Measures 2014/15 2013/14

Central Alert System (CAS) Received 157 232

Clinical Effectiveness The Trust is committed to maintaining excellent standards of clinical effectiveness, developing its existing practice and processes through the review of learning, audit, guidance and best practice.

The following table shows the Trust’s Category A Performance by Clinical Commissioning Group.

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Red 1 Performance Red 2 Performance A19 Performance

Clinical Commissioning Group

No of Incidents*

2014/15* 2013/14 No of

Incidents* 2014/15* 2013/14

No of Incidents*

2014/15 2013/14*

Kernow 1,601 74.83% 70.44% 33,435 69.20% 76.67% 34,826 90.74% 94.24%

South Devon & Torbay

966 83.23% 78.49% 18,656 75.99% 82.49% 19,617 96.21% 97.77%

NEW Devon 2,486 79.49% 78.88% 51,516 75.61% 81.98% 53,720 93.69% 95.91%

Somerset 1,399 72.98% 71.56% 28,531 70.92% 78.17% 29,886 92.82% 95.88%

Dorset 2,517 84.07% 83.63% 47,531 73.70% 81.78% 49,970 95.77% 97.86%

North Somerset

816 70.34% 63.36% 11,451 68.56% 67.70% 12,255 93.25% 93.15%

Bath & NE Somerset

594 74.75% 71.50% 8,409 72.22% 74.10% 9,001 93.73% 94.71%

Bristol 2,045 76.63% 78.17% 27,922 74.29% 78.50% 29,931 97.11% 97.87%

South Gloucestershire

808 65.35% 62.71% 12,235 63.64% 66.36% 13,037 94.58% 96.75%

Gloucestershire 2,223 67.07% 69.10% 30,573 66.44% 71.92% 32,790 91.53% 94.44%

Wiltshire 1,479 65.86% 58.73% 22,569 62.28% 64.38% 24,013 88.71% 90.72%

Swindon 839 81.88% 88.70% 11,705 79.03% 87.70% 12,545 96.99% 99.00%

Trust 17,806 75.24% 73.15% 305,072 71.42% 72.23% 322,159 93.62% 95.76%

Urgent Care Service

The Urgent Care Services, both GP Out of Hours and NHS 111, are monitored through the assessment against national quality requirements. These quality requirements cover a number of different areas (including the auditing of calls and patient experiences). This information is reported in the Integrated Corporate Performance Report, presented to the Board of Directors at each meeting, and available on the Trust’s website

GP Out of Hours Service

During 2014/15 the Trust delivered GP Out of Hours Services across Dorset, Somerset and Gloucester. The table below shows the achievement of the national quality requirements. These requirements are set by the Department of Health and are applicable to every Out of Hours service in England.

Despite a challenging year, the Out of Hours services performed well and improved on last year’s performance against the quality requirements. In order to meet some of the challenges faced by the service, we implemented a number of actions including changes to the triage queue to enable GPs in local treatment centres (and

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in some cases from their own homes) to triage patients when they have spare capacity, thereby enhancing and supporting the capacity of our central triage team. Other actions have included revising the training plan for supervisors and dispatchers to ensure a high level of focus on responding quickly to patients with urgent needs; enhancing GP pay in both Dorset and Somerset to encourage good levels of shift coverage; reviewing shift patterns to make them more attractive for GPs; and implementing direct booking into treatment centres by the NHS 111 services to free up GP time.

Quality Requirement Target Dorset Somerset Gloucester

QR1 - Providers must report regularly to NHS Commissioners on their compliance with the Quality Requirements

Compliance Compliant Compliant Compliant

QR2 - Percentage of Out-of-Hours consultation details sent to the practice where the patient is registered by 08:00 the next working day

95.00% 99.51% 99.74% Compliant

QR3 - 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


QR4 - Providers must regularly audit a random sample of patient contacts (audit should provide sufficient data to review the clinical performance of each individual working within the service)


QR5 - Providers must regularly audit a random sample of patients’ experiences of the service


QR6 - Providers must operate a complaints procedure that is consistent with the principles of the NHS complaints procedure


QR7 - Providers must demonstrate their ability to match their capacity to meet predictable fluctuations in demand for their contracted service


QR10a - All immediately life threatening conditions (walk in patients) to be passed to the ambulance service within 3 minutes of face to face presentation

95.00% n/a n/a n/a

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QR10b - Definitive Clinical Assessment for Urgent cases presenting at treatment location to start within 20 minutes - not applicable to this service as a separate clinical assessment is not carried out between presentation and clinical consultation at walk-in-centres

95.00% n/a n/a n/a

QR10b - Definitive Clinical Assessment for Less Urgent cases presenting at treatment location to start within 60 minutes - not applicable to this service as a separate clinical assessment is not carried out between presentation and clinical consultation at walk- in-centres

95.00% n/a n/a n/a

QR10d - At the end of an assessment, the patient must be clear of the outcome


QR11 - Providers must ensure that patients are treated by the clinician best equipped to meet their needs in the most appropriate location


QR12 – Emergency Consultations (presenting at base) started within 1 hour

95.00% 50.00% n/a (no

emergency cases)

100.00%

QR12 - Urgent Consultations (presenting at base) started within 2 hours

95.00% 92.27% 94.74% 95.68%

QR12 - Less Urgent Consultations (presenting at base) started within 6 hours

95.00% 96.73% 97.15% 95.76%

QR12 - Emergency Consultations (home visits) started within 1 hour

95.00% 75.00% 100.00% 100.00%

QR12 - Urgent Consultations (home visits) started within 2 hours

95.00% 91.76% 91.57% 94.03%

QR12 - Less Urgent Consultations (home visits) started within 6 hours

95.00% 95.45% 97.67% 97.19%

QR13 - 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


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NHS 111

The Trust commenced delivery of the NHS 111 service across Devon, Dorset, Somerset and Cornwall during 2013/14. The following table shows the activity levels for the four counties during their first full year of operation in 2014/15, and the performance against national quality requirements. As with Out of Hours services, national quality targets are set out by the Department of Health for NHS 111 services and are applicable to every service in England.

Whilst the Trust has provided high quality clinical care when delivering the NHS 111 service, it has not been able to achieve the exacting targets relating to the percentage of calls being answered within 60 seconds and the percentage of abandoned calls. These targets have not been achieved due primarily to high levels of call volumes at peak periods. These demand patterns require very large numbers of NHS 111 call advisors to be employed for peak times at weekends over short shift durations; i.e. between 08:00 and 13:00 hours and between 16:00 and 20:00 hours on Saturdays and Sundays.

Whilst the Trust has recruited and trained a high number of call advisors for weekend working and improved the recruitment and retention process, these staff can be difficult to retain due to local job market forces and the nature of the service which requires high numbers of part time staff.

Despite great efforts and additional significant investment, the Trust has reached the decision that the current NHS 111 operating model is not sustainable and so, with great regret, has exercised its right to service notice on the NHS 111 contracts in Devon and Cornwall and will not deliver these after 31 March 2016. The Trust will be working closely with commissioners during the notice period to ensure a smooth handover to the new service provider.

Quality Requirement Target Dorset Devon Somerset Cornwall and IoS

Activity (Total calls answered) N/A 248,683 384,831 154,773 129,940

QR1 - Providers must report regularly to NHS Commissioners on their compliance with the Quality Requirements Compliance Compliant Compliant Compliant Compliant

QR2 - Providers must send details of all consultations (including appropriate clinical information) to the practice where the patient is registered by 0800 the next working day.

95.00% 88.82% 97.76% 96.71% 96.46%

QR3 - 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

Compliance Compliant Compliant Compliant Compliant

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QR4 - Providers must regularly audit a random sample of patient contacts (audit should provide sufficient data to review the clinical performance of each individual working within the service)


QR5 - Providers must regularly audit a random sample of patients’ experiences of the service 1.00% 0.29% 0.38% 0.36% 0.33%

QR6 - Providers must operate a complaints procedure that is consistent with the principles of the NHS complaints procedure


QR7 - Providers must demonstrate their ability to match their capacity to meet predictable fluctuations in demand for their contracted service

Compliance Non-

Compliant Non-

Compliant Non-

Compliant Non-

Compliant

QR8a - No more than 5% of calls abandoned before being answered 5.00% 4.10% 5.07% 5.33% 6.08%

QR8b - Calls to be answered within 60 seconds of the end of the introductory message

95.00% 83.68% 79.91% 80.65% 77.09%

QR9a - All immediately life threatening conditions to be passed to the ambulance service within 3 minutes

100.00% 94.15% 95.45% 91.38% 95.15%

QR9b - Patient callbacks must be achieved within 10 minutes 100.00% 24.63% 44.72% 24.56% 22.97%

QR13 - 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

100.00% 100% 100% 100% 100%

QR14 - Providers must demonstrate the online completion of the annual assessment of the Information Governance Toolkit at level 2 or above and that this is audited on an annual basis by Internal Auditors using the national framework


QR15 - Providers must demonstrate that they are complying with the Department of Health Information Governance SUI Guidance on reporting of Information Governance incidents appropriately.


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Tiverton Urgent Care Centre

The Trust took over the management of the Urgent Care Centre in Tiverton in July 2014. The primary measure within the operating contract is the 4 hour waiting time standard, which is the same target for acute trust emergency departments.

Indicator Target 8 July 2014 – 31 March 2015

Percentage of cases completed within 4 hours 95% 99.43%

Ambulance Clinical Quality Indicators

The following tables show Trust performance for further ACQIs. As previously stated one of the Trust’s quality priorities for 2014/15 was the development of a Post ROSC Care Bundle.

Indicator

Ye

ar

to d

ate

201

4/1

5

(Ap

r to

Oc

t)

201

3/1

4

Na

tio

na

l A

vera

ge

(Ap

r to

Oc

t 2

01

4)

Hig

he

st

Tru

st

Pe

rfo

rma

nc

e

(Ap

r to

Oc

t 1

4)*

Lo

we

st

Tru

st

Pe

rfo

rma

nc

e

(Ap

r to

Oc

t14)*

Return of spontaneous circulation (ROSC) at time of arrival at hospital (Overall)

24.8% 24.8% 27.5% 41.4% 18.7%

Percentage of Face Arm Speech Test (FAST) positive stroke patients (assessed face to face) potentially eligible for stroke thrombolysis, who arrive at a hyperacute stroke centre within 60 minutes of call

56.9% 55.6% 60.6% 71.6% 47.5%


The table above would seem to indicate that the Trust’s performance is below the national average for ROSC and FAST. However, it should be noted that nationally there is variation amongst ambulance trusts as to how data is reported. In light of this, actions are being taken at a national level to ensure that the data criteria is more robustly applied to enable more meaningful comparisons between trusts. Nevertheless, the Trust is still actively engaged in improvement activity in these areas with clinicians being involved in ongoing discussions regarding the progress of ACQIs and a programme of research activity continuing.

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Indicator

Ye

ar

to d

ate

20

14

/15 (

Ap

r

to F

eb

20

15

)

20

13

/14

Nati

on

al

Ave

rag

e (

Ap

r

14

to

Fe

b 1

5)

Hig

hes

t T

rust

Pe

rfo

rma

nce

(Ap

r 1

4 t

o

Fe

b 1

5)

Lo

we

st

Tru

st

Pe

rfo

rma

nce

(Ap

r 1

4 t

o

Fe

b 1

5)

Calls closed with telephone advice 8.3% 6.8% 8.0% 13.4% 3.4%

Incidents managed without the need for transport to A&E

52.3% 51.6% 37.1% 52.4% 27.3%


Last year’s Quality Account reported on the first stage of Transforming Urgent and Emergency Care, which identified that by supporting and developing paramedics and providing direct access to GPs and specialists, around half of all 999 calls requiring an ambulance could be managed at the scene without an unnecessary trip to hospital. The Trust has been working with commissioners and other partner organisations throughout 2014/15 to deliver this priority element of the Right Care initiative. The outcome of this focus is evident in the improved performance of “Hear and Treat” as set out in the table above which shows the percentage of calls closed with telephone advice and those managed without taking the patient to an ED.

Research Activity

Poster Displays at External Conferences

During 2014/15 the Research and Audit team showcased their work to a national audience through attendance at several key conferences. Posters were displayed at the National Health Service Research Network Conference, the National College of Paramedics Conference and the 999 EMS Research Forum. One of the team also won the prize for ‘Most innovative use of routine data’ at the 999 EMS Research Forum.

Research Showcase

The Trust held its second annual Research Showcase in Exeter during March 2015.

The aim of the event, hosted by the Trust’s Research and Audit Team, was to showcase some of the research currently being undertaken within the Trust and to promote engagement with staff and students, highlighting some of the ways in which they can become involved in, and develop, a research career. The event brought together a multi-disciplinary group including a wide range of staff grades, students from University partners, and representatives from the research community and Higher Education Institutions (HEIs).

The speakers presented on a range of projects, including both recently completed and ongoing studies:

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Modelling the Increase in Ambulance Demand - The Peninsula Collaboration for Leadership in Applied Health & Care (PenCLAHRC) led on this operational research, which used a system dynamics model to examine factors relevant to the increase in demand for ambulance resources in the South West.

The OAK Project - Funded by the National Institute for Health Research from the Research for Patient Benefit Programme (NIHR RfPB), aimed to examine whether Ambulance Paramedics and Emergency Care Practitioners can use FRAX® (the WHO Fracture Risk Assessment Tool) to assist GPs in improving the future fracture risk in patients that fall. The feasibility of using the tool and the challenges of patient follow up were discussed.

The CAIRO Project is funded as a National Institute for Health Research (NIHR) Programme Development Grant. One of the Trust’s Research Paramedics gave an overview of the different work packages and how the feasibility of the project will be evaluated ahead of a potential full grant application.

Pre-Hospital Lactate – This small scale service evaluation aimed to assess the feasibility and use of pre-hospital point of care lactate monitors in a single trial area attending one acute Trust.

Airways 2 – Building on previous randomised feasibility work undertaken in the Trust, the Airways 2 project is a multi-centre cluster randomised controlled trial funded by the NIHR. The study will aim to compare supraglottic airway devices (devices which are introduced into the pharynx, ensuring the upper respiratory tract remains open) with current practice during pre-hospital cardiac arrest.

The Shiftwork Study - This qualitative study, funded with a research grant from the College of Paramedics, explored the views of Paramedics on the impact of working shifts.

The Single Dose Activated Charcoal Study (SDAC) – This local trial evaluated the feasibility of using SDAC as an acceptable and effective treatment for self-poisoning in a pre-hospital setting.

Representatives from one of the local medical schools were available to enthuse and encourage delegates with their opportunities for Masters level study. The event was also supported by representatives from one of the Trust’s lead NHS health libraries. There was a display dedicated to the library services with copies of resources available for delegates.

A poster display included some of the ongoing research and quality improvement projects conducted by staff and some that involved collaborations with HEIs and other Trusts. There was also a dedicated display for student projects and two prizes were awarded for these prior to the day.

The event was shared with a global audience through social media. Over 300 ‘tweets’ resulted in over 410,000 twitter impressions. The Research and Audit Team are already planning for the 2015/16 event.

Patient Experience Patient experience and patient engagement provide the best source of information to understand whether the services delivered by the Trust meet the expectations of the patient, including assessing whether a quality service is provided.

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The following table shows some of the Trust’s existing methods and quantitative information on service user experience.

Patient Experience Measures 2014/15 2013/14

Complaints, Concerns and Comments10 1,268 1,020

Patient, Advice and Liaison Service (PALS) – Lost Property, signposting to other services etc

857 711

Health Service Ombudsman complaints upheld 2 1

Compliments 2,055 1,456

Compliments

The Trust receives telephone calls, letters and emails of thanks from many patients every week. Wherever possible this gratitude is passed directly onto the members of staff who attended the patient or service user.

599 more compliments were received during 2014/15 than in the previous year, which equates to a 41% increase. This, however, may be due to the way in which the process is now managed, with all data being collated centrally to enable more accurate reporting.

The Trust continues to use ‘wordles’ – a visual representation of the key words included in the compliments received. These are shared on the Trust’s intranet so that all staff can see the type of positive feedback that the Trust receives about the work that they do.

The picture below is a year-end summary of the compliments received for 2014/15, the larger the word/phrase the more frequently it was used.

10 When noting the number of comments, concerns and complaints received it is important to

consider that the Trust proactively invites feedback from patients and their representatives.

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Patient Engagement

During 2014/15 the Trust continued to develop its patient engagement activities. This engagement helps to ensure that the Trust’s services are responsive to individual needs; are focused on patients and the local community; and support the Trust in improving the quality of care provided.

The Patient Engagement Team source patient stories for use at the start of each meeting of the Board of Directors and of the Council of Governors. These stories can be written testimonies, which are read out by a member of the forum and more recently have involved audio and video patient interviews obtained by the Patients Association as part of the Trust’s membership of this organisation.

Patient Opinion

Patients and their relatives and carers can post details of their experience on the “Patient Opinion” website, with these posts being available to anybody visiting the site. The Trust responds to every comment about its service. Where the feedback is negative or indicates service failure, the individual who provided the comments is invited to contact the Trust directly with further details so that the concerns can be addressed by the Patient Experience Team. Where the post is positive and the incident in question can be identified, the posting is passed directly to the member(s) of staff involved. If there is insufficient detail the Patient Engagement Team will respond requesting additional information in order to be able to convey the positive feedback.

During the year 271 stories relating to the Trust have been posted on Patient Opinion. As of 31 March 2015 these accounts of patients’ experience had been viewed more than 47,590 times.

The headlines of the top three stories, based on number of times they have been viewed, are shown below.

“Paramedic arrived like a knight in shining armour.”

“Emergency air lifted after tractor accident.”

“Impressed by kindness and teamwork.”

Patient Experience Surveys

The Trust audits 1% of patient contacts every month for the NHS 111 contracts and separately for the GP Out of Hours contracts from the responses received from a fortnightly survey. The survey sample is randomly selected and then an audit is undertaken to remove any individuals who it would not be appropriate to contact, for example a sensitive case that may related to a safeguarding concern.

A paper questionnaire is sent out to respondents, which also contains a link to the online survey. The survey includes a series of questions under the following headings:

Friends and Family Test

Getting through

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After the call

Satisfaction

Use of 111/Out of Hours telephone service and satisfaction with the NHS

Caller/patient information

The Trust provides a monthly report to commissioners on the number of calls taken; and the forms returned within that period. A full report is submitted to commissioners every six months.

During the year 661 people responded to the survey in respect of their NHS 111 experience. These responses highlighted that further consideration needs to be given to communication about the service to manage patient expectations, whilst the issue of clinician availability was also raised.

836 responses were received from the GP Out of Hours surveys during the year. Feedback suggests that patients are satisfied with the service received, are likely to recommend the service and to use it again. The positive comments made particular reference to the quality of the service being provided, with patients describing the service as comprehensive, professional, caring and invaluable. Patients also highlighted the way the delivery of care made them feel; reporting feeling reassured and grateful to Trust staff who they described as friendly, sensitive and understanding.

The negative comments are often very detailed though are significantly less in number compared to positive comments. Patients have highlighted a concern regarding a delay in receiving a call back from Trust clinicians and feeling that diagnosis was rushed or incomplete. Patients also highlighted that they felt there should be more home visits made to assess and treat patients. At the end of 2014/15, the Patient Engagement Team has taken responsibility for conducting these patient experience surveys. The Team are using a revised version of the survey that was devised and tested by the Picker Institute at the Trust’s instruction. It is hoped that the new surveys will improve the Trust’s response rate and increase engagement from patients. Learning Disability

During 2014/15 the Patient Engagement Team has been working closely with Plymouth People First, a self-advocacy organisation for adults with a learning disability. There has been a focus on education about the Trust’s services and the development of a patient reference group.

The patient reference group, called SWAG (South Western Ambulance Group), which was established in September 2014, has a 12 month programme which has been agreed with all the members. The meetings of the group are very well attended and members have let the Trust know how much they value this engagement, as evidenced by the comments from group members overleaf:

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‘People were scared of being in an ambulance but not anymore. The ambulance service are now more aware of people with a learning disability.’

‘It’s good to mix with different people. I liked it when the ambulance students came to visit us; that was good.’

‘The group now know more things. As we know the uniform is green we won’t be scared in an emergency as we know the uniforms.’

It is intended that learning from this initiative can be shared across the Trust where appropriate.

Friends and Family Test for Patients

The FFT is a single question survey which asks patients whether they would recommend the NHS service they have received to friends and family who need similar treatment or care. Implementation of this survey was one of the key priorities in the Quality Account for 2014/15.

Public and Patient Involvement

During 2014/15 148 patient and public involvement events were attended, staffed predominantly by volunteers drawn from clinicians, managers, administrators, governors and community first responders.

Examples of the types of events include county shows, community fetes and fairs, school and college visits and public health awareness days. These events provide a fantastic opportunity to engage with existing patients and potential service users, informing them about the services provided and obtaining their views on them.

The events also provide an opportunity to deliver proactive health checks, 1,262 members of the public received a ‘know your blood pressure’ check and 48 people within the community received a free NHS Health Check, covering blood pressure, body mass index, blood glucose and cholesterol levels. The results are provided immediately and where necessary recommendations about further medical care, such as attending their own GP, were made.

A number of activities were also undertaken in conjunction with our partners and included involvement in Road Safety Partnership events, taking part in the festive ‘Drink Drive’ campaign and by placing the Trust’s Mobile Treatment Centre in town centres to enable on the spot access to health care. All of these activities resulted in positive engagement with the community.

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Assurance Statements – Verbatim

Clinical Commissioning Groups (CCG)

South Central and West Commissioning Support Unit South Central and West Commissioning Support Unit (SCWCSU), who manage the 999 contract on behalf of Clinical Commissioning Groups across the South West (referred to as commissioners) is pleased to provide a combined commentary on the South Western Ambulance Service NHS Foundation Trust (SWASFT) Quality Account. SCWCSU have put routine processes in place with SWASFT to agree, monitor and review the quality of services throughout the year covering the key quality domains of safety, effectiveness and experience of care. SWASFT is a responsive, dynamic and innovative organisation, and has worked hard to develop excellent working relationships with commissioners. SWASFT has taken on board extra responsibilities over the past two years including NHS 111 provision but this commentary is primarily based on knowledge of SWASFT as a provider of 999 services. SWASFT makes an important contribution to the health and wellbeing of the population within CCG localities through the services it provides and is committed to providing safe, high quality, clinically effective care. The achievements noted in the Quality Account for 2014/15 demonstrate this. Quality Accounts are intended to help the general public understand how their local health services are performing and with that in mind they should be written in plain English. SWASFT has produced a comprehensive, well written Quality Account. It is easy to read and clearly set out. The document outlines SWASFT’s approach to delivering quality care and quality improvement within its services, providing an open account of their performance in terms of patient safety, patient experience and clinical effectiveness. Commissioners have reviewed the Quality Account and can confirm that the information presented appears to be accurate and demonstrates a successful organisation and a high level of commitment to quality in the broadest sense which is commended. The information it contains accurately represents SWASFT’s quality profile and contains appropriate statements of assurance from the Board. It reflects the very good work undertaken by the organisation and sets out clearly the quality ambitions, challenges and achievements from 2014/15 and sets the direction for 2015/16. Review of Quality Priorities for 2014/15 Commissioners have noted SWASFT’s performance against last year’s quality priorities. They are of the opinion that, in addition to the information given, it would be good to see more outcome focused data from these priorities as well as from other patient safety initiatives during the year. Commissioners would also like to

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have seen the plans on how SWASFT will improve performance for 2015/16, where priorities were not fully achieved. Patient Safety Priority 1: Sepsis (partially achieved) The Quality Account highlights the work SWASFT has done to improve the early identification of sepsis, which is a major cause of unexpected death in the UK. Given the continued and justified local, regional and national focus and commitment to the management of this important clinical issue, commissioners recognise the work undertaken by SWASFT in support of this priority. Commissioners are particularly keen to ensure people with sepsis are identified and treated within the ‘golden hour’ and the work SWASFT has done to date, especially in the development of the Sepsis Assessment and Management (SAM) has been a major support to that initiative. Commissioners are very pleased to note the full engagement of SWASFT in the local and national work to reduce the risk of avoidable child death from sepsis. SWASFT have been a committed partner in the pilot work in Torbay and continues to be a key player in the on-going initiatives to combat sepsis for all ages. The multi-agency group on Paediatric Sepsis (lead by NHS England DCIoS Area Team) was formed to find whole health system changes that would reduce the risk of avoidable child death from sepsis. The group included primary and secondary care, Devon CCG, Devon Doctors and SWASFT and also invited parents of one child who had died and were campaigning for improvements in the care system. The product and effects of these changes are being tested in Torbay and is being evaluated by Plymouth University over the summer. The work of SWASFT in this Quality Account therefore needs to be viewed in this wider context, in supporting both the regional and national direction in travel in respect to sepsis management is to be applauded. Further to this, the most important element of this work has been in supporting parents and carers to make appropriate decisions with the development of the Sepsis Assessment and Management (SAM) leaflet and a clear commitment to ensuring sepsis is quickly identified and treated and harm. Following the evaluation by parents and clinicians of the SAM leaflet, any necessary changes will be made and the SAM leaflet reissued. Clinical Effectiveness Priority 2: Electronic Care System (ECS) (achievement to be confirmed) The Quality Account presents work undertaken to implement the Electronic Care System (ECS) which will allow SWASFT to better manage patient care and report on better quality patient information, with the technical ability to integrate with hospitals and the wider health community system. Commissioners commend such innovative work and will be interested to note the long term success of this project (with supporting data highlighting improved client care).

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Commissioners would encourage SWASFT to be bolder in the roll out of the ECS, to further support the single view of the patient, service interoperability and increasing further clinical effectiveness through the potential better use of more appropriate care pathways. Priority 3: Primary Angioplasty (achievement to be confirmed) Commissioners are looking forward to being advised of the outcome of this work which has been attached to a CQUIN scheme. Patient Experience Priority 4: Friends and Family Test (FFT) (achieved) Commissioners are pleased to see that SWASFT achieved against the Friends and Family Test 2014/15 priority. Commissioners noted the positive responses to the FFT, however they would like to have seen more specific actions and outcomes in relation to how they are using patient feedback from the FFT initiative. Commissioners appreciate that this is not always an easy task for a provider of emergency care, where measures more easily employed in more traditional care settings can be more difficult to deliver. SWASFT’s approach in the implementation of the FFT can be applauded and whilst response levels have been low the feedback provided is noted to have been positive. SWASFT has also been able to confirm a reduction in complaints during 2014/15 and an increase in the number of compliments received. Commissioners recognise that the initiatives detailed for 2015/16 will generate an even greater opportunity for more patients to provide feedback to SWASFT allowing even greater reflection and consideration of the patient experience. Ensuring that FFT data will be accessible to the public demonstrates a transparent and open culture. The innovative decision to include FFT questions on patient safety details will enhance the response rate and should give a rich picture of the service. Quality Improvement Priorities for 2015/16 Commissioners are pleased to see SWASFT’s priorities for 2015/16 focusing on the ‘Sign Up to Safety’ agenda, Paediatric Big 6 and Frequent Callers. All are appropriate areas to target for continued quality improvements and link with the clinical commissioning priorities. The priorities demonstrate recognition of the need to advance clinical effectiveness as well as improve services across the whole patient pathway. Commissioners would support SWASFT in ensuring that this work is reflected across all of the services provided by them where relevant. They would like to see more specific and measurable quality outcomes set for these and have noted that it is quite powerful to acknowledge where something hasn’t gone as well as could be expected and what the lessons learned were in order for on-going improvement.

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Commissioners highlight that achievement of the Paediatric Big 6 priority will be through a Trust-wide CQUIN scheme. They are keen to ensure that this scheme builds on work already done and does not replicate it. If the Paediatric Big 6 priority is achieved SWASFT clinicians will be supported by the latest evidence/best guidance and patients will have access to equitable care pathways. The rationale outlines that one of the reasons for this priority is that ‘national data shows that the “Big Six” accounted for 50% of all emergency and urgent care admissions’ (2008/2009) and that there is scope to reduce this. Commissioners request that SWASFT consider as a measurement of achievement, an overall reduction in conveyances / admissions of the ‘Big Six’ conditions. The Frequent Callers priority will be through a Trust-wide CQUIN scheme, supported by commissioners, to help manage demand and release capacity for SWASFT, although more consideration needs to be given to what success will look like for both the organisation and the high users of SWASFT services - particularly care homes. They would like to see examples and evidence of how this has made a positive impact on this group of clients and how this has helped capacity in the service. Commissioners are of the view work around quality improvement (QI) will enhance the service even further with managers being able to complete the Institute for Healthcare Improvement (IHI) Accelerated Patient Safety Programme and QI paramedics able to support colleagues with QI projects and developments. Key Performance Indicators (KPIs) Whilst there was noted improvement in some of the indicators, performance had reduced from 2013/14. More detailed explanations on how SWASFT plans to improve on these in 2015/16 would provide further assurance to the public as well as commissioners and give more value to the significant work that SWASFT is doing. Commissioners acknowledge and commend the 8,148 fewer conveyances to ED despite an 8.9% increase in activity. It would be helpful to identify by commissioner the variance in activity and conveyances from 2013/14 to 2014/15 as the effect varies considerably across the commissioned service areas. Commissioners find it very disappointing that SWASFT’s performance against Red 1 and Red 2 within Wiltshire is one of the lowest and not within target although the CCG acknowledges an improvement on the previous year. Performance against Red 1 and Red 2 has also been disappointing within South Gloucestershire. Commissioners acknowledge this is alongside some challenging increases in ambulance activity locally in 2014/15. They hope work joint working in 2015/16 will improve the performance of these. Commissioners are supportive of the encouraging early results from the Dispatch On Disposition trial. The percentage of Hear and Treat non-conveyance has almost doubled indicating a better utilisation of vehicles and crew-skills. This has clearly contributed to management of acute and urgent care services in 2014/15.

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In relation to Percutaneous Coronary Intervention (pPCI), SWASFT refer to North performance against Call to Balloon Time targets as 85.2%. The Quality Account states the baseline, but does not confirm what the outturn performance is following the interventions taken to increase it. Commissioners are disappointed to see that the Return of Spontaneous Circulation (ROSC) and Percentage of Face Arm Speech Test (FAST) KPIs were both below the national average performance. SWASFT have advised they are aware that nationally there is variation amongst how ambulance services are reporting the ACQI data across all indicators. Steps are in place both nationally and locally to ensure that the inclusion criteria for this indicator is more robustly applied in order to facilitate meaningful comparisons, and SWASFT is leading on this work. In order to improve SWASFT’s performance, a post ROSC care bundle was introduced in 2012 and they are maintaining a focus of continuous quality monitoring which is reported to the Resuscitation Clinical Sub Group. When mapped as part of an SPC chart it is clear that SWASFT data is within the control limits. SWASFT is actively engaged in improvement activity, and all clinical staff who attend a patient in whom ROSC is gained receive individual feedback reminding them of the elements of the care bundle. An aide memoire has been attached (as part of a PDSA cycle) to defibrillators within two divisional areas to measure the impact on performance. SWASFT is actively engaged with a programme of research activity around cardiac arrest management, which may indirectly impact positively on this indictor. All Operational Officers participated in discussions around the ACQIs as part of the on-going engagement of the Medical Directorate and the Delivery teams with in the organisation. Commissioners wish to see the early implementation of NHS Pathways within the North locality in 2015/16 and the resulting improvement uplifts previous experienced within the East and West areas uniformly achieved across SWASFT. Quality Overview 2014/15 Commissioners have highlighted that the there is no mention of the locally agreed and funded Operational Resilience and Capacity Planning (ORCP) schemes or the centrally funded schemes, or their outcomes. Right Care 2 Commissioners are supportive of the Right Care 2 programme and in the success SWASFT has demonstrated during 2014/15 in safely managing patients in the community rather than conveying them to an Emergency Department (ED). Going forward, commissioners would request that further information is presented in the 2015/16 Quality Account in order to demonstrate to stakeholders the positive impact of the programme, including number of patients treated at the scene (including home) or redirected to other services. SWASFT has worked hard to maintain its UK-lead status for safe non-conveyance of 999 patients utilising two main streams of Hear and Treat and See and Treat.

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Commissioners are heartened by the robust approach undertaken by SWASFT in ensuring the safe delivery of Right Care 2. There is considerable sharing of issues between organisations and all primary care queries raised have been robustly investigated and answered satisfactorily. Commissioners also recognise the excellent work that has taken place during the lifetime of the Right Care initiative to reduce conveyances to ED. Having the highest non-conveyance rate in the South West has posed a challenging starting point for Right Care 2 in terms of driving further improvement in 2014/15. Commissioners would like to see fully developed local plans with clearly defined deliverables for 2015/16. NHS 111 Commissioners have commented that the full roll-out of 111 within the New Devon locality has been successfully delivered with robust monitoring and evaluation of performance. Quality monitoring of all issues raised has been at the forefront of SWASFT’s delivery with clinician to clinician contact where that has been required. There have been some issues of KPI delivery at times of extreme demand in the service but these have mirrored similar issues across the UK occurring with unprecedented peaks in telephone demand. SWASFT has been actively engaged in both local and peninsula-wide clinical effectiveness groups, attending national conferences and development when it is available. Commissioners can further confirm that SWASFT engage fully with the Directory of Services (DOS) team on a regular basis to understand how pathways leads to local services, most appropriate for the patient, again support both provider and commissioner in ensuring good use of local services close to people’s homes. Commissioners highlight that the account notes that SWASFT commenced delivering 111 services in 2013/14 but does not make mention of the fact that SWASFT has now given notice on the contracts for Devon and Cornwall. Tiverton Urgent Care Centre (UCC) Commissioners welcome the extensive input from SWASFT into innovation and development of services at Tiverton UCC. Not only has this provided a more robustly consistent service to the immediate surrounding area, but there has been a ‘can-do’ approach to testing alternatives to acute ED attendances based on improved multi-disciplinary team-worker at Tiverton. This work has been collaborative, transparent and based on improved patient experience, with commentary invited from observers and participants as to the effectiveness of the trial. Care Quality Commission Commissioners have commented that even though the CQC inspection occurred during 2013/14 it is good to see that the inspection did not trigger any concern and resulted in a positive outcome with SWASFT being fully compliant with all five outcomes assessed.

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Patient Safety Commissioners fully support SWASFT’s commitment to high quality, safe and effective care that provides a positive experience for the patient. SWASFT fully support the National Patient Safety Agency expectation to report all patient safety incidents that occur and are a high reporter of incidents. SWASFT continues to demonstrate that they have in place a culture that supports open investigation, review and a commitment to action and learning. This is an approach positively welcomed by commissioners. The reporting of incidents to the NRLS shows a positive increase in the number, though the Quality Account does not explain any highlighted themes or any learning derived from the increase in data. This would be helpful to demonstrate the importance of incident reporting. Concern has been expressed regarding the rise in number of incidents reported as severe harm and deaths in the latter half of 2014/15 and as to whether SWASFT is confident that the causes are understood and being fully addressed in 2015/16. The report explains a big variation in NRLS data between periods as “changes to the staff involved in uploading incidents” – commissioners have requested the provision of further explanation around this and assurance that the NRLS data is now being identified and uploaded appropriately. Clinical Effectiveness SWASFT have shown good involvement in both national and local audits however, commissioners feel it would be good to show the learning gained from these and how this will be taken forward in 2015/16. Patient Experience SWASFT has a number of systems in place to support patient and public feedback, engagement and involvement to ensure its services are responsive to individual needs. The Quality Account outlines the compliments, complaints and concerns SWASFT has received including those on the Patient Opinion website, and it is good to note the increase in the number of compliments received by SWASFT, whilst acknowledging that the new system allows for more accurate reporting of these. The Quality Account was particularly strong in areas of patient and public involvement and experience with good and clear explanation of both how this was achieved alongside the FFT. Although some patient stories were included there could have been more examples given to demonstrate their high level of public and patient engagement and could have been an opportunity to demonstrate this in more detail from the patient perspective.

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Commissioners commend the introduction of a ‘Proactive Apology Process’ and would appreciate an understanding of how this has impacted on the experience of patients and carers in the incident / complaints process. Commissioners recognise SWASFT’s work in supporting people with a Learning Disability. The work of the South Western Ambulance Group (SWAG) has allowed both service users and the service to learn more about each other in a positive and reflective way, removing a great deal of the anxiety and fear that an ambulance journey may cause. Feedback from service users has been very positive and the commissioners would welcome further development of SWASFT’s Patient Engagement Team’s work with people with a Learning Disability, their advocates and carers across the wider New Devon CCG footprint. Overall Commissioners are happy to commend this Quality Account and SWASFT for its continuous focus on quality of care. They look forward to continuing to work in partnership with SWASFT during 2015/16 and developing further relationships to help deliver their vision of healthy people, living healthy lives, in healthy communities.

NHS Dorset Clinical Commissioning Group Over the past 12 months South Western Ambulance Service NHS Foundation Trust (SWASFT) have continued to focus on improving the clinical outcomes, safety and experience of patients within the Urgent Care Service. The work that SWASFT has done throughout the year on improving compliance with the National Quality Requirements for the Out of Hours Service has seen continued improvement on last year’s performance with no areas of non-compliance at the year end. The Trust have fully delivered by the CQUIN schemes set by NHS Dorset and there have been particular areas of improvement in the identification and management of Venous Thromboembolism and in seeking patient feedback. The Trust have found sustaining performance in the 111 service a challenge, but the Trust is working closely with commissioners to improve this. In relation to the priorities identified for 2015/16 there is an increased focus on working on initiatives across all service lines which NHS Dorset CCG welcomes. The CCG recognises and endorses the priorities for the 999 element of the service which support some of the priorities that the CCG will also focus on, particularly in relation to the management of sepsis. The CCG would like to note that a CQUIN plan is being developed for Urgent Care Services for 2015/16 that seeks to improve quality, safety and experience of service users and supports some of the priorities set out by the Trust. The CCG looks forward to working with SWASFT over the coming 12 months to maintain and improve high quality healthcare services for the population of Dorset.

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Local Health and Overview Scrutiny Committees

Poole Health and Social Care Overview and Scrutiny Committee

(HSCOSC)

Members of Borough of Poole’s Health and Social Care Overview and Scrutiny Committee would like to thank South Western Ambulance Service NHS Foundation Trust for the chance to comment on their account of activities undertaken to improve services over the 2014/15 financial year.

The HSCOSC are heartened to note the Trust’s drive for maintaining quality and innovation. We have noted your successful partnership working around mobile alcohol recovery services; that the Trust’s Right Care initiative is leading the way in enabling patients to receive the right care without being conveyed to an emergency department and that you have recognised crucial partners have been involved in achieving this.

It is also encouraging to read that the results of the Care Quality Commission’s “Hear and Treat Survey” which found that 90% of callers who did not receive an ambulance response felt the first person that they had spoken to was re-assuring and the patient had understood the advice given. Members are also delighted to hear that the “Dispatch and Disposition” pilot has led the Trust to amend 999 call handling procedures to enable the Trust to fully triage the call rather than allocating a resource to every incident when an address is available. It will be interesting to understand further if this has had a positive impact in reducing the numbers of ambulances deployed when unnecessary.

Members note that the four priority areas for 14/15 of patient safety, primary angioplasty, clinical effectiveness and patient experience have made progress. This has meant greater identification of Sepsis at an earlier stage; better pathway management and information sharing which has led to better clinical outcomes for patients through the use of the Electronic Care System; an improvement in achieving the target time for those treated for primary angioplasty and implementing the Friends and Family Test using a number of different accessible methods to do this.

Moving into 15/16 we will be interested to understand what is achieved in the below priority areas:

A. Aligning patient safety improvement plans to the National Sign Up to Safety Campaign which will strengthen current approaches by adopting an NHS wide purpose.

B. Developing an overarching Trust document covering the Guideline for Paediatric big six to address the growing hospital admission rates for children under 15 suffering the six most common conditions leading to 999 calls and subsequent admission.

C. improving the management of frequent callers who present to the ambulance

service and cut across multiple patient facing organisations.

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Members are particularly interested in gaining a better understanding of priority area in regards to the review of the top 50 Frequent Callers in relation to Poole residents. This may be an area where the HSOSC could influence how local services work together in an efficient way to deliver services to Frequent Callers. Thank you for the opportunity to comment on an interesting Quality Review and Account we look forward to reading the published version but please take this letter as Borough of Poole’s response to that document based on the draft version sent to the Council on 13th April 2015. May I add a personal thank you for the superb service you give to our residents. In January, in need of medical help, I phoned the 111 Service, received an immediate response; the call handler, reassuringly dealt with my call asked relevant questions and passed me to an 'assessor' who again asked relevant questions, quickly decided (all carried out in a kindly reassuring, quiet and confident manner) that I needed help and told me paramedics would be with me soon. Within about 5 minutes a knock on the door revealed two paramedics, who again with reassurance and a kindly 'bedside manner' decided to speed me to Poole Hospital A&E department. Thankfully I am making a good recovery from a ‘stroke’.

We look forward to continue building good working relationships with SWAS.

Wiltshire Health Select Committee

Wiltshire Council’s HOSC has been invited to comment on the South Western Ambulance Service NHS Foundation Trust’s (SWAST) Quality Account for 2014-15. The committee believes that the Quality Account is an accurate reflection of its performance.

It is noteworthy that whilst there has been a significant improvement in the Red 1 performance data for the year from 58.73% to 65.86%, this was certainly overshadowed by a worsening situation in Red 2 performance resulting in the lowest A19 performance data for Wiltshire and the Trust overall with a decline in the previous year’s figures from 90.72% to 88.71%. It is understood that the last reporting year has been particularly challenging for SWAST, given the surge in 999 calls over the winter period and a large increase in the length of handover delays especially for those rural areas of Wiltshire where response times have also been challenging. Nevertheless, despite this and the increasing demand on the service year on year, we would hope to see improvements in the data provided over the next reporting period.

The committee noted the range of Trust developments, ranging from the introduction of the Electronic Patient Clinical Record (We would like to see this introduced into Wiltshire as soon as practical) to the Right Care initiative resulting in more patients receiving care without the need to be seen at an Emergency Department. Although not highlighted it is understood that substantial progress has been made in South Wiltshire in setting up a 24 hour Community First Responder scheme, this is most welcome and is indicative of the importance placed by the Trust in setting new ambitious targets and priorities.

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Finally, the committee commends South Western Ambulance Services NHS Foundation Trust for its own engagement and openness and transparency of its operations with this Council in these challenging times.

Bristol’s People Scrutiny Commission At its meeting of 13th April 2015 the Commission received a presentation via a DVD setting out the progress against its 2014/15 priorities, and its proposed priorities for 2015/16. There was general consensus amongst members that the priorities chosen were appropriate. Members recognised that 111 services in Bristol were not provided by SWAST but by an alternative provider. Members were pleased to receive information on the school education programme which would provide information to schools on 111 and 999 services.

Joint Health Overview and Scrutiny Committee (North Division)

Thanks should be expressed to SWASFT for engaging with members and attending individual HOSCs. In particular, Gloucestershire committee members would like to thank the service for arranging the visits to the Acuma House Clinical Hub, and the ambulance ride-a-longs. Elected members found these visits to be invaluable and have seen first-hand the compassion in care approach and professionalism of SWAST staff members. It is believed that the Quality Account is an accurate reflection of its performance and that the priorities set out should be supported. It is recognised that, despite the considerable challenges facing the Trust, significant improvements have been found in the following key areas: patient safety, demand management, hospital turnarounds and improved partnership working.

It is noteworthy that whilst there has been a significant improvement in the Red 1 performance data for the year from 58.73% to 65.86%, this was certainly overshadowed by a worsening situation in Red 2 performance resulting in the lowest A19 performance data for Wiltshire and the Trust overall with a decline in the previous year’s figures from 90.72% to 88.71%.

It is understood that the last reporting year has been particularly challenging for SWAST, given the surge in 999 calls over the winter period and a large increase in the length of handover delays especially for those rural areas of Wiltshire where response times have also been challenging. Nevertheless, despite this and the increasing demand on the service year on year, we would hope to see improvements in the data provided over the next reporting period.

It is noted that the range of Trust developments, ranging from the introduction of the Electronic Patient Clinical Record (We would like to see this introduced into Wiltshire as soon as practical) to the Right Care initiative resulting in more patients receiving care without the need to be seen at an Emergency Department. Although not highlighted it is understood that substantial progress has been made in South Wiltshire in setting up a 24 hour Community First Responder scheme, this is most

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welcome and is indicative of the importance placed by the Trust in setting new ambitious targets and priorities.

Finally, commendation should be given to the South Western Ambulance Services NHS Foundation Trust for its own engagement and openness and transparency of its operations with this Council in these challenging times.

Below are additional comments specific to HOSC areas: Gloucestershire Gloucestershire is a very rural county and therefore a significant concern for members of the committee remains the poor response times in the rural areas. The committee has regularly raised these concerns with the Trust and is aware of the work that the Trust is doing to try and address this matter. In this regard members are particularly interested to see the outcomes of the ‘Dispatch on Disposition’ pilot launched by the Department of Health; and the initiative currently being trialled in Wiltshire to base paramedic cars at GP surgeries in order to increase the number of emergency vehicles present in rural areas to combat them being pulled into urban areas to the detriment of rural residents.

SWAST has just taken over the contract for the Out of Hours Service in Gloucestershire and the committee will be monitoring this closely.

The committee would also encourage SWAST to continue to work closely with the Gloucestershire Fire and Rescue Service for the benefit of the people of Gloucestershire.

North Somerset

Whilst the Panel remains concerned by the Trust’s performance against some of the key indicators and by the apparent disparity between performance in North Somerset and elsewhere in the Trust’s locus of operation, Members are encouraged by initiatives to address these challenges including a dedicated North Somerset dispatch area and management team; the “Right Care” initiative and the Dispatch and Disposition Trial. The Panel recognises the considerable potential of these initiatives for delivering sustainable improvements to service efficiency/performance and patient care in North Somerset.

Performance and priorities

Patient safety – Members recognise the Trust’s achievement in meeting the Red 1 (Category A) performance target for 2014/15, particularly given the unpreceded year on year increases in demand for the service, and note that necessary additional focus on the most critical cases especially during the winter peak period contributed to the Trust’s weaker performance against the Red 2 and A19 targets.

Members also welcome the work undertaken by the Trust in implementing its 2014/15 priority of improving the identification and management of paediatric sepsis

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together with its “sign up to safety” priority for 2015/16 - developing and implementing a clear and measurable programme of safety improvement.

Clinical effectiveness – The Panel recognises the significant challenges faced by Trust (and by the Healthcare Sector as a whole) around the recruitment of clinical staff. They are encouraged however by the Trusts initiatives to improve and better prioritise the allocation of clinical resources. Members were impressed, for instance, with the “Dispatch and Disposition” trial and the Panel support the full implementation of this scheme going forward.

The Panel notes that the 2014/15 clinical effectiveness priority - the implementation of the Electronic Care System - is still work-in-progress but is encouraged that the early indications are that its aims of delivering better clinical outcomes, reducing unnecessary transfers to emergency departments and improving communication of patient information across the healthcare community will be deliverable by 2015/16.

The Panel is also encouraged by the greater focus in the document generally on improved partnership working, both in respect of priority setting and delivering a more efficient and responsive service “in the right place at the right time”.

Members welcome in particular the Trust’s 2015/16 priority of promoting the assessment and management of unwell Children and young people for the six most common conditions when accessing 999 ambulance services.

Patient experience – The Panel note the Trust’s achievement of its 2014/15 priority of implementing the Friends and Family Test (FFT) and is encouraged by the positive patient feedback since its implementation.

Members also welcome the Trust’s investment in vehicles, noting that to fleet is now the newest and most reliable to date.

Cornwall Council’s Health and Social Care Scrutiny

Cornwall Council’s Health and Social Care Scrutiny Committee agreed to comment on the Quality Account 2014 -2015 of South Western Ambulance Service NHS Foundation Trust. All references in this commentary relate to the period 1 April 2014 to the date of this statement.

South Western Ambulance Service NHS Foundation Trust have engaged when the committee and attended meetings when items relating to them have been placed on the agenda.

Committee Members felt that the Quality Account provided a good reflection of the services provided by the Trust, and provided a comprehensive coverage of the provider’s services. The Committee were pleased to see that in some presentation of data there was a break down at geographic level.

Quality requirements appear to be being met however there are concerns about the performance variation across the region, specifically regarding Red 2 and A19. Performance in Cornwall appears to be lower than last year.

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The Committee is pleased that there has been an improvement in the performance of Red 1. The performance of NHS 111 is due to be scrutinised in 2015 and the Committee will watch with interest this area.

The Committee welcome the commitment to increasing patient feedback via the Friends and Family Test and development of improved publically accessible data.

The Committee supports the Trust’s Quality Priorities for Improvement and looks forward to working in partnership in 2015-16.

Isles of Scilly Health Overview and Scrutiny Committee

The Isles of Scilly Health Overview and Scrutiny Committee welcomes the opportunity to contribute to these Quality Accounts.

We would like to note the continued dedication and hard work of the staff who provide urgent and non-emergency ambulance services across the five islands.

The committee would welcome more specific work done on the cost of providing urgent and non-emergency services to the islands. We feel that this would make the trust better placed to provide seamless and integrated service provision.

Healthwatch

Healthwatch Dorset

In the past year Healthwatch Dorset has received feedback about the Trust’s services from patients, relatives and carers. Overwhelmingly, the feedback has been positive, especially in relation to staff attitudes and the high quality of care and compassion patients receive in emergency situations from first responders, paramedics and ambulance staff.

However, we received some feedback that on occasion, the telephone support via NHS 111 has not been as good as it should be, with people telling us that they were told to “get a taxi” or that the service was “too busy” and ambulances could not be dispatched or having to call back repeatedly to find out whether an ambulance was on its way. There were a few incidents where patients told us they had to wait between 2 and 4 hours for an ambulance/paramedic.

We welcome the fact that the Trust “Patient Experience Priority 3 – Frequent Callers” will be looking at how to manage this group of patients better. We have received comments about patients being asked to sign “service contracts” and being confused and upset about what this means. We hope that this Priority will help to support this vulnerable group moving forward.

Healthwatch Dorset acknowledges that the Friends and Family Test is relatively new to the Trust and all its service areas. We look forward to seeing more results next year. We commend the various methods being used to engage with service users and would appreciate further information, when available, about the results of the Patient Experience Surveys. It would also be useful to see more information about

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the terms of reference, objectives and ultimately the findings and actions arising from those findings, of the Patient Reference Groups.

Healthwatch Torbay

Healthwatch Torbay's role, in this instance, is to give an independent overview of the public experience of emergency and urgent care, as provided by South West Ambulance Foundation Trust. Our various ways of encouraging the public to provide feedback provides the body of knowledge which is the basis of our comment.

We are very pleased to make the first comment a compliment. The Account is presented in a clear and readable manor, one which the public will be able to understand and appreciate. The glossary of terms is especially welcome as is the systematic presentation of factual information. We are hopeful that the final format will not be text alone as 43% of English adult working-age population cannot fully understand and use health information using only text (Royal College of General Practitioners. Health literacy, 2014).

In overview the Account describes the Trust's drive for continuous practice improvement using evidence, the commitment of employees to learning and its partnership with other organisations. The realism associated with the concept of financial viability is honest but challenging.

System redesign to increase the delivery of urgent care at the point of need should be welcomed by the public and Healthwatch Torbay will be in a position to monitor their reaction. Although not specifically mentioned but relevant, we are concerned about the potential for disruption by future decisions about changes to the delivery of NHS 111 and the associated GP Out of Hours services.

Healthwatch Torbay was not directly consulted as stakeholders in the choice of quality priorities for 2015/16 but we consider the decisions to be appropriate. The Paediatric Big Six is especially welcomed. It is a timely contribution to national and local imperatives:

“The vast majority of children’s illnesses are minor, requiring little or no medical intervention and a significant number of these attendances (emergency department) can be deemed unnecessary or inappropriate. However, each one of these attendances tells us that a parent was worried, and either unable or unsure how to access a more appropriate service.” (Royal College of Paediatrics and Child Health. Facing the future together for child health. 2015)

The update report on 2014/15 priorities gives evidence that quality improvement is building on a sound foundation. We would like to see the Trust as Highest in all categories, but maybe as your report suggests, the middle position suggests honest reporting. Healthwatch Torbay looks forward to being kept informed of progress and will play its part in keeping the public informed.

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Healthwatch Cornwall

Healthwatch Cornwall (HC) is fully aware of the stresses on the current providers of urgent care in Cornwall. From reading South Western Ambulance Service NHS Foundation Trust’s (SWASFT) quality accounts it is clear that there have been many successes such as the implementation of the Electronic Patient Clinical Record (EPCR) system and the continued implementation of the ‘The Right Care’ programme, which has saved the South West health and social care system millions of pounds.

Alongside those successes, Healthwatch Cornwall is disappointed that the trust has not built on the improving picture of the previous year and has missed a number of targets in relation to ambulance response times to Red 2 calls and category A 19 minute waits. HC was expecting to see more detail in the quality account regarding 111 performance as we are aware of missed targets in this service also.

During the year 2014-15 HC worked closely with NHS Kernow as part of the multi-agency Urgent Care Partnership Board. SWASFT also attended these meeting and HC was impressed with the level of information, commitment and willingness to change the current system to alleviate the high current demand on the emergency department. It was evident that the changes that SWASFT were introducing were assisting with the reducing of admissions in to hospitals.

HC is glad to see that SWASFT are continuing to build on the priorities of 2014-15 with the new priorities that have been set, specifically in relation to the work done around SEPSIS and EPCR. HC is pleased to see that SWASFT is trying to improve its current service by putting in place a system that will be able to manage frequent callers in a more constructive way and therefore use important resources more effectively. The feedback received about the ambulance service has always been very positive and shows that people in Cornwall value highly the service they receive and regard it as efficient, professional, respectful and one in which they have confidence. Individual staff is often praised for the care and consideration shown to patients.

In contrast the feedback that has been received in regards to the 111 service that SWASFT runs is a mixture of positive and negative comments, with them generally being more negative. The feedback refers to the triage system and the length of time it takes; the types of questions asked, which are perceived to be irrelevant; and a predictable outcome being stated as “attend your nearest A&E department”. For these reasons some patients have stated that they wouldn’t use the 111 number in the future but would automatically refer to the 999 number or attend the emergency department, and they may need challenging.

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Healthwatch Plymouth

Healthwatch Plymouth report mostly positive comments received on SWASFT services but state that they would welcome an opportunity to work more closely with the local management of SWAST covering the Plymouth area. This would enable service development to include the patient experience.

Healthwatch North Somerset

Healthwatch North Somerset is pleased to have the opportunity to comment on the South Western Ambulance Service NHS Foundation Trust Quality Account.

The Statement on Quality from the Chief Executive provides a good overview and an insight to initiatives undertaken during the year.

The Quality Account helpfully identifies the three domains of quality together with the priorities set under these headings. Progress has clearly been made although without corresponding data, we are unable to satisfy ourselves on the levels of achievement. We note the improvements made last year particularly in the Friends and Family Test but that the Patient Safety (Sepsis) priority was partially achieved and that achievement of the Electronic Care System and the Primary Angioplasty has not been confirmed.

Given the high profile media attention to waiting times and the impact for ambulance service and A & E departments we would have expected comment on this in the Quality Account as this surely must have had a major impact on provision.

The Trust has identified Patient Safety – Sign up to Safety; Clinical Effectiveness – Paediatric Big Six and Patient Experience – Frequent Callers as relevant priorities for 2015/16. These are appropriate areas to target for continued improvement and demonstrate recognition of the need to ensure improvement to services across the patient pathway.

Healthwatch North Somerset notes that there has been an increase in the number of Incidents Reported, Adverse Incidents and Moderate Harm Incidents although it recognises the decrease in Serious Incidents compared to the previous year.

Page 24 shows a surprisingly high incidence of severe harm but figures do not correspond with those given for such incidents on page 27 which are even higher. These issues may relate to 111 and it would be useful to know how appropriate 111 dispatches are.

We welcome the actions that the Trust is undertaking to ensure that patient safety is at the forefront of service provision and is enhanced.

The substantial decrease in conveyance of patients and subsequent cost savings through the Right Care programme is to be commended.

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Key Performance Indicators

Healthwatch North Somerset commends the increase in target objectives achieved for Red 1 but notes that Red 2 and 19 minute Performance target objectives have decreased compared to the previous year – but further note that all targets are commensurate with National Averages. Breach of response times in the last two quarters is a cause for concern. The report quotes ‘assurance of action ‘but omits to detail how improvement is to be achieved.

There is commendable performance for achievement against target for the clinical quality indicators.

Patient Experience Surveys

We are pleased that the Trust takes clear and robust account of issues raised by its service users through the strengthening of the Friends and Family test and we would like the Trust to consider the use of independent data gathering on its services which should give unbiased and honest feedback, which we would be happy to support them with.

Patient experience survey provide a good overview of those patients who responded to the survey and can provide valuable information about the strengths and weaknesses of an organisation, as well as providing pointers about which issues are of importance to patients. It is disappointing to see reference to the Patient Experience Surveys in the draft QR but no details about the number received during the year or of the contents.

Patient Engagement

The level of compliments received is very positive and outweighs the complaints, concerns and Comments received.

Healthwatch North Somerset is disappointed that South West Ambulance Service has not actively engaged with Healthwatch North Somerset. Healthwatch North Somerset is an organisation set up by The Health and Social Care Act 2012 to engage with the public in North Somerset and to feedback issues to commissioners and service providers, as well as a role in formulating views of the standard of services and how they can be improved.

We welcome more specific information and data on the service provided in North Somerset to better assess how the service is meeting the needs of the North Somerset population and comparisons with service provided across the commissioned area. There is some concern about poor performance in North Somerset compared to other areas served by the Trust.

An ‘easy read’ version of the Quality Account would ensure greater accessibility for the general public.

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Healthwatch Devon

Healthwatch Devon welcomes the opportunity to provide a statement in response to the Quality Account produced by SWASFT this year. Our response is based on the feedback we receive about the quality of the services that the Trust provides in Devon.

Firstly, in respect of the Trust’s vision and values that are outlined in this account, we are pleased to report that the feedback that we have received during the last two years, although only a small amount, clearly demonstrates that staff are fully committed to providing a quality service to patients.

Many people who share their experiences with us praise ambulance staff for the quality of care that they provided to them, for their compassion and for their professionalism. Any negative feedback that we have received is mainly focussed on the 111 system, or delays in ambulance arrivals.

Healthwatch Devon recently reported its findings in relation to where people go if they are seeking non-urgent medical treatment and our report revealed that some people do not know about the 111 service and of those that do, only a small number of respondents had ever used the service. Feedback that we have received from people who have called 111 is mixed.

Some report that they have no confidence in the service and that they would not use it again, others found it valuable in providing them with the right route for treatment quickly. We note however from the Trust’s account that data is not available to indicate whether the Trust is compliant in respect of auditing patient experiences of the service and we would be keen to engage with the Trust as to whether their findings are comparative to ours.

In respect of progress, we commend that SWASFT is looking to increase the opportunities for people to complete the ‘Family and Friends’ test, by making it easier for staff to hand patient’s invitations to answer the questions, for those who remain at home.

Looking forward, Healthwatch Devon is encouraged by The Trust’s set of priorities for improvement which encompass: improving patient safety; aiming to reduce avoidable admissions and improving treatment and outcomes for children and young people; and improving the management of ‘frequent callers’ to the service.

These are all topics that we hear about that can present difficulties for patients and carers in Devon and which can cut across a number of services, therefore a multi agency approach and partnership working is key to achieving better outcomes for patients. We will be mindful of these priority areas during the coming year and will share any feedback that we receive that may help to inform this work, with the SWASFT Patient Engagement Team.

With regard to patient experience feedback, the amount we receive that relates to services provided by SWASFT is on the increase. With the imminent launch of our own online patient feedback centre - which neighbouring Healthwatch organisations in Torbay, Plymouth and Cornwall have already successfully implemented on their

http://www.healthwatchdevon.co.uk/non-urgent-care/

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own websites – any experiences shared will be visible for the public, NHS Providers and Commissioners to see. We hope that this will provide SWASFT with another rich source of experience data from which to further understand how their services meets the needs to those who come into contact with them.

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Statement of Directors’ Responsibilities in respect

of the Quality Report

The Directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations to prepare Quality Accounts for each financial year.

Monitor has issued guidance to NHS foundation trust boards on the form and content of annual quality reports (which incorporate the above legal requirements) and on the arrangements that NHS foundation trust boards should put in place to support the data quality for the preparation of the quality report.

In preparing the Quality Report, directors are required to take steps to satisfy themselves that:

The content of the Quality Report meets the requirements set out in the NHS Foundation Trust Annual Reporting Manual 2014/15 and supporting guidance;

The content of the Quality Report is not inconsistent with internal and external sources of information including:

o Board minutes and papers for the period April 2014 to 28 May 2015; o papers relating to Quality reported to the Board over the period April 2014

to 28 May 2015; o Feedback from the commissioners dated 1 May and 19 May 2015; o Feedback from governors dated 19 February and 14 April 2015; o Feedback from Local Healthwatch organisations dated 11 May, 12, 14 and

20 May 2015; o Feedback from Overview and Scrutiny Committees dated 23 April, 6 May,

11 May and 12 May 2015; o The Trust’s complaints report published under regulation 18 of the Local

Authority Social Services and NHS Complaints Regulations 2009, dated 16 April 2015;

o The latest national patient survey dated 8 July 2014; o The latest national staff survey dated 24 February 2015; o The Head of Internal Audit’s annual opinion over the trust’s control

environment dated 20 May 2015; o CQC quality and risk profile dated 31 March 2014.

The Quality Report presents a balanced picture of the NHS Foundation Trust’s performance over the period covered;

The performance information reported in the Quality Report is reliable and accurate;

There are proper internal controls over the collection and reporting of the measures of performance included in the Quality Report, and these controls are

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subject to review to confirm that they are working effectively in practice;

The data underpinning the measures of performance reported in the Quality Report is robust and reliable, conforms to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review; and

The Quality Report has been prepared in accordance with Monitor’s annual reporting guidance (which incorporates the Quality Accounts regulations) (published at www.monitor.gov.uk/ annualreportingmanual) as well as the standards to support data quality for the preparation of the Quality Report (available at www.monitor.gov.uk/annualreportingmanual).

The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the Quality Report.

By order of the Board

20 May 2015 20 May 2015

Heather Strawbridge, Chairman Ken Wenman, Chief Executive

http://www.monitor.gov.uk/%20annualreportingmanual)

http://www.monitor.gov.uk/annualreportingmanual)

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Independent Auditors’ Limited Assurance Report to the Council of Governors of South Western Ambulance Service NHS Foundation Trust on the Annual Quality Report

We have been engaged by the Council of Governors of South Western Ambulance Service NHS Foundation Trust to perform an independent assurance engagement in respect of South Western Ambulance Service NHS Foundation Trust’s Quality Report for the year ended 31 March 2015 (the ‘Quality Report’) and specified performance indicators contained therein. Scope and subject matter The indicators for the year ended 31 March 2015 subject to limited assurance (the

“specified indicators”); marked with the symbol in the Quality Report consist of the following national priority indicators as mandated by Monitor:

Specified Indicators Specified indicators criteria

Category A Call- Emergency response within 8 Minutes

Criteria for the indicators can be found in the Quality Report on page 21 and the Annual Report on page 148 on which we are giving our limited assurance opinion.

Category A Call- Ambulance vehicle arrives within 19 Minutes

Respective responsibilities of the Directors and auditors The Directors are responsible for the content and the preparation of the Quality Report in accordance with the specified indicators criteria referred to on pages of the Quality Report as listed above (the "Criteria"). The Directors are also responsible for the conformity of their Criteria with the assessment criteria set out in the NHS Foundation Trust Annual Reporting Manual (“FT ARM”) and the “Detailed requirements for quality reports 2014/15” issued by the Independent Regulator of NHS Foundation Trusts (“Monitor”). Our responsibility is to form a conclusion, based on limited assurance procedures, on whether anything has come to our attention that causes us to believe that:

The Quality Report does not incorporate the matters required to be reported on as specified in Annex 2 to Chapter 7 of the FT ARM and the “Detailed requirements for quality reports 2014/15”;

The Quality Report is not consistent in all material respects with the sources specified below; and

The specified indicators have not been prepared in all material respects in accordance with the Criteria and the six dimensions of data quality set out in the “2014/15 Detailed guidance for external assurance on quality reports”.

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We read the Quality Report and consider whether it addresses the content requirements of the FT ARM and the “Detailed requirements for quality reports 2014/15; and consider the implications for our report if we become aware of any material omissions. We read the other information contained in the Quality Report and consider whether it is materially inconsistent with the following documents:

Board minutes for the financial year, April 2014 and up to the date of signing this limited assurance report (the period)

Papers relating to quality report reported to the Board over the period April 2014 to the date of signing this limited assurance report;

Feedback from governors dated 19 February 2015 and 14 April 2015;

Feedback from the Commissioners South West Commissioning Support (included combined CCG commentary) dated 19 May 2015 and NHS Dorset CCG dated 1 May 2015;

Feedback from Local Healthwatch organisations; Healthwatch Dorset dated 12 May 2015; Healthwatch Torbay dated 11 May 2015; Healthwatch Cornwall dated 11 May 2015; Healthwatch North Somerset 14 May 2015; Healthwatch Devon 20 May 2015 and Healthwatch Plymouth dated 11 May 2015;

Feedback from other stakeholder(s) involved in the sign-off of the Quality Report: SWASFT (Northern Area) Joint Health Overview and Scrutiny Committee dated 11 May 2015; Borough of Poole Health and Social Care Overview and Scrutiny Committee dated 23 April 2015; Bristol People Scrutiny Commission dated 6 May 2015; Cornwall Health and Social Care Scrutiny Committee dated 12 May 2015; and the Isles of Scilly Health Overview and Scrutiny Committee dated 12 May 2015;

The Trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, dated 16 April 2015;

The national patient survey dated 8 July 2014;

The national staff survey dated 24 February 2015;

Care Quality Commission quality and risk profile dated 31 March 2014;and

The Head of Internal Audit’s annual opinion over the Trust’s control environment dated 20 May 2015.

We consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with those documents (collectively, the “documents”). Our responsibilities do not extend to any other information. We are in compliance with the applicable independence and competency requirements of the Institute of Chartered Accountants in England and Wales (“ICAEW”) Code of Ethics. Our team comprised assurance practitioners and relevant subject matter experts. This report, including the conclusion, has been prepared solely for the Council of Governors of South Western Ambulance Service NHS Foundation Trust as a body, to assist the Council of Governors in reporting South Western Ambulance Service

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NHS Foundation Trust’s quality agenda, performance and activities. We permit the disclosure of this report within the Annual Report for the year ended 31 March 2015, to enable the Council of Governors to demonstrate they have discharged their governance responsibilities by commissioning an independent assurance report in connection with the indicators. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Council of Governors as a body and South Western Ambulance Service NHS Foundation Trust for our work or this report save where terms are expressly agreed and with our prior consent in writing. Assurance work performed We conducted this limited assurance engagement in accordance with International Standard on Assurance Engagements 3000 ‘Assurance Engagements other than Audits or Reviews of Historical Financial Information’ issued by the International Auditing and Assurance Standards Board (‘ISAE 3000’). Our limited assurance procedures included:

Reviewing the content of the Quality Report against the requirements of the FT ARM and “Detailed requirements for quality reports 2014/15”;

Reviewing the Quality Report for consistency against the documents specified above;

Obtaining an understanding of the design and operation of the controls in place in relation to the collation and reporting of the specified indicators, including controls over third party information (if applicable) and performing walkthroughs to confirm our understanding;

Based on our understanding, assessing the risks that the performance against the specified indicators may be materially misstated and determining the nature, timing and extent of further procedures;

Making enquiries of relevant management, personnel and, where relevant, third parties;

Considering significant judgements made by the NHS Foundation Trust in preparation of the specified indicators;

Performing limited testing, on a selective basis of evidence supporting the reported performance indicators, and assessing the related disclosures; and

Reading the documents. A limited assurance engagement is less in scope than a reasonable assurance engagement. The nature, timing and extent of procedures for gathering sufficient appropriate evidence are deliberately limited relative to a reasonable assurance engagement. Limitations Non-financial performance information is subject to more inherent limitations than financial information, given the characteristics of the subject matter and the methods used for determining such information.

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The absence of a significant body of established practice on which to draw allows for the selection of different but acceptable measurement techniques which can result in materially different measurements and can impact comparability. The precision of different measurement techniques may also vary. Furthermore, the nature and methods used to determine such information, as well as the measurement criteria and the precision thereof, may change over time. It is important to read the Quality Report in the context of the assessment criteria set out in the FT ARM the “Detailed requirements for quality reports 2014/15 and the Criteria referred to above. The nature, form and content required of Quality Reports are determined by Monitor. This may result in the omission of information relevant to other users, for example for the purpose of comparing the results of different NHS Foundation Trusts. In addition, the scope of our assurance work has not included governance over quality or non-mandated indicators in the Quality Report, which have been determined locally by South Western Ambulance Service NHS Foundation Trust. Conclusion Based on the results of our procedures, nothing has come to our attention that causes us to believe that for the year ended 31 March 2015,

The Quality Report does not incorporate the matters required to be reported on as specified in Annex 2 to Chapter 7 of the FT ARM and the “Detailed requirements for quality reports 2014/15”;

The Quality Report is not consistent in all material respects with the documents specified above; and

the specified indicators have not been prepared in all material respects in accordance with the Criteria and the six dimensions of data quality set out in the “Detailed guidance for external assurance on quality reports 2014/15”.

PricewaterhouseCoopers LLP Chartered Accountants Princess Court 23 Princess Street Plymouth PL1 2EX

21 May 2015

The maintenance and integrity of the South Western Ambulance Service NHS

Foundation Trust’s website is the responsibility of the directors; the work carried out

by the assurance providers does not involve consideration of these matters and,

accordingly, the assurance providers accept no responsibility for any changes that

may have occurred to the reported performance indicators or criteria since they were

initially presented on the website.

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Statement of the Chief Executive’s

Responsibilities as the Accounting Officer of

South Western Ambulance Service NHS

Foundation Trust

The NHS Act 2006 states that the Chief Executive is the Accounting Officer of the NHS Foundation Trust. The relevant responsibilities of the Accounting Officer, including their responsibility for the propriety and regularity of public finances for which they are answerable, and for the keeping of proper accounts, are set out in the NHS Foundation Trust Accounting Officer Memorandum issued by Monitor. Under the NHS Act 2006, Monitor has directed South Western Ambulance Service NHS Foundation Trust to prepare for each financial year a statement of accounts in the form and on the basis set out in the Accounts Direction. The accounts are prepared on an accruals basis and must give a true and fair view of the state of affairs of South Western Ambulance Service NHS Foundation Trust and of its income and expenditure, total recognised gains and losses and cash flows for the financial year. In preparing the accounts, the Accounting Officer is required to comply with the requirements of the NHS Foundation Trust Annual Reporting Manual and in particular to:

Observe the Accounts Direction issued by Monitor, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis;

Make judgements and estimates on a reasonable basis;

State whether applicable accounting standards as set out in the NHS Foundation Trust Annual Reporting Manual have been followed, and disclose and explain any material departures in the financial statements;

Ensure that the use of public funds complies with the relevant legislation, delegated authorities and guidance; and

Prepare the financial statements on a going concern basis. The Accounting Officer is responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the NHS Foundation Trust and to enable him/her to ensure that the accounts comply with the requirements outlined in the above mentioned Act. The Accounting Officer is also responsible for safeguarding the assets of the NHS Foundation Trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

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To the best on my knowledge and belief, I have properly discharged the responsibilities set out in Monitor’s NHS Foundation Trust Accounting Officer Memorandum. Signed:

Ken Wenman Chief Executive Date: 20 May 2015

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NHS Foundation Trust Code of Governance

Code of Governance

Monitor first issued a Code of Governance in 2006, based on the Cadbury Code with which all FTSE companies are expected to comply. As with Cadbury, the Code is based on the principles of complying with the guidance or explaining why not. Although the Code is not mandatory, all Foundation Trusts are strongly advised by Monitor to follow the guidance, and some disclosures are required of all trusts. SWASFT initially declared compliance with the Code during the assessment process to become a Foundation Trust, and a new compliance plan is monitored and approved by the Quality and Governance Committee each year. The latest update was approved in March 2015. The Code of Governance was updated by Monitor for January 2014, and SWASFT applied the new version to its annual report for the whole of 2013/14. Additional disclosure requirements have been included in the latest version of the Code and some of these (see* below) are required to be specifically mentioned in trusts’ annual reports, while others are disclosures which must be made to the public or to members. The disclosures are divided into six categories: 1) Statutory requirements of the Code of Governance but do not require disclosures; *2) Provisions which require a supporting explanation, even where the NHS

Foundation Trust is compliant with the provision; 3) Provisions which require supporting information to be made publicly available, even where the NHS Foundation Trust is compliant with the provision; 4) Provisions which require supporting information to be made to governors, even where the NHS Foundation Trust is compliant with the provision; 5) Provisions which require supporting information to be made to members, even where the NHS Foundation Trust is compliant with the provision, and *6) Other provisions where there are no special requirements as per 1-5 above and

there is a “comply or explain” requirement.

Code of Governance disclosures The following table sets out the disclosures which must be included within Foundation Trust annual reports for 2014/15. This covers only items falling into category 2 and category 6 above. However, the table also includes statements that are not part of the Code of Governance but became a new requirement within the FT Annual Reporting Manual (ARM) from March 2014. All required disclosures must be referenced in this table, which is published in our annual report. If a statement or requirement is already printed somewhere in the annual report, then a reference to its location has been made in the table. South Western Ambulance Service NHS Foundation Trust has applied the principles of the NHS Foundation Trust Code of Governance on a comply or explain basis. The NHS Foundation Trust Code of Governance, most recently revised in July 2014, is

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based on the principles of the UK Corporate Governance Code issued in 2012. A Code of Governance disclosure statement was approved by the Trust Board of Directors at its meeting in March 2015.

Code of Governance Disclosure Statement – SWASFT Annual Report 2014/15

Relating to Code Ref

Summary of Requirement Annual Report Location, or Comply or Explain

Schedule A (2)

Board and Council of Governors

A.1.1 The schedule of matters reserved for the board of directors should include a clear statement detailing the roles and responsibilities of the council of governors. This statement should also describe how any disagreements between the council of governors and the board of directors will be resolved. The annual report should include this schedule of matters or a summary statement of how the board of directors and the council of governors operate, including a summary of the types of decisions to be taken by each of the boards and which are delegated to the executive management of the board of directors.

Comply – pages 96 and 122 of the Annual Report

Board, Nomination Committee(s), Audit Committee, Remuneration Committee

A.1.2 The annual report should identify the chairperson, the deputy chairperson (where there is one), the chief executive, the senior independent director (see A.4.1) and the chairperson and members of the nominations, audit and remuneration11 committees. It should also set out the number of meetings of the board and those committees and individual attendance by directors.

Comply – page 74 of the Annual Report


A.5.3 The annual report should identify the members of the council of governors, including a description of the constituency or organisation that they represent, whether they were elected or appointed, and the duration of their appointments. The annual report should also identify the nominated lead governor.


Board B.1.1 The board of directors should identify in the annual report each Non-Executive director it considers to be independent, with reasons where necessary.


Board B.1.4 The board of directors should include in its annual report a description of each director’s skills, expertise and experience. Alongside this, in the annual report, the board should make a clear statement about its own balance, completeness and appropriateness to the requirements of the NHS foundation trust.


Nominations Committee(s)

B.2.10 A separate section of the annual report should describe the work of the nominations committee(s), including the process it has used in relation to board appointments.


Chair / Council of Governors

B.3.1 A chairperson’s other significant commitments should be disclosed to the council of governors before appointment and included in the annual report. Changes to such commitments should be reported to the council of governors as they arise, and included in the next annual report.



B.5.6 Governors should canvass the opinion of the trust’s members and the public, and for appointed governors


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the body they represent, on the NHS foundation trust’s forward plan, including its objectives, priorities and strategy, and their views should be communicated to the board of directors. The annual report should contain a statement as to how this requirement has been undertaken and satisfied.

Board B.6.1 The board of directors should state in the annual report how performance evaluation of the board, its committees, and its directors, including the chairperson, has been conducted.


Board B.6.2 Where there has been external evaluation of the board and/or governance of the trust, the external facilitator should be identified in the annual report and a statement made as to whether they have any other connection to the trust.


Board C.1.1 The directors should explain in the annual report their responsibility for preparing the annual report and accounts, and state that they consider the annual report and accounts, taken as a whole, are fair, balanced and understandable and provide the information necessary for patients, regulators and other stakeholders to assess the NHS foundation trust’s performance, business model and strategy. Directors should also explain their approach to quality governance in the Annual Governance Statement (within the annual report). See also ARM paragraph 7.90


Board C.2.1 The annual report should contain a statement that the board has conducted a review of the effectiveness of its system of internal controls.


Audit Committee / control environment

C.2.2 A trust should disclose in the annual report: (a) if it has an internal audit function, how the function is structured and what role it performs; or (b) if it does not have an internal audit function, that fact and the processes it employs for evaluating and continually improving the effectiveness of its risk management and internal control processes.


Audit Committee / Council of Governors

C.3.5 If the council of governors does not accept the audit committee’s recommendation on the appointment, reappointment or removal of an external auditor, the board of directors should include in the annual report a statement from the audit committee explaining the recommendation and should set out reasons why the council of governors has taken a different position.

Comply – not applicable.

Audit Committee

C.3.9 A separate section of the annual report should describe the work of the audit committee in discharging its responsibilities. The report should include:

the significant issues that the committee considered in relation to financial statements, operations and compliance, and how these issues were addressed;

an explanation of how it has assessed the effectiveness of the external audit process and


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the approach taken to the appointment or re-appointment of the external auditor, the value of external audit services and information on the length of tenure of the current audit firm and when a tender was last conducted; and

if the external auditor provides non-audit services, the value of the non-audit services provided and an explanation of how auditor objectivity and independence are safeguarded.

Board / Remuneration Committee

D.1.3 Where an NHS foundation trust releases an executive director, for example to serve as a non-executive director elsewhere, the remuneration disclosures of the annual report should include a statement of whether or not the director will retain such earnings.

Comply – not applicable.

Board E.1.5 The board of directors should state in the annual report the steps they have taken to ensure that the members of the board, and in particular the Non-Executive directors, develop an understanding of the views of governors and members about the NHS foundation trust, for example through attendance at meetings of the council of governors, direct face-to-face contact, surveys of members’ opinions and consultations.


Board / Membership

E.1.6 The board of directors should monitor how representative the NHS foundation trust's membership is and the level and effectiveness of member engagement and report on this in the annual report.


Membership E.1.4 Contact procedures for members who wish to communicate with governors and/or directors should be made clearly available to members on the NHS foundation trust's website and in the annual report.


Additional Requirements, FT Annual Reporting Manual 2015


n/a The annual report should include a statement about the number of meetings of the council of governors and individual attendance by governors and directors.

Page 74 of the Annual

Report

Board n/a The annual report should include a brief description of the length of appointments of the Non-Executive directors, and how they may be terminated


Report

Nominations Committee(s)

n/a The disclosure in the annual report on the work of the nominations committee should include an explanation if neither an external search consultancy nor open advertising has been used in the appointment of a chair or Non-Executive director.

Page 122 of the

Annual Report


n/a If, during the financial year, the Governors have exercised their power* under paragraph 10C** of schedule 7 of the NHS Act 2006, then information on this must be included in the annual report. This is required by paragraph 26(2)(aa) of schedule 7 to the NHS Act 2006, as amended by section 151 (8) of the Health and Social Care Act 2012. * Power to require one or more of the directors to attend a governors’ meeting for the purpose of obtaining information about the foundation trust’s


Report

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performance of its functions or the directors’ performance of their duties (and deciding whether to propose a vote on the foundation trust’s or directors’ performance). ** As inserted by section 151 (6) of the Health and Social Care Act 2012)

Membership n/a The annual report should include:

a brief description of the eligibility requirements for joining different membership constituencies, including the boundaries for public membership;

information on the number of members and the number of members in each constituency; and

a summary of the membership strategy, an assessment of the membership and a description of any steps taken during the year to ensure a representative membership [see also E.1.6 above], including progress towards any recruitment targets for members.

Page 110 of the

Annual Report

Board / Council of Governors

n/a The annual report should disclose details of company directorships or other material interests in companies held by governors and/or directors where those companies or related parties are likely to do business, or are possibly seeking to do business, with the NHS foundation trust. As each NHS foundation trust must have registers of governors’ and directors’ interests which are available to the public, an alternative disclosure is for the annual report to simply state how members of the public can gain access to the registers instead of listing all the interests in the annual report. See also ARM paragraph 7.33 as directors’ report requirement

Pages 86 and 106 of

the Annual Report

Schedule A (6) - Comply or Explain

Board A.1.6 The board should report on its approach to clinical governance.

Comply

Board A.1.7 The chief executive as the accounting officer should follow the procedure set out by Monitor for advising the board and the council and for recording and submitting objections to decisions.

Comply

Board A.1.8 The board should establish the constitution and standards of conduct for the NHS foundation trust and its staff in accordance with NHS values and accepted standards of behaviour in public life

Comply

Board A.1.9 The board should operate a code of conduct that builds on the values of the NHS foundation trust and reflect high standards of probity and responsibility.

Comply

Board A.1.10 The NHS foundation trust should arrange appropriate insurance to cover the risk of legal action against its directors.

Comply

Chair A.3.1 The chairperson should, on appointment by the council, meet the independence criteria set out in B.1.1. A chief executive should not go on to be the

Comply

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chairperson of the same NHS foundation trust.

Board A.4.1 In consultation with the council, the board should appoint one of the independent Non-Executive directors to be the senior independent director.

Comply

Board A.4.2 The chairperson should hold meetings with the Non-Executive directors without the executives present.

Comply

Board A.4.3 Where directors have concerns that cannot be resolved about the running of the NHS foundation trust or a proposed action, they should ensure that their concerns are recorded in the board minutes.

Comply


A.5.1 The council of governors should meet sufficiently regularly to discharge its duties.

Comply


A.5.2 The council of governors should not be so large as to be unwieldy.

Comply


A.5.4 The roles and responsibilities of the council of governors should be set out in a written document.

Comply


A.5.5 The chairperson is responsible for leadership of both the board and the council but the governors also have a responsibility to make the arrangements work and should take the lead in inviting the chief executive to their meetings and inviting attendance by other executives and non-executives, as appropriate.

Comply


A.5.6 The council should establish a policy for engagement with the board of directors for those circumstances when they have concerns.

Comply Policy in place but to be reviewed in 2015/16


A.5.7 The council should ensure its interaction and relationship with the board of directors is appropriate and effective.

Comply


A.5.8 The council should only exercise its power to remove the chairperson or any non-executive directors after exhausting all means of engagement with the board.

Comply


A.5.9 The council should receive and consider other appropriate information required to enable it to discharge its duties.

Comply

Board B.1.2 At least half the board, excluding the chairperson, should comprise non-executive directors determined by the board to be independent.

Comply


B.1.3 No individual should hold, at the same time, positions of director and governor of any NHS foundation trust.

Comply

Nomination Committee(s)

B.2.1 The nominations committee or committees, with external advice as appropriate, are responsible for the identification and nomination of executive and non-executive directors.

Comply


B.2.2 Directors on the board of directors and governors on the council should meet the “fit and proper” persons test described in the provider licence.

Comply Gap analysis underway at the end of 2014/15


B.2.3 The nominations committee(s) should regularly review the structure, size and composition of the board and make recommendations for changes where appropriate.

Comply

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B.2.4 The chairperson or an independent non-executive director should chair the nominations committee(s).

Comply

Nomination Committee(s) / Council of Governors

B.2.5 The governors should agree with the nominations committee a clear process for the nomination of a new chairperson and non-executive directors.

Comply


B.2.6 Where an NHS foundation trust has two nominations committees, the nominations committee responsible for the appointment of non-executive directors should consist of a majority of governors.

Comply


B.2.7 When considering the appointment of non-executive directors, the council should take into account the views of the board and the nominations committee on the qualifications, skills and experience required for each position.

Comply


B.2.8 The annual report should describe the process followed by the council in relation to appointments of the chairperson and non-executive directors.

Comply


B.2.9 An independent external adviser should not be a member of or have a vote on the nominations committee(s).

Comply

Board B.3.3 The board should not agree to a full-time executive director taking on more than one non-executive directorship of an NHS foundation trust or another organisation of comparable size and complexity.

Comply


B.5.1 The board and the council governors should be provided with high-quality information appropriate to their respective functions and relevant to the decisions they have to make.

Comply

Board B.5.2 The board and in particular non-executive directors may reasonably wish to challenge assurances received from the executive management. They need not seek to appoint a relevant adviser for each and every subject area that comes before the board, although they should, wherever possible, ensure that they have sufficient information and understanding to enable challenge and to take decisions on an informed basis.

Comply

Board B.5.3 The board should ensure that directors, especially non-executive directors, have access to the independent professional advice, at the NHS foundation trust’s expense, where they judge it necessary to discharge their responsibilities as directors.

Comply

Board / Committees

B.5.4 Committees should be provided with sufficient resources to undertake their duties.

Comply

Chair B.6.3 The senior independent director should lead the performance evaluation of the chairperson.

Comply

Chair B.6.4 The chairperson, with assistance of the board secretary, if applicable, should use the performance evaluations as the basis for determining individual and collective professional development programmes for non-executive directors relevant to their duties as board members.

Comply

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Chair / Council of Governors

B.6.5 Led by the chairperson, the council should periodically assess their collective performance and they should regularly communicate to members and the public details on how they have discharged their responsibilities.

Comply


B.6.6 There should be a clear policy and a fair process, agreed and adopted by the council, for the removal from the council of any governor who consistently and unjustifiably fails to attend the meetings of the council or has an actual or potential conflict of interest which prevents the proper exercise of their duties.

Comply

Board / Remuneration Committee

B.8.1 The remuneration committee should not agree to an executive member of the board leaving the employment of an NHS foundation trust, except in accordance with the terms of their contract of employment, including but not limited to service of their full notice period and/or material reductions in their time commitment to the role, without the board first having completed and approved a full risk assessment.

Comply

Board C.1.2 The directors should report that the NHS foundation trust is a going concern with supporting assumptions or qualifications as necessary. See also ARM paragraph 7.17.

Comply

Board C.1.3 At least annually and in a timely manner, the board should set out clearly its financial, quality and operating objectives for the NHS foundation trust and disclose sufficient information, both quantitative and qualitative, of the NHS foundation trust’s business and operation, including clinical outcome data, to allow members and governors to evaluate its performance.

Comply

Board C.1.4 a) The board of directors must notify Monitor and the council of governors without delay and should consider whether it is in the public’s interest to bring to the public attention, any major new developments in the NHS foundation trust’s sphere of activity which are not public knowledge, which it is able to disclose and which may lead by virtue of their effect on its assets and liabilities, or financial position or on the general course of its business, to a substantial change to the financial well-being, health care delivery performance or reputation and standing of the NHS foundation trust. b) The board of directors must notify Monitor and the council of governors without delay and should consider whether it is in the public interest to bring to public attention all relevant information which is not public knowledge concerning a material change in: • the NHS foundation trust’s financial condition; • the performance of its business; and/or • the NHS foundation trust’s expectations as to its performance which, if made public, would be likely to lead to a substantial change to the financial well-being, health care delivery performance or reputation and standing of the NHS foundation trust.

Comply

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Board / Audit Committee

C.3.1 The board should establish an audit committee composed of at least three members who are all independent Non-Executive directors.

Comply

Council of Governors / Audit Committee

C.3.3 The council should take the lead in agreeing with the audit committee the criteria for appointing, re-appointing and removing external auditors.

Comply

Council of Governors / Audit Committee

C.3.6 The NHS foundation trust should appoint an external auditor for a period of time which allows the auditor to develop a strong understanding of the finances, operations and forward plans of the NHS foundation trust.

Comply


C.3.7 When the council ends an external auditor’s appointment in disputed circumstances, the chairperson should write to Monitor informing it of the reasons behind the decision.

Comply

Audit Committee

C.3.8 The audit committee should review arrangements that allow staff of the NHS foundation trust and other individuals where relevant, to raise, in confidence, concerns about possible improprieties in matters of financial reporting and control, clinical quality, patient safety or other matters.

Comply Whistleblowing Policy (Speak Up, Speak Out) arrangements to be added to Audit Committee plan

Remuneration Committee

D.1.1 Any performance-related elements of the remuneration of executive directors should be designed to align their interests with those of patients, service users and taxpayers and to give these directors keen incentives to perform at the highest levels.

Comply


D.1.2 Levels of remuneration for the chairperson and other Non-Executive directors should reflect the time commitment and responsibilities of their roles.

Comply


D.1.4 The remuneration committee should carefully consider what compensation commitments (including pension contributions and all other elements) their directors’ terms of appointments would give rise to in the event of early termination.

Comply Remuneration Policy and Committee Terms of Reference to be updated in 2015/16


D.2.2 The remuneration committee should have delegated responsibility for setting remuneration for all executive directors, including pension rights and any compensation payments.

Comply

Council of Governors / Remuneration Committee

D.2.3 The council should consult external professional advisers to market-test the remuneration levels of the chairperson and other Non-Executives at least once every three years and when they intend to make a material change to the remuneration of a Non-Executive.

Comply

Board E.1.2 The board should clarify in writing how the public interests of patients and the local community will be represented, including its approach for addressing the overlap and interface between governors and any local consultative forums.

Comply

Board E.1.3 The chairperson should ensure that the views of governors and members are communicated to the board as a whole.

Comply

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Board E.2.1 The board should be clear as to the specific third party bodies in relation to which the NHS foundation trust has a duty to co-operate.

Comply

Board E.2.2 The board should ensure that effective mechanisms are in place to co-operate with relevant third party bodies and that collaborative and productive relationships are maintained with relevant stakeholders at appropriate levels of seniority in each.

Comply

Corporate Governance Statement Monitor requires all NHS Foundation Trusts to submit, within three months of the end of each financial year, a Corporate Governance Statement by and on behalf of the Trust’s Board of Directors setting out any risks to compliance with the governance condition. The statement must include actions taken or planned to maintain future compliance with this condition, both at the date of the statement and for the next financial year. This Statement will be supported by the Trust’s Annual Governance Statement which provides assurance of the efficacy of the organisation’s internal controls and risk management systems. The Corporate Governance Statement is required by Monitor within three months of the year end. An auditor statement may be requested to provide additional assurance if Monitor has any concerns about Trust arrangements.

The Trust’s Corporate Governance Statement was provided to and approved by the Board in March 2015. Monitor confirmed that the Statement should be included within the Trust Annual Report for 2014/15 and it is therefore included within the Annual Report. A report on preparation of the Corporate Governance Statement has also been included within the Annual Governance Statement for the Trust which was first presented to the Trust Audit Committee on 9th April 2015.

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The Corporate Governance Statement will also be submitted as one of the governance returns to Monitor during Quarter 1, 2015/16. Corporate Governance

Question Confirmed or Not Confirmed

Board Assurance with any risks and mitigating action

1.

The Board is satisfied that the Trust applies those principles, systems and standards of good corporate governance which reasonably would be regarded as appropriate for a supplier of health care services to the NHS.

Confirmed

The Trust is fully and legally constituted; is compliant with (or has provided explanation for non-compliance with) the new Monitor Code of Governance (issued in 2014); is compliant with Monitor’s Audit Code; and has a plan in place to undertake a full Board Governance and Leadership review in 2015/16. The Trust has retained a Green Governance Risk Rating, and a Continuity of Services Risk Rating of 4 throughout 2014/15 (confirmed by Monitor up to and including Quarter 3). SWASFT employs a Trust Secretary to ensure that both the Board, and the Council of Governors is aware of and compliant with corporate governance standards. No risks or mitigating action required

2. The Board has regard to such guidance on good corporate governance as may be issued by Monitor from time to time

Confirmed

The Trust has consistently applied the guidance principles within Monitor’s Code of Governance, with a plan of compliance monitored by the Quality and Governance Committee. An updated plan was presented to the Committee in March 2015. All relevant Code of Governance disclosures will be included within the Trust annual report for 2014/15, together with a comprehensive statement of all disclosures and their location as required by the new Code, issued in July 2014. That statement was presented to the Quality and Governance Committee for approval in March 2015 and agreed for inclusion within the Annual Report. No risks or mitigating action required

3. The Board is satisfied that South Western Ambulance Service NHS Foundation Trust implements: (a) effective board and committee structures; (b) clear responsibilities for its

Board, for committees reporting to the Board and for staff reporting to the Board and

Confirmed

(a) The Board robustly reviewed and agreed its Board and Committee reporting and responsibilities during acquisition of Great Western Ambulance Service in early 2013 and continually considers the fitness for purpose of its governance structure. The membership and focus of the Quality and Governance Committee was reviewed and revised in 2014. The Audit Committee acquired a new Chair in September 2014 and a review of the Committee’s working practice and focus will be undertaken in 2015/16.

(b) A Non-Executive Director appointment and reappointment process is in place and implemented with the Trust Council of Governors. New Executive Directors for Nursing and Governance, and HR and Organisational Development took up posts in 2014. The former acquired responsibility for the Urgent Care Service, as well as

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Corporate Governance Question

Confirmed or Not Confirmed


those committees; and (c) clear reporting lines and

accountabilities throughout its organisation.

Governance and Safeguarding; and the latter has undertaken a structural review of the HR team and developed a whole-Trust Talent and Workforce Strategy to take forward in 2015/16. There are currently (at March 2015) no vacancies on the Board of Directors.

(c) The Trust governance structure is clear in terms of lines and accountabilities throughout the organisation with: a fully constituted Board of Directors; a Council of Governors; a cadre of Associate and Deputy Directors who review business in detail prior to review at Directors’ Group for sign off; each directorate has a clear structure and line of accountability (although both HR and UCS structures are under review at March 2015); and a Performance Management Framework, including Annual Accountability Agreements for each individual Director. Both the Board of Directors and Council of Governors operate in accordance with written Standing Orders (appended to the Trust Constitution), and each of the Board committees has terms of reference which are reviewed regularly and cross-checked against one another.

No risks or mitigating action required

4. The Board is satisfied that the Trust effectively implements systems and/or processes: (a) To ensure compliance with the Licensee’s duty to operate efficiently, economically and effectively; (b) For timely and effective scrutiny and oversight by the Board of the Licensee’s operations; (c) To ensure compliance with health care standards binding on the Licensee including but not restricted to standards specified by the Secretary of State, the Care Quality Commission, the NHS Commissioning Board and

Confirmed

(a) The Trust’s Annual Governance Statement for 2013/14 was supported by a Head of Internal Audit Opinion of significant assurance. The Annual Governance Statement for 2014/15 will include full details of the process put in place by the Board of Directors for recovery and sustainability of performance against the Category A targets, and 111 performance during 2014/15. The Trust has maintained regular and proactive contact with Monitor during the year, particularly where performance was off plan (none of the three Category A targets were achieved for Quarter 3. Two of the targets were not achieved for Quarter 4, however, the Trust Governance Risk Rating remains green. Performance Targets are one of the top three risks on the Corporate Risk Register, with mitigating actions monitored at meetings of the Board, Quality and Governance Committee, and Directors’ Group. However, missing three targets in one quarter has not affected the Trust Risk Ratings to date, and Monitor has confirmed that SWASFT retained a Governance Risk Rating of Green and a Continuity of Services score of 4 for Quarter 3. Missing two targets in Quarter 4 will not affect either rating.

(b) An annual cycle of business is managed by the Board of Directors, with the Board meeting each month other than August. Each Board Committee is chaired by one of the Non-Executive Directors. The Board receives the Integrated Corporate Performance Report at each meeting; the Audit Committee scrutinizes the work of Internal and External Audit, and reviews the process of assurance for key areas such

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statutory regulators of health care professions; (d) For effective financial decision-making, management and control (including but not restricted to appropriate systems and/or processes to ensure the Licensee’s ability to continue as a going concern); (e) To obtain and disseminate accurate, comprehensive, timely and up to date information for Board and Committee decision-making; (f) To identify and manage (including but not restricted to manage through forward plans) material risks to compliance with the Conditions of its Licence; (g) To generate and monitor delivery of business plans (including any changes to such plans) and to receive internal and where appropriate external assurance on such plans and their delivery; and (h) To ensure compliance with all applicable legal requirements.

as risk – the review of the work of the Committee will consider whether it should extend that scrutiny to other functions; the Finance and Investment Committee receives business cases and considers all aspects of financial governance; the Quality and Governance Committee has a large remit and takes annual deep dives into areas of clinical and quality governance as well as receiving highlight and exception reports against annual plans of work.

(c) The Board receives assurance from the Quality and Governance Committee, chaired by a Non-Executive Director, that it reviews compliance with all statutory and regulatory healthcare requirements, as well as commissioning specific deep dives into areas which may not be subject to regulation but could impact upon patient safety and experience, e.g. community responders. It also receives minutes from the Experiential Learning Forum which undertakes focused reviews into areas of risk or trends identified which might impact upon patient safety. This learning is then shared. The Board reviews the Patient Safety and Experience report at most meetings.

(d) The Trust financial controls are monitored by a Finance and Investment Committee, chaired by a Non-Executive Director and the Trust undertakes an annual assessment by the Audit Committee to ensure it remains a going concern

(e) Papers for Board and Committees are drawn from individual annual cycles which are fed by the Trust Regulatory Framework (recording all statutory and regulatory targets). These then support the development of agendas for each meeting and help managers to prepare for the reporting requirements for the year ahead.

(f) A monthly Light Touch monitoring meeting is chaired by the Deputy Chief Executive/ Executive Director of Finance to identify any risk to compliance with the Monitor governance conditions. All Trust meeting agendas include an item to identify any New Risks or Exception Reporting Triggers. Where performance concerns are raised (e.g. breach of Category A or NHS 111 performance during 2014/15) recovery plans are developed and achievement monitored by Directors’ Group with an agreed escalation process to the Trust Board of Directors. In addition, Project Boards and Mobilisation Groups are established for each new contract prior to and immediately following these being awarded. The Board of Directors receives an assurance report to support the signing off of each quarterly submission. This report includes assurance that: the Trust is compliant with its Access and Outcome Targets and Indicators; there are no exceptions in relation to CQC compliance; the Trust remains compliant with Monitor’s Quality Governance Framework; and that there are no exceptions to the Risk Assessment Framework Diagram 6, or any governance concerns.

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(g) The Board engages in the development of the Trust Annual Plan with input from the Council of Governors. Planning and bidding for new contracts is undertaken with executive sponsorship and ownership to support the Planning team in ensuring bids are robust and successful.

(h) A Trust Secretary was appointed in 2013 with responsibility for ensuring the Board of Directors, and the Council of Governors, is appropriately constituted.

See risk and mitigation at a) above

5. The Board is satisfied that the systems and/or processes referred to in paragraph 5 should include but not be restricted to systems and/or processes to ensure: (a) That there is sufficient capability at Board level to provide effective organisational leadership on the quality of care provided; (b) That the Board’s planning and decision-making processes take timely and appropriate account of quality of care considerations; (c) The collection of accurate, comprehensive, timely and up to date information on quality of care; (d) That the Board receives and takes into account accurate, comprehensive, timely and up to date information on quality of care; (e) That the Trust, including its Board, actively engages on

Confirmed

(a) Board capacity and capability was reviewed during the acquisition and at each reappointment or new Non-Executive Director appointment, in conjunction with the Council of Governors.

(b) The Trust’s Quality Strategy is reviewed and updated annually and the Board lead on Quality is the Executive Medical Director. He also reviewed the Strategy in 2014 against the Clinical Effectiveness Strategy and was satisfied that the Quality Strategy met the requirements of both. This view was endorsed by the Quality and Governance Committee.

(c) The agenda and membership of the Quality and Governance Committee were reviewed in May 2014. The Committee will continue to receive annual deep dives for all clinical and quality governance functions, supported by exception reports.

(d) As well as reports and assurance received from the Quality and Governance Committee, the Board reviews the Integrated Corporate Performance Report and an Executive Summary of the Patient Safety and Experience Report at each meeting.

(e) The Board receives a patient story at each meeting. The Board has also supported subscription to Patient Opinion and closer working with the Patient Association. Board members each have responsibility for engagement with a Health Watch organization in their area, and regularly attend station meetings with Trust staff. The Board engages with the Council of Governors, and chairs of the Board committees provide an annual presentation on the work of those committees to the Council. Comments are invited annually on the Trust Quality Account from Clinical Commissioning Groups, Health Watch, and the Health and Well-being Boards and these are included verbatim. In addition, the Trust has a membership of over 18,000 (at March 2015).

(f) The Trust quality focus is led by the Quality and Governance Committee to which those responsible for key areas of quality provide regular reports. The Committee also has an agenda item to allow for escalation of issues and referred a number of issues to the Directors’ Group during 2014/15. The Committee also asks report authors for

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quality of care with patients, staff and other relevant stakeholders and takes into account as appropriate views and information from these sources; and (f) That there is clear accountability for quality of care throughout the Trust including but not restricted to systems and/or processes for escalating and resolving quality issues including escalating them to the Board where appropriate.

additional assurance where it is required. The Trust has a robust incident reporting system and an Experiential Learning Forum which takes a focused approach to a specific subject at each meeting, based upon trends or themes identified from the review of patient safety incidents, complaints, HR cases etc. This Forum reports into the Quality and Governance Committee. Non-Executive Directors are invited to each Serious Incident Review.

No risks or mitigating action required

6. The Board is satisfied that there are systems to ensure that the Trust has in place personnel on the Board, reporting to the Board and within the rest of the organisation who are sufficient in number and appropriately qualified to ensure compliance with the conditions of its NHS provider licence.

Confirmed

The Board has approved a robust process for recruitment of its Executives and Non-Executives and this includes review of skills and experience where a vacancy occurs. The Board has also consulted with Monitor where a vacancy, such as lack of a Nurse Director for a period during 2013, might breach licence conditions, and agreed on corrective action. Operational Resources and Delivery of Statutory and Mandatory Education are (at March 2015) two of the three highest risks on the Corporate Risk Register. Actions to mitigate these risks are monitored at meetings of the Board, Quality and Governance Committee, and Directors’ Group.

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Enhanced Quality Governance Reporting

An Annual Governance Statement has been developed to provide assurance on the strength of the Trust’s systems of internal control. This includes an enhanced section on quality governance arrangements, outlining production of an annual Board Statement on Governance of Quality, and how assurance is provided to support the Board in making its quarterly submissions to Monitor against the conditions of the provider licence. The Statement was approved by the Trust Audit Committee at its meeting in May 2015 and endorsed by a Head of Internal Audit Opinion of significant assurance.

Overview of Arrangements for Governance of Service Quality Quality governance is defined as the combination of structures and processes at and below Board level to lead on Trust-wide quality performance including: Annual governance statement

Ensuring required standards are achieved;

Investigating and taking action on substandard performance;

Planning and driving continuous improvement;

Identifying, sharing and ensuring the delivery of best practice;

Identifying and managing risks to quality of care. The Board of Directors robustly considers the mechanisms in place for the governance of service quality against the requirements of Monitor’s Quality Governance Framework (a series of questions within four categories as set out below): Monitor’s Quality Governance Framework Strategy Capabilities and culture Process and

Structure Measurement

1A Does quality drive the trust’s strategy?

2A Does the Board have the necessary leadership, skills and knowledge to ensure delivery of the quality agenda?

3A Are there clear roles and accountabilities in relation to quality governance?

4A Is appropriate quality information being analysed and challenged?

1B Is the Board sufficiently aware of potential risks to quality?

2B Does the Board promote a quality focused culture throughout the trust?

3B Are there clearly defined processes for escalating and resolving issues and managing quality performance?

4B Is the Board assured of the robustness of the quality information?

3C Does the Board actively engage

4C Is quality information used

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Strategy Capabilities and culture Process and Structure

Measurement

patients, staff and other key stakeholders on quality?

effectively?

To demonstrate compliance with the Framework, a Board Memorandum on Quality Governance has been developed annually since SWASFT’s authorisation as an NHS foundation trust. For 2015/16, this has been streamlined into a Statement on Governance of Quality which also supports production of the Trust Annual Plan and the Board’s quarterly submissions against the requirements of Monitor’s Risk Assessment Framework. It was approved by the Board of Directors at its March 2015 meeting and provides a record of assurance of the robustness of the arrangements in place to govern delivery of a quality service. This document is also cross-referenced to the Board Assurance Framework and the Annual Governance Statement. The latter includes a description of the key elements of the Trust’s quality governance arrangements, including how the quality of performance information is assessed. The Annual Governance Statement can be found in this Annual Report at page 216. A plan to ensure implementation of the Trust’s Governance Strategy was approved at Quality and Governance Committee in May 2014 and monitored thereafter at each meeting by exception. In addition, the Trust’s Quality and Governance Committee approves programmes of work for key quality areas and monitors their progress through highlight and exception reports, as well as an annual deep dive into each area. These are presented by the manager responsible and detail work completed during the year as well as any risk to completion, and future work planned. The following deep dives were undertaken during 2014/15:

Learning Disability Clinical Guidelines Medicines Management

Safeguarding Infection Prevention and Control Risk and Claims

Health, Safety and Security Physical Assaults Governance Framework

Training Ambulance Clinical Quality Indicators

Public Sector Equality Duty

Environmental Work Clinical Audit HR and Well-being

CQC Compliance Community Responders

The Board of Directors scrutinises any risk to Trust performance targets, monitoring plans for recovery and sustainability. Details of breach of the three Category A targets in Quarter 3 and Category A Red 2 and A19 in Quarter 4 have been reported within the Annual Governance Statement. This report includes action taken to improve the position (as well as discussions with Monitor). The Trust maintained its Monitor green governance risk rating throughout the year, and its continuity of services risk rating of 4. Information on the performance issue was included within the Annual Governance Statement and taken directly from the quarterly Board assurance papers. It was mirrored within the Board Assurance Framework, and the Quality Report for 2014/15.

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The Annual Governance Statement also includes issues with NHS 111 performance during 2014/15 including details of an Urgent Care Services deep dive, and implementation of a performance recovery plan. The Trust Board of Directors reviews a Board Assurance Framework (BAF) at each meeting. The BAF is developed annually in line with Department of Health guidance. It has, in addition, assurance levels which enhance the basic Department of Health guidance. This includes a quality assurance score, which rates the quality/robustness of the assurance/evidence provided for each area/indicator within the assurance framework. An internal audit review in March 2015 confirmed that the BAF is used in steering the Board/ Governance agenda, and updates or papers relating to potential gaps in assurance identified within the BAF are discussed within the relevant Committee. In addition, where Internal Audit has reported a serious weakness in control, the Board receives appropriate updates on progress made to address the issues raised. The Directors Group also review any amber rated internal audit reports as part of the audit finalisation/approval process. The BAF cross references the relevant risk register associated with the achievement of their objectives and details the control assurances (internal and external) already in place. Gaps in control and/or assurance are identified and clear action plans to address weaknesses are set out. KPIs, Director responsibilities and Monitoring Forums are also included within the document. We can report that there are no material inconsistencies between the following:

The Annual Governance Statement

The annual and quarterly statements submitted by the Board of Directors against the requirements of Monitor’s Risk Assessment Framework

The Corporate Governance Statement, included within this Annual Report at page 207

The Quality Report for 2014/15

The Annual Report for 2014/15, and

Reports arising from Care Quality Commission planned and responsive reviews of the Trust – there were no planned or response reviews during 2014/15. The last planned review took place in February 2014, and the Trust remained compliant, with no recommendations for improvement

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Annual Governance Statement 2014/15

Scope of Responsibility As Accounting Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the NHS Foundation Trust’s policies, aims and objectives, whilst safeguarding the public funds and departmental assets for which I am personally responsible, in accordance with the responsibilities assigned to me. I am also responsible for ensuring that the NHS Foundation Trust is administered prudently and economically and that resources are applied efficiently and effectively. I also acknowledge my responsibilities as set out in the NHS Foundation Trust Accounting Officer Memorandum.

The Purpose of the System of Internal Control The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control is based on an ongoing process designed to identify and prioritise the risks to the achievement of the policies, aims and objectives of South Western Ambulance Service NHS Foundation Trust, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control has been in place in South Western Ambulance Service NHS Foundation Trust for the year ended 31 March 2015 and up to the date of approval of the annual report and accounts.

Capacity to Handle Risk Risk Leadership

The Board of Directors has overall responsibility for the management of risk within the Trust. The Executive Director of Nursing and Governance is the nominated director with responsibility for risk management, with the Head of Governance as the responsible manager, supported by the Head of Patient Safety and Risk as the senior manager responsible for risk. Risk management is a core component of the job descriptions of senior managers. During 2014/15 the Executive Director of Nursing and Governance and the Head of Governance attended the national ambulance Quality Governance and Risk Directors group (QGARD), with the Head of Patient Safety and Risk attending the South West Risk Forum.

The Trust has a comprehensive Risk Management Strategy which is reviewed annually by the Quality and Governance Committee and approved by the Board of Directors. This is supported by robust 6 monthly review and update of the risk management processes by the Audit Committee. The Strategy meets the requirements of the NHS Litigation Authority Risk Management Standards (which Trusts are no longer assessed against) and the Risk Management International

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Standard ISO 31000:2009. The Board of Directors leads on the development of the Corporate Risk Register and annually reviews all Trust risk registers.

The Board Assurance Framework for 2014/15 was reviewed by Internal Audit in March 2015 as presenting a low risk to the Trust with one recommendation categorised as low. The Framework links all significant objectives to the Trust’s Risk Registers, identifying gaps in controls/assurances, providing clear evidence that those gaps have been addressed, and highlighting sources of assurance. In 2011/12 an assurance evaluation tool, considering the value of each mechanism of assurance, and allocating an overall quality assurance score, was added to the Framework. This was approved as good and innovative practice by the Audit Committee. This evaluation tool has remained within the Board Assurance Framework for 2014/15. A new Board Assurance Framework for 2015/16 will be developed by the Trust Secretary and Head of Governance under the leadership of the Executive Director of Nursing and Governance, has been presented to the Board of Directors in April 2015 and subsequently approved and implemented. As Accounting Officer, I present the Framework to each meeting of the Board of Directors and it is also considered and reviewed by the Directors’ Group and the Quality and Governance Committee. The Audit Committee, chaired by a Non-Executive Director who is a CCAB qualified accountant and attended by internal and external auditors, is the delegated forum for providing assurance on the effectiveness of processes in place for the management of arrangements for governance, risk management, clinical assurance, internal control and financial reporting. The Audit Committee annually reviews the Trust’s Board Assurance Framework, and compliance with Monitor’s Audit Code for NHS Foundation Trusts. In addition the Audit Committee reviews the Trust’s risk management arrangements twice yearly to ensure they are being implemented, are fit for purpose and meet best practice. The Committee leads, with the Council of Governors, the development of criteria for appointing external auditors, and approves and monitors the annual internal and external audit plans.

The Quality and Governance Committee, chaired by a Non-Executive Director, is the delegated forum for clinical and quality governance, and risk management and compliance. As part of its assessment of the Trust risk management standards in 2010, the NHS Litigation Authority reviewed and approved the terms of reference for this Committee. A review of the terms of reference is performed regularly. The most recent one was carried out in July 2014, where membership of the committee changed and a Governance Effectiveness Group created to support the committee’s work. The Finance and Investment Committee, chaired by a Non-Executive Director, is the delegated forum for scrutinising and providing assurance on financial planning, financial reporting, financial performance, cost improvements, investments and disinvestments. It also provides assurance to the Audit Committee on the consistency of reporting to support the annual accounts and annual report disclosure statements.

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Risk Training

The Board of Directors undertakes an annual self-assessment of its role and effectiveness, as do each of its committees. A programme to support leadership and management development is implemented annually and teams are invited to take up these opportunities in line with their own training needs analyses. Risk management is included within the Board Development Programme. During 2014/15 guidance and support was provided by the Governance function, and the Corporate Risk Register is presented and reviewed at each Board of Directors’ meeting, with local Directorate Registers presented annually. The Board Development Programme for 2015/16 is being developed by the Chairman, Chief Executive and Trust Secretary and will specifically include risk management with focus on developing the Trust’s risk appetite.

The Induction Workbook issued to all staff joining the organisation contains a risk management section, incorporating: the identification, rating and prioritisation of risk; incident reporting; and management of risk (including slips, trips and falls). The workbook also contains a comprehensive section on moving and handling, including how to carry out a risk assessment. The Trust Mandatory and Statutory Training Workbook is completed by all staff, including senior managers, which includes Risk Management, Information Governance, Health and Safety, Safeguarding and Control of Infection. All key risk documents are published for staff on the Trust intranet.

The Trust learns from good practice using a variety of mechanisms including: clinical supervision and reflective practice, individual reviews, performance management, continuing professional development and clinical audits. In 2014/15 a review was undertaken of the terms of reference for the Trust’s Learning From Experience Group (LFEG), it was renamed Experiential Learning Forum (ELF) and was assigned the specific duty to undertake focused reviews of themes identified from trends or concerns raised as a result of feedback. ELF is a sub-group of the Quality and Governance Committee and the revised terms of reference were approved by the committee in July 2014. Focused reviews undertaken during 2014/15 included Mental Health and Capacity, Health and Wellbeing, and the non-conveyance of patients. Lessons identified from the focused reviews are disseminated through training, newsletters and publications

The Quality and Governance Committee and Board of Directors receive the Trust’s bi-monthly Patient Safety and Experience Report which is shared with Commissioners. This report includes details of learning from serious, moderate and adverse incidents, claims, complaints and other feedback. To share learning across the organisation the Trust has developed and launched a bi-monthly newsletter which includes lessons learnt and recommendations identified from serious incidents, moderate harm incidents and other feedback mechanisms.

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The Risk and Control Framework Strategy The Risk Management Strategy, which clearly defines the leadership, responsibility and accountability arrangements, requires risk management to be systematic, robust and evident. It requires that risk management processes are applied to business planning at all levels and issues communicated to key stakeholders where necessary. The strategy covers clinical, organisational and financial risk, and defines key management structures, processes, objectives and responsibilities within the Trust. It confirms the commitment to developing a responsible culture. This, in turn, helps to maximise the identification, reporting and avoidance of risk, promoting the safest possible environment for patients and staff. The Strategy is approved annually by the Board of Directors and is published on the Trust’s intranet.

The risk management process is incorporated within the Strategy. It sets out how risks should be identified, reported, assessed and prioritised using a defined categorisation and scoring methodology based on the Australia/New Zealand 4360:2004 Risk Management Standard model and using a 5 x 5 matrix to reach a risk rating. It provides guidance on acceptable risk and how to manage control failure. The Corporate Risk Register comprises those risks rated at 15 and over; the Executive Directors’ Risk Register contains risks rated from 10 to 12; and the individual Directorate Risk Registers (managed by directorate leads) contains local risks rated up to and including 9. The risk management process is reviewed annually by Internal Audit and by the Audit Committee.

Risk Identification and Evaluation The identification of new risks is a standing item on the agenda for the Board of Directors, its committees and key working groups. This ensures that each forum considers risk at the end of each meeting and has been effective in focusing attention on risk. Any risks identified or amended are passed to the Trust’s Risk team and are duly considered, rated and assigned to an appropriate risk register at the regular Quality Risk Watch forum chaired by the Executive Director of Nursing and Governance and attended by standing members: the Head of Governance, Head of Patient Safety and Risk, Trust Secretary and Deputy Director of Finance. They are then referred to the owner of the relevant risk register for additional controls and actions to mitigate the risk. The Quality Risk Watch Group also considers proposed amendments to risk ratings in a corporate context, either agreeing the change or referring amendments back to the proposer. The audit trail for this triangulation of risk is reported to the Quality and Governance Committee. The Board of Directors receives and reviews the Corporate Risk Register at each meeting. In addition, the Board of Directors receives the Executive Directors Risk register and individual Directorate Risk Registers annually providing assurance that all Trust functions are managing their risks effectively.

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The Quality and Governance Committee receives the Corporate Risk Register and Executive Directors Risk Register at each of its bi-monthly meetings where the documents are reviewed and discussed alongside any associated action plans and exception reports that have been produced to manage Trust risks.

The 5 x 5 matrix used when rating risks considers the impact of each risk in terms of: Injury/Safety (including patients, staff and the public); Legal or Financial; Service Interruption; Resource Escalatory Action Plan (REAP) levels; Regulatory; or Adverse Publicity/Reputation. Each risk is then assigned to an appropriate register depending upon the score for its impact multiplied by the score for the likelihood of that occurring. Each rating is also presented as a mitigated score, based upon consideration of the controls in place and of the remedial actions and business priority. Actions are recommended to reduce the risk rating. The risk matrix includes consideration of stakeholders in the assessment of impact of risks identified including, amongst others, patients, the public, service users and the Department of Health. Controls for individual risks are only recorded where they are verified as making an active difference to reducing or mitigating a risk. They are continually reviewed at the Directors Group for Corporate or Executive Directors’ Risks; or by the designated lead for directorate risk registers with guidance and support from the Head of Patient Safety and Risk.

The Trust’s Corporate Risk Register which contains all identified significant risks scoring 15 and above, is a fluid document which is regularly updated depending on internal and external factors. Significant ongoing risks, as well as those newly identified and contained within the Corporate Risk Register during the full year, which remain in March 2015 will be carried forward to 2015/16. The Trust risk registers contain details of the controls that are in place to manage each risk, the action planned to manage the risk and an identified accountable director. These are reviewed and discussed at each meeting of the Board of Directors, Directors Group and Quality and Governance Committee with the accountable director being responsible for advising on the latest position for each risk.

Risk Embeddedness Risk management is embedded in all Trust processes and areas. The Trust’s incident reporting system is web-based and extensively used by staff at all levels, with over 6,500 incidents reported in 2013/14 and an increase of 23% is expected at the end of 2014/15. The Trust continues to encourage incident reporting from staff at all levels and during 2014/15 updated its Mandatory Training Workbook which includes guidance on incident reporting and provided guidance documents for staff on the Trust’s intranet.

The Trust was reassessed against level 1 of the NHS Litigation Authority risk management standards in November 2010, achieving a pass of 50/50 criteria against the revised standards. The NHS Litigation Authority have advised trusts that

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they will no longer be conducting their assessments, however, to ensure best practice, the Trust has continued to ensure that all policies and process meet the existing standards.

Quality Governance Arrangements Statement on Quality Governance The conditions of the Trust’s provider licence require the Board of Directors to ensure that robust arrangements are in place for governance of the quality of care.

Monitor’s Risk Assessment Framework requires ongoing compliance with the Quality Governance Framework and Boards must demonstrate how they derive assurance that the quality of service the Trust provides, safeguards people from harm. This has been undertaken during 2014/15 through consideration of quarterly assurance reports at Board meetings, and approval of a comprehensive Statement on Quality Governance.

During the process of becoming a foundation trust, and acquiring the former Great Western Ambulance Service, the Trust produced and updated an extensive Board Memorandum on Quality Governance as assurance of the robustness of its arrangements. The Memorandum is no longer a requirement of NHS foundation trusts but, in order to demonstrate ongoing compliance with the Quality Governance Framework, the Board approved (at its meeting in March 2015) a comprehensive Statement on Quality Governance. This will be maintained and updated at each future year end.

The Statement also supports the requirements of the Trust Annual Governance Statement; the Annual Plan; Monitor’s Risk Assessment Framework; and the external Governance Review due to take place in 2015/16. Quarterly Board Assurance The Statement on Quality Governance also underpins the Trust’s quarterly submissions to Monitor. At the end of each quarter in 2014/15, an assurance report was approved by the Board of Directors to enable them to sign the governance statements required for submission to Monitor:

For finance, that:

"The Board anticipates that the Trust will continue to maintain a Continuity of Service risk rating of at least 3 over the next 12 months."

The Board confirms that:

“The Board anticipates that the Trust capital expenditure for the remainder of the financial year will not materially differ from the attached reforecast plan.”

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Otherwise

“The Board confirms that there are no matters arising in the quarter requiring an exception report to Monitor (per the Risk Assessment Framework) which have not already been reported.”

The Board of Directors confirmed all statements for each quarter in 2014/15. The assurance reports to the Board of Directors also included evidence of compliance with a series of targets and indicators and various information requirements related to the conditions of the Trust’s provider licence. The Trust performance for 2014/15 was as follows, with exceptions noted:

Indicator Q1

achievement Q2

achievement Q3

achievement Q4

achievement

Access and Outcome Targets and Indicators

Red 1 A8 (target

75%)

75.50% 75.44% 72.9% 77.08%

Red 2 A8 (target

75%)

75.95% 75.78% 69.0% 68.26%

A19 (target 95%) 95.21% 95.04% 92.2% 92.55%

Learning Disability* Compliant Compliant Compliant Compliant

A&E 4 Hour Wait

(target 95%)*

N/A 99.23% 99.4% 99.66%

CQC compliance exceptions

Compliant Compliant Compliant Compliant

Quality governance metrics

No executive

turnover


Patient metrics Compliant Compliant Compliant Compliant

Staff metrics Sickness a concern for Q2

Sickness Sickness and Turnover

Sickness and Turnover

Cost improvements Compliant Compliant Compliant Compliant

Risk Assessment Framework diagram 6

Continuity of

Services


Financial governance Compliant Compliant Compliant Compliant

Governance Compliant Compliant Compliant Compliant

Other risks Compliant Compliant One whistleblowing

case and Regulation 28

Compliant

Risk Assessment Framework diagram 13

CQC judgement Compliant Compliant Compliant Compliant

3rd

Party information One complaint upheld by PHSO

(GWAS)

Compliant Compliant Compliant

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Potential Breach of Performance Target (see Risk Section above) Performance exceptions As stated previously, the Board of Directors felt sufficiently assured to agree the signing of the relevant statements in its quarterly submissions to Monitor throughout 2014/15. However, there were exceptions and not all performance targets were achieved in year. The Board entered proactively into a dialogue with Monitor where performance was at risk, and/or not achieved to ensure all contributory factors were discussed with them, and to provide assurance of the Trust’s recovery plans. These conversations were received positively by Monitor. A Risk Commentary was submitted to them at the end of each quarter, fully explaining any issues or exceptions. Monitor confirmed that, for 2014/15, the Governance Risk Rating remained at Green, and the Continuity of Services Risk Rating remained at 4, in line with the Trust Annual Plan. The following is a summary of the commentaries provided with each quarterly submission to Monitor during 2014/15: Quarter 1 – Access and Outcome Targets and Indicators achieved An A&E Consolidated Action Plan (CAP) was developed for 2014/15 to maintain the

focus on achieving performance by quarter. Supporting narrative was included in the

Operating Plan and quarter one commentary which is summarised as follows:

The CAP incorporated recurrent and on-going actions from the Red Recovery Plan (established at the end of 2013/14) in order to secure in-year performance. This included triggers and processes for escalation should any risk to quarterly or year-end performance arise;

Delivery of the CAP, alongside the service improvement initiatives for 2014/15, secured performance against all three Red targets for Quarter 1 of 2014/15;

The Trust forecast an increased risk environment during Quarter two in relation to delivery of performance and the sustainable achievement of all three ambulance response time targets. Categorised under two broad themes key risks included performance and contracts. Sickness absence was also recorded as a concern;

Compliance with the learning disability indicator is monitored by exception by the Quality and Governance Committee.

Quarter 2 – Access and Outcome Targets and Indicators achieved Performance was delivered against all three Red targets for Quarter 2 of 2014/15. However, as set out within the Trust’s forward plans, there remained a residual risk in guaranteeing performance for the remainder of 2014/15:

The three key drivers affecting the delivery of performance were identified and reported to Monitor as activity, hospital handovers, and abstractions (including vacancies). The level of A&E frontline vacancies was recorded as an issue for

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Quarter 2 and an ongoing concern for Quarter 3. The Trust’s experience correlated with a national shortage of qualified paramedics, and the position was partially mitigated through the use of overtime, agency staff and third party crews.

A new sickness policy was launched in Quarter 2, with a new system for management of sickness. Retention strategies for 111 staff were established to develop career pathways for call advisors;

One complaint against the former GWAS was reopened and upheld by the Parliamentary Ombudsman. Although not against SWASFT, the Trust provided a response to the complainant; £15k in compensation; assurance against the recommendations; a meeting between the complainant and the Trust CEO; and arranged for desensitisation meetings;

Monitoring against the A&E 4 hour wait target began, due to the commencement of the contract for the Tiverton Urgent Care Centre on 8th July 2014, this performance indicator was achieved.

Compliance with the learning disability indicator is monitored by exception by the Quality and Governance Committee. Two exceptions were reported at the July meeting and a request to move the deadlines was approved. A new Accessibility plan was approved, up to the end of 2015/16, by the Committee in September.

Quarter 3 – Access and Outcome Targets and Indicators partly achieved A number of factors (including unprecedented demand over the Christmas and New Year periods) challenged the Trust’s ability to achieve the three Red performance indicators in Quarter 3. It was acknowledged, that for Quarter 4 the focus would be to deliver Red 1 and to recover the performance position for the year. The Trust would not be able to recover the year to date performance position for Red 2 and A19, and those performance targets were at risk for Quarter 4:

For A&E, for the 3 week period from 15 December 2014 to 4 January 2015, the Trust experienced a year on year increase in activity of almost 25%. The busiest day being Saturday 27 December 2014 with 3,188 incidents; a 37% increase compared to the same Saturday in 2013;

Demand for the Trust’s NHS 111 services during this period was also significantly higher than normal activity levels;

A Major Incident Standby, REAP 5, was declared on 27/28 December. This was reported as a Level 2 serious incident. A patient safety review was commissioned by Directors’ Group and levels of consequence management agreed including the issuing of a proactive apology to patients obviously affected;

Board members were provided with a full briefing on the period; Concerns from whistleblowers or complaints – an issue was raised directly with the

CQC by a member of staff in relation to an inquest held on 10 December 2014. This was investigated by the Trust with the findings verbally reported to the CQC at a meeting on 16 January 2015. At the inquest the Coroner made a Regulation 28 Recommendation to Prevent Future Deaths requiring that the Trust put in place additional training and assessment for Ambulance Practitioners prior to their allocation to a Rapid Response Vehicle;

A&E abstraction, both vacancies and sickness levels, remained in the risk commentary for Q3 as an ongoing concern for Quarter 4, along with 111 abstraction.

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Monitor guidance states ‘NHS foundation trusts failing to meet at least four of these requirements at any given time, or failing the same requirement for at least three quarters, will trigger a governance concern, potentially leading to investigation and enforcement action’. For Quarter 3 only the Trust did not meet three of the five access and outcome targets. This therefore did not trigger a formal governance concern with Monitor. Quarter 4 – Access and Outcome Targets and Indicators partly achieved The delivery of the key A&E performance targets continues to be one of the highest scoring risks on the Trust’s Corporate Risk Register. The highest risk at year end is Operational Resources with a risk rating of 25, this risk reduced following the Easter period and year end. In Quarter 4 the Trust prioritised the recovery of Red 1 performance and a Red 1 Recovery Plan was implemented which included a number of time limited actions. This resulted in the Trust achieving an end of year performance for Red 1 of 75.24%. Supporting narrative was included within the Quarter 4 commentary which is summarised as follows:

The Trust’s Red 1 Recovery Plan resulted in the use of incentivised overtime to mitigate the significant vacancies within its A&E service line, alongside agency staff and third party resources used in previous quarters;

Abstractions, operational vacancies and sickness, remain the most significant risk facing the Trust. At 31 March 2015 the Trust-wide vacancy rate was 5.43% and sickness was 6.18% for the year.

Demand during quarter four remained significantly above quarter four 2013/14 (8.9%) and contracted levels (3.25%). The year-end position was an increase of 9.75% incidents compared to 2013/14 and an increase of 3.28% over contract

During Quarter 4 the Secretary of State approved the Dispatch on Disposition (DoD) trial which initially was scheduled to take place for a period of 8 weeks. As a result of the positive initial results delivered this has been approved as an open ended trial into 2015/16.

For the quarter the Trust delivered the following performance, the table shows both standard and DoD Trial performance measures:

Indicator Performance Q4 Performance Q4

(Inclusive of DoD Trial)

Category A8 Red 1 77.08% 77.08%

Category A8 Red 2 64.60% 68.26%

Category A19 91.91% 92.55%

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Other Submissions to Monitor

Corporate Governance Statement A compliant Corporate Governance Statement is included within the Trust Annual Report (a separate statement is included in the following section on how the Trust is able to assure itself of the validity of its Corporate Governance Statement);

Governance Reviews The Board of Directors considered the Monitor guidance on the proposal for each trust to commission a three year external review of its Board governance and has scheduled the first review to commence during Quarter 2, 2015/16. The Board of Directors took considerable assurance from the action taken and reported within the Quarter 3 and 4 assurance papers and approved signing of the governance statement for both quarters, acknowledging the work required to improve performance into 2014/15.

Condition 4, Foundation Trust Governance Corporate Governance Statement The Board of Directors approved a Corporate Governance Statement of assurance at its meeting in March 2015. No significant risks to compliance with Condition 4 of the provider licence were identified during development of the Statement. The following governance arrangements are worthy of note:

Principles and Systems of Good Corporate Governance The Trust is fully and legally constituted; and has a plan in place to undertake a full Board Governance and Leadership review in 2015/16. The Trust has retained a Green Governance Risk Rating, and a Continuity of Services Risk Rating of 4 throughout 2014/15 and at the time of publication is awaiting confirmation from Monitor. SWASFT employs a Trust Secretary to ensure that both the Board, and the Council of Governors is aware of and compliant with corporate governance standards.

Having Regard to Corporate Governance Guidance The Trust has consistently applied the guidance principles within Monitor’s Code of Governance, with a plan of compliance monitored by the Quality and Governance Committee

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Effective Board and committee structures The membership and focus of the Quality and Governance Committee was reviewed and revised in 2014. The Audit Committee acquired a new Chair in September 2014 and a review of the Committee’s working practice and focus will be undertaken in 2015/16 in addition to the appointment of a new Chair from April 2015.

Clear responsibilities for the Board, its committees and staff reporting to them A Non-Executive Director appointment and reappointment process is in place and implemented with the Trust Council of Governors. New Executive Directors for Nursing and Governance, and HR and Organisational Development took up posts in 2014. There are currently (at March 2015) no vacancies on the Board of Directors

Compliance with Licensee Duties The Trust has maintained regular and proactive contact with Monitor during the year, particularly where performance was off plan (none of the three Category A targets were achieved for Quarter 3 and one (Red 1) was achieved in Quarter 4.

Compliance with Healthcare Standards The Board receives assurance from the Quality and Governance Committee, chaired by the Trust’s Vice Chairman, that it reviews compliance with all statutory and regulatory healthcare requirements, as well as commissioning specific deep dives into areas which may not be subject to regulation but could impact upon patient safety and experience.

Identification of Material Risks to Compliance A monthly Light Touch monitoring meeting is chaired by the Deputy Chief Executive/ Executive Director of Finance to identify any risk to compliance with the Monitor governance conditions. All Trust meeting agendas include an item to identify any New Risks or Exception Reporting Triggers.

Planning and Decision-Making for Quality of Care The Trust’s Quality Strategy is reviewed and updated annually and the Board lead on Quality is the Executive Medical Director. He also reviewed the Strategy in 2014 against the Clinical Effectiveness Strategy and was satisfied that the Quality Strategy met the requirements of both.

Engagement with Stakeholders on Quality of Care The Board receives a patient story at each meeting. The Board has also supported subscription to Patient Opinion and closer working with the Patient Association. Board members each have responsibility for engagement with a Health Watch organization in their area, and regularly attend station meetings with Trust staff.

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The Board of Directors reviewed and agreed a Corporate Governance Statement at its March 2015 meeting. The assurance provided against each of the statement requirements had previously been received by the Board or one of its committees and noted on the Board Assurance Framework. The Corporate Governance Statement is presented within the Trust Annual Report at page 207

Care Quality Commission Registration

The Foundation Trust is fully compliant with the registration requirements of the Care Quality Commission.

The Trust maintains a positive relationship with the local CQC Inspector, regular relationship meetings are held, with communication maintained by phone and email in between. The Trust has agreed a proactive communications protocol with the CQC providing information to them on certain levels of serious incidents, and any issues which might attract media attention.

The Trust Compliance Team uses DATIX to store and manage evidence of compliance with the regulations. Provider compliance assessments for each outcome are maintained in draft and updated as required.

The Board of Directors and the Quality and Governance Committee receive regular reports to provide assurance of the Trust’s continuing compliance. The Trust reports all serious and moderate patient safety incidents to the Care Quality Commission via the National Reporting and Learning System.

As part of the Internal Audit plan, an audit was undertaken in year of CQC compliance, assessing three outcomes. This report, by Audit South West presented a low risk to the organisation.

Data Security Further to the Trust’s corporate risk management framework, and linked into it, SWASFT’s Information Governance arrangements include dedicated management of risks to the information held by the Trust in order to reflect the specific requirements, defined through the Information Governance Toolkit and ISO 27001/2, for managing information security risks. These risks are reported to the Information Governance Group as the designated forum to consider issues arising from information governance and security incidents reported and trends that emerge from these.

Any moderate or significant risks are escalated to the Quality Risk Watch Group and are presented to the Quality and Governance Committee. During 2014/15, no information security incidents were classified as being serious.

The Trust achieved compliance with level 2 of the NHS Information Governance Toolkit in 2014/15 and work has taken place to maintain this level of compliance during 2015/16.

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NHS policy for the transfer of personally identifiable data was reinforced in the wake of the series of confidentiality breaches in the public sector towards the end of 2007. Significant work was subsequently undertaken in the Trust in the latter part of 2007 and early 2008, overseen and monitored by its Strategic Health Authority, to identify all transfers of personally identifiable data outside the Trust and ensure they were conducted securely and in accordance with NHS security standards. Further work was conducted as part of the acquisition of Great Western Ambulance Service by SWASFT during 2012/13.

The momentum of this initiative is continued through reported compliance with associated requirements in the Information Governance Toolkit, and the Trust has continued to meet national requirements in this respect, achieving Level 2 for all key requirements at the year end. The Board approved Caldicott Guardian is the Executive Medical Director. An Information Governance Group, chaired by the Senior Information Risk Owner (SIRO) and attended by Information Asset Owners, develops and monitors the information governance work programme.

Stakeholder Engagement The Trust has a dedicated External Relationships Manager who co-ordinates attendance at public events, involving Trust governors to support their engagement with their constituents. He also has well-established relationships with Health Watch and Health Overview and Scrutiny Committees (HOSCs) and co-ordinates their annual review of the annual Quality Report. The Trust manages a comprehensive complaints service, which complies with NHS regulations. As part of the process, the Trust discusses lessons learnt and actions to address any identified issues with complainants. As stated earlier in this governance statement, during the year a review of the membership of the Quality and Governance Committee was undertaken. Directors, managers, staff side representatives and Commissioners are members of the Quality and Governance Committee all of whom contribute to the review of risks on the Risk Register. The Trust attends regular meetings with its Commissioners where shared risks and associated controls and actions are reviewed jointly. Members of the Council of Governors are invited to attend the Board of Directors meeting where the Corporate Risk Register is discussed and reviewed at each meeting. The Trust shares any lessons learnt from serious incidents via the Strategic Executive Information System (STEIS) which is an electronic database used by the Trust to report serious incidents, this is monitored by the NHS England Commissioning Support Unit and the lead Clinical Commissioning Groups. In addition, where a serious incident has been identified which affects other organisations they are invited to contribute to the investigation and attend the final serious incident review meeting where recommendations are made to reduce the risk of re-occurrence.

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Following the serious incident review meeting, actions arising are monitored by the Directors’ Group and progress on completion of actions is addressed by the Chief Executive during 1:1 meetings with each Executive Director and is reported to the Board of Directors. During 2014/15 regular meetings took place with the Commissioning Support Unit regarding completion of serious incidents and associated actions. The following serious incidents and their type and number were identified during 2014/15: Delays 17 Non-conveyance following assessment 14 Treatment and Intervention issues 9 Clinical assessment issues 3 Information Technology issues 3 Infrastructure issues 2 Road traffic Accidents 2 Admission issue 1 Medical device/equipment 1 As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments into the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations. During the year the Trust disseminated information to all staff on the NHS Pension Scheme. Control measures are in place to ensure that all the organisation’s obligations under equality, diversity and human rights legislation are complied with. In March 2015 the Trust’s Quality and Governance Committee reviewed a deep dive undertaken by the Equality, Health and Wellbeing Lead of the Trust’s compliance with the Public Sector Equality Duty and details of actions required to achieve the requirements of Equality Delivery System 2 (EDS2). The Foundation Trust has undertaken risk assessments and Carbon Reduction Delivery Plans (Sustainable Development Plans) are in place (and monitored by the Environmental Management Group) in accordance with emergency preparedness and civil contingency requirements, as based on UKCIP 2009 weather projects, to ensure that this organisation’s obligations under the Climate Change Act and the Adaptation Reporting requirements are complied with. In May 2014 the Quality and Governance Committee reviewed a deep dive undertaken by the Trust’s Head of Estates on the Trust’s environmental management system. The Trust has a Winter Plan which is reviewed each year; as well as a Heatwave Plan; and business continuity plans for all key functions. The dedicated Hazardous Action Response Team (HART) further strengthens the resilience function.

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Review of Economy, Efficiency and Effectiveness of the Use of Resources The Trust has agreed:

Standing Orders and Standing Financial Instructions;

Finance Strategy with objectives for financial health;

Investment Strategy. The Board of Directors processes for managing its resources include delegated responsibility to a Finance and Investment Committee which is chaired by a Non-Executive director. Its purpose is to scrutinise and provide assurance to the Board of Directors on financial planning, cost improvements, investments and financial performance. Its duties include:

Conducting an independent and objective review of activities relating to financial planning, cost improvements, investments, disinvestments and financial performance;

Reviewing monthly financial accounts, investigate and report on material variances against budget and forecast;

Reviewing significant tenders and pricing information, both where the Trust is providing services and procuring services;

Operating under its scheme of delegation and considering partnership arrangements for tenders, as appropriate;

Reviewing the Trust business plan and annual plan;

Developing proposals for the reinvestment of any surpluses generated by the Trust in undertaking its operational activities;

Receiving the annual budgets for revenue and capital and recommend adoption by the Board of Directors

Reviewing proposals for major business cases

Reviewing enabling strategies and their impact on the Trust Forward Plan

Monitoring in year delivery of the Cost Improvement Programme

Identifying opportunities for further cost improvement

As requested by the Board of Directors, regularly reviewing the performance of the Trust against financial performance targets (which should include consideration of: financial performance in relation to both the capital and revenue budgets; financial performance in relation to activity and Service Level Agreements; financial performance in relation to sensitivity analysis and the risk environment).

The Committee reports and makes recommendations to the Board of Directors on issues of financial control. Its’ minutes provide assurance to the Board of Directors and are presented following each meeting. The Integrated Corporate Performance Report contains a summary of performance against the financial plan for the year. Greater detail is set out in a separate Finance Report presented to each meeting of the Finance and Investment Committee which

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includes a cash flow statement and performance against the cost improvement programme by individual scheme.

Information Governance As noted on page 95 there were no Level 2 serious incidents relating to information governance including data loss or confidentiality breach during the 2014/15 financial year.

Annual Quality Report The Board of Directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 (as amended) to prepare Quality Accounts for each financial year. Monitor has issued guidance to NHS foundation trust boards on the form and content of annual Quality Reports which incorporate the above legal requirements in the NHS Foundation Trust Annual Reporting Manual.

The Executive Director of Nursing and Governance leads on the Trust Quality Report and is the Board lead on Governance. The Quality Account indicators for 2014/15, together with the first draft of the 2015/16 priorities, were developed through cross-directorate multi-disciplinary working. The Trust Quality Report for 2014/15 includes all mandatory statements and statements of assurance from mandatory key stakeholders. The Board will sign off the Quality Report for 2014/15 in May 2015 after receiving the draft document and a full briefing paper. The Council of Governors has selected a local indicator for special review by the external auditors (who also review at least two mandated indicators) and will receive the auditors’ opinion by way of assurance that the indicators have been addressed in year. Quality Account priorities for 2015/16 were informed through engagement with the Council of Governors and the Trust’s commissioners, local Healthwatch organisations and Health Overview and Scrutiny Committees. Their views will be considered and taken into account by the Board in agreeing the final Quality Account. The Trust annual corporate objectives include quality targets and all national and local performance indicators. These were reported to the Board of Directors monthly within the Integrated Corporate Performance Report with exception reports and action planning addressing any off plan performance in year. This report is published on the Trust internet site for public scrutiny. Details of any exceptions have been described within the Quality Governance section of this Annual Governance Statement.

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Robust controls remain in place for all data accuracy which is led by the Executive Director of Information, Management and Technology. Data relating to performance against the indicators are verified by the work of the Information Assurance Steering Group, and the Ambulance Clinical Quality Indicators (ACQI) Sub Group throughout the year which provide a multi-disciplinary senior manager review of compliance with the indicators. The Trust’s external auditor Price Waterhouse Coopers is required to audit the content of the Quality Account to ensure it has been prepared in line with the requirements set out in the NHS Foundation Trust Annual Reporting Manual 2014/15 and is consistent with the other information sources detailed in the guidance. This is supported by the inclusion of testing of data within the annual audit programme for 2014/15 by Audit South West. The reports will not be published until June 2015.

Review of Effectiveness As Accounting Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, clinical audit and the executive managers and clinical leads within the NHS Foundation Trust who have responsibility for the development and maintenance of the internal control framework. I have drawn on the content of the quality report attached to this Annual report and other performance information available to me. My review is also informed by comments made by the external auditors in their management letter and other reports. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Board, the Audit Committee, the Finance and Investment Committee, and the Quality and Governance Committee and a plan to address weaknesses and ensure continuous improvement of the system is in place. The Head of Internal Audit provides me with an opinion on the overall arrangements for gaining assurance through the Board Assurance Framework and on the controls reviewed as part of the internal audit work. The Head of Internal Audit Opinion confirms overall as significant assurance. My review is also informed by:

The maintenance of the Trust’s Green governance risk rating by Monitor (see Quality Governance section);

Compliance with Monitor’s updated Code of Governance;

Reports from external auditors;

Assurances on process provided by the Audit Committee and its officers, including annual review of the process for risk management, and the Board Assurance Framework;

Internal Audit reports on arrangements within key Trust functions;

Full compliance with the Care Quality Commission essential standards for quality and safety for all regulated activities across all locations;

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Commissioner feedback;

Corporate performance reports;

Quarterly assurance reports to the Board of Directors for submission to Monitor;

Investigation reports, root cause analysis, and action plans following serious incidents and complaints;

Deep dives to the Quality and Governance Committee. The Board of Directors regularly reviews its governance reporting structure. The Board of Directors, Audit and Quality and Governance committees also undertake annual self-assessment of their own effectiveness. Each forum has an annual cycle of business and a record is maintained throughout the year of all business discussed. The reporting structure was confirmed as remaining for fit for purpose during the acquisition process. The Quality and Governance Committee has been in place for five years and has evolved into a valuable forum for development and review of governance systems and quality improvements including: quality governance policy and strategy; governance framework; patient experience; patient safety; health and safety reports; risk management; identification of new risks; identification of new legislation; learning from experience; infection prevention and control; implementation of NICE guidelines; clinical audit and effectiveness; information governance; communications and public relations; membership; HR activity; clinical and non-clinical training; policy register; compliance; safeguarding updates; medicines management and feedback from sub groups. A wholesale review of the agenda and working of the Quality and Governance Committee took place in 2012. As a result, the Committee has since focused its attention on deep dives into key areas and reporting by exception. The deep dives that took place during 2014/15 included governance, CQC compliance, risk and litigation management, environmental management, community responders, training and education, medicines management, safeguarding, infection prevention and control, information governance and health, safety and security. The Audit Committee and Internal Audit have developed, approved, and monitored a programme for the year to assess the effectiveness and fitness for purpose of key assurance processes and systems of internal control, including assessment of evidence of compliance with Care Quality Commission outcome regulation, and the evidence collection process established for that registration from 1 April 2010; review of the Board Assurance Framework; and review of risk management arrangements.

The outcome of the areas monitored as part of the internal audit programme for 2014/15 did not identify any significant issues. Where scope for improvement was identified, recommendations were made and appropriate action plans agreed which are monitored by the Audit Committee. To enhance the existing process in place for the management of Internal Audits additional scrutiny by the Governance Team is undertaken to ensure there is a corporate overview of all reports considering quality and consistency.

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Clinical Audit is monitored by the Quality and Governance Committee against an annual clinical audit plan, developed by the Trust Research and Audit Manager, which includes mandatory audits. An annual Internal Audit plan is also developed, approved and monitored by the Audit Committee with a quality assurance process managed by the Trust Compliance Manager.

The Trust has a Health Safety and Security Manager in post who is also the Trust’s Local Security Management Service lead. They lead the Health and Safety Group and associated work programme, under the line management of the Head of Patient Safety and Risk. The Audit Committee includes a Local Counter Fraud Specialist who reports any matters of concern to the Deputy Chief Executive/Executive Director of Finance. These are, in turn, reported to the Audit Committee and myself as the Accountable Officer. The system of internal control has been managed at Board level through scrutiny of the Board Assurance Framework and management of the Trust committees. Action plans are monitored by the appropriate committee which receives exception reports and monitors progress, and this includes actions to address non-compliance with the quality indicators as described within the Quality Governance section of this statement. Escalation is applied where it is felt that a higher level of focus is required e.g. reports required by the Directors to ensure that issues are being fully managed and that any risk to the Trust is mitigated. The Integrated Corporate Performance Report is also monitored at each Board of Directors meeting and provides exception reports and action plans where necessary. The Board of Directors of the South Western Ambulance Service NHS Foundation Trust approves this Annual Governance Statement for the South Western Ambulance Service NHS Foundation Trust, for signature by the Chief Executive Officer. The Board of Directors has taken assurance from the Head of Internal Audit Opinion of significant assurance presented to the SWASFT Audit Committee on 20 May 2015. It is based on these assurances that the Annual Governance Statement is approved.

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Conclusion

No significant control issues have been identified. My review confirms that South Western Ambulance Service NHS Foundation Trust has a generally sound system of internal control that supports the achievement of its policies, aims and objectives. Signed

Ken Wenman Chief Executive Date: 20 May 2015

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Independent auditors’ report to the Council of Governors of South Western Ambulance Service NHS Foundation Trust

Report on the financial statements

Our opinion

In our opinion, South Western Ambulance Service NHS Foundation Trust’s (“the Trust’s”) financial statements (the “financial statements”):

give a true and fair view of the state of the Trust’s affairs as at 31 March 2015 and of its income and expenditure and cash flows for the year then ended 31 March 2015; and

have been properly prepared in accordance with the NHS Foundation Trust Annual Reporting Manual 2014/15.

What we have audited

The Trust’s financial statements comprise:

the Statement of Financial Position as at 31 March 2015;

the Statement of Comprehensive Income for the year then ended;

the Statement of Cash Flows for the year then ended;

the Statement of Changes in Taxpayer’s Equity for the year then ended; and

the notes to the financial statements, which include a summary of significant accounting policies and other explanatory information.

The financial reporting framework that has been applied in the preparation of the financial statements is the NHS Foundation Trust Annual Reporting Manual 2014/15 issued by the Independent Regulator of NHS Foundation Trusts (“Monitor”).

Our audit approach

Overview

Overall materiality: £4,588,000 which represents 2% of total

revenue.

In establishing our overall approach we assessed the risks of material misstatement and applied our professional judgement to determine the extent of testing required over each balance in the financial statements.

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Risk of fraud in revenue and expenditure recognition; and

Revaluations of land and buildings.

The scope of our audit and our areas of focus

South Western Ambulance Service NHS Foundation Trust provides a range of

emergency and urgent care services to the people of the South West of England.

The services provided include:

Provision of the 999 ambulance service across the South West;

Urgent Care Services, including out of hours medical care across Dorset, Gloucestershire and Somerset;

NHS 111 call handling and triage services for Cornwall, Devon, Dorset and Somerset;

Patient Transport Services (PTS) for Bristol, North Somerset and South Gloucestershire and on the Isles of Scilly; and

Hazardous Area Response Teams (HART) for the entire Trust area.

We conducted our audit in accordance with International Standards on Auditing (UK and Ireland) (“ISAs (UK & Ireland)”).

We designed our audit by determining materiality and assessing the risks of material misstatement in the financial statements. In particular, we looked at where the directors made subjective judgements, for example in respect of significant accounting estimates that involved making assumptions and considering future events that are inherently uncertain. As in all of our audits, we also addressed the risk of management override of internal controls, including evaluating whether there was evidence of bias by the directors that represented a risk of material misstatement due to fraud.

The risks of material misstatement that had the greatest effect on our audit, including the allocation of our resources and effort, are identified as “areas of focus” in the table below. We have also set out how we tailored our audit to address these specific areas in order to provide an opinion on the financial statements as a whole, and any comments we make on the results of our procedures should be read in this context. This is not a complete list of all risks identified by our audit.

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Area of focus How our audit addressed the area of focus

Risk of fraud in income and expenditure recognition

See note 1 to the financial statements for the directors’ disclosures of the related accounting policies, judgements and estimates relating to the recognition of revenue and expenditure and notes 2 to 5 for further information.

The Trust receives the majority of its income from local commissioners for the services it provides. The majority of contracts are block contracts which are an agreed amount paid for the year. Within these contracts there are complex terms, including variable performance measures which are dependent on the delivery of activity. In addition and in line with other Trusts, non-contractual income is received during the year, for example winter pressure funding.

The Trust delivered a small surplus this year and with existing contracts changing and going out to tender, we considered there to be an increased risk that income may be deferred to 2015/16 and expenditure recognised in 2014/15 to improve the future financial position.

We therefore determined the risks to be:

- inappropriate deferral of revenue from 2014/15 to 2015/16 in order to support future funding;

- early recognition of expenditure in 2014/15 in order to decrease expenditure in 2015/16 when funding may be more restricted; and

- accruals and provisions are overstated – particularly the ‘workforce provision’, which the Trust established a number of years ago and which is separately disclosed in the financial statements.

Revenue and expenditure

We confirmed that the accounting policy for income and expenditure recognition to ensure that it is consistent with the requirements of the NHS Annual Reporting Manual and noted no issues in this respect.

We utilised Computer assisted audit techniques to identify if the income recognised had been received during the year or the debtor was settled after the year.

We read the relevant parts of the Trust’s significant contract arrangements and determined that none of them were complex.

We tested a sample of revenue transactions recognised after the year end to supporting contracts, to check that the amount of revenue recorded was accurately and appropriately recognised in the appropriate financial year.

We examined intra-NHS confirmations received by the Trust (through Monitors ‘agreement of balances’ exercise) of income and expenditure transactions that had occurred during the year and year end balances. We tested unresolved differences by examining correspondence between the parties, which we found to support the balances recognised by the Trust.

We read the contracts for winter pressures funding and electronic care system record funding, to identify if any there were any restrictions on the funding and the associated expenditure on which these funds were used. We found no exceptions in our testing which indicate that restrictions on the funding had not been complied with.

Our journals work was carried out using a risk based approach. We used data

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analysis techniques to identify the journals that had higher risk characteristics, for example, round sum journals or journals being posted outside “normal” office hours. Where revenue or expenditure was recorded through journal entries outside of the Trust’s normal process, we traced a sample of journals to supporting invoices to establish whether a service had been provided or received or a sale or purchase had occurred.

Similarly, we selected a number of accruals and provisions recorded in the financial statements, traced them to supporting documentation, such as invoices and used our experience of the Trust and the sector to determine whether the expenditure was recognised in the correct period. In respect of the ‘workforce provision’, we read legal advice received from the Trust’s lawyers that confirmed that this continued to be a valid potential liability. We substantively tested and confirmed that the valuation of the provision in the financial statements was fairly stated and that the provision should continue to be recognised in the current year.

We did not identify any transactions that were indicative of fraud in the recognition of income or expenditure.

Revaluations of land and buildings

See note 1 to the financial statements for the directors’ disclosures of the related accounting policies, judgements and estimates and note 9 for further information.

Property, plant and equipment (PPE), totalling £83.4 million, represents the largest balance in the Trust’s statement of financial position. The value of land is £15.7 million and of buildings is £28 million. All property, plant and equipment assets are measured initially at cost with

We confirmed that the valuer engaged by the Trust to perform the valuations had professional qualifications and was a member of the RICS.

We obtained and read the relevant sections of the full valuation performed by the Trust’s valuer. Using our own valuations expertise, we determined that the methodology and assumptions applied by the valuer were consistent with market practice in the valuation of hospital buildings. We determined that the

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land and buildings being subsequently measured at fair value based on periodic valuations. The valuations are carried out by professionally qualified valuers in accordance with the Royal Institute of Chartered Surveyors (RICS) Appraisal and Valuation Manual, and performed with sufficient regularity to ensure that the carrying value is not materially different from fair value at the reporting date.

We focused on this area because the value of the properties and the related movements in their fair values recognised in the financial statements are material. Additionally, the value of properties included within the financial statements is dependent upon the reliability of the valuations obtained by the Trust, which are themselves dependent on:

the accuracy of the underlying data provided to the valuer by the Directors and used in the valuation;

assumptions made by the Directors, including the location of a “modern equivalent asset”; and

the selection and application of the valuation methodology applied by the valuer, including assumptions relating to build costs and the estimated useful life of the buildings.

assumptions made by the Trust and the approach then taken together formed an acceptable basis for valuation.

We tested the data provided by the Trust to the external valuer by:

checking and finding that the portfolio of properties included in the valuation was consistent with the Trust’s fixed asset register, which we had audited; and

agreeing gross the internal area used by the valuer to floor plans for the properties valued.

We agreed that the values provided to the Trust by the valuer had been correctly included in the accounts and that the valuation movements were accounted for correctly.

We physically verified a sample of assets

to confirm existence and in doing so

assessed whether there was any

indication of physical obsolescence which

would indicate potential impairment. No

issues were identified.

How we tailored the audit scope

We tailored the scope of our audit to ensure that we performed enough work to be able to give an opinion on the financial statements as a whole, taking into account the structure of the Trust, the accounting processes and controls, and the environment in which the Trust operates. In establishing our overall approach we assessed the risks of material misstatement, taking into account the nature, likelihood and potential magnitude of any misstatement. Following this assessment, we applied professional judgement to determine the extent of testing required over each balance in the financial statements.

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The Trust comprises one single entity with books and records all retained at the head office in Exeter. We performed our audit at the head office in Exeter.

Materiality

The scope of our audit was influenced by our application of materiality. We set certain quantitative thresholds for materiality. These, together with qualitative considerations, helped us to determine the scope of our audit and the nature, timing and extent of our audit procedures and to evaluate the effect of misstatements, both individually and on the financial statements as a whole.

Based on our professional judgement, consistent with last year, we determined materiality for the financial statements as a whole as follows:

Overall materiality £4,588,000 (2014: £4,510,000).

How we determined it 2% of revenue

Rationale for benchmark applied

Consistent with prior year, we have applied this benchmark, which is a generally accepted measure when auditing not for profit organisations, because the Trust's income/expenditure is a key measure of its financial performance and of interest to the Council of Governors and other users of the financial statements.

We agreed with the Audit Committee that we would report to them misstatements identified during our audit above £229,400 (2014: £225,500) as well as misstatements below that amount that, in our view, warranted reporting for qualitative reasons.

Other required reporting in accordance with the Audit Code for NHS

foundation trusts

Opinions on other matters prescribed by the Audit Code for NHS foundation trusts

In our opinion:

the information given in the Strategic Report and the Directors’ Report for the financial year for which the financial statements are prepared is consistent with the financial statements; and

the part of the Directors’ Remuneration Report to be audited has been properly prepared in accordance with the NHS Foundation Trust Annual Reporting Manual 2014/15.

Consistency of other information

Under the Audit Code for NHS foundation trusts we are required to report to you if, in our opinion:

information in the “Annual Report is:

materially inconsistent with the information in the audited financial statements; or

apparently materially incorrect based on, or materially

We have no exceptions to report arising from this

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inconsistent with, our knowledge of the Trust acquired in the course of performing our audit; or

otherwise misleading.

responsibility.

the statement given by the directors, in accordance with provision C.1.1 of the NHS Foundation Trust Code of Governance, that they consider the Annual Report taken as a whole to be fair, balanced and understandable and provides the information necessary for members to assess the Trust’s performance, business model and strategy is materially inconsistent with our knowledge of the Trust acquired in the course of performing our audit.

We have no exceptions to report arising from this responsibility.

the section of the Annual Report, as required by provision C.3.9 of the NHS Foundation Trust Code of Governance, describing the work of the Audit Committee does not appropriately address matters communicated by us to the Audit Committee.

We have no exceptions to report arising from this responsibility.

the Annual Governance Statement does not meet the disclosure requirements set out in the NHS Foundation Trust Annual Reporting Manual 2014/15 or is misleading or inconsistent with information of which we are aware from our audit. We are not required to consider, nor have we considered, whether the Annual Governance Statement addresses all risks and controls or that risks are satisfactorily addressed by internal controls.

We have no exceptions to report arising from this responsibility

Economy, efficiency and effectiveness of resources and Quality Report

Under the Audit Code for NHS Foundation Trusts we are required to report to you if:

we have not been able to satisfy ourselves that the Trust has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources; and


we have qualified, on any aspect, our opinion on the Quality Report.


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Responsibilities for the financial statements and the audit

Our responsibilities and those of the directors

As explained more fully in the Statement of the Chief Executive’s Responsibilities as the Accounting Officer on page 196, the directors are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view in accordance with the NHS Foundation Trust Annual Reporting Manual 2014/15.

Our responsibility is to audit and express an opinion on the financial statements in accordance with the National Health Service Act 2006, the Audit Code for NHS Foundation Trusts issued by Monitor and ISAs (UK & Ireland). Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors.

This report, including the opinions, has been prepared for and only for the Council of Governors of South Western Ambulance Service NHS Foundation Trust as a body in accordance with paragraph 24 of Schedule 7 of the National Health Service Act 2006 and for no other purpose. We do not, in giving these opinions, accept or assume responsibility for any other purpose or to any other person to whom this report is shown or into whose hands it may come save where expressly agreed by our prior consent in writing.

What an audit of financial statements involves

An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of:

whether the accounting policies are appropriate to the Trust’s circumstances and have been consistently applied and adequately disclosed;

the reasonableness of significant accounting estimates made by the directors; and

the overall presentation of the financial statements.

We primarily focus our work in these areas by assessing the directors’ judgements against available evidence, forming our own judgements, and evaluating the disclosures in the financial statements.

We test and examine information, using sampling and other auditing techniques, to the extent we consider necessary to provide a reasonable basis for us to draw conclusions. We obtain audit evidence through testing the effectiveness of controls, substantive procedures or a combination of both.

In addition, we read all the financial and non-financial information in the Annual Report to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report.

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Certificate

We certify that we have completed the audit of the financial statements in accordance with the requirements of Chapter 5 of Part 2 to the National Health Service Act 2006 and the Audit Code for NHS Foundation Trusts issued by Monitor.

Heather Ancient (Senior Statutory Auditor)

for and on behalf of PricewaterhouseCoopers LLP Chartered Accountants and Statutory Auditors Plymouth

21 May 2015

The maintenance and integrity of the South Western Ambulance Service NHS Foundation Trust website is the responsibility of the directors; the work carried out by the auditors does not involve consideration of these matters and, accordingly, the auditors accept no responsibility for any changes that may have occurred to the financial statements since they were initially presented on the website.

Legislation in the United Kingdom governing the preparation and dissemination of financial statements may differ from legislation in other jurisdictions.

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Annual Accounts

Accounts for the Year Ended 31 March 2015 Foreword to the accounts

These accounts for the year ended 31 March 2015 are presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006.

Signed:

Ken Wenman Chief Executive and Accounting Officer Date: 20 May 2015

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STATEMENT OF COMPREHENSIVE INCOME FOR THE YEAR ENDED 31 MARCH 2015

Year ended 31 March 2015


Note £000 £000

Operating income from patient care activities 3.1 219,773 220,236

Other operating income 3.1 9,666 5,382

Operating expenses from continuing operations 4.1 (227,572) (223,335)

Operating surplus 1,867 2,283

Finance costs:

Finance income 7 95 89

Finance costs - financial liabilities 8 (124) (147)

Finance costs - unwinding of discount on provisions 18 (52) (65)

PDC Dividends payable (1,627) (1,827)

Net finance costs (1,708) (1,950)

Surplus for the year 159 333

Other comprehensive income

Impairments 9.1 (262) (1,259)

Revaluations 9.1 1,605 1,943

Total comprehensive income for the year 1,502 1,017

The notes on pages 251-293 form part of these accounts.

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The accounts on pages 251-293 were approved by the Board on 20 May 2015 and signed on its behalf by:

Signed:

Ken Wenman

Chief Executive

STATEMENT OF FINANCIAL POSITION AS AT 31 MARCH 2015

31 March 2015

31 March 2014

Note £000 £000

Non-current assets

Property, plant and equipment 9.1 83,371 81,974

Trade and other receivables 12 397 0

Total non-current assets 83,768 81,974

Current assets

Inventories 11 2,207 2,036

Trade and other receivables 12 4,974 6,367

Cash and cash equivalents 20 34,066 30,449

Total current assets 41,247 38,852

Current liabilities

Trade and other payables 13.1 (22,672) (20,287)

Borrowings 15 (497) (504)

Provisions 18 (7,266) (7,876)

Other liabilities 14 (398) (141)

Total current liabilities (30,833) (28,808)

Total assets less current liabilities 94,182 92,018

Non-current liabilities

Trade and other payables 13.1 (228) 0

Borrowings 15 (2,822) (3,221)

Provisions 18 (4,215) (3,952)

Total non-current liabilities (7,265) (7,173)

Total assets employed 86,917 84,845

Financed by taxpayers' equity:

Public Dividend Capital 43,025 42,455

Revaluation reserve 19 8,121 7,115

Income and expenditure reserve 35,771 35,275

Total Taxpayers' Equity 86,917 84,845

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STATEMENT OF CHANGES IN TAXPAYERS' EQUITY FOR THE YEAR ENDED 31 MARCH 2015

Note Public dividend capital (PDC)

Revaluation reserve

Income and expenditure reserve

Total Taxpayers' Equity

£000 £000 £000 £000

Changes in taxpayers’ equity

Balance at 1 April 2014 42,455 7,115 35,275 84,845

Surplus for the year 0 0 159 159

Transfers between reserves 0 (336) 336 0

Impairments 9.1 0 (262) 0 (262)

Revaluations - property, plant and equipment 9.1 0 1,605 0 1,605

Asset disposals 0 (1) 1 0

Public Dividend Capital received 570 0 0 570

Taxpayers' Equity at 31 March 2015 43,025 8,121 35,771 86,917

STATEMENT OF CHANGES IN TAXPAYERS' EQUITY FOR THE YEAR ENDED 31 MARCH 2014

Public dividend capital (PDC)

Revaluation reserve

Income and expenditure reserve

Total Taxpayers' Equity

£000 £000 £000 £000

Changes in taxpayers’ equity

Balance at 1 April 2013 39,055 6,868 34,505 80,428

Surplus for the year 0 0 333 333

Transfers by absorption: transfers between reserves 0 (432) 432 0

Impairments 0 (1,259) 0 (1,259)

Revaluations 0 1,943 0 1,943

Asset disposals 0 (5) 5 0

Public Dividend Capital received 3,400 0 0 3,400

Taxpayers' Equity at 31 March 2014 42,455 7,115 35,275 84,845

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STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31 MARCH 2015

Note Year ended 31 March 2015


£000 £000

Cash flows from operating activities

Operating surplus from continuing operations 1,867 2,283


Non cash income and (expense)

Depreciation 4.1 10,150 12,094

Impairments 4.1 1,974 3,508

Reversals of impairments 3.1 (341) (679)

Loss on disposal 4.1 (164) (77)

Decrease/(increase) in trade and other receivables 12.1 1,091 (1,353)

(Increase) in Inventories 11.1 (171) (204)

Increase in trade and other payables 13.1 2,584 1,879

Increase / (Decrease) in other liabilities 14 257 (69)

(Decrease) in Provisions 18 (399) (1,000)

Net cash generated from operations 16,848 16,382

Cash flows from investing activities

Interest received 7 95 89

Purchase of property, plant and equipment 9.1 & 13.1

(14,303)

(12,747)

Sales of Property, Plant and Equipment 3.1, 4.1 & 9.1

2,659 215

Net cash used in investing activities (11,549)

(12,443)

Cash flows from financing activities

Public dividend capital received 570 3,400

Loans received 15 111 0

Loans repaid to the Department of Health 15 (428) (872)

Loans repaid 15 (71) (60)

Capital element of finance lease rental payments (18) 0

Interest paid (67) (86)

Interest element of finance lease (57) (64)

PDC Dividend paid (1,722) (1,701)

Net cash (used in) / generated from financing activities (1,682) 617

Net Increase in cash and cash equivalents 3,617 4,556

Cash and cash equivalents at the start of the year 30,449 25,893

Cash and cash equivalents at 31 March 34,066 30,449

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Notes to the Accounts 1.1 Accounting Policies Monitor has directed that the annual report and accounts of NHS Foundation Trusts

shall meet the accounting requirements of the NHS Foundation Trust Annual Reporting Manual, which shall be agreed with HM Treasury. Consequently, the following annual report and accounts have been prepared in accordance with the 2014/15 NHS Foundation Trust Annual Reporting Manual issued by Monitor. The accounting policies contained in that manual follow International Financial Reporting Standards (IFRS) and HM Treasury's Financial Reporting Manual to the extent that they are meaningful and appropriate to NHS Foundation Trusts. The accounting policies have been applied consistently in dealing with items considered material in relation to the accounts.

1.2 Accounting convention

These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment.

1.3 Going Concern

After making enquiries, the directors have a reasonable expectation that the Trust has adequate resources to continue in operational existence for the foreseeable future. For this reason, they continue to adopt the going concern basis in preparing the accounts.

1.4 Acquisitions and discontinued operations

Activities are considered to be ‘acquired’ only if they are taken on from outside the public sector. Activities are considered to be ‘discontinued’ only if they cease entirely. They are not considered to be ‘discontinued’ if they transfer from one public sector body to another.

1.5 Critical accounting judgements and key sources of estimation uncertainty

In the application of the Trust’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.

1.5.1 Critical judgements in applying accounting policies

The following are the critical judgements, apart from those involving estimations (see below) that management has made in the process of applying the Trust’s accounting policies and which have the most significant effect on the amounts recognised in the annual report and accounts.

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Provisions

The provision calculated for the outcome of outstanding workforce integration issues has been based on management best estimate and legal advice received.

Information provided by the NHS Litigation Authority has been used to determine provisions required for potential employer liability claims and disclosure of Clinical Negligence liability.

The NHS Pensions Agency has provided information with regard to disclosure and calculation of ill health retirement liability.

Provisions for pensions are estimated by using the interim life tables available from the National Statistics.

The 2014/15 accounts included a redundancy provision for workforce restructuring provisions relating to a review of the Trust's organisational structures including the Mutually Agreed Resignation Scheme (MARS).

The Trust has made a provision for the potential dilapidation costs for two leased buildings where notice has been given on the leases.

Property, plant and equipment revaluation

The Trust has used the professional services of the Local District Valuer to value all Land and Buildings as at 31 March 2015. Indexation has not been applied to any non current assets (i.e. vehicles and equipment). The key assumptions for the valuation are set out in note 1.9.

During 2014/15 the Trust sold its Marybush site to the Homes and Communities Association (HCA). The site was revalued in 2013/14 from Depreciated Replacement Cost (DRC) to market value.

Due to the loss of contracts for Somerset 111 and Out of Hours the Trust has recognised an impairment for the St Leonards Hub.

Accruals

Accruals for services received not yet invoiced are estimated on the basis of past experience.

Within the holiday accrual the NIC is estimated at the standard rate and that all employees are in the pension scheme.

Overtime accrual is estimated on the previous month and adjusted for any known movements within the rostering system.

Other critical judgements

The Trust reviews all lease contracts to determine whether they are operating or finance leases.

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The bad debt provision has been calculated based on a detailed review of each balance over 90 days.

Income has been deferred where expenditure will take place during the year ended 31 March 2016.

1.5.2 Key sources of estimation uncertainty

The following are the key assumptions concerning the future and other key sources of estimation uncertainty at the end of the reporting period that have a significant risk of causing a material adjustment to the carrying amounts of assets and liabilities within the next financial year.

A discount rate of 1.3% (2014: 1.8%) has been used to calculate the Injury Benefit provision of £4.320 million (2014: £3.972 million). Non-current asset lives have been reassessed by the District Valuer at 31 March 2015.

1.6 Income

Income in respect of services provided is recognised when and to the extent that performance occurs and is measured at the fair value of the consideration receivable. The main source of income for the Trust is contracts with commissioners in respect of healthcare services.

Where income is received for a specific activity that is to be delivered in the following year, such income is deferred. This is a combination of NHS and non NHS income which is not material in 2014/15.

Income from the sale of non-current assets is recognised only when all material conditions of sale have been met and is measured as the sums due under the sale contract.

The Trust receives income under the NHS Injury Cost Recovery Scheme, designed to reclaim the cost of treating injured individuals to whom personal injury compensation has subsequently been paid e.g. by an insurer. The Trust recognises the income when it receives notification from the Department of Work and Pension's Compensation Recovery Unit that the individual has lodged a compensation claim.

1.7 Expenditure on employee benefits

Short-term employee benefits

Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees.

The cost of annual leave entitlement earned but not taken by employees at the end of the period is recognised in the annual report and accounts to the extent that employees are permitted to carry forward leave into the following period.

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Pension costs

Past and present employees are covered by the provisions of the NHS Pension Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. It is not possible for the Trust to identify its share of the underlying scheme liabilities. Therefore, the scheme is accounted for as a defined contribution scheme.

Employers pension cost contributions are charged to operating expenses as and when they become due.

Additional pension liabilities arising from early retirements are not funded by the scheme except where the retirement is due to ill-health. The full amount of the liability for the additional costs is charged to the operating expenses at the time the Trust commits itself to the retirement, regardless of the method of payment.

1.8 Expenditure on goods and services

Expenditure on goods and services is recognised when and to the extent that they have been received, and is measured at the fair value of those goods and services. Expenditure is recognised in operating expenses except where it results in the creation of a non-current asset such as property, plant and equipment.

1.9 Property, plant and equipment

Recognition

Property, plant and equipment is capitalised if:

● it is held for use in delivering services or for administrative purposes;

● it is probable that future economic benefits will flow to, or service potential will be supplied to, the Trust;

● it is expected to be used for more than one financial year;

● the cost of the item can be measured reliably; and

● the item has cost of at least £5,000; or

● Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or

● Items form part of the initial equipping and setting-up cost of a new building or ambulance station, irrespective of their individual or collective cost.

Where a large asset, for example a building, includes a number of components with significantly different asset lives e.g. plant and equipment, then these components are treated as separate assets and depreciated over their own useful economic lives.

Valuation

All property, plant and equipment is measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management.

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All assets are measured subsequently at fair value. With the exception of land and buildings, depreciated historic costs are considered to reflect fair value.

Land and buildings used for the Trust’s services or for administrative purposes are stated in the statement of financial position at their revalued amounts, being the fair value at the date of revaluation less any

subsequent accumulated depreciation and impairment losses. Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Fair values are determined as follows:

● Land and non-specialised buildings – market value for existing use

● Specialised buildings – depreciated replacement cost.

All other assets are measured subsequently at fair value. Valuations are carried out by professionally qualified valuers in accordance with the Royal Institute of Chartered Surveyors (RICS) Appraisal and Valuation Manual. The latest full revaluation of the Trusts specialised buildings was undertaken as at 31 March 2015.

The Treasury has decided that the NHS should value its property assets in line with the Royal Institution of Chartered Surveyors (RICS) Red Book standards. This means that specialised property, for which market value cannot be readily determined, should be valued at depreciated replacement cost (DRC) on a modern equivalent asset basis.

In accordance with the Treasury accounting manual, valuations are now carried out on the basis of modern equivalent asset replacement cost for specialised operational property and existing use value for non-specialised operational property. The value of land for existing use purposes is assessed at existing use value.

Alternative open market value figures are only used for operational assets scheduled for imminent closure and subsequent disposal.

Specialised buildings - depreciated replacement cost

HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and where it would meet the location requirements of the service being provided, an alternative site can be valued.

Assets in the course of construction are initially valued at cost and are subsequently valued by professional valuers when construction is completed if there is evidence that the construction cost is not a good approximation of fair value. For 2014/15 this includes Croydon Street Bristol and Kestrel Way Exeter, which have been assessed and these impairments are not material.

Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are revalued and depreciation commences when they are brought into use.

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Until 31 March 2009, fixtures and equipment were carried at replacement cost, as assessed by indexation and depreciation of historic cost. From 1 April 2009 indexation has ceased. The carrying value of existing assets at that date will be written off over their remaining useful lives and new fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from fair value.

Revaluation gains and losses

Revaluation gains and losses are recognised in the revaluation reserve, except where, and to the extent that they reverse a revaluation decrease that has previously been recognised in operating expenses, in which case, they are recognised in operating income.

Revaluation losses are charged to the revaluation reserve to the extent that there is an available balance for the asset concerned and are thereafter charged to operating expenses.

Gains and losses recognised in the revaluation reserve are reported in the Statement of Comprehensive Income as an item of 'other comprehensive income'.

Subsequent expenditure

Subsequent expenditure relating to an item of property, plant and equipment is recognised as an increase in the carrying amount of the asset when it is probable that additional future economic benefits or service potential deriving from the cost incurred to replace a component of such item will flow to the enterprise and the costs of the item can be determined reliably.

Where a component of an asset is replaced, the cost of the replacement is capitalised if it meets the criteria for recognition above. The carrying amount of the part replaced is de-recognised. Other expenditure that does not generate additional future economic benefits or service potential, such as repairs and maintenance, is charged to the Statement of Comprehensive Income in the period in which it is incurred.

1.10 Depreciation

Assets in the course of construction are not depreciated until the asset is brought into use or reverts to the Trust, respectively.

Otherwise, depreciation is charged to write off the costs or valuation of property and plant and equipment, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service delivery benefits. The estimated useful life of an asset is the period over which the Trust expects to obtain economic benefits or service potential from the asset. This is specific to the Trust and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over their estimated useful lives.

Freehold land is considered to have an infinite life and is not depreciated.

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Impairments

In accordance with the Foundation Trust Annual Reporting Manual, impairments that are due to a loss of economic benefits or service potential in the asset are charged to operating expenses. A compensating transfer is made from the revaluation reserve to the income and expenditure reserve of an amount equal to the lower of (i) the impairment charged to the operating expenses; and (ii) the balance in the revaluation reserve attributable to that asset before the impairment.

An impairment arising from a loss of economic benefit or service potential is reversed when and to the extent that, the circumstances that gave rise to the loss is reversed. Reversals are recognised in operating income to the extent that the asset is restored to the carrying amount it would have had if the impairment had never been recognised. Any remaining reversal is recognised in the revaluation reserve. Where, at the time of the original impairment, a transfer was made from the revaluation reserve to the income and expenditure reserve, an amount is transferred back to the revaluation reserve when the impairment reversal is recognised.

Other impairments are treated as revaluation losses. Reversals of 'other impairments' are treated as revaluation gains.

Due to the loss of contracts for Somerset 111 and Out of Hours the Trust has recognised an impairment for the St Leonards Hub.

1.11 Donated assets

Donated plant and equipment assets are capitalised at their fair value on receipt. The donation is credited to income at the same time, unless the donor imposes a condition that the future economic benefits embodied in the donation are to be consumed in a manner specified by the donor, in which case, the donation is deferred within liabilities and is carried forward to future financial years to the extent that the condition has not yet been met.

The donated assets are subsequently accounted for in the same manner as other items of property, plant and equipment.

1.12 Software

Software which is integral to the operation of hardware e.g. an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software which is not integral to the operation of hardware e.g. application software, is charged to software in the Statement of Comprehensive Income.

1.13 Leases

Finance leases

Where substantially all the risks and rewards of ownership of a leased asset are borne by the Trust, the asset is recorded as property, plant and equipment and a corresponding liability is recorded. The value at which both are recognised is the lower of the fair value of the asset or the present value of the minimum lease payments, discounted using the interest rate implicit in the lease.

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The asset and liability are recognised at the commencement of the lease. Thereafter the asset is accounted for as an item of property, plant and equipment.

The annual rental is split between the repayment of the liability and the finance cost so as to achieve a constant rate of finance over the life of the lease. The annual finance cost is charged to Finance Costs in the Statement of Comprehensive Income. The lease liability, is de-recognised when the liability is discharged, cancelled or expires.

Operating leases

Other leases are recognised as operating leases and the rentals are charged to operating expenses on a straight-line basis over the term of the lease. Operating lease incentives received are added to the lease rentals and charged to operating expenses over the life of the lease.

Leases of land and buildings

Where a lease is for land and buildings, the land and building components are separated from the building component and the classification for each is assessed separately.

1.14 Inventories

Inventories are valued at the lower of cost and net realisable value using the first-in first-out cost formula with the exception of fleet parts which are valued using the weighted average cost formula. This is considered to be a reasonable approximation to fair value due to the high turnover of stocks.

Provision is made where necessary for obsolete, slow moving and defective stocks.

1.15 Cash and cash equivalents

Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than twenty four hours. Cash equivalents are investments that mature in three months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value.

In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the Trust’s cash management.

1.16 Provisions

Provisions are recognised when the Trust has a present legal or constructive obligation as a result of a past event and it is probable that the Trust will be required to settle the obligation and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where the effect of the time value of money is significant, the estimated risk-adjusted cash flows are discounted using the discount rates published and mandated by HM Treasury.

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When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably.

A restructuring provision is recognised when the Trust has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The measurement of a restructuring provision includes only the direct expenditure arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with ongoing activities of the entity.

1.17 Clinical negligence costs

The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the Trust pays an annual contribution to the NHSLA which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the NHSLA is administratively responsible for all clinical negligence cases the legal liability remains with the Trust. The total value of clinical negligence provisions carried by the NHSLA on behalf of the trust is disclosed within Note 18 but is not recognised in the Trust's accounts.

1.18 Non-clinical risk pooling

The Trust participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the Trust pays an annual contribution to the NHS Litigation Authority and in return, receives assistance with the costs of claims arising. The annual membership contributions and any excesses payable in respect of particular claims are charged to operating expenses when the liability arises.

1.19 Contingencies

Contingent liabilities are not recognised, but are disclosed in Note 21, unless the probability of a transfer of economic benefit is remote.

A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence of one or more uncertain future events not wholly within the control of the Trust, or a present obligation arising from past events but for which it is not probable that a transfer of economic benefits will arise or for which the amount of the obligation cannot be measured with sufficient reliability.

Where the time value of money is material, contingencies are disclosed at their present value.

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1.20 Financial instruments and financial liabilities

Recognition Financial assets and financial liabilities which arise from contracts for the purchase or sale of non-financial items (such as goods and services), which are entered into in accordance with the Trust's normal purchase, sale or usage requirements, are recognised when, and to the extent which, performance occurs i.e. when receipt or delivery of the goods or services is made.

De-recognition

All financial assets are de-recognised when the rights to receive cash flows from the assets have expired or the Trust has transferred substantially all of the risks and rewards of ownership.

Financial liabilities are de-recognised when the obligation is discharged, cancelled or expires.

Classification and measurement

Financial assets are classified as loans and receivables.

Financial liabilities are classified as other financial liabilities.

Loans and receivables

Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. They are included within current assets.

The Trust's loans and receivables comprise: cash and cash equivalents, NHS Receivables, accrued income and other receivables.

Loans and receivables are recognised initially at fair value, net of transactions costs, and are measured subsequently at amortised cost, using the effective interest method. The effective interest rate method is the rate that discounts exactly estimated future cash receipts through the expected life of the financial asset or, when appropriate, a shorter period, to the net carrying amount of the financial asset.

Interest on loans and receivables is calculated using the effective interest method and credited to the Statement of Comprehensive Income.

Impairment of financial assets

At the Statement of Financial Position date, the Trust assesses whether any financial assets, other than those held at 'fair value through profit and loss' are impaired. Financial assets are impaired and impairment losses recognised if, and only if, there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset.

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1.21 Other financial liabilities All other financial liabilities are recognised initially at fair value, net of transaction costs incurred and measured subsequently at amortised cost using the effective interest method. The effective interest rate is the rate that discounts exactly estimated future cash payments through the expected life of the financial liability or, when appropriate, a shorter period, to the net carrying amount of the financial liability.

They are included in current liabilities except for amounts payable more than 12 months after the Statement of Financial Position date, which are classified as long-term liabilities.

Interest on financial liabilities carried at amortised cost is calculated using the effective interest method and charged to Finance Costs. Interest on financial liabilities taken out to finance property, plant and equipment is not capitalised as part of the cost of those assets.

1.22 Value Added Tax

Most of the activities of the Trust are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

1.23 Corporation Tax

South Western Ambulance Service NHS Foundation Trust has determined that it has no corporation tax liability as the Trust's profit generated from non-operational income falls below the threshold amount of £50,000.

1.24 Foreign exchange

The Trust's functional currency and presentational currency is sterling. Transactions denominated in a foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions. When the Trust has assets or liabilities denominated in a foreign currency at the Statement of Financial Position date:

● monetary items are translated at the spot exchange rate on 31 March 2015; ● non-monetary assets and liabilities measured at historical cost are translated using the spot exchange rate at the date of the transaction and ● non-monetary assets and liabilities measured at fair value are translated using the spot exchange rate at the date the fair value was determined. Exchange gains or losses on monetary items are recognised in income or expense in the period in which they arise.

Exchange gains or losses on non-monetary assets and liabilities are recognised in the same manner as other gains and losses on these items.

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1.25 Public Dividend Capital (PDC) and PDC dividend

Public Dividend Capital (PDC) is a type of public sector equity finance based on the excess of assets over liabilities at a time of establishment of the predecessor NHS Trust. HM Treasury has determined that PDC is not a financial instrument within the meaning of IAS 32.

A charge, reflecting the cost of capital utilised by the Trust, is payable as public dividend capital dividend. The charge is calculated at the rate set by HM Treasury (currently 3.5%) on the average relevant net assets of the Trust during the financial year. Relevant net assets are calculated as the value of all assets less the value of all liabilities, except for (i) donated assets, (ii) average daily cash balances held with the Government Banking Services (GBS) and National Loans Fund (NLF) deposits, excluding cash balances held in GBS accounts that relate to a short-term working capital facility, and (iii) PDC dividend balance receivable or payable. In accordance with the requirements laid down by the Department of Health (as the issuer of PDC), the dividend for the year is calculated on the average relevant net assets as set out in the 'pre audit' version of the annual accounts. The dividend thus calculated is not revised should any adjustment to the net assets occur as a result of the audit of the annual accounts.

1.26 Losses and Special Payments

Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature, they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled.

Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had NHS Trusts not been bearing their own risks (with insurance premiums then being included as normal revenue expenditure).

However the losses and special payments note is compiled directly from the losses and compensations register which reports on an accruals basis with the exception of provisions for future losses.

1.27 Accounting standards that have been issued but have not yet been adopted

At the date of authorisation of these annual report and accounts, the following Standards and Interpretations which have not been applied in these annual report and accounts were in issue but not yet adopted. None of them are expected to impact upon the Trust's annual report and accounts.

Standards applicable from 2015/16

IFRS 13 Fair Value measurement

IAS 19 (Amendment) Employer contributions to the defined benefit scheme

IAS 36 (Amendment) Recoverable amounts disclosure

IFRIC 21 Levies

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IFRS 15 Revenue from contracts with customers


IFRS 9 Financial Instruments

2. Operating Segments The Trust has assessed that the chief operating decision maker is the Board of Directors. The Board receives a detailed Integrated Corporate Performance Report (ICPR) on a monthly basis; this includes segmental analysis of the Trust's service lines. This analysis is also received by the Finance and Investment Committee (FIC), a sub-committee of the Board of Directors. The Accident and Emergency Ambulance income (A&E) service line accounts for 77.2% (2014:77.5%)of total income received by South Western Ambulance Service NHS Foundation Trust during the year ended 31 March 2015. Urgent Care Services (UCS) including Out of Hours and 111 accounts for 10.7% (2014:9.9%) of the total income received by South Western Ambulance Service NHS Foundation Trust during the same year.

31 March 2015 31 March 2014

£000 £000

A&E income 177,170 174,825

PTS income 3,887 10,389

UCS income 24,479 22,438

Other income 23,903 17,966

Total income 229,439 225,618

Operating expenses (227,572) (223,335)


Other income include HART, hosting of the Ambulance Radio Programme (ARP) team, Winter Pressures, Road Traffic Accident (RTA), ECS Project, Medical Transport Service (MTS) and Training Income.

Emergency Ambulance Service (A&E)

The Trust provides an emergency response to 999 Category Red and Green injuries and illnesses, which are likely to require treatment and immediate transport to a hospital or other facility. Provision is provided across the entire Trust area being the South West region.

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Urgent Care Service (UCS)

The Trust provides a range of non-emergency responses to people who require, or perceive the need for, urgent (but not emergency) advice, care, diagnosis or treatment. The Out of Hours service is delivered across Dorset, Somerset and Gloucestershire and includes other additional activities. The 111 service is provided for Cornwall, Devon, Somerset and Dorset.

Patient Transport Service (PTS)

The Trust provides ambulance non-emergency medical patient transport services, such as to and from outpatient appointments. At the start of 2013/14 the Trust provided services across the entire Trust area excluding Torbay and South Devon. During 2013/14 the Trust lost a number of contracts and now only provides services in the Bath, North Somerset and South Gloucestershire (BNSSG) area. 3. Operating Income 3.1 Operating Income (by classification)



£000 £000

Income from activities

Income from Commissioner Requested Services

A&E income 177,170 174,825

PTS income 3,887 10,389

Income from non-Commissioner Requested Services

Other income 38,715 35,020

Private patient income 1 2

Total income from activities 219,773 220,236

Other Income The other income from non-Commissioner requested Services of £38.715 million (2014: £35.020 million) can be further broken down as follows:



£'000 £'000

Out of Hours (OOH) 17,472 17,878

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111 7,007 4,560

Hazardous Area Response Team (HART) 6,574 6,432

Other 7,662 6,150

Total Other Income 38,715 35,020

Other income includes winter pressure income of £4.3 million (2014: £1.9 million).

Other operating income

Research and development 257 128

Education and training 1,405 501

Other 6,662 3,163

Profit on disposal of property, plant and equipment 240 131

Reversal of impairments of property, plant and equipment 341 679

Rental revenue from operating leases 140 110

Income in respect of staff costs 621 670

Total other operating income 9,666 5,382

Total operating income 229,439 225,618

Included in other income £6.662 million (2014: £3.163 million) is £2.4 million Ambulance Radio Programme (ARP) for hosting the team (2014: £2.4 million) and Electronic Care System Record (ECS) project income £3.3 million (2014: Nil). 3.2 Income from patient care activities



£000 £000

NHS Foundation trusts 549 5,078

NHS trusts 65 1,397

Clinical Commissioning Groups and NHS England 218,245 212,201

Local Authorities 17 0

Department of Health 0 618

Non-NHS:

Private patients 1 2

Injury costs recovery 684 746

Other 212 194

219,773 220,236

3.3 Operating lease income The 2014/15 Operating lease income relates to the Chippenham aerial site and associated telecommunication companies. The 2013/14 Operating lease income included NHS Direct rental income and aerial sites.

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Operating lease income Year

ended 31 March 2015


£000 £000

Rents recognised as income in the year 140 110

Total 140 110

Future minimum lease payments receivable Year ended 31 March 2015


£000 £000

Not later than one year 28 0

Later than one year and not later than five years 106 0

Later than five years 78 0

Total 212 0

3.4 Income from sale of goods Income is wholly from the supply of services, there is no income from the sale of goods. 3.5 Income generation activities The Trust undertakes income generation activities with an aim of reinvesting any profit in patient care. No income generation activities exceeded £1.000 million. 4. Operating expenses 4.1 Operating expenses (by type) Refer to the table overleaf.

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£000 £000

Services from NHS Foundation Trusts 16 1

Employee Expenses - Executive directors 832 734

Employee Expenses - Non-executive directors 140 130

Employee Expenses - Staff 163,252 158,061

Drug costs 753 596

Supplies and services - clinical (excluding drug costs) 5,919 6,097

Supplies and services - general 2,476 1,589

Establishment 4,685 4,714

Transport 17,534 19,691

Premises 11,681 8,316

Increase in provision for impairment of receivables (26) 119

Change in provision discount rate and increase in other provisions

550 510

Inventories write down 161 168

Rentals under operating leases - minimum lease receipts 2,382 2,184

Depreciation on property, plant and equipment 10,150 12,094

Impairments of property, plant and equipment 1,974 3,508

Audit services- statutory audit 58 56

Other auditor remuneration 18 0

Clinical negligence 200 126

Loss on disposal of property, plant and equipment 76 54

Legal fees 232 356

Other professional fees 755 929

Training, courses and conferences 1,809 1,058

Security 0 48

Redundancy (64) 556

Early retirements 13 10

Insurance 160 220

Other services, eg external payroll 356 338

Losses, ex gratia and special payments 108 100

Other 1,372 972

227,572 223,335

The Trust's contract with its auditors, as set out in the engagement letter signed 19 February 2015, states that the liability of PwC, its members, partners and staff (whether in contract, negligence or otherwise) shall in no circumstances exceed £1 million in aggregate in respect of all services (2014: £1 million).

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4.2 Arrangements containing an operating lease The Trust leases property, vehicles and equipment under operating leases. Lease terms vary from less than one year to seventy seven years remaining. The longest lease relates to land at Torpoint.



£000 £000

Minimum lease payments 2,382 2,184

Future minimum lease payments due


£000 £000 £000 £000 £000

Land Buildings Plant and machinery

Other Total

Not later than one year 33 1,179 22 341 1,575

Later than one year and not later than five years

133 2,692 9 230 3,064

Later than five years 1,974 4,652 0 0 6,626

Total 2,140 8,523 31 571 11,265


£000 £000 £000 £000 £000

Land Buildings Plant and machinery

Other Total

Not later than one year 33 1,147 29 335 1,544


133 3,298 24 77 3,532

Later than five years 1,998 5,105 0 0 7,103

Total 2,164 9,550 53 412 12,179

6. Employee costs and numbers

6.1 Employee benefits

Refer to the following table.

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Employee benefits Year ended 31 March 2015 Year ended 31 March 2014

Total Permanently Employed

Other Total Permanently Employed

Other

£000 £000 £000 £000 £000 £000

Salaries and wages 134,016 123,839 10,177 127,907 119,100 8,807

Social Security Costs 8,848 8,569 279 8,896 8,625 271

Employer contributions to NHS Pension scheme

16,185 15,480 705 15,788 15,208 580

Agency/contract staff 5,035 0 5,035 6,204 0 6,204

Total 164,084 147,888 16,196 158,795 142,933 15,862

5.2 Average number of employees

Average number of employees (WTE basis)

Year ended 31 March 2015 Year ended 31 March 2014

Total Permanently Employed

Other Total Permanently Employed

Other

Number Number Number Number Number Number

Medical and dental 78 7 71 77 7 70

Ambulance staff 2,556 2,503 53 2,499 2,455 44

Administration and estates 970 922 48 853 806 47

Healthcare assistants and other support staff 203 203 0 328 328 0

Nursing, midwifery and health visiting staff 67 67 0 58 58 0

Agency and contract staff 95 0 95 101 0 101

Bank staff 103 0 103 157 0 157

Total 4,072 3,702 370 4,073 3,654 419

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The 2014/15 increase in administration relates to111 control staff and the reduction in other support staff relates to the loss of PTS contracts. 5.3 Staff sickness absence

Staff sickness absence Year ended 31 March 2015 Year ended 31 March 2014

Number Number

Total days lost 50,677 44,402

Total staff years 3,739 3,763

Average working days lost 13.55 11.80

The sickness days reported are for the period from January to December each year. 5.4. Remuneration and other benefits received by Directors The aggregate of remuneration and other benefits received by Directors and Non-Executive Directors during the year to March 2015 was £0.972 million (to 31 March 2014; £0.864 million). The increase related to vacancies in 2013/14. In the year ended 31 March 2015, 6 directors (2014: 6 directors) accrued benefits under a defined benefit pension scheme. During the year to 31 March 2015, the highest paid Director for the Trust was the Chief Executive who was paid a salary between £0.170 million and £0.175 million and benefits in kind of £0.004 million. 5.5. Retirements due to ill-health During the year to 31 March 2015 there were 14 early retirements from the Trust agreed on the grounds of ill-health (31 March 2014: 10 early retirements). The estimated additional pension liabilities of this ill-health retirements will be £1.069 million (31 March 2014: £0.648 million). The cost of these ill-health retirements will be borne by the NHS Business Services Authority - Pensions Division.

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5.6 Exit Packages for staff leaving during the year ending March 2015 Fifteen staff (£0.321 million) left South Western Ambulance Service NHS Foundation Trust during the year ending 31 March 2015 (2014: £2.402 million), they received an exit package when they left the Trust. The majority of exit packages related to redundancies as a result of reorganisation and relocation of the Trust HQ to Exeter as per the Acquisition Business Case. 5.7 Exit packages


Exit package cost band (including any special payment element)

Number of compulsory redundancies

Cost of compulsory redundancies

Number of other departures agreed

Cost of other departures agreed

Total number of exit packages

Total cost of exit packages

Number £000s Number £000s Number £000s

Less than £10,000 0 0 7 46 7 46

£10,001-£25,000 2 40 3 48 5 88

£25,001-£50,000 0 0 2 51 2 51

£50,001-£100,000 0 0 0 0 0 0

£100,001 - £150,000 0 0 1 136 1 136

£150,001 - £200,000 0 0 0 0 0 0

>£200,000 0 0 0 0 0 0

Total 2 40 13 281 15 321

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Exit package cost band (including any special payment element)

Number of compulsory redundancies

Cost of compulsory redundancies

Number of other departures agreed

Cost of other departures agreed

Total number of exit packages

Total cost of exit packages

Number £000s Number £000s Number £000s

Less than £10,000 6 25 6 33 12 58

£10,001-£25,000 9 167 3 65 12 232

£25,001-£50,000 7 252 6 199 13 451

£50,001-£100,000 10 782 1 51 11 833

£100,001 - £150,000 3 358 0 0 3 358

£150,001 - £200,000 1 178 0 0 1 178

>£200,000 1 292 0 0 1 292

Total 37 2,054 16 348 53 2,402

Redundancy and other departure costs have been paid in accordance with the provisions of the NHS Scheme. Where the Trust has agreed early retirements, the additional costs are met by the Trust and not by the NHS pension scheme. Ill-health retirement costs are met by the NHS pension scheme and are not included in the table. Termination benefits are recognised at the earlier of: ● When the Trust can no longer withdraw the offer of those benefits; and ● When the Trust recognises costs for a restructuring that is within the scope of IAS37 and involves the payment of termination benefits. There were thirteen (2014: sixteen) other departures agreed for the year ended 31 March 2015, nine (2014: thirteen) were Mutually Agreed Resignation Scheme (MARS) and four (2014: three) were Compromise agreements.

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This disclosure reports the number and value of exit packages taken by staff leaving in the year. Note: The expense associated with these departures may have been recognised in part or in full in a previous year. 5.8 All Off-Payroll Engagements

Year ended 31 March 2015 Number of Engagements

Number that have existed for less than one year at the time of reporting

4

Number that have existed for between two and three years at the time of reporting

2

Number that have existed for four or more years at the time of reporting

18

Total 24

During 2014/15 there were 24 off-payroll engagements, for more than £220 per day and that last longer than six months related to Board advisor (1) and Out of Hours doctors (23). 6. Pension Costs Past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. The scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS Body of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period. In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the Financial Reporting Manual requires that "the period between formal valuations shall be four years, with approximate assessments in intervening years". An outline of these follows: a) Accounting valuation A Valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data for the current reporting period and are accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31

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March 2015, is based on valuation data as at 31 March 2014, updated to 31 March 2015 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant Financial Reporting Manual interpretations and the discount rate prescribed by HM Treasury have also been used. b) Full actuarial (funding) valuation The purpose of this valuation is to assess the level of liability in respect of the benefits due under the scheme (taking into account its recent demographic experience) and to recommend the contribution rates. The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2012. The Scheme Regulations allow contribution rates to be set by the Secretary of State for Health, with the consent of HM Treasury and consideration of the advice of the Scheme Actuary and appropriate employee and employer representatives as deemed appropriate. c) Scheme provisions In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the Financial Reporting Manual requires that "the period between formal valuations shall be four years, with approximate assessments in intervening years". An outline of these follows: The Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service. With effect from 1 April 2008 members, can choose to give up some of their annual pension for an additional tax free lump sum, up to a maximum amount permitted under HMRC rules. This new provision is known as “pension commutation”. Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971 and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year. From 2011-12 the Consumer Price Index (CPI) has been used and replaced the Retail Price Index (RPI). Early payment of a pension, with enhancement, is available to members of the scheme who are permanently incapable of fulfilling their duties effectively through illness or infirmity. A death gratuity of twice final year’s pensionable pay for death in service and five times their annual pension for death after retirement is payable.

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For early retirements other than those due to ill health, the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to the statement of comprehensive income at the time the Trust commits itself to the retirement, regardless of the method of payment. Members can purchase additional service in the NHS Scheme and contribute to money purchase AVC’s run by the Scheme’s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers. d) National Employment Savings Trust (NEST) "There are a small number of staff who are not entitled to join the NHS pension scheme, for example: ● Those already in receipt of an NHS pension; ● Those who work full time at another Trust; ● Employees who are absent from work due to sickness, maternity leave etc. when the statutory duty to automatically enrol applies. The National Employment Savings Trust (NEST) has been set up specifically to help employers to comply with the Pensions Act 2008. Those employees in the categories above are automatically enrolled in the NEST scheme. NEST Corporation is the Trustee body that has overall responsibility for running NEST; it is a non-departmental public body that operates at arm's length from government and is accountable to Parliament through the Department of Work and Pensions (DWP). In 2013/14 employee contributions to NEST were 1.0% of pensionable pay and employer contributions were also 1.0% of pensionable pay. NEST levies a contribution charge of 1.8% and an annual management charge of 0.3% which is paid for from the employee contributions. There are no separate employer charges levied by NEST and the Trust is not required to enter into a contract to utilise NEST qualifying pension schemes.

7. Finance income

Finance income Year ended 31 March 2015


£000 £000

Interest on bank accounts 95 89

Total 95 89

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8. Finance costs – interest expense

Finance costs - interest expense Year ended 31 March 2015


£000 £000

Loans from the Department of Health 67 86

Finance leases 57 60

Interest on late payment of commercial debt 0 1

Total 124 147

9. Property, plant and equipment

9.1 Property, plant and equipment (2015)

For the year ended 31 March 2015

Land Buildings excluding dwellings

Assets under construction

Plant and machinery

Transport equipment

Information technology

Furniture and fittings

Total

£000 £000 £000 £000 £000 £000 £000 £000

Cost or valuation at 1 April 2014

16,159 26,418 5,613 7,171 67,263 9,986 615 133,225

Additions purchased 0 1,095 5,236 305 5,964 1,460 272 14,332

Impairments charged to the revaluation reserve

(2) (260) 0 0 0 0 0 (262)

Reclassifications 390 3,053 (5,611) 0 1,896 272 0 0

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Revaluation 345 (1,506) 0 (7) (2,866) 0 0 (4,034)

Disposals (1,200) (800) 0 0 (5,631) (4,774) (5) (12,410)

At 31 March 2015 15,692 28,000 5,238 7,469 66,626 6,944 882 130,851

Accumulated depreciation at 1 April 2014

0 0 0 5,131 38,417 7,192 511 51,251

Provided during year 0 1,133 0 493 7,398 1,094 32 10,150

Impairments 20 1,954 0 0 0 0 0 1,974

Reversal of impairments

(211) (130) 0 0 0 0 0 (341)

Revaluation 191 (2,957) 0 (7) (2,866) 0 0 (5,639)

Disposals 0 0 0 0 (5,136) (4,774) (5) (9,915)

Accumulated depreciation at 31 March 2015

0 0 0 5,617 37,813 3,512 538 47,480

Net book value

Owned 15,692 27,722 5,238 1,852 28,729 3,432 344 83,009

Finance leased 0 278 0 0 0 0 0 278

Donated 0 0 0 0 84 0 0 84

Total at 31 March 2015 15,692 28,000 5,238 1,852 28,813 3,432 344 83,371

9.2 Property, plant and equipment 2014

For the year ended 31 March 2014

Land Buildings excluding dwellings

Assets under construction

Plant and machinery

Transport equipment

Information technology

Furniture and fittings

Total

£000 £000 £000 £000 £000 £000 £000 £000

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Cost or valuation at 1 April 2013

16,335 28,709 1,460 7,709 67,014 11,261 857 133,345

Additions purchased 0 1,381 5,347 16 5,953 727 0 13,424

Impairments (123) (1,132) 0 0 (4) 0 0 (1,259)

Reversal of impairments 0 0 0 0 0 0 0 0

Reclassifications 0 95 (1,194) 6 1,052 0 41 0

Revaluation (53) (2,622) 0 0 0 0 0 (2,675)

Disposals 0 (13) 0 (560) (6,752) (2,002) (283) (9,610)

At 31 March 2014 16,159 26,418 5,613 7,171 67,263 9,986 615 133,225

Accumulated depreciation at 1 April 2013

107 1,579 0 4,863 35,283 7,855 731 50,418

Provided during year 0 1,404 0 823 8,465 1,339 63 12,094

Impairments 125 2,095 0 6 1,282 0 0 3,508

Reversal of impairments (174) (505) 0 0 0 0 0 (679)

Reclassifications 0 0 0 0 0 0 0 0

Revaluations (58) (4,560) 0 0 0 0 0 (4,618)

Disposals 0 (13) 0 (561) (6,613) (2,002) (283) (9,472)

Accumulated depreciation at 31 March 2014

0 0 0 5,131 38,417 7,192 511 51,251

Net book value

Owned 16,159 26,133 5,613 2,040 28,708 2,794 104 81,551

Finance leased 0 285 0 0 17 0 0 302

Donated 0 0 0 0 121 0 0 121

Total at 31 March 2014 16,159 26,418 5,613 2,040 28,846 2,794 104 81,974

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9.3 Property, plant and equipment The Trust's land and buildings were revalued by the District Valuer at 31 March 2015. Non specialised operational property was valued at Market Value assuming existing use. Specialised operational property was valued at Depreciated Replacement Cost. Any improvements made to properties during the later months of the year were considered when assessing the value at 31 March 2015. Where the improvements were of a significant value, they were individually assessed by the District Valuer. The District Valuer advised that the impairment on these improvements was 10% and this impairment was applied across all other property improvements. The remaining lives of all properties were also reviewed by the District Valuer at 31 March 2015. No other classes of non-current assets were revalued during the year. The District Valuer also provided a market value at 31 March 2015 for all specialised properties. These values were not significantly different to the Depreciated Replacement Cost used in the accounts, with the exception of St Leonards. No other classes of assets were revalued during the year. Economic lives of non-current assets

Min life Years

Max life Years

Building excluding dwellings 9 70

Plant and Machinery 1 15

Transport equipment 3 7

Information technology 5 5

Furniture and Fittings 5 10

The Gross carrying amount of fully depreciated assets still in use at 31 March 2015 was £18.701 million (2014: £21.663 million). 10. Contractual capital commitments

As at 31 March 2015

As at 31 March 2014

£000 £000

Property, plant and equipment 7,023 3,969

Total 7,023 3,969

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11.Inventories 11.1 Inventories

Inventories 31 March 2015

31 March 2014

£000 £000

Drugs 214 161

Consumables 1,122 999

Energy 206 276

Other 665 600

Total 2,207 2,036

11.2 Inventories movement

Inventories movement Year ended 31 March 2015


£000 £000

Carrying Value at 1 April 2,036 1,832

Additions 402 386

Inventories recognised in expenses (70) (14)

Write-down of inventories recognised as expenses

(161) (168)

Carrying Value at 31 March 2,207 2,036

12. Trade and other receivables 12.1 Trade and other receivables

Trade and other receivables Current Non-current

Current Non-current

31 March 2015

31 March 2015

31 March 2014

31 March 2014

£000 £000 £000 £000

NHS receivables 1,161 0 1,924 0

Other receivables with related parties

2 0 77 0

Provision for impaired receivables (62) 0 (283) 0

Prepayments 2,210 397 3,530 0

Accrued income 149 0 117 0

PDC receivable 99 0 4 0

VAT receivable 94 0 367 0

Other receivables 1,321 0 631 0

Total 4,974 397 6,367 0

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The majority of trade receivables are due from Care Commissioning Groups, as commissioners for NHS patient care services. As Care Commissioning Groups are funded by Government to commission NHS patient care services, there is no need to carry out credit checks. 12.2 Provision for impairment of receivables

Provision for impairment of receivables 31 March 2015

31 March 2014

£000 £000

Balance at 1 April 2014 (283) (164)

Transfers by absorption 0 0

(Decrease) in provision (37) (119)

Amounts utilised 195 0

Unused amounts reversed 63 0

Balance at 31 March 2015 (62) (283)

The majority of the provision relates to the recovery of overpaid salaries. 12.3 Receivables past their due date

Receivables past their due date 31 March 2015

31 March 2014

£000 £000

Ageing of impaired receivables

0-30 days 0 0

30-60 days 0 3

60-90 days 0 12

90-180 days (was "In three to six months")

2 33

180-360 days (was "Over six months")

60 235

Total 62 283

Ageing of non-impaired receivables past their due date

0-30 days 492 131

30-60 days 198 26

60-90 days 63 56

90-180 days (was "In three to six months")

78 26

180-360 days (was "Over six months")

61 227

Total 892 466

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13. Trade and other payables 13.1 Trade and other payables

Trade and other payables Current Non-

current Current Non-

current

31 March 2015

31 March 2015

31 March 2014

31 March 2014

£000 £000 £000 £000

NHS payables 272 0 655 0

Amounts due to other related parties - revenue

26 0 61 0

Other trade payables - capital 2,996 0 2,967 0

Other trade payables - revenue 5,604 0 5,773 0

Social Security costs 1,511 0 1,469 0

Other taxes payable 1,421 0 1,420 0

Other payables 80 0 934 0

Accruals 10,762 228 7,008 0

Total 22,672 228 20,287 0

13.2 Better Payment Practice Code – measure of compliance

13.2 Better Payment Practice Code - measure of compliance

31 March 2015 31 March 2014

Number £000 Number £000

Total Non-NHS trade invoices paid in the year

46,352 63,481 48,088 55,532

Total Non NHS trade invoices paid within target

44,720 60,591 46,857 54,452

Percentage of Non-NHS trade invoices paid within target

96% 95% 97% 98%

Total NHS trade invoices paid in the year

1,130 2,847 931 6,183

Total NHS trade invoices paid within target

1,095 2,766 884 6,064

Percentage of NHS trade invoices paid within target

97% 97% 95% 98%

The Better Payment Practice Code requires the Trust to aim to pay all undisputed invoices by the due date or within 30 days of receipt of goods or a valid invoice, whichever is later. No amounts have been included in financial costs during the year in relation to claims under this legislation (2014: £nil). £nil million compensation has been paid during the year to cover debt recovery costs under this legislation (2014: £0.001).

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14. Other liabilities

Other liabilities Current Non-current

Current Non-current

31 March 2015

31 March 2015

31 March 2014

31 March 2014

£000 £000 £000 £000

Deferred income 398 0 141 0

Total 398 0 141 0

15. Borrowings

Borrowings Current Non-current

Current Non-current

31 March 2015

31 March 2015

31 March 2014

31 March 2014

£000 £000 £000 £000

Loans from Department of Health

428 2,146 428 2,574

Other loans 59 72 43 48

Obligations under finance leases

10 604 33 599

Total 497 2,822 504 3,221

A loan was taken out by Great Western Ambulance Service NHS Trust (GWAS) and was transferred as part of the acquisition. This loan with the Department of Health, was a Working Capital loan (£4.500 million) taken out in 2010 at an interest rate of 2.3% due to expire 2021. The Trust has an agreed £5.0 million Overdraft Facility in place which has not been utilised during the year. 16. Finance lease obligations Finance lease liabilities relate to four leasehold premises with lease periods ranging from 56 to 75 years and sixteen vehicles which expire the year ended 31 March 2015.

Amounts payable under finance leases:

Buildings and vehicles Gross lease liabilities

Net lease liabilities

Gross lease liabilities

Net lease liabilities

31 March

31 March

31 March

31 March

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2015 2015 2014 2014

£000 £000 £000 £000

Not later than one year; 26 10 49 33

Later than one year and not later than five years;

104 41 104 40

After five years 1,443 563 1,469 559

Less future finance charges (959) 0 (990) 0

Present value of minimum lease payments

614 614 632 632

Included in:

Current borrowings 10 33

Non-current borrowings 604 599

614 632

17. Finance lease commitments The Trust has no new finance lease commitments as at 31 March 2015 (2014: £nil). The obligation Note 17 lays out the existing financial lease details. 18. Provisions

Current Non-current

Current Non-current

31 March 2015

31 March 2015

31 March 2014

31 March 2014

£000 £000 £000 £000

Pensions relating to other staff

253 4,067 237 3,735

Other legal claims 353 0 473 0

Workforce Integration 5,628 0 5,628 0

Restructurings 0 0 664 0

Redundancy 352 0 786 0

Other 680 148 88 217

Total 7,266 4,215 7,876 3,952

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Provisions continued

Pensions relating to other staff

Other legal claims

Workforce Integration

Restructuring Redundancy Other Total

£000 £000 £000 £000 £000 £000 £000

At 1 April 2014 3,972 473 5,628 664 786 305 11,828

Change in the discount rate

225 0 0 0 0 0 225

Arising during the year 336 343 0 0 507 657 1,843

Utilised during the year - accruals

0 0 0 (621) 0 0 (621)

Utilised during the year - cash

(253) (142) 0 (43) (261) (79) (778)

Reversed unused (12) (321) 0 0 (680) (55) (1,068)

Unwinding of discount 52 0 0 0 0 0 52

At 31 March 2015 4,320 353 5,628 0 352 828 11,481

Expected timing of cash flows:

Not later than one year 253 353 5,628 0 352 680 7,266


1,011 0 0 0 0 24 1,035

Later than five years 3,056 0 0 0 0 124 3,180

Total 4,320 353 5,628 0 352 828 11,481

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The provisions represent a material amount in the financial accounts and a more detail breakdown is listed below:

Provision for "Pensions relating to other staff" represents injury benefit pension payable to staff who retired through injury and is payable for the remainder of their lives. The provision has been calculated using current life expectancy tables and a discount factor of 1.3% (2014: 1.8%).

The provision for other legal claims includes information provided by the NHS Litigation Authority and estimated legal costs arising from ongoing employment tribunal cases.

A provision has been made for the potential outcome of outstanding workforce integration issues. This provision has been maintained at the same level as per the 2013/14 accounts following Board consideration and legal advice. This is expected to be resolved during 2015/16.

A restructuring provision was made in 2013/14 relating to the Trust's Operational Structure Change Programme this is now reflected as an accrual.

An estimated redundancy provision is included as the Trust continues to review its organisational structure following the acquisition of GWAS. This figure includes £0.057 million for Mutually Agreed Resignation Schemes (MARS).

Other provisions includes provision for non-guaranteed overtime, long term sick and dilapidations for two lease sites due to termination of the leases.

Included with the provisions of the NHS Litigation Authority at 31 March 2015 is £17.776 million (2014: £9.692 million) in respect of clinical negligence liabilities of the Trust.

19. Revaluation Reserve

Revaluation reserve 31 March 2015

31 March 2014

£000 £000

Property, plant and equipment

Property, plant and equipment

At 1 April 7,115 6,868

Impairments (262) (1,259)

Revaluations 1,605 1,943

Transfers to other reserves (336) (432)

Asset disposals (1) (5)

At 31 March 8,121 7,115

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20. Cash and cash equivalents

Cash and cash equivalents 31 March 2015

31 March 2014

£000 £000

Balance at 1 April 30,449 25,893

Net change in year 3,617 4,556

Balance at 31 March 34,066 30,449

Represented by: £000 £000

Cash at commercial banks and in hand 6 7

Cash with the Government Banking Service 34,056 30,438

Other current investments 4 4

Cash and cash equivalents as in statement of financial position and statement of cash flows

34,066 30,449

21. Contingencies

The Trust is currently managing a number of employment cases and no provision has been made against those which it has been advised are unlikely to succeed. In normal circumstances, a worst case assessment of the outcome of such cases would be disclosed as a contingent liability but the Trust has decided to refrain from doing so in this instance because it considers such disclosure would seriously prejudice its position. (31 March 2014, £nil).

22. Related party transactions

During the year, there were no material transactions relating to the Trust and members of the Trust Board, senior managers, or parties related to any of them.

"Key management includes Directors, both executive and non-executive. The compensation paid or payable in aggregate to key management for employment services is shown in note 5.1.

None of the key management personnel received an advance from the Trust. The Trust has not entered into guarantees of any kind on behalf of key management personnel. There were no amounts owing to key management personnel at the beginning or end of the financial year. "

The Department of Health is regarded as a related party. During the year the Trust has had a significant number of material transactions with the Department and with other entities for which the Department is regarded as the parent Department. These entities are listed overleaf:

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Income Income Receivables Receivables

31 March 2015

31 March 2014

31 March 2015

31 March 2014

£000 £000 £000 £000

Bath And North East Somerset CCG

6,049 6,229 23 2

Bristol CCG 16,933 16,642 61 411

Kernow CCG 24,592 23,317 72 325

Department of Health 2,655 3,101 1 25

NEW Devon CCG 32,545 30,530 529 8

Dorset CCG 34,310 34,376 26 199

Gloucestershire CCG 26,429 26,368 110 78

North Somerset CCG 7,869 7,839 78 143

Gloucester Hospitals NHS Foundation Trust

0 1,443 0 2

Somerset CCG 25,967 25,409 201 155

South Gloucestershire CCG

8,207 8,215 0 372

Swindon CCG 6,395 6,350 41 53

South Devon and Torbay CCG

12,186 11,121 0 0

Wiltshire CCG 16,396 16,044 65 102

Other NHS organisations

5,909 5,529 318 49

226,442 222,513 1,525 1,924

Expenditure Expenditure Payables Payables

31 March 2015

31 March 2014

31 March 2015

31 March 2014

£000 £000 £000 £000

Department of Health

0 121 0 95

Dorset Health Care NHS Foundation Trust

62 62 0 16

Dorset CCG 211 240 54 220

Great Western Hospitals NHS Foundation Trust

164 146 1 12

NHS Litigation Authority

1,112 932 0 2

Portsmouth Hospitals NHS Trust

525 351 45 25

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Plymouth Hospitals NHS Trust

236 212 4 7

Avon And Wiltshire Mental Health Partnership NHS Trust

0 137 0 0

Yorkshire Ambulance Service NHS Trust

0 70 0 11

South Devon Healthcare NHS Foundation Trust

176 170 326 338

Other NHS organisations

770 483 571 253

3,256 2,924 1,001 979

The Trust has entered into the following contracts for 2015/16:-

Lead Commissioner Contract Type Comments

NHS Gloucestershire CCG

A&E ambulance services

Comparable with the value of the 2014/15 contract

NHS Somerset CCG Out of Hours Contract expires 30/06/2015

NHS Dorset CCG Out of Hours Comparable with the value of the 2014/15 contract

NHS Gloucestershire CCG

Out of Hours The Trust was successful to expand the contract to include OOHs treatment centres from 01/04/2015

NHS Dorset CCG 111 Comparable with the value of the 2014/15 contract

NHS NEW Devon CCG 111 Contract commenced in June 2013-second year

NHS Kernow CCG 111 Contract commenced in February 2014-second year

NHS Somerset CCG 111 Contract expires 30/06/2015

NHS South Gloucestershire CCG

Patient Transport Services

Contract expires 30/09/2015

Charitable Funds

As at 31 March 2015 South Western Ambulance Service NHS Foundation Trust had charitable funds of £0.212 million (2014: £0.214 million).

The Trust acts as Corporate Trustee to the South Western Ambulance Service Foundation Trust Fund Charity (Registered charity number: 1049230). Previously HM Treasury has granted dispensation to the application of IAS 27 (Revised) by NHS Foundation Trusts in relation to the consolidation of NHS Charitable funds. From 2013/14 the Treasury dispensation is no longer available and therefore NHS

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Foundation Trusts are required to consolidate any material NHS charitable funds determined to be subsidiaries. The Audit Committee has agreed that the level of charitable funds is below materiality and therefore consolidation is not required. The management of the Charitable Funds is the responsibility of the Charitable Funds Committee and its terms of reference state that the committee is made up from the Executives and Non-Executives of the Trust. The Trust Chairman, Chief Executive and Deputy Chief Executive/Executive Director of Finance have served as members of the Charitable Funds Committee during the year.

The Trust has also had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with the HM Revenue and Customs.

23. Intra-Government and other balances

Intra-Government and other balances

Current receivables

Non-current receivables

Current payables

Non-current payables

£000 £000 £000 £000

Balances with other central government bodies

136 0 5,239 0

Balances with local authorities

0 0 94 0

Balances with NHS Trusts and FTs

71 0 779 0

Balances with Public Corporations and Trading Funds

1,454 397 209 228

Intra government balances

1,661 397 6,321 228

Balances with bodies external to government

3,313 0 16,351 0

At 31 March 2015 4,974 397 22,672 228

24. Financial Instruments

24.1 financial assets by category

Financial assets by category Loans and receivables

£000

Trade and other receivables excluding non-financial assets

1,757

Other Financial Assets 0

Cash and cash equivalents 34,066

Total at 31 March 2015 35,823

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Trade and other receivables excluding non-financial assets

2,350

Other Financial Assets 0

Cash and cash equivalents 30,449


The book value of loans and receivables detailed above is equal to the fair value of

the financial assets. This is due to the short term nature of the assets.

24.2 Financial liabilities by category

Financial liabilities by category Other financial liabilities

£000

Borrowings excluding finance lease and PFI liabilities

2,705

Obligations under finance leases 614

Trade and other payables excluding non-financial liabilities

16,846

Provisions under contract 7,160


Borrowings excluding finance lease and PFI liabilities

3,093

Obligations under finance leases 632

Trade and other payables excluding non-financial liabilities

16,752

Provisions under contract 7,855


The book value of financial liabilities detailed above is equal to the fair value of the

financial assets. This is due to the short term nature of the liabilities

25. Financial risk management

Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the year in creating or changing the risks a body faces in undertaking its activities. Due to the continuing service provider relationship that the Trust has with primary care trusts and the way those primary care trusts are financed, the Trust is not exposed to the degree of financial risk faced by business

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entities. Financial instruments also play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The Trust has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the Trust in undertaking its activities.

The Trust’s treasury management operations are carried out by the finance department, within parameters defined formally within the Trust’s standing financial instructions and policies agreed by the Board of Directors. Trust treasury activity is subject to review by the Trust’s internal auditors.

Currency risk

The Trust is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The Trust has no overseas operations. The Trust therefore has low exposure to currency rate fluctuations.

Interest rate risk

The Trust's borrowings comprise of a interest free loan and finance leases so the Trust is not considered to be exposed to interest rate risk.

Credit risk

As the majority of the Trust’s income comes from contracts with other public sector bodies, the Trust has low exposure to credit risk. The maximum exposures as at 31 March 2015 are in receivables from customers, as disclosed in the trade and other receivables note. The Trust procurement process is robust and the Trust restricts prepayments to suppliers.

Liquidity risk

The Trust’s operating costs are incurred under contracts with Clinical Commissioning Groups (CCGs), which are financed from resources voted annually by Parliament. The Trust funds its capital expenditure from funds obtained within its prudential borrowing limit. The Trust is not, therefore, exposed to significant liquidity risks. The Trust invests surplus funds in line with its Treasury Management policy. The Trust produces a twelve month rolling cash flow to manage liquidity risk.

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26. Losses and Special Payments

There were 671 (2014: 627) cases of losses and special payments totalling £0.244

million (2014: £0.205 million) paid during the year ended 31 March 2015.

Number of Cases

Value of Cases

Number of Cases

Value of Cases

2014/15 2014/15 2013/14 2013/14

£'000 £000

Losses

Salary Overpayments 223 36 184 62

Bad Debt 31 2 32 2

Other 395 127 392 83

Total Losses 649 165 608 147

Special payments

Personal Injury with advice 22 79 16 45

Special Severance Payments

0 0 3 13

Total Special Payments 22 79 19 58

Total Losses and Special Payments

671 244 627 205

Other losses include insurance excess payments for vehicles and damage to

property.

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Glossary of terms and acronyms

Term Description

111 National phone number for people to access non-emergency healthcare

and advice

A19

Performance

A19 performance is based on the combination of both Red 1 and Red 2 categories of call. (Please see definitions of Red 1 and Red 2 below.)

A&E Accident and Emergency

ACQIs Ambulance Clinical Quality Indicators – a set of nationally agreed

measures for ambulance trusts which reflect best practice and stimulate

continuous quality improvement.

AGM An Annual General Meeting is held every year for the stakeholders of an

organisation. It is typically where an annual report is presented by senior

management (showing the performance and strategy of a company for

the preceding financial year).

AI - Adverse

Incident

Any event or circumstance that could have or did lead to unintended or

unexpected harm, loss or damage to any individual or the Trust.

Adverse incidents may or may not be clinical and may involve actual or

potential injury, mis-diagnosis or treatment, equipment failure, damage,

loss, fire, theft, violence, abuse, accidents, ill health, near misses and

hazards.

ATP Testing Adenosine triphosphate testing – process whereby a swab is used to

pick up contamination on a surface which can then be measured to

assess its cleanliness.

Audit

Commission

The Audit Commission has the role of protecting the public purse which it

does by auditing a range of public bodies in England. Information

gleaned from audits are used to provide evidence based analysis to help

services learn from one another. The Audit Commission closed on 31

March 2015

Board of

Directors

Executive body responsible for the operational management and

conduct of the organisation

Category A

Incidents

Incidents with patients with a presenting condition which may be immediately life threatening and who should receive an emergency response within 8 minutes irrespective of location, in 75% of cases.

In addition Category A patients should receive an ambulance response at the scene within 19 minutes in 95% of cases.

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Clinical Audit A quality improvement process that seeks to improve patient care and

outcomes by measuring the quality of care and services against agreed

standards and making improvements where necessary.

CCGs Clinical commissioning groups – GP-led commissioners of local

healthcare services

CFR Community First Responders are members of the public trained by the

ambulance service to respond to certain, time critical incidents whilst an

ambulance is on its way.

Clinical

Guidelines

Trust documents which introduce guidance which is either not considered within the scope of the JRCALC guidelines, or where further clarification is required.

Clinical Hub SWASFT term for control room, where phone calls to the Trust are

handled.

CoG Council of Governors – elected body that acts as guardians of NHS

Foundation Trusts, holding the board of directors to account and

representing views of staff, public and other stakeholders

Co-Responder A Co-responder is someone who responds to certain emergency

incidents whilst an ambulance is on its way.

CoSHH Control of Substances Hazardous to Health (COSHH) is the law that requires employers to control substances that are hazardous to health.

CQC Care Quality Commission - the independent regulator of health and adult social care.

CQUIN Commissioning for Quality and Innovation payment framework enables

commissioners to reward excellence, by linking a proportion of

healthcare providers’ income to the achievement of local quality

improvement goals.

CTB Call to balloon – when a heart attack is suffered, the time taken from the

initial emergency call to the balloon being inflated during primary

angioplasty (see below.)

DATIX The IT system that Trust staff access to report incidents that have

occurred whilst on duty.

Definitive

Clinical

Assessment

An assessment carried out by an appropriately trained and experienced clinician on the telephone or face-to-face. It is the assessment which will result either in reassurance and advice, or in a face-to-face consultation (either in a centre or in the patient’s own home).

DH Department of Health – the government department that provides

strategic leadership to the NHS and social care organisations in the UK

EBITDA An accounting term and indicator of a company's financial performance.

(Earnings before interest, taxes, depreciation and amortization.)

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ECG Electrocardiogram - a diagnostic tool that is routinely used to assess the

electrical and muscular functions of the heart.

ECS Electronic Care System – allows the Trust to electronically capture,

exchange and report on patient information.

e-PCR Electronic patient clinical record. These forms are completed each time

someone attends a patient and contains personal information and details

about their condition. The e-PCR replaces the hard copy form.

Executive

Directors

Senior members of staff (including the Chief Executive and Finance

Director) who sit on the Board of directors, have decision-making powers

and a defined set of responsibilities.

FAQ Frequently asked questions

FAST test Face, Arm, Speech, Time – brief but effective test to determine whether

or not someone has suffered a stroke.

FFT Friends and Family Test – NHS single question survey which asks

patients whether they would recommend the service to their friends and

family.

NHS FT National Health Service Foundation Trust – A not-for-profit, public benefit corporation which is part of the NHS and created to devolve decision-making from central government to local organisations and communities.

Governance ‘Rules’ that govern the internal conduct of an organisation by defining the

roles and responsibilities of key offices/groups and the relationships

between them, as well as the process for due decision making and the

internal accountability arrangements

GP General Practitioner

GWAS Great Western Ambulance Service (historically served the former Avon

area, Gloucestershire and Wilshire), acquired by South Western

Ambulance Service on 1 February 2013.

HART Hazardous Area Response Team. The Trust has two teams, one based

in Bristol and one in Exeter. They are paramedics trained to respond

under a variety of challenging conditions including flooding and incidents

occurring at height.

Health Service

Ombudsman

Full title is the Parliamentary and Health Service Ombudsman

established by Parliament to investigate complaints that individuals have

been treated unfairly or have received poor service from government

departments, the NHS and other public organisations in England.

HCPC Health and Care Professions Council – the organisation responsible for

regulating healthcare professionals.

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Healthwatch Organisations comprised of individuals and community groups working

together to improve health and social care services. They represent the

views of the public, people who use service and carers on the Health

and Wellbeing boards set up by local authorities.

HEI Higher Education Institutions (including universities and further education

colleges)

HOSCs Health Overview and Scrutiny Committees – local authority committees

with powers to scrutinise local health services to ensure improvements

are made and inequalities reduced.

Hospital

Episode

Statistics

A data warehouse containing details of all admissions, outpatient

appointments and A&E attendances at NHS hospitals in England.

HSE Health and Safety Executive – has a national framework and aims to

prevent death, injury and ill-health in the workplace.

ICPR Integrated Corporate Performance Report – a document which reports

the Trust’s progress against its business plans, highlights where

performance targets have not been met and describes the corrective

action and timescales to address any performance issues.

IFRS International Financial Reporting Standards (IFRS) are designed as a

common global language for business affairs so that company accounts

are understandable and comparable across international boundaries.

IG Information Governance is a framework which brings together all the

legal rules, guidance and best practice that apply to the handling of

information. It demonstrates that an organisation can be trusted to

maintain the confidentiality and security of personal information and is

consistent in the way in which it handles personal and corporate

information.

IHCD The Institute of Healthcare Development (IHD) was founded in 2010 with

the goal of providing advanced healthcare education and hands-on-

training to managers, physicians, nurses, technologists, and support staff

to deliver the highest quality of healthcare to patients and their family

members.

IV Intravenous - substance administered to the body via a vein.

JRCALC

Guidelines

National clinical practice guidelines for NHS paramedics developed by

the Joint Royal Colleges Ambulance Liaison Committee.

KPIs Key performance indicators – a set of quantifiable measures used to

demonstrate or compare performance in terms of meeting strategic and

operational objectives.

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Local Clinical

Audit

A quality improvement project involving healthcare professionals

evaluating aspects of care they have selected as being important to the

organisation and its patients.

MEAP Mitigation Escalatory Action Plan – put in place by the Trust to manage

risk.

MI Myocardial infarction – heart attack

MINAP Myocardial Infarction National Audit Project – established in 1999 to

examine the quality of heart attack treatment (pre-hospital and in

hospitals across England and Wales). As part of this, ambulance

services report regularly on the number of MI patients they have

attended, the treatment provided (thrombolysis and/or PPCI) and the

time it took for patients to receive the treatment.

MIU Minor Injuries Unit – a treatment facility where attending patients have

less serious conditions than those being conveyed to the emergency

department of a hospital.

Moderate

Harm Incident

A patient safety incident that resulted in a moderate increase in

treatment and that caused moderate, but not permanent, harm to one or

more patients. A moderate increase in treatment is defined as a return to

surgery, an unplanned re-admission, a prolonged episode of care, extra

time in hospital or as an outpatient, cancellation of treatment, or transfer

to another area such as intensive care as a result of the incident.

Monitor Independent regulator of NHS Foundation Trusts.

National

Clinical Audit

A clinical audit involving healthcare professionals across England and

Wales in the systematic evaluation of their clinical practice against

standards, and to support and encourage improvement and deliver

better outcomes in the quality of treatment and care.

The priorities for national clinical audits are set centrally by the

Department of Health and all NHS Trusts are expected to participate in

the national audit programme.

NEDs Non-Executive Directors – members of the Board of Directors, but not

part of the executive management team.

NICE National Institute for Health and Clinical Excellence – independent

organisation responsible for providing national guidance on promoting

good health and preventing and treating ill health.

NPSA National Patient Safety Agency – An arm’s length body of the

Department of Health that leads and contributes to improved, safe

patient care by informing, supporting and influencing organisations and

people working in the health sector.

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NRLS National patient safety incident database.

OoH Out of Hours – a service which enables patients to access a GP out of

normal practice hours.

PALS Patient Advice and Liaison Service – a confidential advice, support and

information service in respect of health related matters.

Patient

Opinion

An independent website where people can post their experiences of

using a health care service.

Payment by

Results

The payment system in England under which commissioners pay

healthcare providers for each patient seen or treated, taking into account

the complexity of the patient’s healthcare needs.

PDC Public Dividend Capital - A form of long-term government finance which

was initially provided to NHS trusts when they were first formed to

enable them to purchase the Trust’s assets from the Secretary of State.

PPCI Primary percutaneous coronary intervention, a cardiac medical

procedure (sometimes "pPCI")

PPI Patient and Public Involvement – the process of engaging with the needs

and expectations of patients and the wider public in order to inform

service development and delivery.

Primary

Angioplasty

Definitive treatment for a heart attack which involves the insertion of a

small tube through a vein into the blocked blood vessel in the heart

where a balloon at the tip of the tube is inflated to open the blood vessel.

Priorities for

Improvement

There is a national requirement for NHS Trusts to select three to five

priorities for quality improvement each year. These priorities must reflect

the three key areas of patient safety, patient experience and patient

outcomes.

PSV Pathways Support Vehicle – part of the Trust’s fleet used to respond to

less urgent incidents.

PTS Patient Transport Service – the non-emergency conveyance of patients

to and from healthcare facilities.

QIPP QIPP stands for Quality, Innovation, Productivity and Prevention. It is a

national, regional and local level programme designed to support clinical

teams and NHS organisations to improve the quality of care they deliver

while making efficiency savings that can be reinvested into the NHS.

Quality

Strategy

This document sets out how the Trust will deliver high quality, cost

effective emergency and urgent health care services to people in the

South West.

http://en.wikipedia.org/wiki/Percutaneous_coronary_intervention

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Rag Rating Project progress reports often use the traffic light rating system or RAG

status definition as a visual cue to project performance (red, amber and

green).

REAP Resource Escalatory Action Plan (REAP) is a structured set of actions to

assist in Business Continuity Management. REAP is designed to ‘be

informed’ by any disruptive challenges and ‘to inform’ the Trust and

wider NHS of the pressures applied to the organisation at any time.

Red 1 and Red

2 Calls

Those calls requiring the most time critical response and cover cardiac

arrest patients who are not breathing and do not have a pulse and other

severe conditions such as airway obstruction. Red 2 calls are those

serious but less immediately time critical and cover conditions such as

stroke and fits.

RIDDOR The Reporting of Injuries, Diseases and Dangerous

Occurrences Regulations (RIDDOR) is the law that requires

employers and other people in control of work places to report any work related accidents and diagnosed cases of industrial disease.

Right Care Trust initiative to work with local health communities to ensure that

patients receive the right care, in the right place at the right time,

resulting in patients being treated without the need to attend an

Emergency Department.

RoSC Return of spontaneous circulation – desirable clinical outcome of a

patient in cardiac arrest

RRV Rapid response vehicles are staffed usually by paramedics and

specialist paramedics and often used as an initial response to incidents.

Secondary

Uses Service

A national NHS database of activity in Trusts, used for performance

monitoring, reconciliation and payments.

Sepsis A life threatening condition that arises when the body’s response to an

infection injures tissues and organs.

SI – Serious

Incident

An incident requiring investigation that has resulted in one or more of the

following:

Unexpected or avoidable death;

Serious harm;

Prevents an organisation’s ability to continue to deliver health care services;

Allegations of abuse;

Adverse media coverage or public concern;

Never events (serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented).

http://www.leadershipthoughts.com/the-highlight-report/

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SPoA Single point of access – a contact point which health and social care

professionals can use to arrange the right care for urgent and non-urgent

patient needs.

STEMI ST elevation myocardial infarction – particular type of heart attack

determined by an electrocardiogram (ECG) test

SP Specialist Paramedic – formerly known as emergency care practitioners

(ECPs)

SWASFT South Western Ambulance Service NHS Foundation Trust

Thrombolysis Drug that can dissolve blood clots and used for patients who have

suffered a heart attack or stroke

Triage Process for assessing patients based on their need for or likely benefit

from immediate medical treatment to ensure a fair, appropriate allocation

of resources

TUPE TUPE refers to the "Transfer of Undertakings (Protection of

Employment). The TUPE rules apply to organisations of all sizes and

protect employees' rights when the organisation or service they work for

transfers to a new employer.

UCS Urgent Care Service – this refers to the range of non-emergency

services provided by SWASFT.

WTE Whole Time Equivalent – a member of staff who works full-time.

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© South Western Ambulance Service NHS Foundation Trust 2015

If you would like a copy of this report in another format including braille, audio tape, total communications, large print, another language or any other format, please contact: Email: [email protected] Telephone: 01392 261649 Fax: 01392 261510

Post: Communications and Engagement Department, South Western Ambulance Service NHS Foundation Trust, Abbey Court,

Eagle Way, Exeter, Devon, EX2 7HY

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