annual reporteach year. the south west has the highest proportion of elderly people living in the...

responsive committed effective

annual report

and accounts1 Apr i l 2013 - 31 March 2014

S O U T H W E S T E R N A M B U L A N CE S E R V I CE N H S F O U N DAT I O N T R U S TA N N U A L R E P O R T A N D A CCO U N T S1 A P R I L 2 013 – 31 M A R CH 2 014

Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) of the National Health Service Act 2006

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

for quality, innovation and high performance. On 1 February 2013, SWASFT acquired neighbouring Great

Western Ambulance Service (GWAS) – covering the former Avon area, Gloucestershire and Wiltshire –

creating a single ambulance service serving the entire south west of England.

The Trust enjoys a positive national reputation. The Chief Executive, Ken Wenman, is a member of the

Association of Ambulance Chief Executives and the Chairman, Heather Strawbridge, is also former Chairman

of the National Ambulance Service Network and a current Non-executive Director and Trustee of the NHS

Confederation.

The Trust is proud of its successful history of clinical and performance excellence.

This Annual Report covers the performance of the Trust in the 2013/14 financial year.

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

A N N U A L R E P O R T 2 0 1 3 / 1 4 5

contents

A N N U A L R E P O R T 2 0 1 3 / 1 4 7

Contents

S T R AT E G I C R E P O R T 1 0

Commentary from our Chief Executive and Chairman 11

Our business – about us 13

Improvements in Services 40

Patient Experience and Stakeholder Engagement 47

Valuing staff 54

NHS Staff Survey 56

Sustainability Report 68

D I R E C T O R S ’ R E P O R T 7 2

Board of Directors 73

Council of Governors 91

Our membership 106

Operating and Financial Review 111

R E M U N E R AT I O N R E P O R T 1 1 8

Q U A L I T Y R E P O R T 1 2 6

Part 1 – A statement on quality from the Chief Executive 127

Part 2 – Priorities for Improvement and Statements of Assurance from the Board of Directors 129

2013/14 Quality Priorities 131

Quality Priorities for Improvement 2014/15 137

Statements of Assurance from the Board 142

Part 3 – Quality Overview 2013/14 150

Assurance Statements - Verbatim 163

Statement of Directors’ Responsibilities in respect of the Quality Report 178

Independent Auditors’ Limited Assurance Report to the Council of Governors of South Western Ambulance Service NHS Foundation Trust on the Annual Quality Report 180

S TAT E M E N T O F A C C O U N T I N G O F F I C E R ’ S R E S P O N S I B I L I T I E S 1 8 4

N H S F O U N D AT I O N T R U S T C O D E O F G O V E R N A N C E 1 8 8

C O R P O R AT E G O V E R N A N C E S TAT E M E N T 2 0 0

E N H A N C E D Q U A L I T Y G O V E R N A N C E R E P O R T I N G 2 0 4

A N N U A L G O V E R N A N C E S TAT E M E N T 2 0 8

A U D I T O R S ’ R E P O R T 2 2 8

A N N U A L A C C O U N T S 2 3 2

G L O S S A R Y 2 8 0

A N N U A L R E P O R T 2 0 1 3 / 1 4 9

strategic report

Commentary from our Chief

Executive and Chairman

Welcome to the 2013/14 Annual Report and Accounts for the South Western Ambulance Service NHS

Foundation Trust (SWASFT). 2013/14 was a challenging year for SWASFT in many ways including the first full

year of integration following the acquisition of the former Great Western Ambulance Service in 2013; the loss

of Patient Transport Service contracts following a competitive tender; winning and the rollout of additional

NHS 111 contracts and the the introduction and delivery of the Red Recovery Plan to support the Accident

and Emergency (A&E) service contracts.

During our first full year as an enlarged Trust, we worked hard to deliver our pre-acquisition pledges and had

particular success with our innovative Right Care Initiative. Right Care has reduced the number of patients

attending hospital emergency departments unnecessarily. It has delivered substantial benefits and savings for

the health community.

The central aim of Right Care is to ensure that patients receive the best possible care, in the most appropriate

place and at the right time. It introduced a wide range of developments to improve the appropriateness

of the care delivered to patients who have been clinically assessed or triaged as needing an ambulance

following a 999 call. As a result of Right Care, we now have the lowest patient conveyance rate to

emergency departments in England. Based upon the October 2013 Ambulance Clinical Quality Indicator

performance data, we transported 83,517 fewer patients annually to emergency departments (EDs) across

the South West compared to the national average.

This means that last year we exceeded the level agreed with our NHS commissioners by 2%, resulting in an

increase in the non-conveyance rate of managed patients to ED from 50.84 per cent in 2010/11 to 57.45 per

cent in 2013/14. This was achieved in the face of many pressures – nationally and locally – to the provision of

emergency and urgent care services. Despite these continuing pressures, out-of-hours service performed well

and improved on last year’s performance against the quality requirements.

We had outstanding success in meeting our Commissioning for Quality and Innovation (CQUIN) targets. We

achieved all of our CQUIN targets for Emergency 999 Ambulance Services (A&E) and Out-of-Hours in Dorset

for 2013/14, and received the full contracted value for each of these CQUINs.

We delivered a combined Financial Risk Rating in line with the SWASFT Finance Strategy and Governance risk

rating of green, and ended the year with a small but significant financial surplus.

Perhaps the most testing challenge of the year was in delivering the Category A8 Red 1 target. This target

requires ambulance services to provide an emergency response to 75 per cent of the total number of the

most critical, immediately life threatening incidents within eight minutes or just 480 seconds, regardless of

the area served. Our ability to meet this target across our large operating area was compromised due to a

number of factors, not least being the most rural ambulance service in England. We worked with Monitor

and with our commissioners to implement a robust action plan with monthly monitoring and review. This

A N N U A L R E P O R T 2 0 1 3 / 1 4 11

enabled us to meet the target in the last three months of the year, but not for the whole reporting period.

Alongside responding to change and challenges, we have continued to work on the integration of the

expanded Trust created by the acquisition of the former Great Western Ambulance Service. The emphasis

has been on ensuring the best practice from each organisation is adopted and implemented across the wider

operating area which includes the communities of: Cornwall and the Isles of Scilly, Devon, Somerset, North

Somerset, Dorset, Wiltshire, Gloucestershire, South Gloucestershire, Bristol, Bath and North East Somerset,

and Swindon.

We are delighted that this work received national recognition last year. In June 2013, we were presented with

the Shared Learning Award from the National Institute for Health and Clinical Excellence for the Trust’s work

in reviewing the clinical guidelines from both organisations. The revised clinical guidelines were available to

staff from the first day of operation as an extended organisation. Our Finance Team also won the Healthcare

Financial Management Association South West Branch’s Best Team of the Year award, and we received Best

Flu Fighter Team award at the annual Flu Fighters Awards.

In March 2014, Sir Bruce Keogh, NHS Medical Director visited our integrated hub in Dorset. This hub houses

one of our three 999 control centres, the Dorset NHS 111 control centre, the Dorset and Somerset Out-

of-Hours Doctors Service, and the innovative Single Point of Access (SPoA) hub for Dorset. Accompanied

by Nigel Acheson, Regional Medical Director for NHS England South, Sir Bruce was able to see integrated

services in action and how they provide seamless patient care.

There were a number of changes to our Council of Governors, following elections throughout our public and

staff constituencies. We welcomed a number of new governors to the Trust including appointed governors

from partner organisations such as the police. As a Foundation Trust, the governors form important links

with local communities, our staff and stakeholder organisations and we look forward to working together.

We believe that meeting regularly with our staff is very important, especially in the expanded operating

area. Our staff and volunteers never fail to impress us with their attitude, commitment, professionalism and

sense of pride in SWASFT. This was reflected in the unannounced Care Quality Commission (CQC) inspection

which took place in February 2014. The CQC report noted the positive way in which staff responded to the

inspectors and recorded some of the pleasing comments made by patients about our staff. We would like

to record our sincere thanks and congratulations to the staff and volunteers of SWASFT for their collective

efforts and achievements over the year.

We look forward to 2014/15, during which we will continue to work towards continuous improvements in

services for the benefit of patients. As a key provider of emergency and urgent care services within a large

geographical area, it is important that we work closely with other healthcare providers in the South West.

This collaborative approach to improving quality will ensure that services become more clinically effective,

timelier and more patient-focused.

Ken Wenman Heather Strawbridge

Chief Executive Chairman

Our business – about us

South Western Ambulance Service NHS Foundation Trust (SWASFT) provides ambulance 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 promotes best practice.

SWASFT was the first ambulance service to be authorised as an NHS Foundation Trust on 1 March 2011. In

February 2013 we acquired the neighbouring former Great Western Ambulance Service NHS Trust (GWAS).

As a result, our operating area now 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). This makes us responsible for providing ambulance services across an area of

10,000 square miles, equating to 20 per cent of mainland England.

SWASFT is recognised as a high-quality, effective and efficient NHS organisation. We are the primary provider

of 999 ambulance services across our operational area. Our core operations include the following service

lines:

❙ Emergency ambulance 999 services (A&E)

❙ Urgent Care Services (UCS) – GP out-of-hours medical care (Dorset, Gloucestershire and Somerset)

❙ NHS 111 call-handling and triage services for Cornwall and the Isles of Scilly, Devon, Dorset and Somerset.

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

❙ Patient Transport Services (PTS)

❙ Chemical, Biological, Radiological, Nuclear and Explosive (CBRNE) Training

❙ Transport of medical samples and clinical records (Medical Transport Service)

❙ Treatment/staff at Newquay Minor Injury Unit

❙ Commercial and higher education training to meet the requirements of both the private and public sectors

❙ Medical services at events

❙ Driving tuition, statutory compliance advice and incident investigation.

O U R M I S S I O N A N D A I M SOur mission statement is: ‘To respond to patients’ emergency and urgent care needs quickly and safely to

save lives, reduce anxiety, pain and suffering.’

Last year we formulated a new vision, which takes account of the recent acquisition of GWAS in 2013/14,

and is also forward looking and influenced by the new national direction of refocusing health policy on

prevention, on reshaping urgent and emergency care and increasing care delivered within the community

and in people’s homes.

Our 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.’

A N N U A L R E P O R T 2 0 1 3 / 1 4 13

Both the Mission and Vision Statements reflect the vision for emergency and urgent care set out by Sir Bruce

Keogh that ‘for those people with urgent but non-life threatening needs we must provide highly responsive,

effective and personalised services outside of hospital.’

T H E A R E A W E S E R V EWe serve a total population of over 5.3 million with an additional estimated influx of over 17.5 million visitors

each year. The South West has the highest proportion of elderly people living in the region: 19.7 percent of

over 65 year olds, compared with 17.5 percent in most other English regions and 11 percent in London.

The operational area is predominantly rural, which means that SWASFT is the most rural ambulance service in

the country. This has major implications for the delivery of our services. We also serve several cities and large

urban centres including Bristol, Plymouth, Exeter, Bath, Swindon, Gloucester, Bournemouth and Poole.

O U R CO M M I S S I O N E R SFrom 1 April 2013, as part of changes to the NHS, responsibility for commissioning local health services

moved from primary care trusts (PCTs) to clinical commissioning groups (CCGs) led by GPs.

GPs are now responsible for almost 60 per cent of the NHS budget. Every GP surgery has to belong to a CCG;

it is intended to make GPs more responsive to the needs of patients as they have day-to-day contact with

them.

Our operational area aligns with the boundary of the South West region. This comprises 12 Clinical

Commissioning Groups (CCGs) responsible for commissioning healthcare services for the local population.

As Emergency Ambulance 999 Services (A&E) are provided across all 12 CCG areas, we have a co-ordinated

commissioning arrangement led by NHS South Devon and Torbay CCG. We have quality monitoring,

performance and contracting meetings with the CCG bi-monthly. During 2013/14, the CCGs contracted with

the South West Commissioning Support Unit which will co-ordinate the commissioning of the A&E contract

going forwards.

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. We deliver four of the NHS 111 services

across the counties of Cornwall and the Isles of Scilly, Devon, Dorset and Somerset.

The majority of our Patient Transport Service (PTS) contracts came up for tender in 2012/13 and a number

of these were transferred to private providers last year. We still provide PTS services for the Bristol, North

Somerset and South Gloucestershire areas and the Isles of Scilly (until 30 September 2014). 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.

H O W W E O P E R AT ESWASFT is run by a Board of Directors made up of a 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 two

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 72-117.

We employ over 4,000 mainly clinical and operational staff (including paramedics, emergency care

practitioners, advanced technicians, ambulance care assistants and nurse practitioners) plus GPs and around

2,785 volunteers (including community first responders, BASICS doctors, fire co-responders and volunteer

PTS drivers). The gender split of the workforce is: 2,281 males and 1,813 females.

SWASFT works 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 local treatment

centres (LTC) and minor injury units (MIU).

We have three operational divisions:

❙ North – Gloucestershire, Wiltshire, Bristol, South Gloucestershire, Bath and North East Somerset and North

Somerset

❙ West – Devon, Cornwall and the Isles of Scilly

❙ East – Dorset and Somerset.

Our headquarters is in Exeter, Devon where we also have one of the clinical hubs (emergency control rooms).

We have a further two 999 clinical hubs in St Leonards (Dorset) and Bristol, 96 ambulance stations and 14

vehicle workshops.

We also make use of a range of dispatch points and we have clinicians working in the heart of communities,

based at Local Treatment Centres (LTC) and Minor Injury Units (MIU).

To support the delivery of its activities, the Trust has a diverse fleet of 1,002 vehicles including:

❙ Emergency ambulance 999 service (A&E) frontline vehicles

❙ Rapid-response vehicles including Urgent Care Services (UCS) cars

❙ Patient Transport Service (PTS) vehicles

❙ Motorcycles and bicycles

❙ A boat (used across the Isles of Scilly)

❙ Specialist vehicles for the two Hazardous Area Response Teams (HART)

❙ Medical cleaning units.

We 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).

A N N U A L R E P O R T 2 0 1 3 / 1 4 15

We have five organisational directorates, led by the Chief Executive:

❙ Delivery

❙ Finance

❙ Human Resources (HR) and Governance

❙ Information Management and Technology

❙ Medical.

In addition we have a Communications and Engagement Department that reports to the Chief Executive. See

more about our workforce on in Valuing Staff starting on page 54.

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.

The CQC made a routine unannounced inspection during February 2014. The inspection took place over five

days and involved four inspectors. In the CQC’s report, we were found to be fully compliant in the following

five areas:

❙ Consent to care and treatment

❙ Care and welfare of people who use services

❙ Safety and suitability of premises

❙ Assessing and monitoring the quality of service provision

❙ Complaints.

The report included some really pleasing comments made by patients, for example, that staff are ‘kind’,

‘professional’, ‘caring’, and that ‘they do a fantastic job’. There are also many references within the report to

the positive way staff have responded to the inspectors, explaining what, why and how they carry out their

role

E D U C AT I O N , T R A I N I N G A N D P R O F E S S I O N A L D E V E L O P M E N TWe continue to drive forward professional standards by bringing together first-class teaching, research and

clinical services.

There are two well-established training colleges in the West and East Divisions, with several further specific

small training venues located at stations across our area. Plans are also in place to upgrade training venues in

the North Division.

We work closely with our three regional university partners – Bournemouth, Plymouth and the University

of the West of England (UWE) in Bristol – all of whom provide undergraduate and post-registration

paramedics with continued professional development (CPD) opportunities. We also work closely with external

organisations such as the Local Education and Training Boards (LETBs) and Academic Health Science networks

(AHSNs) to ensure that SWASFT remains at the forefront of innovation in education.

Our team of highly-skilled tutors are predominantly registered paramedics educated to degree level and

above, with additional teaching qualifications. They offer learning opportunities both in the classroom and

in the workplace. They also carry out assessments, induction and remedial training. The training team works

closely with our Clinical Directorate and research colleagues to provide in-house expertise.

The training team delivers an annual core training schedule, which includes:

❙ Statutory Mandatory and Essential (SME) training for clinical personnel

❙ Continuous Personal and Professional Development (CPPD) courses and programmes

❙ Management and Leadership programmes

❙ Driver training for frontline operational crews

❙ Bespoke courses, for example trauma, obstetrics, paediatric training packages

❙ E-learning packages in conflict resolution, CBRNE (chemical, biological, radiological, nuclear, and

explosives) and stroke care

❙ Refresher courses for hub staff and clinicians in the 999 control rooms linked to the new ambulance

clinical quality indicator (ACQI) reporting

❙ Training for Hazardous Area Response Team (HART) members

❙ An increasing number and range of continuing professional development (CPD) opportunities.

O U R S T R AT E G YWe developed a 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 999 A&E services and acquiring Great Western Ambulance Service

NHS Trust in early 2013. 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 brought forward a programme of work in 2013/14 to re-set our priorities and establish a new over-

arching strategy.

In order to underpin delivery of our Integrated Business Plan, which was due to be finalised and published in

July 2014, we have developed four new strategic goals covering the next five years from 2014/15 to 2018/19.

These 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 - Continue 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.

We have set corporate objectives for 2014/15 which are aligned to each of these strategic goals and will be

measured against key performance indicators throughout the year. These objectives include delivering and

improving on national ambulance and out-of-hours quality indicators; meeting targets to build a workforce of

competent and capable staff and developing organisational sustainability and financial stability.

A N N U A L R E P O R T 2 0 1 3 / 1 4 17

O P E R AT I O N A L P L A NWe have developed an operational plan to cover the first two years of the refreshed strategy. The

Operational Plan 2014 to 2016 is designed to respond to a number of challenges that we face both internally

and within the local health economy. It describes a number of quality improvements, which may be

summarised as:

❙ Delivery of national ambulance response time targets

❙ Implementation of the Electronic Care System (ECS)

❙ Ensuring standardisation and integration across the Trust

❙ Continuing to focus on delivering a reduction in attendances to emergency departments through the Right

Care2 imitative

❙ Delivery of our clinical strategy and 2014/15 CQUIN initiatives.

These quality improvement initiatives aim to:

❙ Deliver all standards and quality requirements providing significant health community benefits

❙ Ensure the core business of the Trust remains centred on clinical leadership, quality, safety and productivity

and is aligned to known current and future commissioning plans

❙ Optimise patient experience whilst striving to secure a safe working environment for staff that operate

around the clock delivering health care services 365 days a year

❙ Continue to deliver the benefits identified as part of the acquisition associated with improving the quality

of clinical care and services provided to our patients.

The Integrated Business Plan and Operational Plan provide more detailed information about our business

objectives. Copies are available on our website www.swast.nhs.uk or from Trust Headquarters, Abbey Court,

Eagle Way, Exeter, Devon, EX2 7HY.

R I S K S A N D U N CE R TA I N T I E SWe 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 March 2013 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 risk management is led by our Risk Manager, with a clear

escalation process in place. Risks are scored on a 5x5 matrix, 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 5 represents

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 meetings.

In addition, the following risks to business have been identified within our Operating Plan for 2014 to 2016:

❙ Accident and emergency response time targets

❙ Workforce establishment levels

❙ Handover delays at hospital

❙ The current 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

❙ Increases in activity.

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 and a table setting out the highest risks to the Trust as at 31 March 2014 can

be found in the Annual Governance Statement on pages 208-227.

T R E N D S A N D FA C T O R SWe have identified the key external factors that are likely to affect our business during 2014/15. As a provider

of emergency 999 ambulance services 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:

Political Economic

❚ Re-organisation of NHS delivery structure

❚ Increased encouragement of competition for services amenable to choice

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

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

❚ Public sector financial deficit

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

❚ National funding settlement for NHS

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

Social Technological

❚ 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

❚ 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

❚ Continuing increased demand for round the clock ambulance services

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

❚ National programme for information technology introducing the electronic care system

❚ Growth in use of social media

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

Legislative Environmental

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

❚ NHS constitution including new rights for patients

❚ A tougher and continually changing regulatory regime by regulators

❚ Volatility in fuel prices and requirement to reduce fuel usage

❚ Tougher environmental and sustainability targets

❚ Environmental factors including weather and pandemics

A N N U A L R E P O R T 2 0 1 3 / 1 4 19

G O I N G CO N CE R NAfter 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 pages 111-115.

P E R F O R M A N CE AG A I N S T CO N T R A C TDuring 2013/14, the Trust received a total number of 872,836 emergency and urgent calls of which 751,911

resulted in a response being sent to patients. This was an increase of 3.2 per cent in the total number of

calls and a 2.8% rise in the number of those responded to when compared with the same period and

geographical area during the 2012/13 financial year.

Against this background, and increased pressures in demand on emergency and urgent services throughout

the year, the Trust faced many challenges in meeting its performance targets including the Category A8 Red

1 target.

Despite these pressures, the Trust was successful in achieving all of its Commissioning for Quality and

Innovation (CQUIN) targets for Emergency 999 Ambulance Services (A&E) and Out-of-Hours in Dorset

for 2013/14, improved our quality requirements for Out-of-Hours and consistently achieved our planned

governance and financial risk ratings. Details of our performance against contract are reported below.

Background

For 2013/14, the A&E service was covered by two contracts, one each for the areas covered formerly by

GWAS and SWASFT.

We have contracts to provide a range of Urgent Care Services throughout the South West. Currently these

are:

❙ Three Out-of-Hours contracts in Gloucestershire, Somerset and Dorset all of which are block contracts.

They are monitored against activity (patient contacts) compared with the same period in the previous

financial year, National Quality requirements and against local key performance indicators

❙ 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

❙ A number of smaller Urgent Care Service contracts. These include a Single Point of Access to Healthcare

Professionals in Dorset, dental call handling and triage, Out-of-Hours services to the Ministry of Defence

and prisons in Dorset, and GP practice telephone cover.

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 2013/14 for each of our core services and for PTS is summarised in the table

below.

Performance figures for PTS services within Devon, Dorset, Somerset, Bath and North East Somerset,

Wiltshire, Gloucester and Swindon reflect a proportion of the year up until each of the contracts were

transferred to the new providers. PTS performance for Bristol, North Somerset and South Gloucestershire

and Cornwall shows full year performance whilst the Isles of Scilly contract reflects performance from the

1 September 2013 through to 31 March 2014. Contracted activity levels for all contracts have also been

included for 2014/15.

Activity Levels and Contract Values for 2013/14 and 2014/15

Service – Currency/Activity Measure

Contracted 2013/14

Actual2013/14

Contracted2014/15

Emergency 999 Ambulance Services

❚ East and West Divisions = 483,416 Activations*

❚ North Division = 291,420 Incidents with a Response*

❚ East and West Divisions = 477,818 Activations*

❚ North Division = 302,209 Incidents with a Response*

839,932 Incidents

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 and the national quality requirements

175,600 Patient Contacts There is no contracted activity level. Monitoring is undertaken against the activity for the same period in the previous financial year and the national quality requirements

NHS 111 - Calls Received

❚ Cornwall and the Isles of Scilly = 189,731**

❚ Devon = 221,467 (6 months)

❚ Dorset = 219,118

❚ Somerset = 69,864 (5 months)

❚ Cornwall and the Isles of Scilly = 10,052**

❚ Devon = 92,301 (6 months)

❚ Dorset = 230,854

❚ Somerset = 57,584 (5 months)

❚ Cornwall and the Isles of Scilly = 192,173

❚ Devon = 393,469

❚ Dorset = 236,042

❚ Somerset = 173,070

Patient Transport Services - Patient Seats / Journeys

❚ Bath and North East Somerset, Cornwall, Devon, Dorset, Gloucestershire, Somerset, Swindon and Wiltshire (6 months) = 221,750

❚ Isles of Scilly operated on a block contract basis for 2013/14

❚ Bristol, North Somerset and South Gloucestershire (included Royal National Hospital for Rheumatic Diseases NHS Foundation Trust) = 99,702

❚ Bath and North East Somerset, Cornwall, Devon, Dorset, Gloucestershire, Somerset, Swindon and Wiltshire (6 months) = 242,915

❚ Isles of Scilly operated on a block contract basis

❚ Bristol, North Somerset and South Gloucestershire = 101,885

❚ Isles of Scilly will operate on a block contract basis until 30 September 2014

❚ Bristol, North Somerset and South Gloucestershire = Not agreed with commissioners at the time of print

* During 2013/14 the Trust has held two contracts for 999 A&E services each based upon a different currency. From 1 April 2014 the Trust will be commissioned under a single A&E contract that covers the whole of the South West region and is based upon one currency.

** NHS 111 services in the South West were tendered in seven geographic blocks with the Trust securing four of the contracts within the south of the region. Implementation and ‘go live’ of each of the services has been staggered with the last of the services in Cornwall and Isles of Scilly service being launched on the 4 February 2014.

*** The Trust was contracted to provide PTS in Bath and North East Somerset, Wiltshire, Gloucester for a six month period in 2013/14. However the contract was subsequently extended through to the 30 November 2013 (eight months) after which it transferred to the new provider.

A N N U A L R E P O R T 2 0 1 3 / 1 4 21

N AT I O N A L P E R F O R M A N CE TA R G E T SEmergency Ambulance 999 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 2012/13 and 2013/14.

❙ 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

❙ Category A8 (Red 2): Total number of Category A Red 2 incidents presenting conditions which may

be life threatening but less time critical then Red 1 and should receive an emergency response within 8

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.

During 2013/14 we faced many challenges in meeting the Category A8 Red 1 target, although we were

consistent in delivering the Category A8 Red 2 and A19 national target throughout the year.

We worked with the CCGs during the year to deliver sustainable Red 1 performance. This resulted in the Trust

achieving the target for the fourth quarter of last year. However, performance earlier in the year means that

the target was not achieved for the full year 2013/14.

Our ability to achieve the Red 1 target may be 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.

Other factors included peaks in activity; the impact of the new NHS 111 service across the South West region;

hospital handover delays creating pressure points in the system; and a national shortage in paramedics in

order to support service delivery.

The Trust has an action plan in place to sustain the improvement in performance.

Key Performance Indicator

National Target %

Actual Performance 2012/13* (%)

Actual Performance 2013/14 (%)

Category A8 Red 1 75 73.01 73.15

Category A8 Red 2 75 75.93 77.23

Category A19 95 95.36 95.76

* From 1 June 2012 the A8 measure was split into two parts, Red 1 and Red 2. This split reflects the way that ambulance trusts already sub-divide their Category A calls for operational purposes. Red 1 and Red 2 were introduced from 1 June 2012. Furthermore in line with the date of acquisition this data only includes information for the north division for February and March 2013.

R E G U L AT O R Y R AT I N G SAs 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.

Financial Risk Rating

Each Financial criterion is rated 1 (high risk) to 5 (low risk) and compared with a grid of standard values.

This method of assessing risk was applied by Monitor until the 30 September 2013 under the Compliance

Framework. After this date it was replaced by the Continuity of Services Risk Rating.

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 the 1 October 2013 as part of the Risk Assessment

Framework.

Governance Risk Rating

Under the old Compliance Framework there were four rating categories which utilise the RAG (red, amber,

green) rating scale, with green portraying ‘no material concerns’ and red being a potential breach of the

Trusts Governance Licence. From the 1 October 2013, as part of the Risk Assessment Framework, Monitor

assign a green rating if there is no governance concern identified. Where a potential material causes for

concern is identified Monitor will replace the 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.

During 2013/14 we consistently achieved our planned governance risk rating of green. We also achieved

a financial/continuity of services risk rating of 3 in the first quarter of the year and in quarter two, This

increased in quarter three to a risk rating of 4, in line with plan. These scores have been determined through

an assessment of key submissions to Monitor.

For the fourth and final quarter of 2013/14 (January, February and March 2014), we submitted a forecast

governance risk rating of green and a continuity of services risk rating of 4 to Monitor. Amongst other

factors, the submitted scores reflect that we achieved the Category A targets for the A&E 999 service during

Quarter 4. Our Governance and Financial/Continuity of Services risk ratings for 2012/13 and 2013/14 are set

out below:

2013/14Annual Business Plan*

Quarter 1 2013/14

Quarter 2 2013/14

Quarter 3 2013/14

Quarter 4 2013/14*

Financial / Continuity of Services Risk Rating

3 3 3 4 4

Governance Risk Rating Green Green Green Green Green

2012/13Annual Business Plan

Quarter 1 2012/13

Quarter 2 2012/13

Quarter 3 2012/13

Quarter 4 2012/13

Financial Risk Rating 4 4 4 4 4

Governance Risk RatingGreen Green Green Green Amber-

Green

* The outcome from the Trust’s monitoring return for quarter 4 of 2013/14 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.

A N N U A L R E P O R T 2 0 1 3 / 1 4 23

U R G E N T C A R E S E R V I CE S - O U T- O F - H O U R S Q U A L I T Y R E Q U I R E M E N T SNational 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 and/or other healthcare

professional clinical services.

There are 13 quality requirements that specifically relate to Out-of-Hours services. However not all these

targets are applicable to all of the services delivered by the Trust. 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 call-taking and triage functionalities 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

2012/13 and 2013/14. These have been ‘RAG’ rated, which stands for red, amber or green. A rating of red

means that the requirement has not been met, amber means ‘partially met’ and green means ‘fully met’.

Despite a challenging year, the Out-of-Hours Service performed well and improved on last year’s

performance against the quality requirements. The area of greatest improvement was in QR12 – Urgent

Home Visits within two hours, which rose from non-compliant to compliant, only missing the ‘compliant’

range for February by 0.06%. QR12 - Urgent Consultations at Base within two hours also proved challenging,

but remained compliant throughout the year.

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 local GPs to triage local patients; revising the training plan for

supervisors and dispatchers; enhancing GP pay in both Dorset and Somerset; 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.

Urgent Care Service Out-of-Hours Quality Requirements

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QR1

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

Green Green Green Green Green Green

QR2

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


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 (including patients with terminal illness)


QR4

Providers must regularly audit a random sample of patient contacts. The sample must be defined in such a way that it will provide sufficient data to review the clinical performance of each individual working within the service


QR5

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


A N N U A L R E P O R T 2 0 1 3 / 1 4 25

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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


QR8a

No more than 0.1% of calls engaged

Green Green Green Target no longer applicable:

This element of the service is now delivered by NHS 111, with appropriate calls being transferred to Out-of-Hours

No more than 5% of calls abandoned

Amber Amber Green

QR8b

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

Red Red Amber Target no longer applicable:

This element of the service is now delivered by NHS 111, with appropriate calls being transferred to Out-of-Hours

QR9a

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

Green Green Green Target no longer applicable:

This service is now run by NHS 111, with appropriate calls being transferred to Out-of-Hours

QR9b

Definitive Clinical Assessment for urgent calls started within 20 minutes

Red Red Amber Target no longer applicable:

Calls are now routed through the NHS 111 service

Definitive clinical assessment for all other calls started within 60 minutes

Red Red Green Target no longer applicable:

Calls are now routed through the NHS 111 service

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QR10a

(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

QR10b

(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

QR10c

At the end of the 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 (presenting at base)

Emergency consultation started within an hour

Red Red This quality standard is not applicable to this service as it does not operate from local treatment centres

Red Red This quality standard is not applicable to this service as it does not operate from local treatment centres

Urgent consultations started within two hours

Amber Amber Amber Amber

Less urgent consultations started within six hours.

Green Green Green Green

A N N U A L R E P O R T 2 0 1 3 / 1 4 27

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QR12 (home visit)

Emergency consultations started within one hour

Red Red Green Red Red Green

Urgent consultations started within two hours

Red Red Green Red Red Green

Less urgent consultations started within six hours

Amber Amber Green Green Green Green

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


U R G E N T C A R E S E R V I CE S - N H S 111 Q U A L I T Y R E Q U I R E M E N T SThe 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. The Trust 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

February 2014

❙ Devon: The Trust has delivered the NHS 111 service from its initial launch 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.

As with any new service, the Trust is learning lessons and applying them to make improvements for the

benefit of patients. Moving into 2014/15, we have devised a performance plan to focus on key areas

for improvement. This includes a focus on QR8b (calls to be answered within 60 seconds of the end of

introductory message) and QR9a and b (all immediately life threatening conditions to be passed to the

ambulance service within three minutes and patient call-backs must be within 10 minutes). Revisions of rotas

to increase the number of clinicians available to give advice at peak times, along with additional call advisors

have already been implemented to improve performance in these areas.

The table below sets 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 2013/14. These have also been ‘RAG’ rated (see above

for explanation).

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Dorset RAG Ratings 2012/13 (Feb to Mar 2013 only)

RAG Ratings for 2013/14

Dorset Somerset Devon Cornwall

QR1

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

Green Green Green Green Green

QR2

Providers must send details of all consultations (including appropriate clinical information) to the practice where the patient is registered by 8.00 a.m. the next working day

Green Green* Green* Green* RAG rating not available*

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 (e.g. 1% per quarter)


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


A N N U A L R E P O R T 2 0 1 3 / 1 4 29

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Dorset RAG Ratings 2012/13 (Feb to Mar 2013 only)

RAG Ratings for 2013/14

Dorset Somerset Devon Cornwall

QR8a

No more than 0.1% of calls engaged


No more than 5% of calls abandoned

Red Green Green Green Green

QR8bCalls to be answered within 60 seconds of the end of introductory message

Red Amber Amber Amber Amber

QR9a

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

Green Red Red Red Red

QR9bPatient call-backs must be achieved within 10 minutes

Green Red Red Red Red

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


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


* National operational amendments to improve the messages to GPs surgeries have resulted changes to the reporting requirements. Data is currently only available for the period 1 April 2013 to 31 January 2014. As the Cornwall service went live after this date the Trust has no information for this metric currently. Advanced Health and Care are working to resolve this.

PAT I E N T T R A N S P O R T S E R V I CE ( P T S ) PTS provides non-urgent transport for patients who have a medical need. These services include:

❙ Attending outpatient appointments

❙ Admission or discharge to or from a hospital

❙ Transfers between hospitals.

PTS operates in a competitive commercial environment. During 2012/13 the CCGs responsible for

commissioning PTS across the South West tendered the majority of contracts, with nine CCGs awarding

new contracts during 2013/14. This resulted in a significant loss of business for the Trust. Despite this, PTS

delivered in excess of 345,000 journeys in 2013/14. We retained the contract for Bristol, North Somerset and

South Gloucestershire and deliver a small 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%

satisfaction rate. As a result of the patient surveys, we have formed an action plan resulting in improved

information provided to the public on how to contact the PTS service directly, and how to provide feedback

in relation to patient experience. We are enhancing the popular existing call-to-confirm with SMS text

messaging features.

2014/15 will see further service improvements with the development of an in-house bariatric capability. This

will be achieved through the procurement of specialist bariatric equipment and the adaptation of an existing

vehicle from within our fleet. Specialist training will be provided to staff who will provide the service.

Over the coming year we will focus on improving the timeliness of the service delivered to patients. This will

be underpinned by creating a more flexible and responsive workforce. We will invest 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, will ensure that we use resources wisely to deliver a high quality PTS service to our

patients and commissioners.

The tables below set out performance for 2012/13 and 2013/14 against the locally agreed PTS targets.

Key Performance Indicators – North Division Contracts

Locally agreed Target %

Actual Performance 2012/13 %


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% 91.54% 95.73%

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% 97.25% 95.76%

1c - Patients living over 35 miles away from 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%)

90% 100% 97.38%

A N N U A L R E P O R T 2 0 1 3 / 1 4 31





2a - Patients should not arrive more than 45 minutes before their booked arrival time

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

90% 83.74% 83.79%

2b - Patients should not arrive after their booked arrival time

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

97% 84.57% 87.24%

3a - The Trust is to arrive to collect patients from the agreed location within 45 minutes of the outwards journey time

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

90% 80.06% 84.51%

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% 91.24% 92.47%

3b - A summary of reasons and actions to be provided, for each month, for all cases where collection was outside (i.e. later) 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 personal 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 = assessed through the annual patient satisfaction survey

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

85% 97.80% 97.80%

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% 89.43% 93.16%





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 standard and timeframes (reported immediately; investigated within 24 hours and lessons learnt shared, then closed within 60 working days of the incident)

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

100% 100% 100%

Key Performance Indicators – East and West Division Contracts



Actual Performance* 2013/14 %

Calls received answered within 25 seconds 80% 92.95% 92.56%

Calls into the Patient Transport Services control abandoned

Less than 4% 2.41% 3.13%

Contracted activity levels to be completed 100.00% 100.98% 99.59%

* Key Performance Indicators for 1 April 2013 to 30 September 2013, following PTS contracts being transferred to private providers.

A M B U L A N CE CL I N I C A L Q U A L I T Y I N D I C AT O R S ( A Q I s ) Ambulance trusts are required to publish all data in relation to each Ambulance Quality Indicators (AQIs) on a

monthly basis both locally (on an ambulance service’s website) and nationally (by the Department of Health).

AQIs are used to understand the quality of care provided, focussing particularly on the outcome of care

provided for patients, as well as the speed of responding to patients.

Ambulance service providers use AQIs to stimulate continuous improvements in the care they provide for

patients. AQIs were created to provide a comprehensive and balanced view of care and should be used as a

complete set rather than focussing only on a few specific indicators. As a complete set, AQIs provide a much

fuller picture of how ambulance services are performing. AQIs are designed to be consistent with measures in

other parts of the NHS, most notably those in hospital emergency departments. Our AQIs are reported in the

Quality Accounts on pages 157.

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CO M M I S S I O N I N G F O R Q U A L I T Y A N D I N N O VAT I O N (CQ U I N ) - 2 013 / 14Lord 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 CQUIN targets for each service for 2013/14.

For 999 A&E services eleven CQUINs were agreed with commissioners for 2013/14 representing 2.5%

(£1.770m) of our block contract for the North Division A&E contract, and 1.5% £1.490m of the East and

West Division contract. The Somerset and Dorset Out-of-Hours contracts included local CQUIN schemes as

presented below, however CQUIN did not form part of the Gloucestershire Out-of-Hours contract or any of

the Patient Transport Service contracts in 2013/14.

For 2013/14 the Trust achieved all of its CQUIN targets for Emergency 999 Ambulance Services (A&E) and

Out-of-Hours in Dorset for 2013/14, therefore receiving the full contracted value for each of these CQUINs.

Emergency 999 Ambulance Services (A&E) CQUIN - 2013/14

Contract CQUIN Target Description Target NameContracted Value £

Actual Value £

North

Expand mechanisms (including electronic) to facilitate patient engagement and feedback including enhancing and promoting the use of the Patient Opinion website, developing a range of patient experience evaluation methods and undertaking patient experience data gathering

Patient Experience Escalator

354,000 354,000

North

Work with Clinical Commissioning Groups to understand the factors which influence Health Care Professional (HCP) referrals and identify areas for joint working

HCP Calls 177,000 177,000

North

Maintain conveyance percentage threshold by ensuring patients are treated close to home in the most appropriate place for their care needs and continued requirement to reduce the number of acute admissions through A&E

Appropriate Conveyance / Conveyance Volume

885,000 885,000

North

Evaluate the care delivered to patients who experience an acute exacerbation of asthma and remain on scene following treatment, including auditing the introduction of oral prednisolone

Prednisolone implementation and management of asthmatic patients treated on-scene

354,000 354,000

East and West

Improving the quality of care delivered to patients presenting with sepsis

Sepsis 298,063 298,063

East and West

Improving the Quality of Care Delivered to Patients Presenting with Pain

Pain Management

298,063 298,063

East and West

Improving the appropriate utilisation of ambulance services by care homes. This scheme aims to evaluate the impact of a range of targeted interventions on general utilisation and the level of inappropriate admissions to care homes

Care Homes 298,063 298,063

Contract CQUIN Target Description Target NameContracted Value £

Actual Value £

East and West

Urgent care pathway development in Dorset focused on improving the services provided to patient presenting with sepsis to reduce mortality and morbidity

Urgent Care 149,031 149,031

East and West

Participate in the Frail Elderly Programme Board to work in collaboration with providers to agree a care pathway for frail elderly patients in Somerset

Frail elderly care pathway development

149,031 149,031

East and West

Increase the opportunity for the identification of patients with undiagnosed Atrial Fibrillation, instigating appropriate referral for primary care review, reducing the risk of stroke and other cardiovascular events

Atrial fibrillation screening and referral in Devon

149,031 149,031

East and West

Participate in the Long Term Condition work in collaboration with providers to agree a care pathway for frail elderly patients in Cornwall

Long Term Conditions Care Pathway Development (Cornwall)

149,031 149,031

Total 3,260,313 3,260,313

A N N U A L R E P O R T 2 0 1 3 / 1 4 35

Out-of-Hours Service CQUIN – Dorset 2013/14

Target Description Target NameContracted Value £

Actual Value £

❚ Improve communication across organisations (Encourage enrichment of the Summary Care Record in Dorset and Somerset to support end of life care)

❚ Liaise with GP practices to ensure they are using the Trust standard special notes forms. Ensure the Trust is receiving special notes from all practices re palliative care patients

❚ Ensure that all special notes appertaining to palliative care patients include preferred place of death – now called place of CARE

❚ Ensure clinicians working in the service are up to date with palliative care training needs

❚ Ensure a timely response at the time of a patient’s death which is supportive to family and friends

End of Life Care 29,711.66 29,711.66

Improve the outcomes for patients who are triaged by clinicians

Improve the performance and competencies of the practitioners

To improve the outcomes from triage

29,711.66 29,711.66

To improve the quality of prescribing practice in relation to methadone

To contribute to the reduction in the no. of emergency supplies provided during Out-of-Hours

Prescribing Practice

29,711.66 29,711.66

To ensure a robust skills mix on all shifts to further improve the quality of care for patients

Skill mix and shift compliance

29,711.66 29,711.66

Develop the use of NHS Pathways for Out-of-Hours. This will allow call receivers to provide improved assessment and more appropriate dispositions for patients contacting the service

Effective call streaming

29,711.66 29,711.66

Improve our knowledge (both quantitative and qualitative) of patient experiences of Out-of-Hours Services in order to enhance our service to them

Improved Patient Experience

29,711.66 29,711.66

Total 178,269.98 178,269.98

Out-of-Hours Service CQUIN – Somerset 2013/14

Target Description Target NameContracted value £

Actual Value £*

To improve the quality of care for patients at the end of life using shared case notes to ensure patients’ needs and preferences are met within a community setting;

All health care professionals (GPs, ECPs, Nurses) receive end of life care training to improve the quality of end of life care

To improve the quality of care for patients at the end of life

40,400 36,360

Increase response rate to Out-of-Hours Services Survey from 18% to 23% by quarter 4;

Narrow Somerset/ Dorset gap with satisfaction rates (92% versus 86%) to within 4% by quarter 2 2013/14

Remodel existing survey and introduce and promote it online so that it is shorter, easier to fill out and encourages patients to complete their details so that we can contact them for further feedback by quarter 4;

Develop current Survey Satisfaction report to include more qualitative and quantitative analysis and actions for improvement by quarter 4;

Investigate and report on a Satisfaction Survey / feedback card for: treatment centres, home care patients, staff, clinicians and other healthcare professionals by quarter 4;

Investigate and report on a social media mechanism to capture more patient views by quarter 4;

Work with Peninsula University in Devon to improve approach to patient feedback e.g. gather more patient details to enable focus group / telephone surveys for detailed feedback. This exercise will lead to actions plans to increase levels of satisfaction

Improved Patient Experience

25,250 22,725

Reduce the number of requests made for repeat/emergency prescriptions

Prescribing Activity

17,675 15,907.50

Develop and evaluate an evidence based multi-disciplinary model to improve the response provided to patients with unscheduled primary medical care needs (i.e. ECP training)

Improved Patient Access

22,725 20,452.50

All Health Care Professionals receive training to improve the quality care and outcomes for vulnerable adults

Improve care planning and safe guarding processes for vulnerable adults

20,200 18,180

Total 126,250 113,625

At the time of going to print the Trust received 90% of the total CQUIN income for the year and was in

discussions with Commissioners as to the remaining 10 per cent.

A N N U A L R E P O R T 2 0 1 3 / 1 4 37

CO M M I S S I O N I N G F O R Q U A L I T Y A N D I N N O VAT I O N (CQ U I N ) 2 014 / 15For 999 A&E services nine CQUINs have been agreed with our Commissioners for 2014/15 representing 1.5%

of the Trust’s block contract. CQUIN for the Dorset and Somerset Out-of-Hours contracts totals 2.5% of the

2014/15 contract value. CQUIN is not applicable to the Gloucestershire Out-of-Hours contract or any of the

Patient Transport Service contracts.

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

CQUIN Target Description Indicator Name

Contracted 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 3 or more conditions. The aim of the LTC CQUIN is to focus on improving pathways for patients with LTC, and where possible, reducing inappropriate A&E admissions:

❚ Explore current pathways and the availability of direct referral by ambulance clinicians;

❚ Measure pathway use

Frailty/LTCs in the elderly

393,850

The Trust will work 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

In 2013/14 the Trust delivered a CQUIN that focused predominately on adults with sepsis. Given the recent ombudsman’s involvement into paediatric cases in Devon, this year the Trust would like to focus on improving the recognition and management of sepsis in children

Sepsis 393,850

To improve 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

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

Working Better Together

210,054

This scheme aims to target local deliverables by identifying opportunities within the NEW Devon catchment area (North, East and West Devon)

Exceeding Right Care2

210,054

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 will aim to explore the potential use the score within a pre-hospital setting (in Bristol, North Somerset and South Gloucestershire)

Patient Safety 210,054

For agreed local areas, focus 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 sites (in Dorset and Somerset).

Community Engagement

210,054

To complete a root cause analysis of the call to balloon (CTB) time breaches patient 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

Total 2,625,670

Out-of-Hours Service CQUIN – Dorset 2014/15

Target Description Indicator NameContracted 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 also 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

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 Family and Friends test to run alongside the Patient Family and Friends test. Introduce surveys in the Treatment Centres and home visits

Patient Surveys and Friends and Family Test

29,545

To contribute to the reduction in the number of emergency supplies provided during Out-of-Hours

Prescriptions 29,545

Triage is a major part of our patient experience treatment service. It allows for effective use of our resources whilst being able to have contact with our patients. Homes visits also form a major part of our service and it is a key contact between GPs and the patients. It is important that home visits are made with a timely manner whilst not jeopardising other resources.

Remote Triage and Ad Hoc On Call Remote Home Visits

29,545

To ensure that the management of patients records - Special Patient Notes (SPN) and Summary Care Records (SCR) are carried out effectively and consistently, to the benefit of the patient

Special Patient Notes and Summary Care Records

29,545

To introduce an electronic management system of the drugs that is used in the Out-of-Hours service

Medicines Management

29,545

Total 177,270

Out-of-Hours Service CQUIN – Somerset 2014/15

Target Description Indicator NameContracted value £

All Health Care Professionals to receive training to improve the quality care and outcomes for patients. To include:

❚ Venous Thromboembolism training for Nurses and Emergency Care Practitioners

❚ Multi skill mix training covering for example telephone triage, palliative care and paediatrics for GPs, Advanced Nurse Practitioners, Nurse Practitioners and Emergency Care Practitioners

Health Care Professional Training

123,282

Total 123,282

A N N U A L R E P O R T 2 0 1 3 / 1 4 39

Improvements in Services

R I G H T C A R E The Right Care1

initiative was established in 2010/11 and has been a major success story in reducing the

number of patients attending hospital emergency departments unnecessarily. It has delivered substantial

benefits and savings for the health community.

Historically SWASFT’s rate for transporting patients to hospital emergency departments consistently has been

one of the lowest in the country.

However, in response to the need to reduce this rate further, we set up the initiative, originally called ‘Right

Care, Right Place, Right Time1’, as part of our previous five year strategy.

The central aim of Right Care was to ensure that patients receive the best possible care, in the most

appropriate place and at the right time. It introduced a wide range of developments to improve the

appropriateness of the care delivered to ‘managed patients’. These are patients who have been clinically

assessed or triaged as needing an ambulance following a 999 call. This could be either under emergency or

normal road speed conditions depending on severity and clinical need.

As a result of Right Care1, we now have the lowest patient conveyance rate to emergency departments

in England. Based upon the October 2013 Ambulance Clinical Quality Indicator performance data, we

transported 83,517 fewer patients annually to emergency departments (EDs) across the South West

compared to the national average. If we had transported patients at the same level as the lowest performers

within England, it would have resulted in an additional 140,864 more patients attending EDs in the South

West.

This means that we exceeded the trajectory agreed with our NHS commissioners by 2%, resulting in an

increase in the non-conveyance rate of managed patients to ED from 50.84 per cent in 2010/11 to 57.45 per

cent in 2013/14.

In addition, Right Care1 has delivered cumulative savings of £72m to the local health community since

2010/11 for an investment of £10.5m.

We will now continue to build on the success of Right Care1 and deliver Right Care2 across two phases

covering the periods 2014/15 to 2015/16 and 2016/17 to 2018/19.

In phase 1 we plan a further reduction of 1% in the number of patients conveyed to EDs. This would result

in an overall reduced rate of 44.89%, against the backdrop of a predicted 5% growth in activity per annum.

By the end of 2015/16 we plan that this will result in 8,864 fewer attendances at South West emergency

departments.

We have a Right Care2 Group, which will continue to focus on three key areas:

❙ Culture – ensuring that SWASFT staff, other healthcare providers and the public anticipate hospital

attendances only when they are necessary

❙ Clinical Support – training and supporting clinicians so they can feel confident in making decisions about

the most appropriate care for patients

❙ Communication – ensuring a high level of effective communication with SWASFT staff, external

stakeholders, and the general public.

CL I N I C A L F O CU SWe 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 national launch of Clinical Commissioning Groups (CCGs) last year led 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. During 2013, therefore, we strengthened the Medical Directorate to meet this

demand.

To provide increased medical support to Medical Director Dr Andy Smith, we made the following

appointments:

❙ Dr Simon Scott-Hayward, a Devon GP and BASICs Doctor as Primary Care Medical Director, with a focus on

the 111 and Urgent Care Service

❙ Dr Phil Coburn, an Emergency Consultant and Critical Care Doctor from Bristol as Acute Care Medical

Director, with a focus on driving forward critical care.

Whilst each division continues to be supported by a dedicated Paramedic Clinical Development Manager, we

also introduced the post of Clinical Development Officer to provide much needed additional local clinical

support.

D R I V I N G F O R WA R D C A R EEvery day our clinicians work to deliver the very best possible care to patients. Behind the scenes, our clinical

team ensures that staff have the medicines, guidelines and training required to do their challenging roles.

In June last year, the painstaking pre-acquisition work, which we carried out to bring together the best

clinical guidelines from both SWASFT and the Great Western Ambulance Service, received national

recognition. We were presented with the Shared Learning Award from the National Institute for Health and

Clinical Excellence for the team’s work in reviewing the clinical guidelines from both organisations so that

they were available to staff from the first day of operation as an extended organisation. In May 2013 we also

implemented the latest version of the national Joint Royal Colleges Ambulance Liaison Committee Guidelines,

which further strengthened the care that our clinicians are empowered to provide.

During the year, the clinical team has concentrated on embedding the new local and national guidelines

across the organisation, to ensure that every patient benefits from the improvements in care that were made

possible by the new publications.

A N N U A L R E P O R T 2 0 1 3 / 1 4 41

We invested in additional care-enhancing equipment within the North Division. Every double-crewed

ambulance has been issued with an EMMA capnometer, a device which improves patient safety during

endotracheal intubation, a procedure where a tube is placed in the patient’s airway. Children now benefit

from investment in additional pulseoximeters and measuring probes, which enable the amount of oxygen

being carried in their bloodstream to be measured. A range of new medicines have also been introduced

across the Trust, including those to help patients who feel sick or are in severe pain. For example, the

provision of intravenous Paracetamol enables paramedics to relieve severe pain in patients who were

previously too unwell to receive morphine.

E L E C T R O N I C C A R E S Y S T E MWe are progressing with the implementation of Electronic Care System. This exciting innovation will be used

in the pre-hospital arena to better manage patient care and which would also have the technical ability to

integrate with acute and other wider health community systems.

The procurement of the new system will give a fully managed service that will allow us to electronically

capture exchange and report on patient information. This will help us to deliver benefits throughout the

wider health and social care community, to better meet the needs of patients and support the urgent care

agenda. The benefits across the emergency care pathway include:

Patient

❙ Better clinical outcomes through better pathway management, data sharing and informed decision

making.

System

❙ Reductions in A&E attendances

❙ Reduced dependency via better care

❙ Support for pathway based care and activity monitoring

❙ Shared patient data with wider health care community including receiving units, GPs and other parties

involved with patient care.

Staff

❙ Support for extended roles

❙ Improved job satisfaction.

NHS Trusts

❙ Improved productivity

❙ Improved ability to manage contracts.

The implementation of Electronic Care Systems will start in the summer of 2014 and will be completed in

2015.

This has also been selected as a priority for improvement in 2014 within our Quality Account. See pages 126-

183.

T R A U M A Major trauma is the leading cause of death in people under 45 years of age and a significant cause of short

and long term disability. Historically, all trauma patients have been transported to the nearest hospital

emergency department (ED), with those with the most significant injuries subsequently being transferred to a

specialist centre.

Since the April 2012, ambulance clinicians have used a triage tool to transfer patients with the most

significant injuries directly to the one of the Major Trauma Centres at Plymouth, Southampton and North

Bristol Hospitals.

The Trauma Review Group was launched during April 2013 to provide a clinically-focused forum to review the

quality of care delivered to patients experiencing major trauma. Senior Trust and trauma network clinicians

meet each month to review cases, and identify lessons that can be learnt and areas for improvement.

Feedback is provided to the clinicians who cared for the patient and a number of areas of organisational

learning have been identified and progressed to further enhance clinical care.

In addition to the monthly review of clinical quality, all cases of major trauma are audited to evaluate the

impact of the major trauma system. The collation of 99 individual items of anonymised data, such as pulse

rate, from almost 3,000 trauma patient records now enables us to carefully model proposed improvements in

care before they are actually launched.

A I R A M B U L A N CELast year the Air Ambulance Clinical Group focused on providing support for the increasing provision of

Critical Care Paramedics (CCPs). CCPs are experienced paramedics who receive additional education and

supervised clinical practice, to enable them to deliver a wider range of life-saving interventions. CCPs are

mentored by Critical Care Doctors, who work alongside paramedics on a number of the air ambulances.

S E P S I SImproving the care we provide to patients with suspected septicaemia remains a priority. Our continued focus

on improving services for patients with sepsis has seen further developments over the past year including:

❙ An audit of septic patients was performed to better understand the quality of care provided

❙ Literature reviews have been performed on the use of lactate point of care testing and the use of pre-

hospital antibiotics

❙ Feasibility study commenced in the use of lactate point of care testing in Cornwall

❙ Regular review of adverse and serious incidents, ensuring lessons learned are disseminated across the Trust

and wider

❙ Participation at local and national sepsis groups.

Key work streams for 2014/15 include raising awareness of sepsis in children by educating clinicians on the

differences between sepsis and fever, to improve outcomes for patients. We will work with stakeholders to

develop a face-to-face tool to be included on the new electronic clinical record. Sepsis in children has also

been selected as a priority for improvement in 2014 within our Quality Accounts. Please see page 131.

A N N U A L R E P O R T 2 0 1 3 / 1 4 43

I N F E C T I O N CO N T R O LInfection prevention and control continues to be as a high priority for the Trust as it is within the NHS

nationally.

During 2013/14 we amalgamated the policies from the East, West and North Divisions and began to

harmonise practice across the entire Trust to ensure that patients are cared for in a clean, safe environment:

one that we would be proud for our relatives to experience.

We brought the audits for station and vehicle cleanliness online, which has made data analysis and the

monitoring of compliance much easier. The audits now allow for themes to be identified and captured within

the infection prevention and control annual programme.

For the first year hand hygiene audits were undertaken across all major emergency departments in the East

and West Divisions, building on previous successes in monitoring compliance with hand decontamination

policy and procedures in the North Division. This will be developed further during the 2014/15, with the

2013/14 audits used as a baseline for measuring implemented interventions.

Last year we immunised 66.4% of staff against influenza. This was our most successful flu campaign to

date and made us the highest achieving ambulance service. This resulted in us being shortlisted for the most

improved Trust and winning the award for the Best Flu Fighter Team at the annual Flu Fighters Awards.

CO M M U N I T Y A N D S O C I A L I S S U E SResponders

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 3,205 responders

across the operational area, comprising:

❙ 770 community first responders

❙ 89 clinical staff responders

❙ 1,904 establishment-based responders

❙ 267 fire co-responders

❙ 175 St John Ambulance community first responders.

We have additional support from other volunteers across a range of organisations such as the Royal National

Lifeboat Institution (RNLI) and BASICS doctors.

An increase in coverage and availability of volunteer responders during the past year has resulted in a 10.5

per cent increase in allocations to life threatening emergency calls attended ahead of an ambulance arriving

on scene.

The placement of defibrillators within communities for public access has increased dramatically this year.

There are now 315 public access defibrillators supported by SWASFT which can be accessed by anyone

around the clock.

We have also provided defibrillators at 89 of the busiest care homes across our region and are providing

an additional 450 defibrillators in high-footfall, high-demand or rural locations in the North Division. Both

initiatives are to help improve cardiac arrest survival rates and with these additional resources, we now have

1,747 defibrillators in community initiatives which can be used ahead of an ambulance arriving at the scene of

a 999 call.

These resources not only help to save lives but also form an important part of our plans to improve

performance in meeting the Red 1 target, especially in rural areas and those of high population density.

S A F E G U A R D I N GSafeguarding 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 responsibility to safeguard vulnerable patients and promote their welfare requires staff members to

recognise their individual responsibility to safeguard, as well as the commitment of Trust management to

support them in this. This includes ensuring that staff have access to appropriate training, advice, support

and supervision in relation to this responsibility.

With this in mind, the Safeguarding Service has been further developed since the acquisition. The

Safeguarding Manager has been in post since January 2013 and is supported by two full-time named

safeguarding professionals – one covering the North Division and one covering the East and West Divisions.

In addition, the team is now up to full establishment with 1.8. WTE administrative support.

We are aligned to 28 Adult and Child Safeguarding Boards within our operational area. In order to maintain

relationships with all these organisations, in the interests of our responsibility to safeguard, we needed an

efficient and pragmatic approach to be agreed. Following national guidance, we have proposed working with

the Boards under a ‘memorandum of understanding’ agreement to maintain communication relationships.

Apart from the activity with the Safeguarding Boards such as the child death review meetings, co-operation

with child death overview panels and in the serious case reviews and audits, the safeguarding service has its

‘everyday’ activities. There are three main strands to this:

❙ Advice and supervision

❙ Training

❙ Safeguarding referrals.

Referrals and training were the main focus in this financial year. There have been approximately 5,814

safeguarding referrals across the whole Trust area in 2013/14, an average of 484 a month. This is an increase

of 50.5% on the year 2012/13. The increase is mainly due to the training and greater exposure to the

safeguarding agenda. The percentage of frontline staff who have received level 2 training is 95 per cent.

The referrals are submitted from frontline crews, call-handlers, PTS staff or others who have felt a patient,

of whatever age, may be vulnerable to abuse or neglect. These referrals are sent to police, social care, GP or

CCG colleagues according to need where they are investigated.

A N N U A L R E P O R T 2 0 1 3 / 1 4 45

It is a statutory requirement to present a separate Safeguarding Annual Report to the Board of Directors

detailing how the organisation has met its safeguarding responsibilities in line with Working Together to

Safeguard Children (HM Government 2013). This provides a more detailed report on safeguarding activity.

E M E R G E N C Y P R E PA R E D N E S SThe Emergency Planning, Resilience and Response (EPRR) Team is responsible for protecting the Trust from

significant threats, in order that the organisation can continue to deliver its core services. Over the year,

activity has developed in all areas for the department, which has almost one hundred staff across the Trust.

Both of the Hazardous Area Response Teams (HART) were deployed on flood response over many weeks.

Although we continue to recruit to them, the teams are well established and remain busy, providing

paramedic care for patients who would often be inaccessible to ambulance crews because of their location or

the environment.

Other members of the department have been engaged in preparing to deliver the Joint Emergency Services

Interoperability Programme (JESIP). JESIP is a two year programme that aims to improve the ways in which

police, fire and ambulance services work together at major and complex incidents. This training will ensure

that there is a common understanding and doctrine between all of the emergency services.

We launched a revised Business Continuity Strategy, which includes a campaign “The SWAST 5” aimed

at incorporating business continuity into all activities and structures. Business Continuity is about building

and improving resilience in the organisation through a process. This involves identifying key products and

services and the most urgent activities that underpin them and then devising plans and strategies that enable

operations to continue or to recover quickly and effectively from any significant disruption, whatever its size

or cause.

The EPRR team maintains a fleet of specialist vehicles which can be used to support operations and

major events, including the four wheel drive vehicles used in to provide assistance to the flooding of the

Somerset Levels. In addition to ambulances, which we send to sports stadia and occasions as diverse as the

Cheltenham Gold Cup and the Glastonbury Festival, the team equip and maintain the response to Chemical,

Biological Nuclear or Radiation, terrorism and major accidents.

Patient Experience and Stakeholder Engagement

CO N S U LTAT I O N A N D E N G AG E M E N T W I T H L O C A L G R O U P S A N D O R G A N I S AT I O N SWe were not required to undertake any statutory consultations during 2013/14 but carried out a series of

activities to engage key stakeholders in re-setting our strategic priorities. In the context of establishing a

new over-arching strategy, the key stakeholders were defined by the Board of Directors as patients and the

general public, Trust staff, NHS Commissioners and local health system managers.

Starting early last year, the Board of Directors and Directors’ Group took part in numerous activities focused

on:

❙ Identifying initiatives that build upon our clinical strengths

❙ Considering new markets and opportunities

❙ Identifying where we could add value to existing care models and service provision in the wider health

community

❙ Assessing the implications of current NHS and emergency service reviews on the future structure and

service model of the Trust

❙ Exploring the potential benefits of pursuing ‘partnerships’ of various forms including integrated working,

shared services, contractual outsourcing and joint ventures

❙ Considering the potential for future acquisitions or mergers on an opportunistic basis.

We used the results of these discussions to develop a draft set of strategic goals for delivery through

to 2018/19. These were developed further through discussions with the Deputy Director’s Group before

being presented to NHS Commissioners, members of the Council of Governors, senior managers and union

representatives at a strategic away day held in July 2013. Further Board discussions were held throughout

September to December 2013 to finalise and approve these goals.

The principles of the strategy, were tested with the South West CCGs and South West Commissioning

Support Unit (CSU) during the planning stages. This helped to secure wider stakeholder support, Key

activities included:

❙ The production of an information pack in July 2013 providing key facts, a description of each of the core

services and the role in serving patients and commissioners. The pack included a range of clinical case

studies for initiatives either currently delivered by the us, or for future consideration as part of the new

strategy

❙ We gave presentations on future plans and individual service developments to commissioners at a number

of contracting and network meetings. This included a presentation to the 12 Clinical Commissioning

Groups on the Single Point of Access service commissioned by NHS Dorset CCG

❙ We hosted a number of commissioner visits to its services including the urgent care service in St Leonards

and the new NHS 111 services provided from the West and East clinical hubs

❙ We attended a contract planning event organised and led by the South West CSU to provide an overview

of our activities to the enlarged commissioning group

A N N U A L R E P O R T 2 0 1 3 / 1 4 47

❙ We ensured representation at each of the Urgent Care Boards established across the South West region

❙ We involved our Council of Governors in the development of the refreshed Strategy. In December 2013

the Mission, Vision, Values and Strategic Goals were presented to the full Council. The overall the

principles of the future strategy were felt to be appropriate and clear. Staff governors were particularly

pleased to see the introduction of a goal solely linked to staff and their future development and well-

being.

The Planning Sub Group of the Council of Governors used the structure of the goals and mission for the basis

of their annual plan engagement questionnaire. This was distributed electronically to members who have

told us that they are happy to be involved, take part in surveys and consultations, or attend meetings early in

2014 as well as being published on the public website.

To secure wider stakeholder support, we are developing a communications and engagement strategy to

ensure on-going discussion and feedback on the approved strategic goals. This will include a series of

planned testing and feedback mechanisms for a range of audiences, including staff, members, Governors,

local Councillors and MPs, as well as existing networks of patients and the public (HealthWatch, PPI and

patient groups).

A more robust mechanism is now in place to ensure structured engagement with commissioners and

key stakeholders, including Health Overview and Scrutiny Committees, Health and Wellbeing Boards,

HealthWatch groups and Urgent Care Groups. This is being led by the Board of Directors and has enabled

routine and regular updates and exchanges that will continue to influence the development of our strategy

and direction of travel.

In addition, a more creative approach to engagement is being employed to enable a range of responses from

a variety of audiences on a number of key service developments. This includes online surveys, voting and

social media activity, as well as opportunities to engage and debate face-to-face at meetings and events. A

programme of events has already created opportunities to engage with GPs and MPs across the South West.

PAT I E N T A N D P U B L I C I N V O LV E M E N T ( P P I )Last year we attended 147 Patient and Public Involvement (PPI) events averaging 12 per month. These

were staffed predominantly by volunteers drawn from clinicians, managers, administrators, Governors and

community first responders.

PPI activities encompass a variety of events and visits, as well as presentations. Examples include county

shows, community fetes and fairs, school and college visits and public health awareness days.

Great partnerships with a multitude of agencies across the south-west have been forged and further

strengthened during the year with the enlargement of the organisation.

As part of our engagement work, we were instrumental making accident-prevention films aimed at young

drivers, and a Right Care, Right Time, Right Place education DVD. We also took part in national film and

television programmes, including the making of Channel 5’s Emergency Bikers and BBC1’s Real Rescues, in an

attempt to raise awareness and educate.

H E A LT H CH E CK SPart of our PPI activity has been providing health checks to members of the public. This feeds in to the

national public health campaign Know Your Blood Pressure.

Every five minutes in the UK someone experiences a stroke. Stroke is a devastating condition that can happen

to people of all ages. Over 150,000 people across the UK experience one every year. Some people make a

full recovery: some suffer permanent disabilities, others die.

With this in mind, we continued to focus on delivering free community health checks, working in partnership

with the Stroke Association to deliver Know Your Blood Pressure events across the south-west.

SWASFT clinicians provide checks to identify members of the public who may be suffering from high blood

pressure. Identifying and treating high blood pressure as early as possible is the most significant way of

reducing the risk of future stroke or heart attack in the future: the risk of stroke can be decreased by as

much as 40 per cent. Members of the public also can have their pulse checked to screen for an abnormal

irregular heart rhythm (atrial fibrillation) that may significantly increase the risk of a stroke. Everyone screened

is also taught the Face, Arm, Speech (FAST) test, a simple examination that will help people recognise the

symptoms of a stroke.

Last year 7876 members of the public received a Know Your Blood Pressure check. These identified some

people who were potentially suffering from high blood pressure and required referral to their General

Practitioner for further assessment.

We also provided the Free NHS Health Checks to 220 people within the community. This encompasses a

series of health checks, including blood pressure, Body Mass Index, blood glucose and cholesterol levels.

We also provided these checks to Royal Marines returning from active service to their base in Lympstone,

Exmouth.

This information is fed in to a computer to assess the person’s chances of developing cardiovascular disease

within the next 10 years, and the results can be given back immediately.

H U M A N R I G H T S I S S U E SSWASFT 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 Report on pages 62.

A N N U A L R E P O R T 2 0 1 3 / 1 4 49

L E A R N I N G F R O M E X P E R I E N CEOur Learning From Experience Group (LFEG) reviews and brings together lessons learned from external

sources, adverse incidents, litigation, comments, concerns, complaints, compliments, audits, major incidents,

safeguarding and information governance issues.

The group analyses themes, developing trends or issues of concern in greater detail making recommendations

for action to minimise risk and improve experiences for patients and staff. This adds to the previously

established model of clinical leadership by ensuring that lessons learnt are embedded in our clinical practice,

further enhancing the quality of care patients receive.

Lessons learned from LFEG, Serious Incident Review meetings and all other sources are presented and

considered at the Quality and Governance Committee.

Examples of issues identified at LFEG and changes made or further work commissioned, include:

❙ Following several incidents around back-up for rapid response vehicles, a new Standard Operating Protocol

has been issued covering both front-line responsibilities and those of the clinical hub

❙ Development of a Trust-wide clinical guideline based on the recently published emerging best practice

when providing spinal immobilisation and transportation of the pre-hospital trauma patient

❙ Change to the way tea spills and burns incidents involving children are managed within in the clinical hubs

to ensure a timely response

❙ A change has been made to the way in which ambulances are dispatched to lower priority calls by the

North Division clinical hub to ensure that responses are not unduly delayed

❙ Additional training has taken place with all staff in the North Division clinical hub regarding the use of one

of the specific protocols within the triage system

❙ A refresher training programme has been developed and is being rolled out in the East/West clinical hubs

around address searching

❙ Patient Opinion website promoted by cards distributed by all front-line staff

❙ Details of all compliments and praise received by ambulance station and staff members published on our

intranet

❙ Remedial work to fit protective film to all ambulance skylights

❙ The addition of ‘prompts’ on the North Division triage system to alert Emergency Medical Dispatchers to

serious bleeding

❙ The development of guidance and ‘clinical conundrums’ for GPs working on behalf of the SWASFT Urgent

Care Service.

PAT I E N T E X P E R I E N CE – CO M P L A I N T S H A N D L I N GComments, 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 round. So 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.

Details of our policy for handling comments, concerns and complaints can be found in the ‘Making

Experiences Count’ policy. The 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 bi-monthly. 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, based on patient and

public feedback. In addition, key learning is reflected in our statutory, mandatory and essential training

programme.

In 2013/14 SWASFT received a total of 1,020 comments, concerns and complaints. We received 1,454

compliments. In addition, we received 711 general enquiries including issues such as lost property and sign-

posting patients to other organisations.

O M B U D S M A N P R I N C I P L E SWe 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

2013/14. 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 received seven contacts from the Ombudsman’s Office during 2013/2014 relating to comments, concerns

and complaints.

Of the seven contacts, the Ombudsman independently reviewed one complaint file in its entirety and

considered it to be part upheld.

F R E E D O M O F I N F O R M AT I O N ( F O I ) A C T A N D DATA P R O T E C T I O N A C T We received a total of 2,171 external requests in 2013/14. Of these, 266 were requests for corporate

information made under the Freedom of Information Act. This was up by 67 requests (34%) compared with

last year. Of those requiring a response, 96.8% were responded to within the statutory 20 working day

deadline.

A total of 1,905 requests were received for personal or patient data under the Data Protection Act, an

increase of 4.4% on last year. A total of 99.4% of responses were met within the 40-day statutory deadline,

compared to 99.2% the previous year.

A N N U A L R E P O R T 2 0 1 3 / 1 4 51

Incidents Involving Data Loss or Confidentiality Breach

We are required to assess and report information risks and data losses in a standard format provided by the

regulator.

During 2013/14 there was one serious untoward incident involving data loss or confidentiality breach with a

severity rating of 2 or more. The details are as follows:

Summary of serious incidents requiring investigations involving personal data as reported to the information commissioner ’s office in 2013/14

Date of Incident (month)

Nature of Incident

Nature of data involved

Number of data subjects potentially affected

Notification steps

October

Personal identifiable data relating to 999 calls transferred by hand to commissioners on unencrypted disks. No data has been lost

Where provided, name, age, date of birth, location of incident, reason for call, NHS number

45,431 Individuals have not been notified

Further action on information risk

The Trust has reviewed the data flows of information to external organisations to ensure that only appropriate information is shared and in a secure manner

Summary of other personal data related incidents in 2013/14

Category Breach Type Total

A Corruption or inability to recover electronic data 0

B Disclosed in Error 4

C Lost in Transit 0

D Lost or stolen hardware 0

E Lost or stolen paperwork 73

F Non-secure Disposal – hardware 0

G Non-secure Disposal – paperwork 0

H Uploaded to website in error 0

I Technical security failing (including hacking) 1

J Unauthorised access/disclosure 0

K Other 2

I N F O R M AT I O N , M A N AG E M E N T A N D T E CH N O L O G Y ( I M &T )Through 2013/14, we continued to develop our Information, Management and Technology (IM&T) capability,

with particular successes in extensive call-centre developments in support of the launch of the 111 services,

and on-going infrastructure initiatives following the acquisition of Great Western Ambulance.

We have signed contracts for the delivery of an Electronic Patient Care Record system to ambulances and

receiving departments for implementation through 2014/15. We have also been successful in two bids

through the Safer Hospitals, Safer Wards Technology Fund for the development of a Medicines Management

system and a series of paramedic applications to support front line activities such as a Paramedic Triage and

Directory of Service systems.

We are currently in the process of tendering for a new Computer Aided Dispatch system which, alongside

upgraded telephony and patient triage systems, will allow us to operate with a virtual clinical hub across the

region.

Information Management through NHS 111 Pathways and the Content Management System Directory of

Services (CMS DoS) will continue to identify ways to optimise our service to the public. Real-time reporting

of information for all staff on a corporate, location and individual basis provides invaluable intelligence for

decision-making on service developments and productivity benefits.

Ambulance services nationally are also reviewing future options in respect to mobile communications systems

and integration with wider health systems within and in support of national and local programmes.

A N N U A L R E P O R T 2 0 1 3 / 1 4 53

Valuing staff

I N T R O D U C T I O NAs at 31 March 2014, we employed a workforce of 4,213. 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

❙ Emergency Care Practitioners (ECPs)

❙ Hazardous Area Response Team (HART) Paramedics

❙ Lead Paramedics

❙ Paramedics

❙ Technician, Advanced Technicians and Ambulance Practitioners.

We also have access to 152 (148 WTE) student paramedics, 521 bank staff, 400 sessional and eight employed

GPs who support the delivery of the Out-of-Hours Service, and 3,205 responders, who support delivery of

the A&E service. Responders are individual volunteers or partner agencies that respond to emergencies within

their local communities and include:

❙ Community First Responders: Volunteers who support their local community by attending emergency

calls ahead of an ambulance

❙ St John Ambulance Community First Responders: Volunteers working for St John Ambulance who

respond within their local community ahead of an ambulance

❙ Fire Co-Responders: Retained fire fighters who attend emergency calls on behalf of the Trust, as part of

their day to day role with the fire and rescue service

❙ RNLI Co-Responders: Life guards who patrol beaches and respond to local incidents

❙ Establishment Based Responders: Staff who respond to an incident that may occur during their normal

working day, for example in a railway station or shopping centre

❙ Staff Responders: Ambulance clinicians who volunteer to attend emergencies in their local communities

on their day off.

S TA F F E N G AG E M E N T We take 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 wellbeing. 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 electronic 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 Director team

❙ Local Consultation Committee, providing a union and management forum for each locality area designed

to represent the staff within a locality area. This in turn feeds into the Joint Negotiation and Consultative

Committee 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.

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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 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 wellbeing 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 improve patient care. A recent example of this has included the production of ‘I’ve been

brave for the ambulance service’, which are carried by crews and handed out to children that they treat.

S U M M A R Y O F P E R F O R M A N CE – R E S U LT S F R O M T H E N H S S TA F F S U R V E YA total of 1,563 staff participated in the 2012/13 survey; this represents a response rate of 40%, which is

average for ambulance trusts in England.

Historical national NHS Staff Survey response rates

2013 2012

Trust %National Average %

Trust %National Average %

Response Rate

East 38.8%

West 45.7%

North 35.3%

40%

East/West 46.3%

North 32.8% 50%

S TA F F E N G AG E M E N TThe 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 3.40, above (better than) average, when compared to

other ambulance trusts in England, which is 3.19.

The following table highlights the key findings for which the Trust compares most favourably with other

ambulance trusts in England.

Top Key FindingsSWASFT Score 2013

SWASFTScore 2012

GWAS Score 2012

National average for all ambulance trusts2013

KF24 - Staff recommendation of the Trust as a place to work or receive treatment (higher score better)

3.31 3.39 3.15 3.12

KF17 - Percentage of staff experiencing physical violence from staff in last 12 months (lower score better)

2% 2% 3% 3%

KF6 - Percentage of staff receiving job-relevant training, learning or development in the last 12 months (higher score better)

75% 81% 80% 71%

KF16 - Percentage if staff experiencing physical violence from patients or relatives in last 12 months (lower score better)

30% 34% 29% 33%

KF15 - Fairness and effectiveness of incident reporting procedures (higher score better)

3.23 3.33 3.07 3.09

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The following table highlights the key findings for which the Trust compares least favourably with other

ambulance trusts in England.

Bottom Key FindingsSWASFT Score 2013

SWASFTScore 2012

GWAS Score 2012

National average for all ambulance trusts2013

KF14 - Percentage of staff reporting errors, near misses or incidents witnessed in the last month (higher score better)

78% 82% 78% 79%

KF7 - Percentage of staff appraised in last 12 months (higher score better)

61% 81% 86% 67%

KF12 - Percentage of staff saying hand washing materials are always available (higher score better)

35% 48% 34% 38%

KF8 - Percentage of staff having well-structured appraisals in the last 12 months (higher score better)

15% 13% 28% 19%

KF20 - Percentage of staff feeling pressure in the last 3 months to attend work when feeling unwell (lower score better)

44% 42% 43% 43%

The top five improvements, where staff experiences have significantly improved since the 2012 survey, are as

follows. The lower the scores are better and show improvements.

Key improvements 2012 score 2013 score

More training in how to handle violence to staff/patients/service users 18% 11%

More staff are left feeling their work is valued after appraisals/development reviews

13% 10%

Clear work objectives are agreed during more staff appraisals 54% 46%

More appraisal/performance reviews identify training, learning or development needs

62% 55%

Less discrimination from patients/service users their relatives or other members of the public

10% 7%

The bottom five key findings, where staff experiences have significantly deteriorated since the 2012 survey,

are as follows.

Key finding 2012 score 2013 score

KF19 - Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 month (lower score better)

16% 28%

KF7 - Percentage of staff appraised in the last 12 months (higher score better)

81% 61%

KF6 - Percentage of staff receiving job-relevant training, learning or development in the past 12 months (higher score better)

81% 75%

KF12 - Percentage of staff saying hand washing material are always available (higher score better)

48% 35%

KF27 - Percentage of staff believing the Trust provides equal opportunities for career progression or promotion (higher score better)

82% 72%

KF7 (Percentage of staff appraised in the last 12 months) and KF12 (Percentage of staff saying hand washing

materials are always available) are also reported in the nationally compared bottom ranking scores.

In terms of hand-washing facilities, all front line staff are provided with personal issue infection prevention

and control alcohol gel in recognition that traditional ‘hand washing facilities’ are not present on an

emergency vehicle. This question is therefore somewhat misleading for ambulance staff.

KF6 (Percentage of staff receiving job-relevant training, learning or development in the last 12 months) is also

reported in the top five ranking scores when compared to other ambulance services in England.

Action Plans

Priority One – Appraisals

KF8 – percentage of staff having well-structured appraisals in the last 12 months.

During 2012, a review of the Knowledge, Skills Framework (KSF) appraisal system was completed, which

led to the successful implementation of the Personal Appraisal and Development Review (PADR) framework

across the Trust in July 2013. Since its launch, a total of 135 managers have completed how to conduct

an effective PADR training. This continues to be provided as part of the 2014/15 Leadership in Action

programme.

To support high quality appraisals, we launched an education and training prospectus to provide

managers and staff with a transparent, one-shop-stop for job-relevant training, learning and development.

Improvements in staff experience as a result of these developments, is reflected in three of the top five local

improvements as previously detailed.

KF7 – percentage of staff appraised in the last 12 months

We will continue to maintain monthly appraisal compliance reporting for all local managers. This should lead

to an increased appraisal completion rate within the first three months of the year, whilst helping to mangers

to focus on the value of the appraisal and effective completion.

Priority Two – Health and wellbeing

KF11 – Percentage of staff suffering work-related stress

In 2012 work related stress was identified as a priority area for the Trust. We introduced Stress Risk

Assessments and harmonised the use of Trauma Risk Management to ensure that staff can access consistent

support. Work is currently underway to ensure staff are aware of the support available to them to cope with

stress. A Health and Wellbeing Handbook for Managers has been developed, which will be made available

via the intranet.

KF20 – Percentage of staff feeling pressure in the last three months to attend work when feeling

unwell

Absence management continues to be a strong focus within the Trust in order to ensure that effective and

supportive mechanisms are in place. In close consultation with staff, the Trust is developing a Health and

Wellbeing strategy. This will be a live document, which will take a holistic approach to supporting staff

wellbeing through the provision of appropriate counselling services, readily accessible advice and a structured

peer-support system.

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A continued focus on staff engagement, involvement and development will further support the staff

satisfaction and wellbeing in work as a priority for 2014. This will be achieved in part by the introduction of

localised Health and Wellbeing Forums, which is expected to be in place by the end of the second quarter of

the year.

Priority Three – Harassment and Bullying

KF19 – Percentage of staff experiencing harassment, bullying or abuse from staff in the last 12

months

We are committed to providing an environment where all staff are treated with dignity and respect, free of

unlawful discrimination, victimisation, bullying or any form of harassment. We operate zero-tolerance to the

bullying and harassment of our staff- as outlined in the Dignity and Respect at Work Policy.

There is a discrepancy in the online incident reporting system (Datix) data compared to the staff survey

findings in regard to harassment and bullying incidents. We are committed to reminding staff of their

responsibility to report any incidents of this nature, in order to make targeted improvements which will be a

key priority in quarters two and three.

We will address concerns relating to harassment and bullying from patients and service users through our

external relations team. A communications and engagement strategy is being developed, with anticipated

roll-out from quarter three.

Priority Four – Incidents, errors and near misses

KF14 – Percentage of staff reporting errors, near misses or incidents witnessed in the last

Month

We acknowledge that a fundamental part of any risk management system is that all adverse incidents,

hazards and near misses are identified, reported, recorded, analysed and controls put in place to avoid their

future re-occurrence. This is demonstrated through the use of our Datix reporting system.

The Mandatory Training Workbook, due to be launched during 2014, will educate, encourage and remind

staff of their reporting responsibilities. This will enable us to analyse trends, root causes and develop

appropriate action plans to eliminate of minimise exposure to associated risks.

Quarterly reminders on the reporting of incidents will be issued to staff through the Bulletin.

F U T U R E P R I O R I T I E S A N D TA R G E T SThe Trust has embraced the introduction of the Friends and Family Test for its entire workforce. The quarterly

survey will provide SWASFT with a rich source of data to highlight and address concerns much faster than

traditional survey methods.

Additionally, the Trust is developing a communications and engagement strategy to ensure that staff:

❙ are able to influence staff involvement in making decisions about service delivery, quality, improvement

and proposals for change

❙ can give feedback – staff giving their managers their opinions and ideas which can influence decision

making

❙ can receive information – staff are informed of issues in the organisation and are required to give others

information about their activities.

To help satisfy this, the Trust will continue to:

❙ Host electronic two-way conversation chat rooms

❙ Publish staff information and articles in regular team briefings and the weekly Chief Executive’s Bulletin

❙ Hold regular meetings with union officials

❙ Hold face-to-face station meetings led by the Chief Executive, Chairman and Executive Directors

❙ Introduce more specialist publications, such as the bi-monthly Reflect newsletter to share learning

from investigations such as those arising from serious incidents, moderate incidents, adverse incidents,

complaints, claims and inquests.

D E PA R T M E N T O F E D U C AT I O N A N D P R O F E S S I O N A L D E V E L O P M E N TWe met our targets for statutory, mandatory and essential (SME) training for the year 2013/14, despite a

very challenging operational environment that resulted in the cancellation of a number of training days. The

department has also gained agreement to run three face to face training days for operational clinical staff

during 2014/15. Using an improved performance approach, the department has provided an accurate picture

of what is required for educational provision next year and we have included financial and operational

modelling to ensure that delivery of training has been planned in close partnership with finance and

operational managers.

During 2014/15 the department will support the delivery of training for the introduction of the Electronic

Patient Record, which has been instrumental in the planning phase this year. This initiative will revolutionise

informatics and provide a huge data source to further analyse and improve patient care.

During 2013/14 we launched a day of focussed training for paramedics in North Division which ensured that

staff in the North were harmonised with the rest of the Trust. This training focussed on use of the Trust’s

Clinical Guidance, medicines and equipment already in use in the East and West Divisions. This has been the

most popular training delivery this year and we have received very positive and consistent feedback from our

students.

Continuing Personal and Professional Development (CPPD) is a growth area for the department and 2014 will

see the introduction of a ‘shop window’ approach to inform staff of all CPPD and career development from

short study workshops and courses to career development advice. The website: www.learnwithswast.co.uk

will go live during May of 2014 and will provide access to CPPD by location and subject. In addition we are

busy producing CPPD in a range of subjects designed to support the new ‘Right Care2’ strategy.

The training team has continued to deliver Commander training under the auspices of the National

Ambulance Resilience Unit (NARU) Guidelines (2012), and has supported the delivery of a second e-learning

package that provided CBRNE training to all clinical staff, as per the Department of Health requirements. We

have been able to add additional e learning resources which included the new Advanced Stroke Life Support

(ASLS) and the MEND process in January 2014, in partnership with the University of Miami. SWASFT is the

first ambulance Trust to offer this to its staff.

Investment in the development of a SWASFT Driving Faculty has continued across the whole Trust, with the

Faculty overseeing all driving tuition, statutory compliance and incident investigation. This helps to reduce

cost and increase quality and utilises an in-house team of Driving Instructors (DIs) who are trained to a

very high standards. The public consultation period for Section 19, (an addition to emergency driving law

which requires staff assessments) has now concluded and the Faculty awaits its enactment. To date driving

A N N U A L R E P O R T 2 0 1 3 / 1 4 61

assessments relating to Section 19 have been taking place in the East and the West and planning is taking

place with regard to its roll out in the North.

The Commercial Training Team continues to develop innovatively and grow its portfolio of courses to meet

the requirements of both the private and public sectors. In the future the department expects a renewed

focus on specialist markets, and it is believed that we can provide a competitive portfolio of courses working

with other departments across the Trusts to provide expert tuition and specialist pre-hospital training.

The direction of travel of the UK ambulance services continues to move through a period of transition that

will see almost all future student paramedic registrants educated to diploma or degree level using a university

route. All three regional partner universities will have moved to B.Sc. Hons level paramedic programmes by

2015. In order to support this, the Trust continues to work in partnership with three local provider universities

to develop student paramedics and provide placement opportunities. In addition, the education team

supports use of an internal development route for its existing staff which is currently provided in partnership

with the Open University.

Non-clinical staff development continues to be a priority and an Organisational Development Team has been

formed to support the development of our future non-clinical and clinical staff and meet the requirements

of the NHS Leadership Academy Framework. In addition, the ‘Change Through People’ initiative has been

developed to support appraisal (PADR) discussions.

E Q U A L I T Y A N D D I V E R S I T Y 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.

In order to implement EDS2, we will be following the NHS England implementation plan as detailed below:

Action Description Lead Target Date

Confirm governance arrangements and leadership commitment

EDS2 will report to the Quality and Governance Committee.

Trust have implemented EDS and also published a Single Equality Scheme

Equality, Health and Wellbeing Lead

N/A

Identify local stakeholders

Need to ensure at least one patient stakeholder group for each protected characteristic for goals 1 and 2.

Identify which internal staff groups will grade goals 3 and 4


April 2014

Assemble evidenceAt next EDS group meeting in April, the group will discuss where to source the evidence that is required

EDS Group July 2014

Agree roles with local authority

SF to liaise with Head of Communications and Engagement to utilise current links with local authorities


Inform of plans:

May 2014

Inform of grades:

December 2014

Analyse performance

Patient stakeholder groups and identified staff group to grade the Trust on the relevant goals


Patient stakeholder groups to grade by September 2014

Staff group to grade by September 2014

Agree grades

EDS Group to meet to review all results from grading sessions.

These will then be discussed and agreed within the group

EDS Group December 2014

Prepare equality objectives and more immediate plans

EDS Group will review the final EDS2 grades and determine where the issues are, these will form the equality objectives for next year’s EDS grading sessions- at least one from each goal


December 2014

Integrate equality work into mainstream business planning

Trust can report EDS2 performance and work towards the Equality Objectives in the integrated business plan

HR Director From January 2015

Publish grades, equality objectives and plans

Grades will be shared with HWBs, HealthWatch and will be used when tendering in addition to being published on the external website


January 2015

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D I S A B L E D E M P L OY E E SAt 31 March 2014, we employed 98 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, we

Trust will seek alternative roles or duties where applicable to meet their needs and comply with Occupational

Health advice and guidance.

O CCU PAT I O N A L H E A LT H S E R V I CE SIn October 2013, we consolidated our occupational health provision by opting for a single provider for the

new enlarged Trust. Capita Health and Wellbeing now provide the occupational health service for the entire

Trust, taking over from IMASS who were previously the provider for the North Division.

Staff have access to a 24-hour confidential consultancy which provides advice and support on health and

well-being issues. We support immunisation programmes for staff such as annual flu jabs, issue infection

control advice, offer pre-employment health screening, and rehabilitation advice following absence or injury,

and sickness absence management. We proactively promote the health and wellbeing of its staff through

forums such as its Health and Wellbeing Group.

S I CK N E S S A B S E N CEThe overall sickness absence rate for 2013/14 was 5.28% which equates to 14.7 days per person.

The Trust’s target is to reduce sickness levels to 4%. Every 1% of sickness absence costs the enlarged

organisation £1,067,506.

The management of sickness remains a priority for the HR Department. In order to achieve the 4% target

the Department implement strict monitoring processes for both short and long-term sickness, which enable

targeted intervention at both operational as well as the individual level. Together with strong leadership and

overview from the senior HR management team, the department maintains a focus on both sickness and the

wider health and well-being strategy.

The Department has invested in the recruitment of a dedicated health and well-being lead to support

managers to achieve long-term improvements in any trends identified. This enables the Trust to ensure

it has targeted interventions and counselling and health services available, which are appropriate and

responsive to the needs of our workforce. A full review of counselling and welfare provisions to enhance the

services available to support incidents of work-related stress, which are a major concern to both staff and

management.

Recognising that consistent and accurate recording of sickness absence is central to the management of

absence, the HR Department have, in association with Resource Centre Manager, reviewed, processes for

staff to report both unfit and fit for duty.

There is now a centralised system to record all sickness, which is linked to the Global Rostering System

allowing sickness reporting at multiple levels. This in turn, enables the HR Business Managers and HR

Business Partners to identify trends and hotspots. Targeted action can then be taken to assist managers in

the management of sickness absence in accordance with Trust policy.

A N N U A L R E P O R T 2 0 1 3 / 1 4 65

This information has enabled the HR Department to identify gastrointestinal illness as the biggest cause

for short term sickness and we have provided general advice and guidance for staff and more targeted

interventions to particular individuals, to help them manage their own health and prevent further

occurrences.

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 have resulted 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.

H E A LT H , S A F E T Y A N D S E CU R I T YThe Health, Safety and Security Team has bases at Taunton, Staverton and Derriford in order to assist the

various departments and stations with their health and safety responsibilities. It is proposed to base a fourth

person in Yeovil later this year in order to cover Somerset and Dorset.

During the past year we continued to support staff and prevent breaches of the Health and Safety Legislation.

The health, safety and security agenda is taken forward through an action plan and key performance

indicators are reported to the Board of Directors, Quality and Governance Group and Health and Safety

Group. We have completed our first NHS Protect Self-Assessment Tool looking at security issues within the

Trust.

During 2013/14 the Department has made some significant achievements including:

❙ New on-line Specsavers Eye Sight Vouchers

❙ 29 staff completed training to become first aiders

❙ 3,299 (77%) staff completed fire e-Learning training

❙ Developing and issuing COSHH assessments on the intranet for staff to access

❙ completing 49 fire risk assessments; 48 health and safety Inspections and 48 security Inspections

❙ On-going implementation and review of existing warning markers on patients addresses

❙ 147 letters were sent to patients following a violence and aggression incident regarding their behaviour

towards crews attempting to assist them.

We dealt with 1,662 datix reports including 936 injury accidents (patient and staff), 676 abuse incidents and

50 security incidents.

During 2013/14 a total of 930 injuries to staff were reported, compared to 516 for the same period in

2012/13. Under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995, we

reported 135 over-seven-day injuries compared to 165 during 2012/13.

CO U N T E R I N G F R A U DWe have 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 in its 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 2013/14, a total of 130 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.

A N N U A L R E P O R T 2 0 1 3 / 1 4 67

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 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 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 achieving the targets set out in the

NHS Carbon Reduction Strategy.

S U S TA I N A B I L I T Y S T R AT E G YThe Trust’s sustainability aims are set out in our Environmental Policy and in the Environment and

Sustainability Strategy. These documents are intended to ensure that environmental awareness and

understanding are embedded in all our activities and operations.

By developing this approach, we are developing a culture that supports improvements in environmental

performance whilst minimising waste and pollution and other environmental impacts by:

❙ Ensuring that the Environment and Sustainability Strategy is embedded in 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

❙ Developing and 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 its

operations, service delivery, staff and estate.

S U S TA I N A B I L I T Y G O V E R N A N CEThe Trust has an Environmental Management Group, chaired by a senior manager, which 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. Currently this is Mr Chris Kinsella.

S U M M A R Y O F P E R F O R M A N CEOver the past few years the Trust has worked consistently to identify and implement improvements in its

environmental performance in the following areas:

❙ Energy and carbon management

❙ Travel and transport including vehicle design and new build concepts

❙ Water and waste

❙ Built environment and workforce development

❙ Partnership and networks

❙ Governance and finance.

The Trust has completed an initial assessment of its overall carbon footprint for 2013/14 and this compares

with the overall NHS carbon footprint as follows:

Trust tCO2e Trust % NHS %

Procurement 15,036 41% 61%

Estate energy and utilities 4,859 13% 17%

Travel and transport 17,180 46% 13%

Commissioning N/A N/A 9%

Total 37,075 100% 100%

The initial 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.

Provisional figures for 2013/14 indicate that carbon emissions arising from the use of energy in our estate

have fallen by an estimated 452 tCO2e from 2012/13 levels. This equates to an overall reduction of 4.82%

since 2006/7. It should be noted that over the same period the total gross internal area of the Trust estate

has grown by 13.87%.

The Trust has calculated that to achieve a 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 carbon emissions in 2014/15 by

just over 183 tonnes of carbon dioxide equivalent (tCO2e).

A N N U A L R E P O R T 2 0 1 3 / 1 4 69

E N V I R O N M E N TA L I M PA C T P E R F O R M A N CE I N D I C AT O R S*

Area

Non- Financial Data 2013/14

Non- Financial Data2012/13

Financial Data2013/14 £

Financial Data2012/13 £

Waste minimisation and management

Incinerated waste (tonnes)

65.07 57.07 Incinerated waste cost

£106,922 £93,783

Landfill waste (tonnes)

556.26 200.45 Landfill waste cost

£145,008 £52,254

Recycled waste (tonnes)

130.89 29.37 Recycled waste cost

£61,811 £13,870

Finite Resources

Water(cubic metres)

72,341 40,066Water cost

£49,154 £27,224

Electricity (Gigajoules)

16,089 9, 309Electricity cost

£754,070 £436,306

Gas(Gigajoules)

18,007 10,611Gas cost

£287,768 £169,574

Oil(Gigajoules)

169 8Oil cost

£6,199 £293

* The data for 2013/14 is provisional as energy, utility and waste information is incomplete and yet to be finalised.

F U T U R E P R I O R I T I E S A N D TA R G E T SAn in-depth review or ‘deep dive’ into the Trust’s environmental responsibilities was due to be presented to

the Quality and Governance Committee in May 2014. In turn, this will be reported to the Board of Directors.

Other future environmental priorities include:

❙ Ensuring that major new developments employ low energy solutions, sustainable design and construction

methods, waste minimisation measures and, where viable, renewable and sustainable energy sources

❙ Continuing to invest in energy conservation to reduce carbon emissions from the use of energy in our

estate

❙ Improving recycling rates and reducing the amount of waste sent to landfill

❙ Investment to reduce water consumption

❙ Continuing to raise staff environmental awareness

❙ Reviewing procurement arrangements to identify opportunities for carbon reduction and cost savings

❙ 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.

A N N U A L R E P O R T 2 0 1 3 / 1 4 71

directors’ report

Board of Directors

R O L E 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 2013/14, the Board of Directors of Directors consisted of the Chairman, six Executive Directors and six

Non-executive Directors:

Chairman

❙ Mrs Heather Strawbridge (reappointed for a further term from 1 July 2014 to 28 February 2017).

Executive Directors

❙ Mr Ken Wenman, Chief Executive

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

❙ Mrs Norma Lane, Executive Director of Delivery, (until 12 July 2013)

❙ Dr Andy Smith, Executive Medical Director

❙ Ms Sue Steen, Executive Director of Human Resources and Governance, (until 5 January 2014)

❙ Mr Francis Gillen, Executive Director of IM&T

❙ Mrs Jennifer Winslade, Interim Executive Director of Nursing and Governance (from 9 December 2013 until

31 May 2014. Jennifer will take up the permanent post on 1 June 2014)

A N N U A L R E P O R T 2 0 1 3 / 1 4 73

❙ Mrs Judy Saunders, Interim Executive Director of Human Resources and Organisational Development (from

2 December 2013 to 30 April 2014).

Non-executive Directors:

❙ Mr Trevor Ware, Deputy Chairman of the Trust (retired 30 September 2013)

❙ Professor Mary Watkins, Senior Independent Director

❙ Mr Robert Davies (reappointed from 1 November 2013 for a further two years)

❙ Mrs Charlotte Russell (retired 30 September 2013)

❙ Mr Tony Fox

❙ Mr Hugh Hood (reappointed from 1 January 2014 for a further two years)

❙ Mr Chris Kinsella (from 1 October 2013 for a three year period).

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

2013/14 Financial Accounts with independent assurance from the Trust’s Internal Auditors, which appears

within this Annual Report on pages 228-231.

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.

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.

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 of performance against the annual plan

❙ develop of medium and long term plans for consideration by the Board of Directors

❙ monitor of 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 Board of Directors to account for compliance with the Terms of

Authorisation and ensuring the interests of members 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 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.

B O A R D O F D I R E C T O R S : B I O G R A P H I E S

Mrs Heather Strawbridge Chairman of the Trust and Council of Governors

Heather has a wealth of experience and extensive understanding of large and

complex organisations, particularly in the public sector. Prior to her appointment as

Chairman of the Trust in 2006, her accomplishments include:

❙ Trustee and Director of NHS Confederation (current)

❙ Chairman for Westcountry Ambulance Services NHS Trust for two years

❙ Chairman of the Ambulance Service Network (to March 2013)

❙ CNL Faculty Vice Chair, HFMA (current)

❙ Chair of Connexions Somerset

❙ 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). Heather was previously the Chairman of the Ambulance Service Network

and continues to work to bring a national perspective to the Board. Heather has led the Board of Directors

of Directors through its application for NHS Foundation Trust status and the acquisition of Great Western

Ambulance Service NHS Trust and is the Board champion for equality and diversity and safeguarding.

A N N U A L R E P O R T 2 0 1 3 / 1 4 75

Mr Ken Wenman Chief Executive

Ken joined the NHS aged 21 years 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 more recently has taken on the Chief

Executive lead roles for IM&T and Operations for the national ambulance groups and a member of the Board

of the Association of Ambulances Chief Executives (AACE). Ken has a Masters in Management (Plymouth

University). He is the nominated individual for the Care Quality Commission.

N O N - E X E CU T I V E D I R E C T O R S

Mr Robert Davies Non-executive Director and Chair of Audit Committee

Robert is an experienced Chartered Accountant (FCA) and holds a Master’s Degree

in Business Administration (MBA) from Cranfield University. He has held a variety of

Board-level appointments in the business and banking sectors and was appointed a

Non-executive Director of the Trust on 1 November 2009. He is Chair of the Audit

Committee. His accomplishments include:

❙ Manager of Corporate Finance at British Leyland, where he 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, where he

helped progress some inspiring local economic initiatives, such as the National Marine Aquarium, the Eden

Project and the Tamar Science Park

❙ A member of the Institute of Chartered Accountants (ICAEW) Ethics Advisory Committee and Chair of its

Support Members Scheme, which provides confidential help and advice to troubled members

❙ A Past President (2005) of the South Western Society of Chartered Accountants.

Mr Tony Fox Non-executive Director

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 Managing

Director of Royal Mail. His experience includes:

❙ Operations Director leading a workforce of 23,000 people across the South West of the UK

❙ Group Logistics Director, where he was accountable and gained valuable experience of supply chain

management, Procurement, facilities Management and owning the national distribution network

❙ Leading Strategic Customer relationships with some of Royal Mails largest clients

❙ Negotiations with national trade unions on a variety of issues

❙ Non-executive Director of Great Western Ambulance Service NHS Trust prior to the acquisition by SWASFT.

Tony brings to the Board of Directors a wealth of operational and strategic commercial experience with a

track record of motivating and managing transformational change programmes and employee relations in a

highly unionised environment.

Mr Hugh Hood Non-executive Director

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. Hugh was appointed to the

Trust on 1 January 2010. Key accomplishments include:

❙ Organisational Development Director for BT (Responsible for training, leadership

pipeline and succession etc.) - current

❙ Human Resources Director for BT Wholesale

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

❙ Member of the Chartered Institute of Personnel and Development

❙ 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 Group’s Human Resources leadership team with key

input on BT’s strategy for the future. He is also a director of One Connect Ltd, a joint venture between BT

and Lancashire County Council. He holds an MSc in Digital Systems Engineering and BSc in Physics from the

University of Manchester, and a Post Graduate Certificate in Organisation Development from the University

of Sussex.

A N N U A L R E P O R T 2 0 1 3 / 1 4 77

Professor Mary Watkins Non-executive Director

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 of working in partnership with Social Services and the voluntary sector.

Mary was appointed to the Trust as a Non-executive Director on 1 August 2006. Her

accomplishments include:

❙ Emeritus Professor (Health Care Leadership) - Plymouth University

❙ Deputy Vice-Chancellor at the University of Plymouth

❙ Served on a NICE Appraisal Committee as a Trustee for the Burdett Trust for Nursing

❙ BUPA Foundation Board member (current)

❙ Registered Nurse.

Mary is Board champion for governance and patient safety has a keen interest in health economics. She

has a Diploma in nursing, 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 Non-executive Director

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. His


❙ Chief Financial Officer for the British Council

❙ 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

❙ 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 business degrees 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.

Mrs Charlotte Russell Non-executive Director

Charlotte is a qualified journalist and has extensive project management experience.

Charlotte was appointed to the Trust as a Non-executive Director on 1 July 2006. Her


❙ Non-executive Director of the former Westcountry Ambulance Services NHS Trust

❙ Successful organic farmer, managing 650 acres (current)

❙ Consultant in environmental issues, most recently with the Eden Project

❙ Head of Publications for the Soil Association

❙ Producer for Tyne Tees TV farming and environmental programmes.

Charlotte is Board champion for environment and sustainability. She holds a Master of Arts in Agricultural

and Forest Science (Oxford University).

Mr Trevor Ware Non-executive Director - (Vice Chairman)

Trevor has a wealth of knowledge and expertise in sales, marketing and exporting

business marketing products. Trevor was appointed to the Trust as a Non-executive

Director on 1 July 2006. His accomplishments include:

❙ Non-executive Director for former Dorset Ambulance Service NHS Trust

❙ Positions at Unilever, Nestle, Geest, and Baxters

❙ Non-executive Director for Baxters Food Group (current)

❙ Non-executive Director for Southern Fruits Limited (current)

❙ Chairman of Bridport Arts Centre.

Trevor is Board Champion for Health and Safety, Patient Transport Services and Electronic Staff Records.

He holds three professional memberships and his qualifications include communications, advertising and

marketing. He has an MA in Maritime History.

A N N U A L R E P O R T 2 0 1 3 / 1 4 79

E X E CU T I V E D I R E C T O R S

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, which followed a period of secondment commencing in January

2008, her accomplishments included:

❙ Director of Finance of a Primary Care Trust

❙ Associate Director of Performance at the South West Strategic Health Authority

leading one of the four national pilots to develop the Foundation Trust diagnostic

❙ Fellow of the Association of Chartered Certified Accountants

❙ Served an eight year short service commission in the Royal Air Force

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

Jennie has a BSc Hons, (University of Birmingham) and graduated from the NHS South West Top Leaders

Programme cohort one. She is the Chair of the National Ambulance Directors of Finance Group and a

member of the Board of the Association of Ambulances Chief Executives (AACE).

Mrs Jennifer Winslade Interim Executive Director of Nursing and Governance

Jennifer was appointed as NHS Devon, Plymouth and Torbay Director of Nursing

in June 2010. She has previously been the executive board nurse for NHS Devon,

covering quality and patient safety.

Before 2007 Jennifer worked for East Devon Primary Care Trust as the deputy director

of nursing combined with a lead role for children’s services.

Jennifer 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.

Mrs Judy Saunders Interim Executive Director of HR & Workforce

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 Authority and

Ambulance Services.

Judy is currently overseeing this position as the Trust proceeds with the recruitment

for 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 & 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. Judy is also a fellow of the CIPD (Chartered Institute of Personal Development).

Dr Andy Smith Executive Medical Director

Andy has been a GP in Devon for 15 years 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.

Prior to his appointment to the role of Executive Medical Director in February 2010

Andy was the Associate Director of Primary Care Services for the Trust since April

2008. His accomplishments include:

❙ Board member of Devon Primary Care Trust Professional Executive Committee

❙ Member of the Royal College of General Practitioners

❙ 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 and is the Caldicott Guardian and DIPC. He has a Bachelor of Science Hons

Microbiology (University of Bristol), Bachelor of Medicine & Surgery MB Ch.B (University of Bristol), Post

Graduate Diploma of the Royal College of Obstetricians and Gynaecologists, Diploma in Child Health.

A N N U A L R E P O R T 2 0 1 3 / 1 4 81

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

Francis has been an IT Professional for over 25 years with expertise gained from

working in private, public and emergency services. His accomplishments include:

❙ Head of ICT for Westcountry Ambulance Service NHS Trust

❙ Messaging Consultant for HP responsible for the design and provision of national

messaging solutions to private and public sector

❙ 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). Francis was appointed to the role of Executive Director in March 2013.

Mrs Norma Lane Executive Director of Delivery

Norma is a State Registered Nurse, who specialised in emergency department

medicine in the early part of her nursing career and has been instrumental in

pioneering triage and telephone assessments, urgent and emergency care, and the

development of new integrated patient care pathways.

She has 30 years of experience in the NHS most of which has been spent working

clinically in both urgent and emergency care. Her accomplishments include:

❙ Director of Urgent Care and Clinical Services for the South Western Ambulance Service since July 2006

and the former Westcountry Ambulance Services since 2004

❙ Director of Nursing for NHS Direct West Country

❙ Lead Director in managing the GP Out-of-Hours and urgent care service across Dorset and Somerset

❙ Lead Director for establishing the concept and successful implementation of clinical hubs (former 999

control rooms)

❙ Lead Director for negotiations with the Joint Commissioning Board

❙ Lead Director for negotiations at Quality Monitoring Meetings

❙ Deputy Accountable Officer for Controlled Drugs

❙ Lead Director for the Trust 2009 infection control initiative which won the first ever National Patient Safety

award.

Mrs Sue Steen Executive Director of Human Resources and Governance

Sue has 20 years’ experience of working in human resources and workforce

development working within a local government environment. She has worked

in a large unitary council in a social services environment and smaller and unitary

and district councils. She has a particular interest in organisational development

and qualified in HR Management through the Chartered Institute of Personnel

Development in 1992 at Coventry University. Sue joined the South Western

Ambulance Service in November 2009 as the Associate Director Human Resources

and Workforce Development and was promoted to Acting Executive from the 1 April 2010. Sue was then

appointed Executive Director of HR & Governance on the 1 April 2011. Her previous accomplishments include:

❙ Head of Human Resources at Exeter City Council

❙ South West Regional Chair for the Public Sector People Management Association (PPMA), the national

association for local government human resources leaders

❙ HR Manager at North Somerset Council

❙ Local Government experience gained over 20 years in a number of local authorities starting her career as a

trainee in Coventry City Council.

R E G I S T E R O F I N T E R E S T S 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 March 2014, 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 Trust

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 Secretary, Trust Headquarters, Abbey Court, Eagle Way, Exeter, Devon, EX2 7HY

or 01392 261500.

A N N U A L R E P O R T 2 0 1 3 / 1 4 83

B O A R D M E E T I N G S 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 –

and details are circulated to a wide range of media contacts 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.

The following table sets out the attendance of the Board of Directors at meetings from 1 April 2013 to 31

March 2014.

Name PositionAttendance: Actual/possible

Mrs Heather Strawbridge Chairman 11/12

Mr Trevor Ware Deputy Chairman and Non-executive Director 6/6

Mrs Charlotte Russell Non-executive Director 6/6

Professor Mary Watkins Non-executive Director 11/12

Mr Hugh Hood Non-executive Director 10/12

Mr Robert Davies Non-executive Director 11/12

Mr Ken Wenman Chief Executive 12/12

Mrs Jennie Kingston Deputy Chief Executive and Executive Director of Finance 11/12

Mrs Norma Lane Executive Director of Delivery 4/6

Ms Sue Steen Executive Director of Human Resources and Governance 8/9

Dr Andy Smith Executive Medical Director 12/12

Mr Francis Gillen Executive Director of IM&T 11/12

Mr Tony Fox Non-executive Director 7/11

Mr Chris Kinsella Non-executive Director 2/4

Mrs Judy Saunders Interim Executive Director of HR and OD 3/3

Mrs Jenny Winslade Interim Executive Director of Nursing and Governance 3/3

B O A R D CO M M I T T E E SThe Board has five committees, two of which – the Audit Committee and the Remuneration Committee

– are statutory requirements. The following section identifies each committee, its membership and its

responsibilities.

A U D I T CO M M I T T E EThe 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.

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

The Audit Committee’s responsibilities include:

❙ Monitor the integrity of the Trust’s financial statements and management reporting and make

recommendations to the Board of Directors regarding the approval of the Annual Report and Accounts

❙ Provide assurance to the Board that operations are being conducted safely and responsibly, in line with

agreed procedures that uphold relevant professional standards, and on the adequacy and effectiveness of

the Internal Controls and Risk Management processes that underpin them

❙ Provide assurance to the Board that appropriate Quality Governance processes and structures are in place

and fit for purpose

❙ Agree annual plans for Internal Audit, Counter Fraud and External Audit and ensure their continuing

relevance and delivery

❙ Consider the reports resulting from this activity and ensure appropriate and timely action is taken, as

required

❙ Make recommendations to the Council of Governors (CoG) regarding the appointment, reappointment

and, if appropriate, removal of the External Auditors, as required under the terms of the Trust’s

Constitution

❙ Formulate policy for the commissioning and supply of non-audit services by the external Auditor.

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 2013/14. The following table shows members’

attendance at these meetings:


Mr Robert Davies Committee Chairman and Non-executive Director 5/5

Mr Trevor Ware (retired 30 September 2013)

Non-executive Director 2/3



Mr Chris Kinsella (appointed 1 October 2013)

Non-executive Director 1/2

A N N U A L R E P O R T 2 0 1 3 / 1 4 85

This table lists other Board members who attended meetings of the Audit Committee during 2013/14





Ms Sue Steen (Resigned 5 January 2014)

Executive Director of HR and Governance 3/4

I N T E R N A L A U D I TInternal 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 2013/14, a

programme involving 340 days of internal audit activity and a further 130 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.

E X T E R N A L A U D I TFollowing an extensive tendering exercise, PricewaterhouseCoopers (PwC) were appointed Auditors of the

Trust for 2012/13, in succession to the Audit Commission; matters were then complicated by the acquisition

of Great Western Ambulance Service (GWAS) on 1 February 2013, whose accounts for the 10 months to

31 January 2013 were audited by Grant Thornton. This is the first time PwC have audited the enlarged

Trust for a full year and they developed a Plan for the assignment, following discussion with the Finance

team, which was approved by the Committee. 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. No non-audit related services

have been procured from them during the year.

CO U N C I L O F G O V E R N O R S (Co G )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.

The initial appointment was made on a rolling, annual basis in the expectation it would be renewed,

subject to satisfactory performance, for up to five years before being market tested, in line with Monitor’s

recommendations, in order to allow PwC time to gain an increased understanding of the Trust’s operations.

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.

S I G N I F I C A N T I S S U E SAt its meeting on 3 April 2014, the Committee considered a number of matters relating to the Annual

Accounts for the year to 31 March 2014; the significant issues included:

❙ Provisions covering the rationalisation and integration of the workforce

These provisions relate primarily to matters associated with and resulting from the acquisition last year.

The Committee noted the extensive discussion that had taken place at both the Finance & Investment

Committee (FIC) on 13 March and the Board on 27 March, as well as the legal advice received. Taking all

factors into account, including the need for prudence, the extent of the uncertainty involved and the fact

that the integration process was still ongoing, the Committee saw no reason to depart from the approach

followed last year and supported the provisions made.

❙ Impairments to Property

The Committee noted that, at its meeting on 13 March, FIC had been updated on the sale of the Bristol

Central Ambulance Station and Marybush Lane offices which, because of the scale of remedial work

required, will result in a substantial loss. It was also noted that the District Valuer had provided updated

valuations on the Trust’s estate, for year-end purposes. It was agreed full provision should be made for

the impairment on the Bristol site and for any other properties where the latest valuation was below book

value.

❙ Revaluation of PTS vehicles

The loss of PTS contracts had rendered a number of specialist passenger transport vehicles surplus to

requirements. An impairment to reflect market value has been recognised. The asset life of the residual

fleet of PTS vehicles has been reviewed with the depreciation charge aligned to the life of contract.

CH A R I TA B L E F U N D SIn January 2014, the Committee considered whether the Trust should consolidate its charitable funds into

the Annual Accounts, following the Treasury’s decision to extend the application of IAS 27. It was decided

it would be inappropriate to adopt this approach due to the limited sums involved and that, instead, an

appropriate disclosure note should be included in the accounts.

R E M U N E R AT I O N CO M M I T T E EThe 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 2013/14 form part

of the Remuneration Report on page 118.

O T H E R B O A R D CO M M I T T E E SMembership 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.

A N N U A L R E P O R T 2 0 1 3 / 1 4 87

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

Quality and Governance Committee

In addition to executive and Non-executive Directors, membership comprises Head of Governance,

Compliance Manager, Head of Education, a commissioner representative, and a union representative.

Responsibilities include:

❙ Board Assurance Framework and Risk Registers

❙ Regulatory and legislative strategies, policies, action plans, and compliance reports

❙ Risk management including NHS Litigation Authority risk management standards

❙ Research, guidelines, development, innovation and audit reports

❙ Patient Experience (Serious Incidents, Claims, Complaints)

❙ Membership, Human Resource, Governance, and Training reports

❙ Clinical quality (eg Safeguarding, Medicines Management, Infection Prevention and Control, NICE

Guidance)

❙ Quality governance reviews and checklists

❙ Relevant working group minutes and reports.

The following table sets out the attendance Executive and Non-executive Directors at the Quality and

Governance Committee at meetings from 1 April 2013 to 31 March 2014:

Name Position Attendance Actual/possible

Prof Mary Watkins Committee Chairman and Non-executive Director 5/6


Mr Trevor Ware Non-executive Director 1/3





Mrs Jennie Kingston Deputy Chief Executive and Director of Finance 3/6

Ms Sue Steen Executive Director of HR 4/4



Mrs Jenny Winslade Interim Executive Director of Nursing & Governance 2/2

Mrs Judy Saunders Interim Executive Director of HR and OD 1/2


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.

Responsibilities include:

❙ Review enabling strategies and their impact on the Medium Term Financial Strategy including the Long

Term Financial Model

❙ Oversee the development of the five year Cost Improvement Programme that is to be incorporated into

the Long Term Financial Model

❙ Oversee arrangements to ensure the delivery of the Cost Improvement Programme

❙ Monitor in year delivery of the Cost Improvement Programme.

The following table sets out the attendance of the Finance and Investment Committee members at meetings

from 1 April 2013 to 31 March 2014.


Mrs Charlotte Russell Committee Chairman and Non-executive Director * 2/2

Mr Hugh Hood Committee Chairman and Non-executive Director * 6/6




Mrs Heather Strawbridge Trust Chairman 5/6



* Mr Hugh Hood took over as Chairman of the committee after Mrs Charlotte Russell left partway through the year.

A N N U A L R E P O R T 2 0 1 3 / 1 4 89

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

❙ 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 2013 to 31 March 2014.





Council of Governors

S T R U C T U R E A N D R O L EAs 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 the voices of those they represent are heard at

the highest level in the Trust. Governors inform the development of the future strategy and direction of the

Trust, as well as monitoring its performance in achieving its aims and targets.

S TAT U T O R Y R O L E S A N D R E S P O N S I B I L I T I E S O F T H E CO U N C I L O F G O V E R N O R S ❙ 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.

A D D I T I O N A L P O W E R S 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 members and the public on the Trust’s

future plans. To this end, a questionnaire was devised by the sub group and sent out to members and the

public. The results were collated and due to be presented to the Board of Directors at its meeting in May.

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.

A N N U A L R E P O R T 2 0 1 3 / 1 4 91

D E V E L O P M E N T S D U R I N G 2 013 T O 142013/14 was a year of transition for the Council of Governors, and one in which the first governors

completed their three-year, full term of office. The CoG was restructured following the introduction of

interim arrangements to take account of the acquisition of GWAS. As a result, elections were held and new

Governors came into office.

From 1 February 2013 to 28 February 2014, the Council was made up of 47 governors with 28 being elected

by Public Members, 10 by the Staff Members, one local authority appointed governor and the remaining

eight being appointed by partner organisations.

For the period 1 March 2014 to 31 March 2014, the Council was reduced in size to 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.

P U B L I C , S TA F F A N D A P P O I N T E D G O V E R N O R S U P T O , A N D I N CL U D I N G , 2 8 F E B R U A R Y 2 014 Public Governors

CONSTITUENCY AREA NUMBER OF GOVERNORS

Bath & North East Somerset

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

1

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

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

3

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 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

6

Dorset

The electoral ward areas comprising the area covered by Christchurch Borough Council, Dorset County Council, East Dorset District, North Dorset District Council, Purbeck District Council, West Dorset District Council, Weymouth and Portland Borough Council, Borough of Poole Council and Bournemouth Borough Council

4

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

3

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

1

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

1

Somerset

The electoral ward areas comprising the area covered by Mendip District Council, Sedgemoor District Council, Somerset County Council, South Somerset District Council, Taunton Deane Borough Council and West Somerset District Council and, for the avoidance of doubt, any successor authority of 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 and West Somerset District Council

3

South Gloucestershire

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

1

SwindonThe electoral ward areas comprising the area covered by Swindon Borough Council, and, for the avoidance of doubt, any successor authority of Swindon Borough Council

1

WiltshireThe electoral ward areas comprising the area covered by Wiltshire Council, and, for the avoidance of doubt, any successor authority of Wiltshire Council

2

Staff Governor Classes

❙ Accident and Emergency

❙ Urgent Care Services

❙ Patient Transport Services

❙ Volunteers Staff

❙ Administration and Support

❙ Former GWAS Accident and Emergency

❙ Former GWAS Urgent Care Services

❙ Former GWAS Patient Transport Services

❙ Former GWAS Volunteers

❙ Former GWAS Administration and Support.

A N N U A L R E P O R T 2 0 1 3 / 1 4 93

A P P O I N T E D G O V E R N O R S

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 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

1

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

1

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

1

Air ambulanceCornwall 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 and Southern Devon Health and Care NHS Trust

1

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

P U B L I C CO N S T I T U E N C I E S F R O M 1 M A R CH 2 014

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 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

580 4

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

436 3

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

1

A N N U A L R E P O R T 2 0 1 3 / 1 4 95

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

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 successor authority of Wiltshire Council or Swindon Borough Council

2

S TA F F CL A S S E SAccident and Emergency (North Division) Staff Class 1 governor

Accident and Emergency (East Division) Staff Class 1 governor

Accident and Emergency (West Division) Staff Class 1 governor

Urgent Care Services Staff Class 1 governor

Volunteers Staff Class 1 governor

Administration, Support and Other Services Staff Class 1 governor

A P P O I N T E D G O V E R N O R S

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 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

1

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

1

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

1

Air ambulanceCornwall 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 and Southern Devon Health and Care NHS Trust

1

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

A N N U A L R E P O R T 2 0 1 3 / 1 4 97

G O V E R N O R S U N T I L 2 8 F E B R U A R Y 2 014

Governor Elected/AppointedConstituency/Stakeholder Grouping

Mr Albertus Tappe 6 Aug 2013 – uncontested Public – Bath & North East Somerset

resigned 17 December 2013

Mr Rae Care Uncontested (18 April 2013) Public – Bristol

Dr Harriet Lupton Uncontested (18 April 2013) Public – Bristol

Mr Steve Hobbs Elected (10 March 2011) Public – Cornwall

Mr Tony Rowe Elected Public – Cornwall

Mr William Thomas Elected Public – Cornwall

Ms Iris Cristoforo Elected Public – Devon

Mr Colin Leigh Elected Public – Devon

Mr Edward McGrachan Elected Public – Devon

Mr Adrian Rutter Elected Public – Devon

Mr Philip Simonds Elected Public – Devon

Mr Peter Vallance Elected (17 October 2011) Public – Devon

Mr Jim Duffie Uncontested Public – Dorset

Mrs Valerie Farrar-Hockley Uncontested Public – Dorset

Mr Kelvin Jury Elected (22 June 2012) Public – Dorset

Mr Steve Beckingham Elected (28 February 2012) Public – Dorset

Mr Andrew Gravells Uncontested (4 May 2013) Public – Gloucestershire

Mr Craig Holmes Uncontested (18 April 2013) Public – Gloucestershire

Mr Paul Richardson Uncontested (18 April 2013) Public – Gloucestershire

Mr Christopher Mills Elected (24 January 2013) Public – Isles of Scilly

Mr Jeff Liddiatt Elected (18 April 2013) Public – North Somerset

Mr Colin Thomas Elected (26 February 2013) Public – Somerset

Mrs Alison Tucker Elected (28 October 2011) Public – Somerset

Mr Kevin Tuhey Elected (28 May 2012) Public – Somerset

Mr Terry HaywardUncontested (18 April 2013) Public – South Gloucestershire

resigned 10 September 2013

Mr Roderic MarshallElected (18 April 2013) Public – Swindon

resigned 20 November 2013

Mr George GardinerUncontested (18 April 2013) Public – Wiltshire


Dr Dee Nix Uncontested (4 May 2013) Public – Wiltshire

Mr Mark Bradford Elected Staff – A&E

Ms Rachel Tozer Uncontested Staff – Administration & Support

Mr Richard EvansElected Staff – PTS

leaving date 01 July 2013

Governor Elected/AppointedConstituency/Stakeholder Grouping

Mr Terry Raper Uncontested (18 December 2012) Staff – UCS

Mr Peter DawsonElected Staff – Volunteers


Mr Mark Stubbs Elected (18 April 2013) Staff – Former GWAS A&E

Mrs Victoria BlakeUncontested (18 April 2013) Staff – Former GWAS

Administration & Support leaving date 03 September 2013

Mr Alan Peak Elected (18 April 2013) Staff – Former GWAS PTS

Mr Ian Harris Uncontested (4 May 2013) Staff – Former GWAS UCS

Mr Mally McLane Elected (18 April 2013) Staff – Former GWAS Volunteers

Mr Steve Wallwork Appointed (28 April 2011) Torbay Care Trust

Mrs Teresa Hensman Appointed NHS Dorset

Mr Andrew Williamson, NHS Cornwall & the Isles of Scilly

Appointed Primary Care Trusts

Councillor Bob Deed, Mid-Devon District Council

Appointed Local Authorities

Mr Steve Brown, Cornwall Fire & Rescue Service

Appointed (12 March 2012) Fire & Rescue Services

Chief Superintendent Andy Francis

Appointed Police Services

Vacancy Appointed Council for Voluntary Services

Mrs Andrea Hunt, Taunton & Somerset NHS Foundation Trust

Appointed NHS Acute Trusts

Mr Edward Colgan, Somerset Partnership NHS Foundation Trust

Appointed NHS Mental Health Partnerships

Mr John Christensen Appointed Air Ambulance Charities

A N N U A L R E P O R T 2 0 1 3 / 1 4 99

G O V E R N O R S P O S T 1 M A R CH 2 014

GovernorElected/Appointed

Constituency

Mr Rae CareUncontested Public – Bristol and Bath & North East

Somerset

Dr Harriet LuptonUncontested Public – Bristol and Bath & North East

Somerset

Mr David Clare Elected Public – Cornwall

Mr William Thomas Elected Public – Cornwall

Ms Iris Cristoforo Elected Public – Devon

Mr Stephen Moakes Elected Public – Devon

Mr Adrian Rutter Elected Public – Devon

Mr Paul Young Elected Public – Devon

Mr Robert Day Elected Public – Dorset

Mr Jim Duffie Elected Public – Dorset

Mr Andrew Gravells Elected Public – Gloucestershire

Mr Craig Holmes Elected Public – Gloucestershire

Mr Paul Richardson Elected Public – Gloucestershire

Mr Christopher Mills Uncontested Public – Isles of Scilly

Mr Terry Beale Elected Public – Somerset

Mr Anthony Leak Elected Public – Somerset

Mr Colin Thomas Elected Public – Somerset

Mr Torquil MacInnes Uncontested Public – Wiltshire

Dr Dee Nix Uncontested Public – Wiltshire

Vacancy Staff – A&E (East)

Mr Alan Peak Elected Staff – A&E (North)

Mr Mark Bradford Uncontested Staff – A&E (West)

Mr Neil Hunt Elected Staff – Admin, Support & Other Services

Ms Andrea Henley Uncontested Staff – UCS (inc NHS 111)

Mr Mark Norbury Elected Staff – Volunteers

Cllr Bob Deed Appointed Appointed – Local Authorities

Mrs Kay Haughton Appointed Appointed – CCGs (North Division)

Mr Steve Wallwork Appointed – CCGs (East and West)

Mr Steve Brown Appointed Appointed – Fire Services

Mr Iain Tulley Appointed Appointed – Mental Health Partnerships

1 x tbc Appointed Appointed – Acute Trusts

Assistant Chief Constable Sally Crook

Appointed Appointed – Police Forces

Mr John Christensen Appointed Appointed – Air Ambulance Charities

L E A D G O V E R N O RGovernors are invited to nominate themselves for the posts of Lead and Deputy Lead Governor annually.

Following election by their peers at the Annual General Meeting on 12 September 2012, the Lead Governor

is Edward McGrachan, Public Governor – Devon, and the Deputy Lead Governor is Iris Cristoforo, Public

Governor – Devon. Their terms of office run until the Annual General Meeting on 11 September 2013.

At the AGM Edward McGrachan was reappointed as Lead Governor and Pete Vallance was appointed as

Deputy Lead Governor. Their terms of office would have run until the AGM on 11 September 2014, however

neither was reappointed and so the vacancies stand for this CoG.

R E G I S T E R O F I N T E R E S T SGovernors 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.

M E E T I N G SThe Council of Governors met formally on three occasions during 2013/14, 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.

Governors and Board of Directors

Name Constituency Notes

Mr Steve Beckingham Public – Dorset 3/3

Mrs Victoria Blake Staff – Admin & Support 1/1

Mr Mark Bradford Staff – A&E 3/3

Mr Steve Brown Appointed – Fire Services 1/3

Mr Rae Care Public – Bristol 3/3

Ms Iris Cristoforo Public – Devon 3/3

Mr Peter Dawson Staff – Volunteers 1/3

Cllr Bob Deed Appointed – Local Authorities 3/3

Mr Jim Duffie Public – Dorset 3/3

Mr Richard Evans Staff – PTS 0/3

Mrs Valerie Farrar-Hockley Public – Dorset 2/3

Mr Andy Francis Appointed – Police Services 1/3

Mr George Gardiner Public – Wiltshire 2/3

Mr Andrew Gravells Public – Gloucestershire 1/3

Mr Ian Harris Staff – UCS 2/3

Mrs Kay Haughton Appointed – CCG 2/3

A N N U A L R E P O R T 2 0 1 3 / 1 4 101

Mr Terry Hayward Public – South Gloucestershire 0/3

Mr Steve Hobbs Public – Cornwall 3/3

Mr Craig Holmes Public – Gloucestershire 3/3

Ms Andrea Hunt Appointed – Acute Trusts 3/3

Mr Kelvin Jury Public – Dorset 3/3

Mr Colin Leigh Public – Devon 2/3

Mr Jeff Liddiatt Public – Bath & North East Somerset 1/3

Dr Harriet Lupton Public – Bristol 3/3

Mr Roderic Marshall Public – Swindon 1/3

Mr Edward McGrachan Public – Devon 2/3

Mr Mally McLane Staff – Volunteers 1/3

Mr Chris Mills Public – Isles of Scilly 3/3

Dr Dee Nix Public – Wiltshire 2/3

Mr Alan Peak Staff – PTS 3/3

Mr Terry Raper Staff – UCS 3/3

Mr Paul Richardson Public – Gloucestershire 1/3

Mr Tony Rowe Public – Cornwall 1/3

Mr Adrian Rutter Public – Devon 3/3

Mr Philip Simonds Public – Devon 1/3

Mr Mark Stubbs Staff – A&E 3/3

Mr Albertus Tappe Public – B&NES 3/3

Mr Colin Thomas Public – Somerset 1/3

Mr William Thomas Public – Cornwall 2/3

Ms Rachel Tozer Staff – Admin & Support 3/3

Mr Iain Tulley Appointed – Mental Health 0/0

Mrs Alison Tucker Public – Somerset 2/3

Mr Kevin Tuhey Public – Somerset 1/3

Mr Pete Vallance Public – Devon 2/3

Mr Steve Wallwork Appointed – Torbay PCT 2/3

Board of Directors



Mrs Jennie Kingston Deputy Chief Executive/Executive Director of Finance 1/3



Ms Sue Steen Executive Director of HR and Governance 3/3


Prof Mary Watkins Non-executive Director 3/3




Mr Trevor Ware Non-executive Director 1/3

Mrs Chris Kinsella Non-executive Director 1/3


Others

Mrs Nicole Casey Head of Governance 1/3

Ms Helen Braid Membership Manager 3/3

Mrs Sarah Knight /

Mr Marty McAuley

Trust Secretary 3/3

Ms Corrie Payne Membership and PPI Assistant 3/3

Mr Jonathan James Deputy Director of Finance 1/3

Ms Claire Warner Interim Head of Communications and Engagement 1/1

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.

S U B G R O U P S O F Co GThe Council of Governors has a number of sub groups which enable governors to contribute in the follow

specific areas:

❙ Remuneration and Recommendations Panel (statutory see details below)

❙ Planning sub group

❙ Communications and Membership

❙ Audit sub group

❙ Patient experience sub group.

Over the past year, the work programme for CoG at its meetings included:

❙ the Care Quality Commission (CQC) on its role and purpose

❙ the Foundation Trust Network (FTN) on the role of the Governor; including their accountability to members

and responsibility to hold the Non-executive Directors to account for the performance of the Board

❙ updating the constitution

❙ agreeing a recruitment process for Non-executive Director

❙ input into the annual plan

❙ reviewing the composition of the council

A N N U A L R E P O R T 2 0 1 3 / 1 4 103

❙ the appointment and reappointment of the Chairman and Non-executive Directors

❙ reviewing the strategic objectives of the Trust.

R E M U N E R AT I O N A N D R E CO M M E N DAT I O N PA N E LThe 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 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 2013/14 financial year:

Name Position Attendance: Actual/Possible

Mrs Heather Strawbridge Trust Chairman 3/3

Mr Adrian Rutter Public Governor – Cornwall 5/5

Mr Philip Simonds Public Governor – Devon 2/5

Ms Rachel Tozer Staff Governor – Administration & Support 5/5

Ms Andrea Hunt Appointed Governor – Acute Trusts 5/5

In addition:

❙ Mr Ken Wenman (non-member), Chief Executive, attended 5/5 meetings

❙ Mr Marty McAuley, Trust Secretary attended two meetings

❙ Ms Sue Steen, Executive Director of Human Resources and Governance, (non-member) attended 1 meeting

❙ Prof Mary Watkins Senior Independent Director, attended two meetings

❙ Mr George Gardiner, public governor attended two meetings.

A N N U A L R E P O R T 2 0 1 3 / 1 4 105

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 intend 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.

We reviewed the strategy during 2012 in light of the pending acquisition of GWAS in February 2013.

The current version, which was approved in July 2012, incorporated an interim arrangement for public

constituencies across the new operating area and staff classes for those staff employed by GWAS up until

the point of acquisition.

The strategy also describes the structure for the Council of Governors and the public and staff governor seats

on the Council. We expanded the Council, as an interim measure, from the date of acquisition to include

public and staff governor seats representing the new extended membership constituencies and staff classes.

Post-acquisition, these interim arrangements were reviewed during the summer of 2013 and a more

streamlined structure introduced from 1 March 2014. The detail of the structure is set out below and will be

incorporated into the Membership Strategy when it is reviewed during 2014.

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

newsletter, widely publicising information about forthcoming Governor elections and consulting members on

our annual plan.

At 31 March 2014, 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 89 per cent of the membership compared with 95 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 under-

representation 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 was

due to take place at a meeting of the Council of Governors in May 2014. It is proposed that they will form

part of a quarterly report presented to the Board of Directors.

Our public membership at 31 March 2014, numbered 14,188 members – exceeding the 0.22 per cent of total

population target contained within the membership strategy – and 4,378 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

Targ

et

Me

mb

ers

hip

3

1/0

3/2

01

4(0

.22

% o

f p

op

ula

tio

n)

Act

ua

l M

em

be

rsh

ip

31

/03

/20

14

Nu

mb

er

of

Go

ve

rno

rs

E l igibility

Bristol and Bath & North East Somerset

1,356 1,211 2 Age 16 and above residing in 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 those listed above

Cornwall

1,196 3,123 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

2,529 3,206 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

A N N U A L R E P O R T 2 0 1 3 / 1 4 107

Public Constituency

Targ

et

Me

mb

ers

hip

3

1/0

3/2

01

4(0

.22

% o

f p

op

ula

tio

n)

Act

ua

l M

em

be

rsh

ip

31

/03

/20

14

Nu

mb

er

of

Go

ve

rno

rs

E l igibility

Dorset

1,664 1,606 2 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

1,927 1,468 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

Isles of Scilly

25 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

1,643 2,515 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

1,529 985 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. Due to the re-configuration of staff classes, it is not possible provide

an accurate breakdown of increase by staff class. However, overall staff membership has decreased by

eight members. Targets in respect of staff membership are to be included in the review of the Membership

Strategy to take into account changes in service provision and working practices.

Staff Constituency

Act

ua

l M

em

be

rsh

ip

31

/03

/20

14

No

of

Go

ve

rno

rs

E l igibility

Accident & Emergency: East Division Staff Class

672 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 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

1,429 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

1,075 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

478 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

168 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

Administration, Support and Other Services Staff Class

556 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 4,378 6

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

swast.nhs.uk.

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].

A N N U A L R E P O R T 2 0 1 3 / 1 4 109

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 the Membership Manager on 01392 261526 or via [email protected].

W O R K I N G G R O U P SThe Council of Governors has established four sub working groups to meet outside the formal meetings of

the full council, to focus on specific issues. These cover the key areas of patient experience, audit, planning,

and communications and membership. In addition a Remuneration & Recommendations Panel has been

established to consider the remuneration of the Chairman and Non-executive Directors, as well as the

appointment process for these positions.

J O I N T W O R K I N GThe Board of Directors and Council of Governors work closely and in a co-operative and supportive manner,

with Board members attending Council meetings and vice versa. A Policy of Engagement was developed and

agreed with the first Shadow Council of Governors in February 2011 to support the exchange of information

between the Board of Directors and Council of Governors. This Policy will be reviewed in 2014/15. The

information provided by the Board of Directors to support the working of the Council of Governors has

evolved throughout the years. The Trust Chairman chairs both forums and Governors attend the public Board

of Directors meetings.

Operating and Financial Review

F I N A N C I A L R E V I E WSummary of Financial Performance

Key highlights of SWASFT’S financial performance for 2013/14 are as follows:

❙ Income of £225.6million, this is above plan but includes the loss of PTS contracts and additional income

for 111, A&E Activity and Winter Pressures funding

❙ A surplus of £0.333million, this was lower than the plan of £1.5million but was in line with the revised

forecast after the recognition of the impairment of the PTS fleet following the loss of the contracts

❙ Earnings Before Interest, Tax, Depreciation and Amortisation (EBITDA) of £17.9million representing

7.9% of income

❙ A year-end cash balance of £30.4million (2013: £25.9million). The Trust’s strong cash position is due to

the recognition of the impairments and slippage in the capital plan until 2014/15

❙ Net current assets of £10.0million (2013: £4.7million). 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).

2013/14 was a challenging year for SWASFT and included:

❙ the first full year of integration following the acquisition of GWAS on 1 February 2013

❙ the introduction and delivery of the Red Recovery Plan to support the A&E service contracts

❙ the loss of Patient Transport Service contracts following a competitive tender

❙ the success in winning additional 111 contracts and their rollout.

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.

2012/13 Accounts - Accounting by Absorption

In providing a comparative figure to the 2013/14 accounts this Operating and Financial Review includes

comparable information for the enlarged Trust only for 2012/13. This was based on:

❙ GWAS produced a set of accounts for the period 1 April 2012 to 31 January 2013

❙ SWASFT reported the financial performance for the 12 months from 1 April 2012 to 31 March 2013. This

consolidated financial transactions for the twelve months of SWASFT plus two months for the acquired

organisation GWAS trading as SWASFT

❙ The value of the GWAS assets and liabilities as at 31 January 2013 were transferred to the Statement of

Financial Position for SWASFT and the remaining balances were reflected in the Statement of Financial

Position as at 31 March 2013

❙ The balance of the Net Assets of GWAS (£35.1m) at 31 January 2013 was shown as a gain on the face of

the Statement of Comprehensive Income as a Transfer by Absorption. Note: This exceptionally increased

the reported surplus of SWASFT for 2012/13.

A N N U A L R E P O R T 2 0 1 3 / 1 4 111

A N A LY S I S O F I N CO M ESWASFT recognised income of £147.2million in 2012/13. This has increased by 53.3% to £225.6million for

2013/14. The table below provides a summary of the key movements.

Income Movements 2012/13 to 2013/14

£’m

Income 2012/13 147.2

Full year impact of GWAS income 74.5

Additional A&E income 6.2

Loss of PTS & VACs income (5.3)

Additional 111 contract income 4.5

Other income movements (1.5)

Total Income 2013/14 225.6

The Trust’s principal source of income is from local NHS commissioning contracts for the provision of A&E

Services. This income totalled £174.8million (2013: £109.6million) which represented 77.5% of the Trust’s

2013/14 turnover (2013: 74.4%). The table below provides a summary of the key movements.

Trust income 2013/14 to 2012/13

2013/14 2012/13

£’m % £’m %

A&E Income 174.8 77.5% 109.6 74.4%

PTS Income 10.4 4.6% 8.3 5.6%

UCS Income 22.4 9.9% 14.9 10.1%

Other Income 18.0 8.0% 14.4 9.8%

225.6 100.0% 147.2 100.0%

A N A LY S I S O F E X P E N D I T U R EThe operating expenditure for the Trust reflects the changes in income and the impact of the acquisition.

The operating expenditure for 2012/13 was £144.0 million. This has increased by 55% to £223.3million for

2013/14. The table below provides a summary of the key movements.

Operating expenditure in 2013/14 and 2012/13

2013/14 2012/13

£’m % £’m %

Staff costs 158.9 71.2% 104.3 72.4%

Supply and Services 8.3 3.7% 4.7 3.2%

Establishment 4.7 2.1% 3.4 2.4%

Transport 19.7 8.8% 11.3 7.8%

Premises 8.3 3.7% 5.1 3.6%

Depreciation 12.1 5.4% 7.2 5.0%

Impairments 3.5 1.6% 0.2 0.2%

Other 7.8 3.5% 7.7 5.4%

223.3 100.0% 144.0 100.0%

These movements reflect:

❙ The full year impact of the acquisition by SWASFT of GWAS

❙ The reduction in staff costs for PTS following their transfer under TUPE to the successful providers

❙ The increase in staff costs relating to the Trust success in winning new 111 contracts

❙ The use of external third parties (included in the Transport section) to support the frontline operations of

PTS and A&E arising from vacancies

❙ The increase in supply and services relating to the procurement of additional medical equipment in support

delivery of the Red Recovery Plan

❙ Impairments including the PTS fleet following the loss of contracts

❙ Estates movements including an impairment relating to the sale of Marybush Ambulance Station and the

impact of the annual revaluation of the estate by the District Valuer

❙ It should be noted that the dispensation for the consolidation of the Trust charitable accounts is no longer

available but due to the size of the Trust funds of £0.2 million the Trust has agreed for the accounts not to

be consolidated.

CO S T I M P R O V E M E N T S T R AT E G YThe 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 Trust has in place

an approved five year Cost Improvement Strategy.

During 2013/14, SWASFT delivered a recurrent cost improvement programme of £9.4 million through the

implementation of recurrent schemes. 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 organisation.

A N N U A L R E P O R T 2 0 1 3 / 1 4 113

The 2014/15 cost improvement plan is £9.0million. The cost improvement plan has been identified on a

recurrent basis and includes schemes such A&E modernisation, review of non-pay, rationalisation of clinical

hubs, Urgent Care Service modernisation and a fuel reduction action plan. The continued delivery of cost

improvements is critical to the ongoing financial health of the Trust.

C A P I TA L I N V E S T M E N TThe 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 2014 was

£13.4million (2013: £7.9million). Details of key elements of spend during the year is detailed below.

Capital programme 2013/14 and 2012/13

2013/14 2012/13

£ m % £ m %

Fleet 7.8 58% 5.4 68%

Information Communication and Technology 1.0 7% 1.5 19%

Estates 1.6 12% 0.4 5%

Hazardous Area Response Team estate 3.0 22% 0.2 3%

Other including Medical Devices 0.0 0% 0.5 6%

13.4 100% 8.0 100%

The main changes in capital expenditure include:

❙ The fleet replacement programme relates to the enlarged Trust following acquisition

❙ The estate costs which relate to the implementation of 111 and centralisation of Trust Headquarters in

Exeter

❙ The HART expenditure which relates to the permanent HART estate in Exeter which was funded through

the receipt of Public Dividend Capital

❙ Medical device replacement relates to the vital signs equipment and has been delayed to 2014/15 to be

aligned to the introduction of the Electronic Care Summary record project.

F I N A N C I N G A N D I N V E S T M E N TThe Trust has a working capital facility of £16million. The Trust had no requirement to access the facility

during 2013/14, maintaining healthy cash balances throughout the year. The Trust continues to forecast its

cash requirements on a rolling 12-month basis and has no plans to use the facility over the period.

B E T T E R PAY M E N T P R A C T I CE CO D EThe 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.

B E T T E R PAY M E N T P R A C T I CE CO D E P E R F O R M A N CE2013/14 2012/13

Number £ m Number £ m

Total Non-NHS trade invoices paid in the year 48,088 55.5 32,486 34.5

Total Non NHS trade invoices paid within target 46,857 54.5 31,750 32.0

Percentage of Non-NHS trade invoices paid within target 97% 98% 98% 93%

Total NHS trade invoices paid in the year 931 6.2 818 4.0

Total NHS trade invoices paid within target 884 6.1 781 3.8

Percentage of NHS trade invoices paid within target 95% 98% 95% 95%

P U B L I C D I V I D E N D C A P I TA LThe Trust is required to pay a dividend to the Department of Health based on 3.5% of average relevant

net assets. During 2013/14, the Trust recognised a dividend payable of £1.8million within the Statement of

Comprehensive Income based on an average relevant net assets of £52.2 million.

M O N I T O R ’ S CO N T I N U I T Y O F S E R V I CE S R I S K R AT I N GFor the first half of 2013/14 the Trust was assessed against the Monitor Financial Risk Rating metrics and ten

financial risk indicators under the Compliance Framework. The Trust was assessed as a risk rating of three in

line with plan for quarter one and quarter two (where 5 is the best and 1 is the worst).

During quarter three of 2013/14 Monitor introduced a framework for the measurement of financial risk. 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.

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.

F I N A N C I A L O U T L O O KThe sound financial performance of the Trust in 2013/14 secures a strong starting point for 2014/15. This

is further supported by a robust medium term Financial Plan for 2014/15 and 2015/16 and 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:

❙ Heads of Terms agreed for the A&E contract

❙ Signed contracts in place for all other services

❙ Approved financial plans for 2014/15 including identified cost improvement plan

❙ The Trust cash flow forecast.

A N N U A L R E P O R T 2 0 1 3 / 1 4 115

G E N E R A L E CO N O M I C CL I M AT EThe Trust is expecting a very challenging financial environment over the medium term within the local health

economy with the Trust 12 clinical commissioning groups (CCGs). It is likely that commissioners will continue

to review their funding allocations and reduce contract values. The Trust continues to work closely with

commissioners to minimise the impact on patient care.

O T H E R D E V E L O P M E N T SThe Trust continues to operate in competitive markets under the Government policy of Any Willing Provider.

The Trust is expecting to respond to tenders for a number of Urgent Care Services including Out-of-Hours.

As part of the Trust A&E contract the Trust has launched the Right Care2 service development the investment

is profiled within the Trust Financial plan for 2014/15.

The Trust has a number of service developments during 2014/15 the most significant of which are the rollout

of the Electronic Care Summary 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.

P L A N N I N GAs 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. The Trust has developed a

Mitigation Escalatory Action Plan (MEAP) to allow the Trust to manage these risks should they materialize.

A U D I T O R SThe 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 2013/14 was £0.056million

(2012/13: £0.083million).

D I S CL O S U R E O F I N F O R M AT I O N T O A U D I T O R SAs 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.

P O L I T I C A L A N D CH A R I TA B L E D O N AT I O N SThe Trust has not made any political or charitable donations this year (2013: £nil).

G O V E R N O R E X P E N S E SThe total amount of expenses claimed by Governors is contained in the Remuneration Report on page 120.

A N N U A L R E P O R T 2 0 1 3 / 1 4 117

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.

The Chief Executive, any other directors, or the Trust Secretary may be asked to attend by the Chairman. The

Committee met on three occasions during 2013/14.

Confirmation of attendance at these meetings is provided in the following table:

Name PositionAttendance: Actual/Possible

Mrs Heather Strawbridge Chairman (Non-executive Director) 3/3






In addition, the following non-members attended:

Name PositionAttendance: Actual/Possible


Mr Marty McAuley Trust Secretary 2/2

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.

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 (for more details please see Remuneration and Recommendations Panel on page 105).

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 the NHS Appointments Commission.

A N N U A L R E P O R T 2 0 1 3 / 1 4 119

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 the 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 will take up the permanent post on 1 June 2014.

There is no compensation for early termination of contracts, other than payment in lieu of notice.

There have been no significant awards made to past senior managers.

There were 16 Directors of the Board during the reporting period. Two were interim directors and did not

claim expenses. The total expenses claim of the Board of Directors was £19,214.28. (This figure includes a

£2,777 adjustment of incorrect payment in previous years.)

In 2013/14 the Council of Governors was made up of 47 Governors until 28 February 2014 when it reduced

to 34 Governors. 34 Governors claimed expenses which came to a total of £12,709.68.

2013/14 2012/13

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5-10 0 10-15 0

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15-20 0 15-20 0

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10-15 0 10-15 0

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15-20 0 15-20 0

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10-15 0 0-5 0

Mr Chris Kinsella (Non-executive Director)

5-10 0 0 0

Mr Ken Wenman (Chief Executive)

170-175 1600 65-70 90-100 2800

Mrs Jennie Kingston (Deputy Chief Executive and Executive Director of Finance)

125-130 4000 125-130 3800

Mrs Norma Lane (Executive Director of Delivery)

30-35 1000 95-100 3400

Dr Andy Smith (Executive Medical Director)

50-55 5100 40-45 5100

Mrs Sue Steen (Executive Director of Human Resources and Workforce Development)

75-80 3400 75-80 10-15 53100

Mr Francis Gillen (Executive Director of Information Management and Technology)

95-100 5000 5-10 400

Band of highest paid Director ’s Total

Remuneration (£’000) 170-175 160-165

Median Total Remuneration (£’000) 30

Ratio 5.6 5.5

A N N U A L R E P O R T 2 0 1 3 / 1 4 121

Trevor Ware

Trevor left during the 2013/14 year and so his salary is only for part of the year.

Tony Fox

Tony joined during the 2012/13 year and so his salary was only for part of the year.

Chris Kinsella

Chris joined during the 2013/14 year and so his salary was only for part of the year.

Charlotte Russell

Charlotte left during the 2013/14 year and so her salary is only for part of the year.

Ken Wenman and Sue Steen

In February 2013, we acquired Great Western Ambulance Service. In the period of time leading up to the

acquisition Ken Wenman and Sue Steen were seconded to Great Western Ambulance Service. Therefore in

the 2012/13 year, their salary was part paid by Great Western Ambulance Service. In 2013/14, their salaries

were paid in full by SWASFT. This accounts for the difference between the salary payments for the two years.

Francis Gillen

In February 2013, Francis Gillen was appointed as Executive Director of Information Management and

Technology. Therefore his salary for 2012/13 only covers a two month period until the end of the financial

year. This accounts for the difference between the salary payment for the two years.

Dr Andy Smith

In October 2013, the Remuneration Committee increased Dr Andy Smith’s salary. This review was based on

his performance as an Executive Director and ensured that the Trust was able to retain Dr Smith’s knowledge,

skills and experience. The rise ensured that his salary was commensurate with his work as a GP.

The banded remuneration of the highest-paid director in South Western Ambulance Service NHS Foundation

Trust in the financial year 2013/14 was £170-175,000. This was 5.6 times the median remuneration of the

workforce, which was £30,158.

As Non-executive Directors do not receive pensionable remuneration, there will be no entries in respect of

pension for Non-executive Directors.

Pensions for the Year Ended 31 March 2014

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£000 £000 £000 £000 £000 £000 £000

Mr Ken Wenman (Chief Executive)

2.5 to 5 10 to 12.5 75 to 80 225 to 230 1671 1544 128

Mrs Jennie Kingston (Acting Chief Executive and Executive Director of Finance)

2.5 to 5 12.5 to 15 35 to 40 110 to 115 745 641 104

Mrs Norma Lane (Executive Director of Delivery)

0 to 2.5 0 to 2.5 40 to 45 125 to 130 805 788 5

Dr Andy Smith (Executive Medical Director)

2.5 to 5 10 to 12.5 15 to 20 45 to 50 263 200 63

Mr Francis Gillen (Executive Director of Information Management and Technology)

0 to 2.5 5 to 7.5 10 to 15 30 to 35 183 140 44

Mrs Sue Steen (Executive Director of Human Resources and Workforce Development)

0 to 2.5 0 5 to 10 0 58 55 3

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.

A N N U A L R E P O R T 2 0 1 3 / 1 4 123

C A S H E Q U I VA L E N T T R A N S F E R VA L U E S (CE T V )A Cash Equivalent Transfer Value 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 Cash Equivalent Transfer Value 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 Cash Equivalent Transfer Value 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.

R E A L I N CR E A S E I N C A S H E Q U I VA L E N T T R A N S F E R VA L U E SThis reflects the increase in Cash Equivalent Transfer Value 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 above 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: 22 May 2014

A N N U A L R E P O R T 2 0 1 3 / 1 4 125

quality report

A N N U A L R E P O R T 2 0 1 3 / 1 4 127

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.

Each year I seem to report on significant change both in the NHS in general and our Trust specifically. Last

year was no different and there have been a number of changes to the services we provide including a large

increase in NHS 111 services and a reduction in patient transport services.

We now deliver the NHS 111 service in Devon, Somerset and Cornwall and the Isles of Scilly as well as in

Dorset, which was launched in the previous year. Our consolidated experience of delivering call-handling and

triage services has greatly benefited the patients who have used the service and contributed to improved job

satisfaction and morale of the staff working for 111.

Most of the areas where we provided patient transport services came up for re-tender during 2013 with the

result that the Trust now provides PTS services only in Bristol, North Somerset and South Gloucestershire

and the Isles of Scilly. Although reduced numerically, there has been no let off in the drive for quality and

innovation.

Alongside these service changes, we have continued to work on the integration of the expanded SWASFT

created by the acquisition of the former Great Western Ambulance Service. The emphasis has been on

ensuring the best practice from each organisation is adopted and implemented across the wider operating

area which includes the communities of: Cornwall and the Isles of Scilly, Devon, Somerset, North Somerset,

Dorset, Wiltshire, Gloucestershire, South Gloucestershire, Bristol, Bath and North East Somerset, and

Swindon.

The Board of Directors and I have always made time to meet and speak with our hard-working staff across

the Trust. The expanded area makes this even more important. When I visit staff, I am always impressed

by their attitude, commitment and professionalism and sense of pride in SWASFT. This was reflected in

the unannounced Care Quality Commission (CQC) inspection which took place in February 2014. The CQC

reported noted the positive way in which staff responded to the inspectors, explaining what, why and how

they perform their role. It also recorded some of the pleasing comments made by patients about our staff. I

congratulate and applaud the staff and volunteers of SWASFT for their collective efforts and achievements

over the year.

In January 2013, Professor Sir Bruce Keogh, National Medical Director of the NHS, announced a

comprehensive review of urgent and emergency care and in November 2013, the first stage of Transforming

Urgent and Emergency Care in England was published. The report identified that there was an opportunity

to bring about a shift from patients being treated in hospital to treatment at home. It specified 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. I

am pleased to include information in this quality report showing that we are already achieving this level of

outcome.

I was, therefore, delighted to invite Sir Bruce Keogh to visit our clinical hub in Dorset during March 2014.

This hub houses one of our three 999 control centres, the Dorset NHS 111 control centre, the Dorset

and Somerset Out-of-Hours Doctors Service, and the innovative single point of access (SPoA) for Dorset.

Accompanied by Nigel Acheson, Regional Medical Director for NHS England South, Sir Bruce was able to see

integrated services in action and how they provide seamless patient care.

In 2014/15, we will continue to drive through improvements in experience and clinical outcomes for

patients and to enhance patient safety, putting this at the centre of every decision made. Our plans include

implementing the Electronic Care System, which will enable us to deliver even better clinical outcomes for

patients, through improved pathway management, data sharing and informed decision making.

We have a long experience of implementing quality changes, based on an established knowledge base. As

a key provider of emergency and urgent care within such a large geographical area, it is imperative that we

work closely with other healthcare providers in the South West. This collaborative approach to improving

quality will ensure that services become more clinically effective and timely, more patient-focused and,

ultimately, safer.

I confirm that, to the best of my knowledge, the information in this quality report is accurate and reflects a

balanced view of SWASFT, its achievements and future ambitions.

Ken Wenman

Chief Executive

A N N U A L R E P O R T 2 0 1 3 / 1 4 129

Part 2 – Priorities for Improvement and Statements of Assurance from the Board of Directors

A R E V I E W O F Q U A L I T Y I M P R O V E M E N T P R I O R I T I E S M A D E W I T H I N S WA S F T I N 2 013 / 14Providing quality services to its patients remains a top priority for the Trust. During 2013/14 the Trust

reviewed and realigned its mission statement, vision, identified its values and updated its strategic goals.

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.

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 the corporate objectives reflect 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 set for 2014/15 have been directly aligned to the newly revised strategic goals and

show the recurrence of quality throughout the strategic approach.

S T R AT E G I C G O A L S A N D CO R P O R AT E O B J E C T I V E S 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, providing high

quality services 24 hours a days, seven days a week.

Creating Organisational Strength; Continue 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 Integrated Corporate Performance

Report which is presented to the Board of Directors at each publicly held meeting, and is available on our

website.

In 2013/14 the Trust reviewed its Quality Strategy. 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.

A N N U A L R E P O R T 2 0 1 3 / 1 4 131

2013/14 Quality Priorities

In 2013/14 the Trust published a Quality Account building on its continuous quality improvement journey and

setting out its priorities for the year ahead. Priorities are listed under three categories, patient safety, clinical

effectiveness and patient experience. The priorities from 2013/14 are restated below as they appeared in the

Quality Account, along with an overview of the Trust’s performance:

PAT I E N T S A F E T YPriority 1 – Identification of Sepsis - why a priority?

❙ Sepsis is a life-threatening condition that arises when the body’s response to an infection injures 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

❙ Research shows that simple interventions,-such as giving IV antibiotics and fluids in the first hour, can

reduce the risk of death by over one-third, yet international guidelines representing these interventions are

delivered to fewer than one in eight patients in the NHS

❙ The key to saving lives lies in early recognition and immediate treatment.

Aims

❙ Increase the number of patients with sepsis who are rapidly identified and treated by ambulance clinicians

❙ Reduce the number of incidents reported regarding the lack of recognition of sepsis by 50% by 31 March

2014.

Initiatives

❙ Utilise the new sepsis diagnosis code introduced to the patient clinical record during 2012 to audit the

management of sepsis

❙ Explore the feasibility of pre-hospital lactate testing to aid in sepsis recognition

❙ Explore the implementation of pre-hospital antibiotics.

Did we achieve this priority?

Yes, we partially achieved this priority. The introduction of the new sepsis diagnosis code in the east and

west divisions in late 2012 enabled the number of potential sepsis cases to be identified. Analysis of the

data demonstrates that 795 patients were identified as potentially suffering from sepsis during the period

August 2013 - October 2013 (the most recent data available), compared to just 541 during November 2012 -

January 2013. This represents a 47% increase in the number of cases of potential sepsis being identified by

ambulance clinicians.

Whilst the Trust aspired to reduce the number of adverse incidents reported during the year relating to

the lack of recognition of sepsis by 50%. The emphasis on sepsis has led to a significant increase in staff

awareness. This in turn has led to a growth in adverse incidents being reported relating to sepsis. The

Trust view this as a positive step to further improving care and one that reflects an increased awareness as

opposed to an increase in risk. Whilst the number of lower risk incidents have increased due to improved

reporting, it should be noted that the number of serious incidents linked to sepsis has remained at the same

level as 2012/13 with two incidents occurring.

Priority 2 – Infection Prevention and Control Monitoring - Why a priority?

❙ The need to improve cleanliness and reduce healthcare acquired infections remains one of the top national

priorities detailed within the NHS. The Trust remains fully committed to tackling infection prevention and

control challenges, whilst sustaining compliance with national guidance and regulation

❙ Robust policies and procedures are in place, which if followed will ensure that every patient will receive

care in an environment in which we would be proud for our relatives to experience

❙ The challenge is to objectively monitor the level of environmental cleanliness within emergency

ambulances

❙ During 2012/13 the Trust piloted the use of adenosine triphosphate (ATP) monitoring on PTS ambulances

❙ ATP can only be produced by living cells, where it is their energy currency. ATP testing involves using a

swab to pick up the contaminants present on a surface. An enzymic reaction converts the ATP present on

the surface into a small amount of light, which is measured by a luminometer. The more bacteria on the

surface, the more light is produced and the higher the reading reported.

Aim

❙ Implement ATP environmental monitoring, to evaluate and improve the level of cleanliness of surfaces

within the patient compartment of emergency ambulances.

Initiatives

❙ Implement random ATP swab testing to 10% of ambulance vehicles during each quarter of 2013/14

❙ Utilise the results to highlight the importance of regular cleaning by clinicians each day and after each

patient.


Yes we did achieve this priority.

ATP monitoring was used throughout the year to check the standard of cleanliness on emergency ambulances

across the fleet. Whilst the aim was to swab three specific areas on 10% of vehicles each quarter, initial

experience demonstrated that far more value could be achieved from swabbing a wider number of areas.

The protocol was revised to focus more on the quality of the swabbing process than the quantity of tests

conducted. A total of 10% of emergency ambulances were checked over the course of the year.

The results highlighted areas of good practice and enabled the Trust to focus on areas that would benefit

from further improvements. Recommendations from the initiative have been incorporated into the 2014/15

Annual Infection Prevention and Control plan. The Trust is committed to further expanding the application

of ATP swabbing during 2014/15, by including it as a core part of the regular unannounced inspections of

ambulance stations and vehicles by the Infection Control Lead.

A N N U A L R E P O R T 2 0 1 3 / 1 4 133

CL I N I C A L E F F E C T I V E N E S SPriority 3 – Post ROSC Care Bundle - Why a priority?

❙ Every month the Trust responds to around 200 patients who have suffered a cardiac arrest; 25% will

regain a pulse (return of spontaneous circulation - ROSC) before they reach hospital

❙ Historically, the pre-hospital management of cardiac arrest patients has focused more on resuscitating the

patient to achieve a ROSC, than on delivering high quality care once it is has been achieved to ensure that

the pulse is maintained

❙ The Trust focused on the implementation of evidence based guidelines introduced during 2012 through

the use of a post-ROSC care bundle, based on standards recommended by the Intensive Care Society

❙ Post ROSC care consists of a number of elements:

Patients are more likely to make a good recovery after a cardiac arrest if they are able to maintain

a reasonable blood pressure during the first two hours. Paramedics now infuse a small dose of

adrenaline and use intravenous fluids to ensure that the patients blood pressure is maintained

Following resuscitation, many patients have a poor neurological outcome as a result of brain injury

caused by a lack of oxygen. Paramedics now cool patients to induce hypothermia, as this improves

outcomes

Many cardiac arrests are caused by a heart attack. Paramedics now obtain an ECG (picture of the

heart) to identify a heart attack early, to allow prompt treatment at hospital

Clinicians use state of the art monitors to measure the amount of carbon dioxide in the air breathed

out by patients, to ensure that they are ventilated to deliver the optimum concentration of oxygen

The amount of glucose in a patient’s blood is measured to identify and treat any abnormalities.

Aim

❙ Improve the level of care delivered to patients who regain a pulse after a cardiac arrest, to ensure that they

are more likely to retain their pulse, and have a better chance of survival without brain damage.

Initiatives

❙ Implement and monitor a post-ROSC care bundle, providing feedback to clinicians on their performance.

❙ Establish a Resuscitation Group to lead on the monitoring and improvement of the care delivered to

patients following a cardiac arrest.


Yes we did achieve this priority.

The post ROSC care bundle was introduced at a study day held in April 2013. A range of experts, including

one international speaker, presented on the importance of the post ROSC phase in pre-hospital care and

the event was well attended with over 70 delegates from across the Trust area. Comparison of baseline data

on the post ROSC care bundle showed an improvement of 23.8% in the delivery of the care bundle to this

patient group, from 8.3% to 32.1%.

The Trust’s bi-monthly Resuscitation Group has been established and is now a regular fixture where relevant

research papers and their implications for clinical practice are reviewed. A selection of clinical cases is also

scrutinised by this group and carefully structured feedback is given to clinical staff following this review.

❙ The post-ROSC care bundle is reported regularly to the Resuscitation Group

❙ Clinicians receive individual email feedback on their care of patients who obtain ROSC and are reminded

of the importance of the care bundle

❙ Minutes from the Resuscitation Group are reported to the Clinical Effectiveness Group

❙ A programme of Quality Improvement activity has been started, which has included the provision of an

updated Ambulance Clinical Quality Indicator (ACQI) checklist, which provides details of the care bundle,

on each vehicle.

PAT I E N T E X P E R I E N CEPriority 4 – Dignity Privacy and Respect - why a priority?

❙ The NHS has put patient safety and patient experience at the centre of delivering high-quality care. People

receiving health services need to be treated with dignity. The NHS aims to create a culture in which there

is a zero-tolerance approach to the abuse of, and disrespect to, all patients, and likewise an expectation of

the same approach from patients to healthcare staff

❙ It is acknowledged that Trust staff can face many barriers to communication in the course of their

work including language, ethnicity, cultural diversity, and also vulnerability (i.e. the effects of alcohol).

Overcoming, or at the very least, recognizing these barriers will support staff in carrying out their

professional duties to the best of their abilities and ensure they treat patients, and their families and carers,

with dignity, privacy and respect. It will also encourage patients to afford the same respect and courtesy to

staff attending them

❙ In 2012/13 the Trust undertook interviews with support groups for patients with dementia or who

self harm. The Trust received some very positive feedback but also some comments about how those

patients felt when attended by an ambulance crew which sometimes included feelings of anxiety

and embarrassment. Further work was recommended to consider how patients’ perceptions could be

communicated to staff attending them, and whether any behaviour modification was required for some

groups of patients. These findings have directed the focus of this quality indicator.

Aim

❙ SWASFT will seek to improve its methods of communication with its patients to improve their experience

of contact with all clinicians employed by the ambulance service.

Initiatives

❙ Undertake a review during the first six months of 2013/14 of feedback where patients or their family or

carers have reported a less than satisfactory experience in terms of dignity, privacy or respect. Sources will

include:

Patient Opinion website feedback

Have Your Say leaflet returns

Complaints and concerns

Reported incidents

Urgent Care Service monthly survey.

❙ Review and update the set of tools used to assist staff in communicating with patients, their carers and

families and implement improvements which help to ensure they are treated with dignity, privacy and

respect, learning lessons from colleagues working in more culturally diverse urban areas such as Bristol.


Yes, we did achieve this priority.

A N N U A L R E P O R T 2 0 1 3 / 1 4 135

The Trust undertook a review of collective patient (patient, family member, carer, friend) feedback that cited

a less than favourable experience with regards to dignity, privacy or respect. This was also compared with

information reported by healthcare staff, both internal and external.

There were correlations between incident reports submitted from other care organisations/professionals and

complaints made by the public. During the first six months of 2013/14, the consistent top areas of reporting

for both patients/public and other caring professions were:

❙ Treatment/clinical management plans

❙ Attitude/communication

❙ Conveyance issues.

Of the complaints regarding communication issues, the most prominent was staff attitude. It is apparent

that how a person (whether patient or someone around the patient) feels as a result of contact with the

ambulance service seems to be as important as the clinical care, in influencing whether their experience was

positive or negative.

Common themes from complainants primarily referring to staff attitude include:

❙ Complaints regarding attitude issues are specific to individual members of staff rather than applying to all

staff members across the Trust

❙ During investigations relating to staff attitude, crews often responded that the complainant or those

around them were aggressive/rude and this had a negative impact on all communication

❙ Making recommendations regarding staff attitude is problematic. Without an independent witness to the

events it is often difficult to offer an objective viewpoint on what happened.

Common themes highlighted from incident reports primarily referring to communication include:

❙ Poor levels of professional conduct, with regards to attitude, demonstrated by individual staff members

❙ Incident reports regarding communication issues are often specific to the one issue rather than

encompassing other elements

❙ Incident reports from other healthcare professionals comment on how staff are seen to be abrupt or

challenging.

The Trust subscribes to the Patient Opinion website, an independent site where people can post their

experiences of using our services. The content of this is not coded in the same way that incidents or

complaints are - postings are rated for their level of criticism (referred to as a criticality score).

It is difficult to determine themes from the postings on the website, as there were only two posts that made

reference to a less than satisfactory experience with regards to dignity, privacy or respect. However, what is

clear from the majority of the postings on the website is that, largely, patients/carers are able to report a very

positive experience with the Trust, with no concerns in relation to dignity, privacy or respect.

Using the information gathered as part of the review of privacy, dignity and respect issues, a number of

recommendations have been identified, which include:

❙ Consider ways to educate patients on the service they can expect. For example the development of an FAQ

section on the internet regarding Trust policy/procedure

❙ Build an online education tool using the stories provided by patients to support staff to provide excellent

customer service

❙ Review complaints to identify members of staff with multiple attitude complaints within a 12 month

period and consider how these staff members could be supported to help reduce the number of

complaints.

This action plan has been presented to the Learning From Experience Group and will continue to be

monitored by the group until completion.

Tools available to support staff communication with patients include:

❙ Access to the pre-hospitalisation communication guide that offers help to staff in conversing with patients

who may need help with communication e.g. where English is not their first language

❙ Invitation for patients to provide feedback via calling cards. The card offers a question based on the

Friends and Family Test (Based on your experience of our service, would you be happy for a relative or

friend to receive the same level of service?) and directs them to the Patient Opinion website (or Freephone

number) to provide the feedback. This card has encouraged staff to promote feedback opportunities with

collective patients and give them an option to share their experience with the Trust, whether positive or

less favourable

❙ The Trust has also made a script for a film that will be available to staff online. The script uses a real

patient account in the patient’s words to demonstrate the different experiences they had when they used

the service twice in one week.

Further work to support future commitment to continuous communication improvements include:

❙ During 2013/14 the Trust carried out some face-to-face ‘real-time’ patient surveys in Emergency

Departments. In these surveys patients were asked specific questions around dignity, privacy and respect.

These surveys will be reviewed to further identify means to support positive staff communication with

patients in future

❙ Specific work is now being undertaken to review the content of Trust plaudits (compliments) from patients

and those who support them, to understand the motivation for those who make a specific effort to say

‘thank you’ to Trust staff. This work will help to highlight pockets of excellence that will be translated into

guidance for staff to promote improved communication in all aspects of patient contact.

A N N U A L R E P O R T 2 0 1 3 / 1 4 137

Quality Priorities for Improvement 2014/15

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 the Trust has a Council of Governors which is

invaluable in providing representation of the views of Governors constituents, the membership and the

public, gained through engagement activities.

The Trust consulted with its Council of Governors to obtain their opinion and input on the suggested

priorities within this report. Senior Trust personnel gave information to the Governors to facilitate table top

discussions. This enabled them to input into the construction and content of the priorities.

In developing the priorities for 2014/15, the Trust has also taken into account feedback provided by

stakeholders, including commissioners, from the 2012/13 Quality Account. This feedback has also been taken

into account in the inclusion of information within the quality overview in Part 3 of this report.

The Trust’s commissioners have been consulted on the priority areas proposed for 2014/15, to ensure the

health community supports the areas identified.

In setting the priorities for 2014/15 consideration has also been given to Quality Account priorities from

previous years, learning from these and the benefits in focusing further on these areas. As a result the

patient safety priority continues to relate to sepsis and how this is identified and managed. This year it will

focus on sepsis in children. The indicator relating to sepsis was originally introduced due to the identification

of trends from learning through adverse and serious incident reporting and balancing this with information

reported from other organisations and the wider health community. Whilst improvements have been made in

the management of sepsis, continuing the focus in this area will benefit patient care.

The Trust is required to submit information for a number of quality targets known as Ambulance Clinical

Quality Indicators. These are a set of indicators which have been agreed nationally by ambulance trusts as a

way of driving continuous quality improvement. Some of these are indicators included in this quality report

as mandatory indicators. The third improvement indicator this year relates to one of these quality indicators.

Analysis of the root cause of breaches to the STEMI call-to-balloon (CTB) time (a treatment for patients

suffering from a heart attack) will occur to identify areas for improvement. This has been identified by local

commissioners as a priority for improvement.

A major project during 2014/15, which will be a key driver for quality improvement, is the implementation

of the Electronic Care System (ECS). This exciting innovation will improve the management of pre-hospital

care and will have the technical ability to integrate with systems within both the acute and community care

settings.

During 2013/14 the implementation leads for the agreed priorities were responsible for monitoring 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. This structure will be continued during the forthcoming year.

PAT I E N T S A F E T YPriority 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.

Board Sponsor:

Executive Medical Director

Implementation Lead:

Clinical Development Manager West

How will we know if we have achieved this priority?

❙ The Trust will publish a clinical audit focusing on the management of sepsis

❙ A report will be presented to the Clinical Effectiveness Group setting out the choice of recognition tool

and the impact it will have on practice

❙ Share feedback from local paediatric sepsis champions through the Clinical Effectiveness Group and other

relevant working groups.

A N N U A L R E P O R T 2 0 1 3 / 1 4 139

CL I N I C A L E F F E C T I V E N E S SPriority 2 – Electronic Care System (ECS) - Why a priority?

The implementation of 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.

Board Sponsor:


Implementation Leads:

Clinical Development Manager East


❙ Implementation of the ECS according to the delivery plan

❙ Delivery of the training required for Trust staff to be able to effectively utilise the system.

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 call-

to-balloon 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%.

Board Sponsor:


Implementation Lead:

Clinical Development Manager North


❙ Achieve 84% CTB local target by 31/03/2015

❙ Provide evaluation report and plans to sustain performance to participating CCGs and Lead Commissioner.

PAT I E N T E X P E R I E N CEPriority 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

SWASFT 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 measure, together with supporting questions to help understand the

important elements that drive patient satisfaction across its various services.

A N N U A L R E P O R T 2 0 1 3 / 1 4 141

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 and it has committed to extending

the FFT to the all NHS-funded services, including ambulance services, by the end of March 2015. In addition,

from 1 April 2014, all NHS trusts providing acute, community, ambulance and mental health services in

England are required to implement the FFT for staff.

Initiatives

The initiatives include:

❙ Implement staff Friends and Family Test according to the 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.

Board Sponsor:

Executive Director of Nursing and Governance

Implementation Leads:

Senior Patient Experience Manager and Patient Engagement Manager

How will we know if we achieve this priority?

❙ We will have mechanisms for asking the FFT for both patients and staff

❙ We will be able to report FFT by service line

❙ We will be able to track FFT by time

❙ We will be able to publish FFT internally.

Statements of Assurance from the Board

S TAT U T O R Y S TAT E M E N TThis 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 2013/14 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 and GP Out-of-Hours)

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 all of these relevant health services.

1.2 The income generated by the relevant health services reviewed in 2013/14 represents 97.61% per

cent of the total income generated from the provision of relevant health services by the South

Western Ambulance Service NHS Foundation Trust for 2013/14.

2 During 2013/14, 1 national clinical audits and 0 national confidential enquiries covered

relevant health services that South Western Ambulance Service NHS Foundation Trust provides.

2.1 During that period South Western Ambulance Service NHS Foundation Trust participated in 100%

national clinical audits and 0% 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 2013/14 are as follows:

National Ambulance Non Conveyance Audit.


NHS Foundation Trust participated in during 2013/14 are as follows:

National Ambulance Non Conveyance Audit.


NHS Foundation Trust participated in, and for which data collection was completed during 2013/14,

are listed below 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 Ambulance Non Conveyance Audit - 290 cases (100%).

A N N U A L R E P O R T 2 0 1 3 / 1 4 143

2.5 The reports of 1 national clinical audits were reviewed by the provider in 2013/14 and South Western

Ambulance Service NHS Foundation Trust intends to take the following actions to improve the quality

of healthcare provided:

Participate in the 2014/15 National Ambulance Audit of Non Conveyance.

The reports of 17 local clinical audits were reviewed by the provider in 2013/14 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

Following successful trials of drug interventions for patients who have overdosed, continue

to engage with the Medicines Management Group to inform medicines evaluation and

procurement

Work with the Clinical Development team to reiterate the importance of reducing on scene

times for patients with a suspected stroke

Work with the sepsis clinical sub group to develop a programme of work improving recognition

of suspected sepsis and trialling the feasibility of pre-hospital point of care testing for lactate

Ensure that the outputs of clinical audit are used to inform the work of the Quality Improvement

Paramedics.

3 The number of patients receiving relevant health services provided or sub-contracted by South

Western Ambulance Service NHS Foundation Trust in 2013/14 that were recruited during that period

to participate in research approved by a research ethics committee was 341.

4 A proportion of South Western Ambulance Service NHS Foundation Trust income in 2013/14

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

2013/14 and for the following 12 month period are available on request from www.swast.nhs.uk.

The monetary total available for the Commissioning for Quality and Innovation payments, for all

service lines, for 2013/14 was £3,564,833 and for 2012/13 was £2,558,968.

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’. South

Western Ambulance Service NHS Foundation Trust has the following conditions on registration:

None.

The Care Quality Commission has not taken enforcement action against South Western Ambulance

Service NHS Foundation Trust during 2013/14.

6 South Western Ambulance Service NHS Foundation Trust has participated in special reviews or

investigations by the Care Quality Commission relating to the following areas during 2013/14:

An unannounced inspection of:

Outcome 2 – Consent to care and treatment

Outcome 4 – Care and welfare of people who use services

Outcome 10 – Safety and suitability of premises

Outcome 16 – Assessing and monitoring the quality of service provision

Outcome 17 – Complaints.

The final report was published in March 2014 and the South Western Ambulance Service NHS

Foundation Trust was assessed as being compliant with these standards.

South Western Ambulance Service NHS Foundation Trust intends to take the following actions to

address the conclusions or requirements reported by the Care Quality Commission:

None (assessed as compliant).

South Western Ambulance Service NHS Foundation Trust has made the following progress by 31

March 2014 in taking such action:

Not applicable.

7 South Western Ambulance Service NHS Foundation Trust did not submit records during 2013/14 to

the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the

latest published data.

8 South Western Ambulance Service NHS Foundation Trust Information Governance Assessment Report

overall score for 2013/14 was 68% and was graded green.

9 South Western Ambulance Service NHS Foundation Trust was not subject to the Payment by Results

clinical coding audit during 2013/14 by the Audit Commission.

10. South Western Ambulance Service NHS Foundation Trust will be taking the following action to

improve data quality:

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

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.

A N N U A L R E P O R T 2 0 1 3 / 1 4 145

K E Y P E R F O R M A N CE I N D I C AT O R SThis 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.

C AT E G O R Y A P E R F O R M A N CE ( W H O L E T R U S T )

Performance

Category A Performance

Targ

et

20

13

/14

20

12

/13

Jun

to

Ma

r(S

WA

SF

T)

20

12

/13

Jun

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(GW

AS

)

20

12

/13

Ap

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M

ay

*

Na

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01

3/1

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*

Hig

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01

3/1

4*

*

Lo

we

st

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01

3/1

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*

Red 1 75% 73.15% 73.01% 75.3% 75.8%(SWASFT)

76.8% (GWAS)

75.5 80.6 71.0

Red 2 75% 77.23% 75.93% 76.9% 74.6 78.8 70.1

Performance

Category A Performance

Targ

et

20

13

/14

20

12

/13

(SW

AS

FT

)

20

12

/13

Ap

r to

Ja

n

(GW

AS

)

Na

tio

na

lA

ve

rag

e2

01

3/1

4*

*

Hig

he

st

Tru

st2

01

3/1

4*

*

Lo

we

st

Tru

st2

01

3/1

4*

*

19 Minute 95% 95.76% 95.36% 95.7% 96.1 97.8 80.0

*In 2012/13 the reporting of Category A 8 minute response times was split into Red 1 and Red 2 with effect from 1 June 2012, previously performance was reported on a combined basis.

**Highest/Lowest Trust reporting has been noted for each indicator independently, current information from YTD 2013/14 reported at the end of February.

For clarification, Category A incidents are those with patients with a presenting condition which may

be immediately life threatening and who should receive an emergency response within eight 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 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 position at the start of quarter four 2013/14 showed the Trust had breached the Red 1

performance target for four consecutive quarters (including quarter three of 2013/14). Details of this breach

have been reported within the Annual Governance Statement, which forms part of the Annual Report. This

includes assurance of the action taken to improve the position (as well as discussions with Monitor) and the

performance for the final quarter of 2013/14 is 76.86%. The Trust maintained its Monitor Green Governance

Risk Rating throughout the year.

In addition, during the final quarter of 2013/14 the Trust received an unannounced CQC inspection, which

included the outcome relating to the quality of service provision. The inspectors requested information

on current Red 1, Red 2 and A19 performance. They were provided with documentation and assurance

of the processes which had been implemented to achieve Red 1 performance in quarter four, and the

improvements that had already been delivered at the time of the inspection. The lead inspector also spoke

with commissioners, who confirmed their satisfaction with the progress made. The CQC did not make any

recommendations or impose any compliance conditions following their inspection.

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

❙ Additional scrutiny on the quality of performance information has also been received this year with the

delivery of an internal audit report on Red 2 performance information.

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 areas of the Trust and commissioners to identify where and how

improvements to performance can be achieved.

A M B U L A N CE CL I N I C A L Q U A L I T Y I N D I C AT O R S ( A CQ I s ) :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

May 2013 a national benchmarking day was led by SWASFT’s Research and Audit Manager. The day aimed

to capture the process maps from each trust and look at any differences in data collection and validation

points before submissions. The largest variations were found in the application of the inclusion and exclusion

criteria, and not in the application of the criteria to measure performance. The results of this work have been

shared with the National Ambulance Clinical Quality Group and the National Medical Directors Group and a

programme of work is being developed nationally to progress key actions during 2014/15. This will include:

❙ Updates to the technical guidance issued to ambulance services, including bespoke guidance for users of

electronic record solutions

❙ Establishing a robust method of peer review to provide assurance on quality and comparability of data.

Whilst there are currently no national performance targets, local thresholds have been agreed with the

Trust’s commissioners and these are shown in the table below. In addition the data on 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

SWASFT’s monthly integrated corporate performance report presented to the Trust Board of Directors and

available on the Trust’s website.

A N N U A L R E P O R T 2 0 1 3 / 1 4 147

Indicator

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20

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/13

Na

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)

Hig

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stTr

ust

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3)*

Lo

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stTr

ust

Pe

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(Ap

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3)*

Outcome from Acute ST-Elevation Myocardial Infraction (STEMI) - % of patients suffering a STEMI and who receive an appropriate care

bundle

85% 89.8%

84.2% (SWASFT)

94.7%(GWAS)

80.5% 89.8% 66.7%

Outcome from Stroke for Ambulance Patients - % of suspected stroke patients (assessed face to face) who receive an appropriate care bundle

95% 97.3%

95.8% (SWASFT)

100%(GWAS)

96.3% 99.4% 91.8%

*Highest/Lowest Trust reporting has been noted for each indicator independently.

Data for these indicators is not currently available for information after November 2013. 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.


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 Ambulance Clinical Quality

Indicators.

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 provision of emails to staff every time they attend a patient in cardiac arrest achieves ROSC on arrival

at hospital. These feedback emails have been well received by those staff concerned, enabled constructive

discussion and review of care bundle delivery at station level and will enable the Trust to identify any

recurrent issues or concerns to help inform future service/process developments

❙ Undertaking a programme of quality improvement activity across all regions, supported by two quality

improvement paramedics.

An appropriate care bundle is a package of clinical interventions that are known to benefit patients’ health

outcomes. These actions are the ‘must dos’ but do not include all the clinical actions that may take place

during the treatment of the patient.

S TA F F S U R V E Y:One of the key findings in the 2013 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 strongly disagree

to strongly agree. Staff responses were then converted into scores. The table below shows SWASFT’s

performance, compared to last year and other trusts performance.

Staff Survey IndicatorPerformance 2013

Performance2012

National Average 2013

Highest Trust Performance 2013

Lowest Trust Performance 2013

Staff recommendation of the trust as a place to work or receive treatment

3.313.39 (SWASFT)

3.15 (GWAS) 3.08 3.31 2.72

South Western Ambulance Service NHS Foundation Trust considers that this data is as described for the

following reasons:

❙ The Trust actively encouraged all staff to complete and return the staff survey by visiting all stations and

work areas to promote the survey

❙ Responses to the survey were collated and reported to the Trust by an external source.

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 2013 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

❙ Ensuring that staff have the opportunity to give feedback on this point through implementing the Friends

and Family Test for Staff by Q1.

A N N U A L R E P O R T 2 0 1 3 / 1 4 149

N AT I O N A L R E P O R T I N G A N D L E A R N I N G S Y S T E M :All trusts are required to provide confidential 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 6883 incidents reported in 2013/14, 1,429 have been identified as relating to patient safety.

The reporting of a high level of patient safety incidents to the NRLS has continued during 2013/14. 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/Date2013/14** 2012/13

NationalAverage

HighestTrust*

LowestTrust*

1 Oct to 31 Mar

01 Apr to 30 Sep

01 Oct to 31 Mar

01 Apr to 30 Sep

01 Oct 12 to 31 Mar 13

Total Incidents Reported to NRLS

699 730 604 496 273 749 50

Number of Incidents Reported as Severe Harm

2 21 12 6 4 12 0

Number of Incidents Reported as Death

0 0 1 0 2 8 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 October 2012 to 31 March 2013.


following reasons:

❙ The Trust has a good culture for reporting of adverse incidents

❙ Information is provided to the National Reporting and Learning System (NRLS) electronically through the

upload of data taken from the Trust’s adverse incident reporting system

❙ This information is then reported back to the Trust in aggregated reports by the NRLS.

The South Western Ambulance Service NHS Foundation Trust has taken the following actions to improve this

number, and so the quality of its services, by:

❙ Continued to encourage the reporting of adverse incidents by all members of staff so learning can occur at

all levels of the Trust

❙ Reviewed the mechanisms for learning from adverse incidents to ensure this is done quickly and effectively,

and disseminated to staff so they have confidence in the reporting system

❙ Reviewed the mapping of coding of patient safety incidents with the NRLS to ensure reporting is

consistent with national requirements.

Part 3 – Quality Overview 2013/14

A D D I T I O N A L Q U A L I T Y A CH I E V E M E N T S A N D P E R F O R M A N CE O F T R U S T AG A I N S T S E L E C T E D M E T R I C SThis section provides an overview of other performance metrics for the Trust.

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.

The remaining indicators contained in this Quality Report continue to follow the existing themes of the report

and have been categorised into patient safety, clinical effectiveness and patient experience.

R I G H T C A R EThe Trust established its Right Care initiative in 2010/11. This continues to focus on ensuring patients who

contact the 999 service receive the most appropriate care in the right place, at the right time, delivered

through a wide range of developments all aimed at improving the appropriateness of care given to patients.

Based upon the October 2013 Ambulance Clinical Quality Indicator performance data, the Trust conveyed

83,517 fewer patients annually to Emergency Departments across the South West compared to the national

average. If the Trust conveyed patients at the level achieved by the lowest performing Trust within England,

this would have resulted in an additional 140,864 patients attending South West Emergency Departments.

The Right Care Action Group continues to focus actions on the three key areas:

❙ Culture – ensuring that SWASFT staff, other healthcare providers and the public anticipate hospital

attendances only when they are necessary

❙ Clinical Support – training and supporting clinicians so they can feel confident in making decisions about

the most appropriate care for patients

❙ Communication – ensuring a high level of effective communication with SWASFT staff, external

stakeholders, and the general public.

CL I N I C A L G U I D E L I N E SIn 2013/14 the Trust won a Shared Learning award from the National Institute of Health and Clinical

Excellence (NICE). As part of the preparation for acquisition of the Great Western Ambulance Service NHS

Trust, the Trust was keen to combine best practice from both organisations. Every member of staff received a

copy of the new guidelines prior to 1 February 2013, to ensure all patients received the same high standard

of care. This resulted in an award recognising best practice in the implementation of clinical guidelines, which

was voted for by over 1000 healthcare professionals at the NICE annual conference.

A N N U A L R E P O R T 2 0 1 3 / 1 4 151

S I N G L E P O I N T O F A CCE S S P I L O TDuring 2013/14 the single point of access service based at the control room in St Leonards has been running

a pilot scheme aiming to reduce pressure on acute hospitals and to ensure the best patient care. The scheme,

run in conjunction with the Royal Bournemouth Hospital NHS Foundation Trust, has access to two dedicated

Emergency Care Practitioners (ECPs) from 8am to 8pm each day. They are able to make non-urgent home

visits to patients with more complex medical conditions who may become vulnerable without medical

assessment.

CQ C I N S P E C T I O NOn Tuesday 11 February 2014 the CQC commenced an unannounced inspection of the Trust. The lead

inspector confirmed this was a routine inspection, and that it was not triggered as a result of any concern.

The inspection occurred over five days, involved a total of four inspectors and assessed the Trust’s compliance

with five outcomes:

❙ Outcome 2 – Consent to Care and Treatment

❙ Outcome 4 – Care and Welfare of people who use services

❙ Outcome 10 – Safety and Suitability of Premises

❙ Outcome 16 – Assessing and monitoring the quality of service provision

❙ Outcome 17 – Complaints.

The outcome of the inspection was very positive. The final report, which is publicly available on the CQC’s

website confirms that the Trust is fully compliant with all outcomes assessed.

The report includes some really pleasing comments made by patients, including that staff are ‘kind’,

‘professional’ ‘caring’, and that ‘they do a fantastic job’. There are also many references within the report to

the positive way staff have responded to the inspectors explaining what, why and how they do their role.

Whilst this was an excellent outcome for the Trust, the inspection did provide an opportunity for constructive

criticism from the inspectors, and they did make some minor observations of areas the Trust could consider

improving. The Trust is taking these comments forward as part of its commitment to continuous quality

improvement.

The CQC are in the process of changing the way that they inspect health and social care organisations. The

new regime has been implemented for acute trusts, and will be introduced for ambulance trusts during

2014/15. Guidance documents are expected to become available early in 2014/15, and any future inspections

will follow the new regime.

PAT I E N T S A F E T YAll three core service lines for the Trust: A&E; Patient Transport Service and Urgent Care Service, are covered

in the patient safety measures reported. The table below reports other patient safety measures monitored.

Other Patient Safety Measures 2013/14 2012/13

Adverse Incidents 6787 5604

Moderate Harm Incidents 18 N/A*

Serious Incidents 78 54

*Introduced with effect from 1 April 2013.

The Trust has a central reporting system for adverse incidents, including near misses. The National Reporting

and Learning Service (NRLS) state that there is an emerging evidence base that organisations with a higher

rate of reporting have a stronger safety culture.

A fundamental part of the Trust’s risk management system is appropriately managing serious incidents

to ensure lessons are learnt. Serious Incidents are identified through a systematic review of both adverse

incidents and patient feedback. All incidents which are believed to potentially meet the nationally set criteria

for a serious incident are passed to the clinically qualified Serious Incident Manager for preliminary review,

before being circulated to the Director led decision making group.

The Trust has seen an increase in serious incidents in 2013/14 and analysis of the information has shown that

there is an equal split between serious incidents identified between North and East/West divisions for the

A&E Service line. There is a similar, equal divisional split for the serious incidents identified from the clinical

hubs. It is important to note that the proportion of serious incidents as a percentage of patient contact

activity remains very low. The Trust has contributed to the National Ambulance Service Medical Directors

(NASMeD) review of serious incidents reported by all ambulance trusts. This identified very similar themes to

those being seen at this Trust.

Serious incident investigations are heard by Serious Incident Review Meetings, these meetings are chaired by

a clinical director or deputy director; 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, Trustwide or at times

national level, for example referring learning to NHS Pathways to help them improve the national system. A

Serious Incident Action Plan is maintained to monitor progress against actions identified.

From 1 April 2013, a duty 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). The Trust developed a process for management of these

incidents and agreed this with our commissioners.

The Trust continues to report information relating to adverse incidents, moderate harm incidents and serious

incidents to a variety of forums, in order for themes and trends to be identified. Having 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 a Learning

From Experience Group receiving reports on incidents and considering these alongside complaints, claims,

A N N U A L R E P O R T 2 0 1 3 / 1 4 153

safeguarding and workforce reports in order to collectively and individually identify trends, and recommend

improvements in practice. The Trust’s commissioners also receive comprehensive reports on adverse incidents

as required.

During the year the Trust has introduced an additional newsletter, called Reflect. This provides a mechanism

for feedback from all levels of incidents to be reported to all staff. Previously it was likely that only the staff

involved in the incident, or those working within the same area, would hear of feedback. Now a bi-monthly

publication provides specific feedback on learning. This newsletter complements the existing suite provided

to staff including the weekly bulletin from the Chief Executive, Clinical News, Hubbub and The Mercury.

Other Patient Safety Measures 2013/14 2012/13

Central Alert System (CAS) Received 232 142

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 2013/14 the Trust acknowledged 100% of CAS within 48

hours, thereby meeting the national requirement. In 2013/14 the Trust implemented all relevant CAS within

the timeframe specified.

CL I N I C A L E F F E C T I V E N E S SThe 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 tables below show the Trust’s Category A Performance by Clinical Commissioning Group. In the 2012/13

report information was supplied by Trust division, this has been changed as a direct result of feedback from

stakeholders.

Clinical Commissioning Group

No

of

Inci

de

nts

*

Re

d 1

P

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orm

an

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01

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4*

No

of

Inci

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*

Re

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P

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ce

20

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/14

*

No

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Inci

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A1

9 P

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orm

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ce

20

13

/14

*

Kernow 1,086 70.44% 34,834 76.67% 35,650 94.24%

South Devon & Torbay 651 78.49% 18,919 82.49% 19,562 97.77%

NEW Devon 1,619 78.88% 49,548 81.98% 50,796 95.91%

Somerset 946 71.56% 29,463 78.17% 30,380 95.88%

Dorset 1,503 83.63% 47,081 81.78% 48,421 97.86%

North Somerset 737 63.36% 10,510 67.70% 11,246 93.15%

Bath & NE Somerset 570 71.50% 7,647 74.10% 8,208 94.71%

Bristol 1,810 78.17% 25,645 78.50% 27,387 97.87%

South Gloucestershire 743 62.71% 10,464 66.36% 11,206 96.75%

Gloucestershire 1,945 69.10% 28,729 71.92% 30,668 94.44%

Wiltshire 1,379 58.73% 21,548 64.38% 22,891 90.72%

Swindon 744 88.70% 10,537 87.70% 11,249 99.00%

Trust 13,763 73.15% 295,515 77.23% 308,283 95.76%

Due to the changes in the clinical commissioning groups which came into effect from 1 April 2013 comparative historical data is not provided.

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, the auditing of patients experiences.

In the 2012/13 report the Trust identified that full reporting of the national quality requirements in relation

to the Urgent Care Services would be included in this year’s report. 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.

A N N U A L R E P O R T 2 0 1 3 / 1 4 155

GP Out-of-Hours Service

The table below shows the achievement of the national quality requirements.

Quality Requirement TargetSomerset & Dorset

Gloucester

QR1 - Providers must report regularly to NHS Commissioners on their compliance with the Quality Requirements

Compliance 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% 99.47% 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

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

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

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 - Urgent Consultations (presenting at base) started within 2 hours

95.00% 92.73% 100%

QR12 - Less Urgent Consultations (presenting at base) started within 6 hours

95.00% 98.11% 100%

QR12 - Urgent Consultations (home visits) started within 2 hours 95.00% 87.50% 97.67%

QR12 - Less Urgent Consultations (home visits) started within 6 hours

95.00% 95.68% 98.29%

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


NHS 111

The Trust commenced delivery of the NHS 111 service in Dorset with full launch effective during March 2013.

During 2013/14 additional 111 services delivered by the Trust became live. In September the Trust launched

the Devon 111 service, and in November 2013 and February 2014, the Trust started delivering the services in

Somerset and Cornwall and the Isles of Scilly, respectively.

The Trust took the opportunity to learn from the implementation of the service in Dorset to ensure smooth

transition for the delivery of services in the other three counties.

The table below shows the activity levels for the four counties in 2013/14, and the achievement of the

national quality requirements for these areas.

Quality Requirement Target Dorset Devon SomersetCornwall and IOS

Activity (Total calls answered) N/A 204,307 80,383 52,201 8,678

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 8.00 a.m. the next working day

95.00% 97.75% 98.46% 97.42%Not Available

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


QR8a - No more than 5% of calls abandoned before being answered

5.00% 2.09% 1.27% 1.18% 1.63%

A N N U A L R E P O R T 2 0 1 3 / 1 4 157

Quality Requirement Target Dorset Devon SomersetCornwall and IOS

QR8b - Calls to be answered within 60 seconds of the end of the introductory message

95.00% 91.55% 92.85% 92.36% 91.65%

QR9a - All immediately life threatening conditions to be passed to the ambulance service within 3 minutes

100.00% 86.61% 85.49% 86.33% 89.99%

QR9b - Patient callbacks must be achieved within 10 minutes

100.00% 44.86% 38.44% 36.76% 31.02%

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% Compliant Compliant Compliant Compliant

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


Ambulance Clinical Quality Indicators

The tables below, and overleaf, show Trust performance for further ACQI. As previously stated one of the

Trust’s selected priorities for 2013/14 is the development of a Post ROSC Care Bundle.

Ambulance Clinical Quality Indicators

Indicator

Ye

ar

to d

ate

2

01

3/1

4(A

pr

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ov

)

20

12

/13

Na

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ve

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e(A

pr

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ov

-13

)

Hig

he

stTr

ust

Pe

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nce

(Ap

r to

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v-1

3)*

Lo

we

stTr

ust

Pe

rfo

rma

nce

(Ap

r to

No

v-1

3)*

Return of spontaneous circulation (ROSC) at time of arrival at hospital (Overall)

24.4%24.6% (SWASFT)

25.8% (GWAS)

25.9% 39.5% 16.9%

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

55.0%52.6% (SWASFT)

61.3% (GWAS)

63.3% 77.0% 43.2%


Ambulance Clinical Quality Indicators: Ambulance calls closed with telephone advice or managed without transport to A&E departments (where clinically appropriate)

Indicator

Ye

ar

to d

ate

2

01

3/1

4(A

pr

to F

eb

)

20

12

/13

Na

tio

na

lA

ve

rag

e(A

pr

13

to

Fe

b 1

4)

Hig

he

stTr

ust

Pe

rfo

rma

nce

(Ap

r 1

3 t

o F

eb

14

)*

Lo

we

stTr

ust

Pe

rfo

rma

nce

(Ap

r J1

3 t

o F

eb

14

)*

Calls closed with telephone advice 6.7%6.4%

(SWASFT)

7.2% (GWAS)

5.9% 11.7% 2.2%

Incidents managed without the need for transport to A&E

51.6%51.2% (SWASFT)

47.8% (GWAS)

36.1% 51.6% 25.4%


As stated earlier in this report, in November 2013 the first stage of Transforming Urgent and Emergency

Care in England was published. The report identified that there was an opportunity to bring about a shift

from patients being treated in hospital to treatment at home. It specified 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 table above shows

the percentage of calls closed with telephone advice and those managed without taking the patient to an

Emergency Department.

CL I N I C A L Q U A L I T Y I M P R O V E M E N T SQuality Improvement Paramedics

The role of the Quality Improvement Paramedic (QIP) is to identify best practice, review current Trust

performance, work with operational staff to identify areas for improvement and develop and test changes to

practice. The Trust now has a QIP in each of its divisional areas, working in collaboration with the Research

and Development team and wider Medical Directorate colleagues.

They have been responsible for facilitating quality improvement collaboratives which aim to engage clinical

staff and identify barriers to the delivery of optimal care. Several of these events have been held during

2013/14, some internally and others with partner agencies to improve the delivery and organisation of care

from call taking to clinical interventions at scene.

Through the use of ‘Plan, Do, Study, Act’ cycles, staff led interventions have been identified and evaluated

to allow the most effective ideas to be shared to spread the positive change. Post ROSC care and the timely

conveyance of stroke patients to appropriate centres have been two of the areas where quality improvement

work has focussed this year. The Trust has also enjoyed sharing quality improvement methods with a wide

audience who attended study days hosted by the College of Paramedics.

Inaugural Research Day

The Trust held its inaugural research showcase on 15 July 2013 in Taunton, Somerset.

The aim of the event, hosted by the Trust’s Research and Audit Team, was to showcase some of the

A N N U A L R E P O R T 2 0 1 3 / 1 4 159

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 two

of the Trust’s University partners (Plymouth University and the University of West of England Bristol), and

representatives from the research community and Higher Education Institutions (HEIs).

The speakers presented on a range of projects, including both recently completed and open studies:

❙ Stroke Pathways - The Peninsula Collaboration for Leadership in Applied Health & Care (PenCLAHRC)

led on this operational research, which used discrete event modelling to assist with the delivery of

thrombolysis in acute ischemic stroke. The project created computer simulations that explore the different

ways in which people who have suffered a stroke are managed between arriving at hospital and receiving

thrombolysis. The simulations consider the number and level of healthcare

❙ Professionals involved with each case, the time of day or night, and how busy the different hospital

departments involved in this pathway are. The simulations allow the benefit to be measured (in terms of

patients free of disability) from alterations to the emergency pathway for stroke

❙ REVIVE Airways - This project is a randomised, feasibility study, funded by the National Institute for

Health Research (NIHR) and seeks to determine whether the proposed design will allow comparison of

supraglottic airway devices (SADs) with current practice during pre-hospital cardiac arrest

❙ Lucas in Cardiac Arrest: the LINC study - This international trial compared conventional cardiopulmonary

resuscitation (CPR) methods with a mechanical chest compression device and simultaneous defibrillation

❙ The OAK study - is funded by the National Institute for Health Research from the Research for Patient

Benefit Programme (NIHR RfPB) and aims to examine whether the Ambulance Paramedics and ECPs can

use FRAX® (the WHO Fracture Risk Assessment Tool) to assist GPs in improving the future fracture risk

in patients that fall. This feasibility study seeks to explore whether ambulance clinicians can obtain the

necessary information to estimate a patient’s fracture risk, and if the GPs will act on the information given

to them. The study will help the team to design a full trial. The full trial will find out if the ambulance crew

can collect information from people that fall and help GPs to target treatment for osteoporosis at those

patients most likely to have a future fracture.

A representative from the College of Paramedics, illustrated some of the developments within the paramedic

profession that have led to a change in focus and delivery of care and explained why ambulance staff need

to be, at the very least, research aware. She gave examples of career pathways and funding opportunities

that could be explored by those interested in becoming career researchers.

The Trust’s own Research Paramedics shared their experience of starting off on their research journey and

provided an insight into some of the requirements for undertaking a Masters in Clinical Research (MRes).

They explained that there is a competitive process for the NIHR places and that the course is demanding but

rewarding and is equipping them well for a future career with research as a key component.

The event was supported by a representative from one of the Trust’s lead NHS health libraries. Staff were

provided with information, tools, hints and tips on searching for evidence to support their learning and to

promote evidence based pre-hospital practice and research skills. There was a display dedicated to the library

services with copies of resources available for staff to take away.

A poster display included some of the ongoing research and quality improvement projects conducted by staff

and some that involved collaborations with Higher Education Institutions (HEIs) and other Trusts. There was

also a dedicated display for student projects and two prizes were awarded for these on the day.

The event was shared with a global audience through social media. Over 300 ‘tweets’ were sent during the

event, which resulted in over 300,000 twitter impressions. The event was so successful that it will become an

annual showcase of research activity.

PAT I E N T E X P E R I E N CEPatient experience and patient engagement provides 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.

The table below shows some of the Trust’s existing methods and quantitative information on service user

experience.

Patient Experience Measures 2013/14 2012/13

Complaints, Concerns and Comments 1,020 923

Patient, Advice and Liaison Service (PALS) –

Lost Property, signposting to other services etc711 1150

Health Service Ombudsman complaints upheld 1 0

Compliments 1,454 1,261

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.

The information for 2012/13 is a combined figure for the former GWAS Trust and SWASFT. The reason for the

clear reduction in PALS from 2012/13 to 2013/14 is a change in the processes for categorising and handling

comments, concerns, complaints and PALS, which were reviewed to identify best practice during acquisition.

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 actual members of staff who attended the patient or

service user.

In addition during the year the Trust had introduced the use of ‘wordles’ - 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 2013/14, the larger the word/phrase the more frequently it

was used.

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PAT I E N T E N G AG E M E N TDuring 2013/14 the Trust has continued to develop its patient engagement activities. Engagement helps to

ensure that the Trust’s services are responsive to individual needs, they are focused on patients and the local

community, and support SWASFT in improving the quality of care provided.

The patient engagement team source patient stories for use at the start of each Board of Directors’ meetings,

and Council of Governors meetings. These can be written testimonies which are read out by a member

of the forum, or more recently have involved audio and video patient interviews obtained by the Patients

Association as part of our annual membership of this organisation.

Patient Opinion

Patients and their relatives and carers can post details of their experience on the website Patient Opinion,

and this can be viewed publicly. The Trust responds to every post relating to SWASFT on Patient Opinion.

Where the feedback is negative or indicates service failure, the reporter is invited to contact the Trust directly

with further details. This information would be passed to the Patient Experience Team to process. Where

the response is positive but there is insufficient detail the patient engagement team will respond requesting

additional information in order to be able to process the information as a compliment direct to the member(s)

of staff involved.

In total in 2013/14 224 stories relating to the Trust had been posted on Patient Opinion, as at 7 April 2014

these accounts of patients’ experience had been viewed 57,866 times.

The headlines of the top three stories, based on number of times they have been viewed, are shown below.

‘The paramedic could not have been kinder or more caring.’

‘There was nothing any of them could have done better.’

‘I am confident that everything that could have been done was done for my wife.’

A trial was undertaken early in 2013/14 on the use of a business card being handed out to patients inviting

them to share their feedback via Patient Opinion and to answer the Friends and Family Test question. The

trial initially focussed on the Patient Transport Service, but this business card has now been rolled out to all

A&E frontline vehicles and the GP Out-of-Hours Service.

The Trust has improved the use of social media during the year to promote the Trust’s engagement methods,

including Patient Opinion.

Surveys

The patient engagement team is working towards standardising the Trust’s approach to patient surveys which

are conducted as a contractual requirement. This includes ensuring that the Friends and Family Test question

is asked consistently across all feedback mechanisms and the inclusion of a national ambulance service

patient quality indicator as developed by the National Ambulance Service Patient Experience Group (NASPeG).

The patient engagement team has also carried out some face to face research with patients. This has included

trialling a realtime patient feedback survey tool in the Royal Cornwall Hospital NHS Trust and the Royal Devon

and Exeter NHS Foundation Trust.

During 2013/14 147 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 these. The events also provide an opportunity to deliver proactive health checks, 7,876 members of the

public received a ‘Know Your Blood Pressure check’ and 220 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, are made.

A N N U A L R E P O R T 2 0 1 3 / 1 4 163

Assurance Statements - Verbatim

CL I N I C A L CO M M I S S I O N I N G G R O U P S (CCG)South West Commissioning Support (including combined Clinical Commissioning Group

commentary)

South Devon and Torbay Clinical Commissioning Group (CCG) is the Lead Commissioner for the 999 part of

the South Western Ambulance Service NHS Foundation Trust (SWASFT) organisation and NEW Devon CCG is

the Lead Commissioner for the Devon 111 Service. South West Commissioning Support (SWCS), who manage

the 999 contract on behalf of Commissioners, have provided a combined commentary on the performance

of the organisation. SWCS 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.

Commissioners appreciate your sharing of the draft Quality Account for 2013/14 and are pleased to accept

the opportunity to comment. Commissioners have monitored the safety, effectiveness and patient experience

of the service provided by SWASFT during 2013-14. The Trust’s engagement in the quality contract

monitoring process provides the basis for commissioners to comment on the quality account including

performance against quality improvement priorities and the quality of the data included.

Commissioners are very pleased to have worked alongside SWASFT during 2013/14 to maintain and further

improve the quality of commissioned services. The Trust is a responsive, dynamic and innovative organisation,

and has worked hard to develop excellent working relationships with commissioners. SWASFT has taken

on extra responsibilities over the past year including NHS 111 provision but commentary is primarily based

on knowledge of the Trust as a provider of 999 services. New Devon CCG does recognise the proactive

and collaborative work undertaken by the joint 111 Clinical Action Group. The Trust 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 2013/14 demonstrate this.

South Gloucestershire CCG highlights SWASFT’s acknowledgement that this has been a challenging year for

the NHS and the local health economy. Taking into account the acquisition of Great Western Ambulance

Service (GWAS) in 2013 – the Trust now provides ambulance services in Devon, Dorset, Somerset, Cornwall

and the Isles of Scilly, Bath, Swindon, North East Somerset and Bristol, North Somerset and South

Gloucestershire (BNSSG). Also, the underlying organisational change that the Trust has managed with little

demonstrated impact on quality of services. The Trust should be commended for 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. The Trust has produced a

comprehensive, well written Quality Account. It is easy to read and clearly set out. All the relevant sections

required are present and it is clearly presented in the format required by the Department of Health Toolkit.

SWASFT has been open and transparent regarding the challenges and concerns and the CCGs acknowledge

this transparency.

Commissioners have reviewed and can confirm that the information presented in the Quality Account

appears to be accurate and fairly interpreted, from the data collected. The Quality Account demonstrates a

high level of commitment to quality in the broadest sense and is commended. The information it contains

accurately represents the Trust’s quality profile and contains appropriate statements of assurance from the

Board. It reflects some of the very good work undertaken by the organisation and sets out clearly the quality

ambitions and achievements of 2013/14 and sets the direction for 2014/15 (building upon elements of the

2013/14 priorities). Commissioners support objectives which have clear outcomes for patients describing how

this intervention has made a difference to them.

Performance

Following the publication of ‘Transforming Urgent Care in England’ in November 2013, there was the

opportunity to shift the care of patients to home rather than necessarily transfer all 999 calls to hospital.

New Devon CCG is pleased to be the lead commissioner for the Devon 111 service. They recognise that

2013/14 has been challenging for the organisation. The Trust has recruited and trained a large number of

new call handler staff which may indicate why the key performance indicator relating to the target for call

backs within 10 minutes has not been achieved. They are assured that SWASFT are fully sighted on the

priorities for the implementation and delivery of the service and look forward to working closely with the

Trust to continue to develop the service over the coming year.

Whilst Wiltshire CCG recognises the challenges that a rural locality presents and they will continue to work

collaboratively to improve patient outcomes, they are disappointed that Category Red 1 performance for

Wiltshire was only 59.05%. North Somerset CCG have also expressed disappointment with the performance

for Category A type calls which are significantly below target for their area. They look forward to the

acquisition benefits being realised in order to enable the promised improvement.

B&NES CCG are of the opinion report is very well presented and broadly covers the areas and overall

performance, however there is no real recognition of the drop in the response standards within the North

region (old GWAS) and the subsequent drop in quality for the public within some of this area. It would be

useful to incorporate within the report the need for improvement in the North, as this will provide greater

necessity on SWASFTs part to improve. It’s good to see B&NES call to balloon CTB objectives in the report.

Within the report, North Somerset CCG would like to have seen information pertaining to the performance

of ‘Green’ category calls which are performance areas with locally agreed targets for the ‘North Division’.

This was considered important as patient experience and feedback pertains to these calls that comprise the

majority of responses and include, suspected stroke with no serious symptoms, fractured arm/leg, fall with

injuries.

Governance

Somerset CCG notes that there was evidence of engagement with the Council of Governors in the

development of the draft Quality Account and setting improvement priorities for 2014/15 (though

engagement appears to have been more passive than active). There was no engagement with patients and

staff.

There has been reporting against mandatory ambulance performance indicators, ambulance clinical quality

A N N U A L R E P O R T 2 0 1 3 / 1 4 165

indicators. It was positive to see reporting against Out of Hours Clinical Standards and NHS 111 Clinical

Standards, and these are congruent with CCG quality monitoring. Somerset CCG believes it would be helpful

to have had commentary on actions being taken to improve those areas of poorer performance to reassure

patients and the public. In future it would be helpful to see relevant reporting against each contracted

service in the three domains of quality: patient safety, patient experience and clinical effectiveness.

Gloucestershire CCG mentions that during 2013/14 there have been robust arrangements in place with

SWASFT and Gloucestershire Hospital NHS Foundation Trust (GHNHSFT) to agree monitor and review the

quality of services. The Clinical Quality Review Group has met on a quarterly basis and brings together GPs,

senior clinicians and managers from both SWASFT and Gloucestershire CCG. Assurance has been received

throughout the year from the Trust in relation to key quality issues, both where quality and safety has

improved and where it occasionally fell below expectations with remedial plans put in place and learning

shared wherever possible. They very much welcome SWASFT’s strong focus on patient experience and quality

of care, which demonstrates a joint commitment to delivering high quality compassionate care.

Quality Improvement Measurement

There is evidence of comparison of performance and data with peers - in respect of nationally mandated

quality indicators for stroke care bundle for ambulance patients and outcome for patients suffering acute

STEMI.

North Somerset CCG would like to have seen more detailed analysis of ambulance response information

relating to STEMI and Stroke care for patients, given this was commissioned as a priority area for improving

outcomes across BNSSG several years ago, and could inform future consideration in the centralisation of key

emergency services e.g. the ambulance service request to consider cardiac arrest centres.

In relation to the Trust taking actions to improve data quality, Somerset CCG is of the opinion that the

challenges raised through the Urgent Care Service have not picked upon and addressed. Also within the

report there is no clear reference to systems for assuring the validity of data supplied.

The Trust has partially reported on engagement in agreeing CQUIN schemes with commissioners - there is

some mention of CQUINs but no actual reporting against CQUIN performance.

Clinical Effectiveness

Achievement noted by Commissioners includes the undertaking of a range of national and local audits and

using the outcomes to inform priority work for 2014/14. Somerset CCG highlights that the Trust reported

on participation in only one relevant national clinical audit which pertained to national ambulance non-

conveyance. There were no actions reported for outcomes from national clinical audits, outcomes have been

reported for local clinical audits.

There is good information pertaining to the launch of a research focus in the organisation. Achievements of

note which the Trust should be commended upon include the undertaking of a variety of clinical research

and promoting this throughout the organisation via the inaugural research day. Also the shared learning

award from the National Institute for Health and Clinical Excellence (NICE) on the implementation of clinical

guidelines.

Somerset and Swindon CCGs point out there is no review of performance against any of the published NICE

quality standards.

Patient Safety

Achievement which the Trust should be commended upon includes having a robust and thorough complaints

and incidents process, which indicates that lessons learnt are quickly fed back into the organisation to inform

practice and learning.

Somerset, Swindon and North Somerset CCGs are of the opinion the Quality Account needs to be

strengthened to demonstrate learning is being implemented from Serious Incidents, and improvements being

made to areas of sub-optimal performance. The organisation has reported on patient safety incidents and

serious incidents during 2013/14 and it is positive to see this quantitative information reported, but it would

be helpful to have had information on the common types of patient safety incident reported and the key

themes from lessons learned and the actions taken to improve service provision as a result.

Patient Experience

The Trust has reported on patient experience and identified improvement priorities in relation to this.

The Trust is to be commended on having a good process to quality monitor call handling which quickly

establishes and facilitates areas for improvement for individual staff.

External Inspections and Regulations

The Trust reported on the unannounced Care Quality Commission (CQC) inspection undertaken in February

2014. The CQC made no recommendations, or imposed any compliance notices as a result. The Trust should

be commended upon receipt of an excellent review and congratulated on the outcome. The positive report

highlighted the high opinion patients have of staff when they come into contact with them.

Staff Survey

It is positive to see the report against staff survey and recommendation of a place to work and actions to

improve this.

Review of Quality Priorities for 2013-14

The four priorities based around patient safety, clinical effectiveness and patient experience were well

presented within the report. SWASFT reviewed their progress against 2013/14 priorities achieving three out

of four:

Patient Safety

Priority 1: Early identification of Sepsis (partially achieved)

Commissioners welcome the focus on this important clinical issue. The report highlights the work the Trust

has done to improve the early identification of sepsis, which is a major cause of unexpected death in the

UK. South Devon and Torbay CCG are particularly keen as a commissioner to ensure people with sepsis are

identified and treated within the ‘golden hour’ and the work SWASFT has done to date, and plans to do next

year will be a major support to that initiative.

A N N U A L R E P O R T 2 0 1 3 / 1 4 167

Through the use of the new diagnostic code 68% more potential cases of sepsis have been identified, which

offers the opportunity for improved outcomes.

The Trust highlighted two further initiatives:

❙ Explore the feasibility of pre-hospital lactate testing to aid sepsis recognition

❙ Explore the implementation of pre-hospital antibiotics.

New Devon CCG are of the opinion it would be helpful to understand if there were any outcomes resulting

from these initiatives which have improved outcomes for patients.

The Trust has reported that whilst they were aiming for a decrease by 50% in incidents relating to lack of

recognition of sepsis by staff, the number of adverse incidents in relation to sepsis has risen; this should be

seen as a positive outcome of an increase in staff awareness.

Priority 2: Infection Prevention and Control Monitoring - introduction of adenosine triphosphate monitoring

(achieved)

Commissioners welcome the Trusts commitment to improving Infection Prevention and Control monitoring

and commend SWASFT in achieving this priority. The report presents work undertaken to improve hygiene

and to protect patients from acquiring infections. The Trust has reported against this quality improvement

priority to improve cleanliness in the ambulance environment. In particular the use of adenosine triphosphate

(ATP) monitoring as part of the assurance process during vehicle inspections (achieved implementation

of ATP swabbing in 10% of areas). Furthermore SWASFT are extending ATP swabbing during 2014-15, to

include ambulance stations, which will undoubtedly assist in raising staff awareness and the importance of

following best practice. Commissioners recognise that to swab 10% of a very large fleet of vehicles is quite

a task and should be applauded. The introduction of ATP swabbing is commended and the future planned

work supported by South Devon and Torbay CCG. The Trust has ensured that the lessons learnt from the ATP

monitoring have been incorporated into the 2014/15 annual Infection Prevention and Control plan. Somerset

CCG are of the opinion that though areas of good practice and actions for improvement were identified, it

is felt that actions have not been detailed and it would have provided further assurance to have had this

information.

Clinical Effectiveness

Priority 3: Post return of spontaneous circulation (ROSC) care bundle (achieved)

Commissioners welcome the Trust’s focus on the support and recovery of patients immediately following

cardiac arrest. They fully support the clinical strategies being implemented to improve patient outcomes in

the area of ST Elevation Myocardial Infarction (treatment for patients suffering from a heart attack). Patients

who have suffered a cardiac arrest and have a return of spontaneous circulation (ROSC) and the timely

conveyance of stroke patients have been two of the areas where quality improvement work has focussed

this year. It is pleasing to see the improvement in the delivery of this care bundle to patients over the past

year. The implementation of the care bundle resulting in a 23% increase in its delivery to 32.1% is a good

outcome. They look forward to hearing what the Trust’s expectation is with respect to what percentage the

trajectory will continue to increase next year.

Although the data presented shows an improving position within the Trust, Wiltshire CCG remains concerned

that within Wiltshire this improvement does not seem to be evident when compared with the 2012/13

outturn.

New Devon CCG is mindful of the ROSC objective and the mentioning of ‘cooling’ and that NICE guidance

may change this.

Patient Experience

Priority 4: Dignity, privacy and respect (achieved)

There is detailed reporting on the quality improvement priority for dignity and respect for patients with focus

on improving communication with patients. A significant focus on complaints is welcomed post-Francis.

The Trust has written about types of complaints and concerns received and common themes and has

identified a number of recommendations for improving patient experience. This was missing in the last

Quality Account and South Devon and Torbay CCG are pleased to see that it is included this year.

The Trust has highlighted an innovative and varied approach to gaining feedback from patients including

face to face consultations within the emergency department. There has been utilisation of questions similar

to those in the Friends and Family Test (FFT). It is pleasing to note that the Trust uses the patient experience

information gathered to facilitate the improvement in practice of individuals within the organisation and

the organisation as a whole. Learning includes the way in which communication may be perceived and the

need to improve information for patients. This in turn has provided tools and education for staff on how to

improve communication with patients.

Somerset CCG mentions there is no reference to review of the complaints process and Commissioner

concerns regarding access (patient identification).

There is mention that of the complaints received the most prominent pertain to communication - staff

attitude and behavioural issues. North Somerset CCG expressed concern that the report wording in this area

could be strengthened to reflect national findings on the importance of patient experience and highlights

that there is no identification as to how the Trust is going to address these concerns.

New Devon CCG, as the Lead Commissioner for Devon 111, would welcome specific information on patient

experience relating to this service in next year’s quality report.

Commissioners are pleased that the 2013/14 objectives will now become business as usual.

Quality Improvement Priorities for 2014/15

The Trust addresses the three domains of quality and has identified relevant priorities for 2014/15.

Commissioners support the four priorities suggested for 2014/2015 and are pleased to see these priorities

focus on improving early recognition of paediatric sepsis (which fits within the wider health community work),

electronic care system, primary angioplasty and Friends and Family Test. All are appropriate areas to target

for continued improvement and link with the Clinical Commissioning priorities. The priorities demonstrate

recognition of the need to engage with patients and their families, support staff and advance clinical

effectiveness as well as improve services across the whole patient pathway. The CCGs would support the

Trust in ensuring that this work is reflected across all of the services provided by SWASFT where relevant, and

in particular that the 111 service are included within the initiatives set out within the child sepsis priority.

Commissioners look forward to seeing achievement of 2014/15 objectives. Bristol CCG have noted the

importance of seeing how the Trust is learning systematically from patient and user experiences and how the

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advent of the crisis concordat will enable the Trust to engage well with multi agency training between police/

crisis and paramedics, in addition to achievement of national standards.

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 the Trust during 2014/15 and

developing further relationships to help deliver their vision of healthy people, living healthy lives, in healthy

communities.

NHS Dorset CCG

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 seeking patient feedback within Urgent Care

Services and triangulating this with information from complaints and incidents has identified key areas for

service improvement and staff training. It is further worth noting that by the end of 2013/14 financial year

there were no areas of non-compliance with the National Quality Requirements for Out-of-Hours Services.

In relation to the priorities identified for 2014/15 the focus is predominantly on the Emergency Service (999)

contract rather than Urgent Care Services. The CCG would like to note that a CQUIN plan has been agreed

for Urgent Care Services for 2014/15 that seeks to improve quality, safety and experience of service users.

The CCG looks forward to working with SWASFT over the coming 12 months to maintain and improve high

quality care for the population of Dorset.

H E A LT H WATCHHealthwatch Cornwall

Healthwatch Cornwall Response to South West Ambulance Trust Quality Account 2013/14

Do the priorities of the provider reflect the priorities of the local population?

Healthwatch Cornwall was pleased to read the Quality Account for South West Ambulance Service 2013/14

and note the improvements made last year particularly in terms of dignity and respect where we are

heartened that the Trust takes clear and robust account of issues raised by its service users.

We feel that this process can only be strengthened by the move this year to bring in the Friends and Family

test, however 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.

In particular for this year, the introduction of the Electronic Patient Clinical Record, whereby patient notes

can be integrated with the hospitals and the wider healthcare community, show a clear move in the right

direction for service users and fit with feedback we have received. Patients and carers or relatives have

shared their frustration that they have shared medical and case information thoroughly with ambulance

staff but that this is lost on admission to hospital and they have to go through it again in the Emergency

Department and then on a ward. We will look with interest to see how this system works.

In Cornwall the new 111 number was introduced in February 2014 and early performance indicators show

targets were not met around call handling. There are additional pressures in Cornwall for not meeting target

call out times on red calls. We trust that these indicators of quality will be of equal importance for the Trust

this coming year too.

We would like to add that 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 are often praised for the care and

consideration shown to patients.

Healthwatch Isles of Scilly

SWASFT services in the islands are comprehensive and probably unique: comprising routine transport and

emergency response; the Star of Life ambulance boat; and a well-equipped and supported co-responder

service.

Feedback received by Healthwatch about local and regional ambulance services is consistently good, with

praise in particular for all personnel. Comments about difficulties when giving directions to control or non-

resident staff have been passed on; this does not appear to be a major problem and could be resolved by

improved, joint, local information.

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Healthwatch Gloucestershire, Bristol, South Gloucestershire, Bath and North East Somerset and

Wiltshire

This is the combined response of Healthwatch Gloucestershire, Healthwatch Bristol, Healthwatch South

Gloucestershire, Healthwatch B&NES and Healthwatch Wiltshire to the South Western Ambulance Services

Trust 2013-2014 Quality Account.

Introduction

Local Healthwatch (HW) organisations are new organisations which have an important role in promoting the

voice of patients and the wider public in respect of health and social care services.

Healthwatch organisations subscribing to this response welcome and approve of the trust’s patient centred

commitment for 2014-15 indicated within the CEO’s statement, through the pursuit of quality improvement,

within the context of a quality strategy. These organisations are pleased to note that this strategy is wide

ranging, embracing a combination of staff training and development, two way staff engagement, the

utilisation of innovative technology, clinical innovations (incorporating research), patient experience feedback

and public engagement activities. They recognise that the Learning From Experience Group is an important

part of the quality improvement process.

Sepsis

Initiatives relating to Sepsis, with a particular focus on paediatric patients is most welcome. Healthwatch

organisations recognise that measurable success is dependent on raising staff awareness and the uniform

application of the required common skill sets, supported by paediatric champions.

Infection Prevention and Control

The enhanced monitoring of Infection Prevention and Control is very positive and welcome. Healthwatch

organisations look forward to data on random, unannounced sampling appearing, including its distribution

across the trust. Is there a possible role within this process for suitably prepared, local PPI representatives?

STEMI and Ambulance Stroke Patients.

Care bundles for STEMI and Ambulance Stroke patients are significant and welcome enhancers of patient

experience and clinical effectiveness. Data provided by the trust fulfils its obligation to QA reporting and

these organisations are pleased to note that the priority was achieved and that trust performance outstrips

local commissioner thresholds. The actions the trust is taking to improve this service to patients is noted and

welcomed, particularly the envisaged programme of quality development across all divisions, supported by

quality improvement paramedics.

The spirit of ‘localism’ does suggest, however, that the provision of localised data (as with Red 1 and Red 2

information) would add greater meaning to the account.

An improving primary angioplasty service is good news for patients. Will this be linked to RCA breaches of

STEMI CTBs? The data on both STEMI and Stroke patients (ACQIs) is confusing to the lay reader. Page 26

indicates performance above commissioner and national average thresholds but the information on page 37

suggests a variation from this.

Dignity and Respect

The trust’s proactive philosophy towards Dignity and Respect is recognised and appreciated and is borne out

by patient/family/carer/ feedback. Feedback from Healthwatch organisations does not appear in the QA?

Electronic Patient Clinical Record (ePCR) System

The implementation of the ePCR is most welcome and should substantially benefit staff and patients. Will

their roll out be uniform across the region or phased?

The dedicated ECP role in Bournemouth is a noteworthy innovation and has the potential to benefit patients

across the region, if adopted by commissioners.

Healthwatch organisations note that calls closed with telephone advice is above the national average and

that the trust leads the way in non- conveyance (to EDs) rates. Some mention of alternative conveyances to

Minor Injuries/Illness Units in Gloucestershire and Wiltshire, will enhance the account.

Emergency Response Times

There continue to be ongoing concerns on emergency response times in rural areas, (Wiltshire, in particular)

Local improvement plans to address this are very welcome and HW organisations hope these will prove

successful. Supplementary, localised, information on these will significantly add to the overall message of the

account and enable local monitoring of trust performance to take place.

General Comments

❙ Healthwatch organisations are concerned about handover delays at acute hospitals and suggest that data

on these (localised) and their impacts on performance would enhance the account.

❙ The importance of the Right Care Action Group and its key focus areas is rightly acknowledged.

Healthwatch organisations look forward to seeing this key dimension of trust activity shining through in

the 2014-15 Quality Account allied to the announced initiatives on robust peer reviews.

❙ The CQC visit and positive report is welcome news for both the trust and patients as it upholds the overall

performance of the trust and also offers some improvement pathways.

❙ The trust’s interest in and commitment to research, with future patient benefit outcomes and staff skills

enhancement is much approved of by Healthwatch--

❙ It will be informative for Healthwatch organisations to eventually receive localised data on stroke

pathways. It is hoped that OAK feasibility study will see paramedics/ECPs empowered to make full use of

the Fracture Risk Assessment Tool.

❙ Overall it is most pleasing to record that the trust is recognised has having robust, effective and wide

ranging strategies and policies in place to enhance patient safety, patient experience and clinical

effectiveness during 2014 -15.

❙ It is noticed that, in its present format, the account lacks both a contents page and a glossary of terms. Is

it possible for the non- technical parts of the account to be written in a more ‘user friendly’ way?

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L O C A L H E A LT H A N D O V E R V I E W S CR U T I N Y CO M M I T T E E SWiltshire Council - Health Select Committee

Wiltshire Council’s Health Select Committee has been invited to comment on the South Western Ambulance

Service NHS Foundation Trust’s (SWAST) Quality Account for 2013-14. The Committee believes that the

Quality Account is an accurate reflection of its performance and the progress in moving the service forward

with its partners in an innovative way.

It is noted that the last reporting year has been particularly challenging for SWAST, given the large increase

in NHS 111 services and the reduction in patient transport services, which on occasions has impacted on their

own performance especially for the rural areas of Wiltshire where response times have also been challenging.

It must also be highlighted that there was a significant increase in call volumes with the introduction of the

NHS 111 services, particularly at evenings and weekends; SWAST must be congratulated on its collaboration

with its partners to improve the NHS 111 service and its own efforts in treating patients in their own homes.

This alone has avoided significant numbers of patients having to be admitted to the acute hospitals.

The Committee is also pleased to note the range of additional initiatives, ranging from the identification

of cases of sepsis, infection prevention and substantial actions to improve the outcomes for those patients

who suffer a heart attack. Further work is underway during 2014 for the roll out of defibrillators throughout

Wiltshire which is welcomed.

Finally, the Committee wishes to commend the South Western Ambulance Service NHS Foundation Trust

for its own engagement with this Council and the Trust’s commitment to continue delivering high quality,

patient centered and improving timely service throughout Wiltshire.

Dorset Health Scrutiny Committee

Comment on the Quality Review and Quality Account 2013/14 of the South Western ‘Ambulance Service

The Dorset Health Scrutiny Committee notes that the clear aim and purpose of SWAST is to improve the

quality of service to patients by using evidence based methods improved treatment. As examples

SEPSIS – utilising the new sepsis diagnosis code and the use of pre-hospital antibiotics

INFECTION CONTROL – using ATP swab testing in some ambulances

CLINICAL EFFECTIVENESS – using the Post ROSC care system

PATIENT EXPERIENCE – seeking to utilize the opinions of patients by regarding compliments as a pathway to

illustrate excellence and complaints to point to areas of concern

COMPASSION – immense care has been taken to deal with the difficulties of patients and carers which often

occur in times of great stress and emotion.

The Trust is to be congratulated on the improvements in service achieved during the period of this report.

DHSC has had contact with the Trust on a number of occasions and queries have always been responded to

in a rapid and robust manner. There have been no presentations to the Committee on the Quality Accounts

by the Trust although this has been done with other trusts on a regular basis throughout the year and is

something which ought to be considered.

The Committee has been very concerned regarding in the changes in the non-emergency transport service

(which is no loner provided by SWAST) as it affected the patients, the hospitals and other user groups,

SWAST and the NHS as a whole. The enquiry is on-going with a special meeting to be held in June 2014.

Gloucestershire Health and Care Overview and Scrutiny Committee

Comments on the South Western Ambulance Service NHS Foundation Trust Quality Account 2013/14.

On behalf of the Health and Care Overview and Scrutiny Committee I welcome the opportunity to comment

on the South Western Ambulance Service NHS Foundation Trust Quality Account 2013/14. As a newly elected

county councillor and newly appointed Chairman of the (new) Health and Care Overview and Scrutiny

Committee (HCOSC) I have valued the attendance of the SWASFT at committee meetings to contribute to

debate and respond to members’ questions. During the course of this year the committee has developed a

constructive and robust working relationship with the SWASFT and I hope that this will continue. I would

particularly like to thank Ken Wenman and Neil le Chevalier for attending meetings and responding to

members many questions.

I would also like to thank Heather Strawbridge and the team at the Acuma House clinical hub for inviting

members to visit this facility. This was a valuable insight into some of the daily dilemmas and challenges faced

by the SWASFT and greatly helped with our understanding of these issues.

Gloucestershire is a rural county and the committee is very concerned with the response times in the

rural areas. The committee has regularly raised this issue with SWASFT officers (and also raised concerns

through the Joint Health Overview and Scrutiny Committee) and whilst concern remains the committee does

acknowledge the work that SWASFT is doing to try to address this situation. Hopefully the learning that

SWASFT has accumulated in the South Division can be translated into the North Division. The committee will

maintain a close interest in this matter.

I do of course recognise that this has been a challenging year for the Trust following on from its acquisition

of the Great Western Ambulance Service.

North Somerset Health Overview Scrutiny Panel

The HOSP acknowledges that the QA indicators show a significant improvement and that the identified

priorities for the forthcoming year demonstrate recognition of where further improvement is needed. The

Trust’s improvement is also borne out by the recent positive Care Quality Commission inspection of the

service. Members are however concerned by the Red 1 response performance indicator results in North

Somerset and note that the Clinical Commissioning Group, whilst acknowledging the challenges of meeting

the targets in rural areas, agree that the current level of performance against that particular indicator is not

at an acceptable standard.

Borough of Poole’s Health and Social Care Overview and Scrutiny Committee

Members of Borough of Poole’s Health and Social Care Overview and Scrutiny Committee would like to

thank South West Ambulance Service NHS Foundation Trust for the chance to comment on their account of

activities undertaken to improve services over the 2013/14 financial year.

The HSCOSC are encouraged to see that a busy year of implementing organisational change for the Trust has

on the whole led to significant service improvements for the patients they serve. These improvements include

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the expansion and integration of the Great Western Ambulance Service, ensuring best practice from each

organisation is adopted as an operating model moving forward. Members also noted that learning from the

Dorset model of implementing NHS 111 services was used to launch NHS 111 services in neighbouring areas.

However, in future it would be useful to gain a better understanding of patient experience in this area as well

as the key performance measures outlined in the report. It would also be helpful to understand how the re-

tendering of Patient Transport Services leading to a reduction in the number of regions covered has impacted

on the regions no longer covered.

It is heartening to note that a recent unannounced CQC inspection was very positive with no

recommendations or compliance conditions imposed.

Members were pleased to see that in 13/14 the four priority areas of patient safety, infection prevention

and control, clinical effectiveness and patient experience have mostly been achieved. This has meant greater

identification of Sepsis at an earlier stage, improved monitoring of cleanliness in emergency vehicles, an

improvement in immediate post care for patients regaining a pulse after a cardiac arrest and therefore

improving long term health outcomes and particularly that learning and service improvement has been

achieved through a range of feedback mechanisms about patient experience.

Moving into 14/15 we will be interested to understand what is achieved in the four priority areas:

a) that the process of managing early identification of Sepsis is fully implemented,

b) that the predicted benefits of introducing Electronic Patient Care is achieved,

c) that even more initiatives are being introduced to improve the life chances and health outcomes of

those suffering a cardiac arrest and finally

d) the introduction of the Friends and Family Test and how this will be used to learn and improve services.

We would like to commend the Trust on their ongoing commitment to ensure patients are receiving the right

service in the right place at the right time which reflects the emerging principles detailed in the NHS England

comprehensive review of urgent and emergency care.

Thank you once again for the opportunity to comment on an interesting Quality Review and Account.

DEVON Health and Wellbeing Scrutiny Committee

Devon County Council’s Health and Wellbeing Scrutiny Committee has been invited to comment on the

South Western Ambulance Service NHS Foundation Trust’s (SWAST) Quality Account 2013-14. All references

in this commentary relate to the reporting period 1st April 2013 to 31st March 2014 and refer specifically to

the SWAST’s relationship with the Scrutiny Committee.

The Scrutiny Committee believes that the Quality Report 2013-14 is a fair reflection and gives a

comprehensive coverage of the services provided by the SWAST based on the Scrutiny Committee’s

knowledge. The Committee would like to commend SWAST on achievement of all 2013/14 priorities. Whilst

the priority for sepsis has only been partially achieved, the 68% increase in potential diagnosis and the

increased awareness are significant improvements. The Committee also notes that sepsis continues to be a

priority for the coming year. This performance is reflected in the positive Care Quality Commission inspection

earlier this year.

Looking at specific performance against the quality requirements, the trust appears to be performing well

overall and is compliant against necessary indicators. The committee would like to see progress towards

achieving the ambitious 100% targets for both QR9a – All immediately life threatening conditions to be

passed to the ambulance service within 3 minutes and QR19b – Patient call backs must be achieved within 10

minutes.

The Francis review provoked a significant challenge to public organisations involved in providing,

commissioning, evaluating and improving health care throughout the country. Local Authority scrutiny was

specifically criticised for a lack of oversight and rigor in holding NHS organisations to account. The Health

and Wellbeing Scrutiny committee undertook a spotlight review earlier this year to further consider how to

hear the voice of vulnerable people and maintain an active challenge; in order to ensure that the work of

scrutiny is as effective as it possibly can be. The review demonstrated that it is only by working with other

agencies and sharing information that scrutiny can identify and work in partnership to improve areas that

are underperforming. The challenge is laid at the door of the County Council the NHS and other partners to

work with the mechanisms of democracy to help develop services from a person centred perspective. The

Committee would like to further explore with SWAST how this may be possible, including regular sight of

NHS Friends and Family test data and mortality rates for example.

The Committee fully supports the Trust’s Quality Priorities for Improvement and looks forward to greater

partnership working in 2014-15.

Torbay Council Health Scrutiny Board

Statement from Torbay Council’s Health Scrutiny Board on South Western Ambulance Service NHS

Foundation Trust’s Quality Account 2013/2014

South Western Ambulance Service NHS Foundation Trust’s Quality Accounts for 2013/2014 has been

considered by representatives of Torbay Council’s Health Scrutiny Board. The clarity with which the Trust has

explained how it has met its priorities for 2013/2014 and what its priorities are for the forthcoming year is

welcomed.

The Quality Accounts for each of the Trusts operating in Torbay were considered at the same time and this

allowed for the inter-relationships between the different initiatives in different Trusts to be examined, in

particular the priority around the identification of sepsis.

The Board met with representatives of South Western Ambulance Service NHS Foundation Trust, South

Devon Healthcare NHS Foundation Trust and South Devon and Torbay Clinical Commissioning Group in

February 2014 to discuss services at the Emergency Department of Torbay Hospital. It was clear that all

organisations were working together to improve services to the public. This partnership working needs to be

embedded throughout all health and social care organisations in Torbay to ensure a truly joined-up approach

for residents and visitors.

The Quality Account makes little reference to mental health and it is felt that this is an omission. The Health

Scrutiny Board will be undertaking a review of mental health services (including services for those with

learning difficulties) over the course of the coming year and would wish to invite South Western Ambulance

Service NHS Foundation Trust to participate in that work.

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The Board commends South Western Ambulance Service NHS Foundation Trust for its openness and

transparency of its operations and hopes that the Trust will continue to work closely with the Board and

Torbay Council as a whole.

Cornwall Council’s Health and Social Care Scrutiny Committee

Cornwall Council’s Health and Social Care Scrutiny Committee agreed to comment on the Quality Account

2013 -2014 of South Western Ambulance Service NHS Foundation Trust. All references in this commentary

relate to the period 1 April 2013 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. However, they believed

it was a complex document which was not easily understandable for the public; this especially applies to

the presentation of data. In some circumstances it may have been useful to have a break down at a lower

geographic level.

Quality requirements appear to be being met however there are concerns about the performance variation

across the region, specifically regarding Red 1 performance and NHS 111 indicators QR9a – All immediately

life threatening conditions to be passed to the ambulance service within 3 minutes and QR19b – Patient call

backs must be achieved within 10 minutes. Performance in Cornwall appears to be lower than other areas

and it is requested that there are demonstrable improvements in the next year.

The Committee welcome the commitment to increasing patient feedback and would like to see regular

feedback on the Friends and Family Test.

The Committee supports the Trust’s Quality Priorities for Improvement and looks forward to working in

partnership in 2014-15.

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 2013/14

❙ the content of the Quality Report is not inconsistent with internal and external sources of information

including:

Board minutes and papers for the period April 2013 to 22/5/14

Papers relating to Quality reported to the Board over the period April 2013 to 22/5/14

Feedback from the commissioners dated 06/05/2014

Feedback from governors dated 02/04/2014 and 06/05/2014

Feedback from Local Healthwatch organisations dated 13/05/2014

The Trust’s complaints report published under regulation 18 of the Local Authority Social Services and

NHS Complaints Regulations 2009, dated 15/05/2014

The latest national staff survey dated February 2014

The Head of Internal Audit’s annual opinion over the trust’s control environment dated 22/5/14

CQC quality and risk profiles dated from April 2013 to 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 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.

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By order of the Board

22 May 2014 Date Heather Strawbridge, Chairman

22 May 2014 Date Ken Wenman, Chief Executive

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 2014 (the ‘Quality Report’) and specified

performance indicators contained therein.

S CO P E A N D S U B J E C T M AT T E R The indicators for the year ended 31 March 2014 in the Quality Report that have been subject to limited

assurance (the “specified indicators”) 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 pages 145 and 146 of the Annual Report) on which we are giving our limited assurance opinion.

Category A Call – Ambulance vehicle arrives Within 19 Minutes

R E S P E C T I V E R E S P O N S I B I L I T I E S O F T H E D I R E C T O R S A N D A U D I T O R S 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 2013/14” 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 2013/14”;

❙ 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 “2013/14 Detailed guidance for external assurance on

quality reports”.

We read the Quality Report and consider whether it addresses the content requirements of the FT ARM, and

consider the implications for our report if we become aware of any material omissions.

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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 period April 2013 to the date of signing this limited assurance report (the period)

❙ Papers relating to Quality reported to the Board over the period April 2013 to the date of signing this

limited assurance report

❙ Feedback from the Commissioners; South West Commissioning Support (included combined CCG

commentary) dated 16 May 2014; and NHS Dorset CCG dated 6 May 2014

❙ Feedback from a local Healthwatch organisation; Healthwatch Cornwall dated 13 May 2014; Healthwatch

Isles of Scilly dated 16 May 2014; Healthwatch Gloucestershire, Bristol, South Gloucestershire, BANES and

Wiltshire dated 15 May 2014

❙ The Trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS

Complaints Regulations 2009, dated 9 May 2014

❙ Feedback from other stakeholders involved in the sign-off of the Quality Report: Wiltshire Council -

Health Select Committee dated 7 May 2014; Dorset Health Scrutiny Committee dated 24 April 2014;

Gloucestershire Health and Care Overview and Scrutiny Committee dated 8 May 2014; North Somerset

HOSP dated 14 May 2014; Borough of Poole’s Health and Social Care OSC dated 9 May 2014; Devon

Health and Wellbeing Scrutiny Committee dated 14 May 2014; Torbay Council Health Scrutiny Board

dated 16 May 2014; and Cornwall Council’s Health and Social Care Scrutiny Committee dated 19 May

❙ The national staff survey dated 25 February 2014

❙ Care Quality Commission quality and risk profile dated 31 March 2014

❙ The Head of Internal Audit’s annual opinion over the Trust’s control environment dated March 2014; and

❙ The CQC Inspection Report of the Trust dated March 2014

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 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 2014, 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.

A S S U R A N CE W O R K P E R F O R M E D 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 2013/14”;

❙ 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 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.

L I M I TAT I O N S 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.

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 and the Criteria referred to above.

A N N U A L R E P O R T 2 0 1 3 / 1 4 183

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.

CO N CL U S I O N 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 2014,

❙ 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 2013/14”;

❙ 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 “2013/14 Detailed guidance for external assurance on

quality reports”.

PricewaterhouseCoopers LLP

Chartered Accountants

Princess Court

23 Princess Street

Plymouth

PL1 2EX

23 May 2014

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.

statement of accounting officer’s responsibilities

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 the Independent Regulator of

NHS Foundation Trusts (“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 are 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.

A N N U A L R E P O R T 2 0 1 3 / 1 4 185

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: 22 May 2014

A N N U A L R E P O R T 2 0 1 3 / 1 4 187

NHS Foundation Trust 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 Code of Governance was updated by Monitor for January 2014, with the new version to be applied

to annual reports for the whole of 2013/14 where possible. Additional disclosure requirements have

been included in the latest version of the Code (as Schedule A) and some of these* are 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.*

CO D E O F G O V E R N A N CE D I S CL O S U R E SThe table below sets out the disclosures which must be included within Foundation Trust annual reports for

2013/14. 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 are a new requirement within the FT Annual

Reporting Manual (ARM), 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 will be made in the table.

The new Code of Governance came into form from 1 January 2014. Where there are new requirements in

the updated Code of Governance that have not been complied with for the whole year, it is acceptable to

explain that these are new requirements that could not be applied retrospectively. However, following review

of the updated Code, SWASFT can confirm that it is compliant with the majority of requirements, new and

old. Any deviation from full compliance is explained and proposed action noted. All compliant statements are

applicable to the whole of 2013/14.

A N N U A L R E P O R T 2 0 1 3 / 1 4 189

Relating to Code Ref Summary of RequirementAnnual Report Location or Comply or Explain

Disclosure Statements, 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

Yes - CoG section

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 remuneration committees. It should also set out the number of meetings of the board and those committees and individual attendance by directors

Yes - Board of Directors – Role


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

Yes - CoG section

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

Yes – in report (How we are organised)

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

Yes - Role section of Board of Directors

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

Yes – Board Committee section and CoG section

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

Yes - Biogs


B.5.6 Governors should canvass the opinion of the trust’s members and the public, and for appointed governors the body they represent, on the NHS 190’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

Yes - Developments during 2013 to 14

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

Yes – in Directors’ Report under Board of Directors section

Board

B.6.2 Where there has been external evaluation of the board, 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

There was no external evaluation of the Board

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)

Yes - Included in AGS and enhanced QG reporting section in annual report. Directors’ comment is standard statement

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

Yes - AGS presented to April Audit Committee and will go back to May Audit

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

Yes – in the Directors’ Report under the section explaining the role of the Audit Committee

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

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 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

Yes – all in the Audit Committee section within the Directors’ Report

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

Not applicable

A N N U A L R E P O R T 2 0 1 3 / 1 4 191

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

Yes - Attendance at CoG covered

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

Yes - annual transparency disclosure

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

Yes – our membership

Additional Requirements, FT Annual Reporting Manual, March 2014


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

Yes – CoG section

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

Yes – Role section

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

Yes – Meetings


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 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)

Yes – Board attendance at CoG

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

Yes – membership

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

Yes – Register of Interests is covered in the Directors’ Report

Disclosure Statements, Schedule A, 6) – Comply or Explain

Board

A.1.4 The board should ensure that adequate systems and processes are maintained to measure and monitor the NHS Foundation Trust’s effectiveness, efficiency and economy as well as the quality of its health care delivery

Comply

Regulatory and Board Assurance Frameworks

Integrated Corporate Performance Reports

Non-Executive chairs of Board committees

Board

A.1.5 The board should ensure that relevant metrics, measures, milestones and accountabilities are developed and agreed so as to understand and assess progress and delivery of performance

Comply

Corporate objectives

Integrated Corporate Performance Reports

Annual Accountability Agreements

Internal Audits of key functions

Board

A.1.6 The board should report on its approach to clinical governance.

Comply

Clinical governance deep dives by Quality and Governance Committee

Quality and Governance strategies

Board Memorandum on Quality Governance

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

Trust Constitution

Annual cycles for Board of Directors and Council of Governors and minutes of meetings

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

Trust Constitution

Code of Conduct for Staff

A N N U A L R E P O R T 2 0 1 3 / 1 4 193

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

Code of Conduct for Directors, including statement of openness

Board A.1.10 The NHS Foundation Trust should arrange appropriate

insurance to cover the risk of legal action against its directors

Comply

Insurance indemnity for directors

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 chairperson of the same NHS Foundation Trust

Comply

Code of Conduct for Directors

Annual declaration of independence by all Board members

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

Senior Independent Director appointment reviewed annually

Board A.4.2 The chairperson should hold meetings with the Non-

executive Directors without the executives presentComply

Meetings held as required

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

Minutes of meetings of the Board of Directors


A.5.1 The Council of Governors should meet sufficiently regularly to discharge its duties

Comply

At least four meetings scheduled each year, plus development workshops


A.5.2 The Council of Governors should not be so large as to be unwieldy

Comply

Structure of the Council reviewed and revised for 2014/15


A.5.4 The roles and responsibilities of the Council of Governors should be set out in a written document

Comply

Role of Governors’ document


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

CEO and Board member attendance at Council recorded in minutes. CEO and Chairman Q&A session at each Council meeting


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 of Engagement in place but needs to be reviewed


A.5.7 The council should ensure its interaction and relationship with the board of directors is appropriate and effective

Comply

Trust Chairman chairs both forums

Minutes of Council meetings and Q&A sessions


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

Chairman reappointed in 2013


A.5.9 The council should receive and consider other appropriate information required to enable it to discharge its duties

Comply

CEO and Chairman’s reports

Performance and quality reports

Presentations on role of each Board committee

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

Annual declaration of independence by each Non-executive Director


B.1.3 No individual should hold, at the same time, positions of director and governor of any NHS Foundation Trust

Comply

Trust Constitution

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

Remuneration Committee for Executive posts

Remuneration and Recommendations Panel for Non-Executive posts


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

“Fit and proper” person stipulation added to Codes of Conduct for Directors and Governors


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

Review of Board composition and skills at each appointment stage


B.2.4 The chairperson or an independent Non-executive Director should chair the nominations committee(s)

Comply

Trust Chairman chairs the Remuneration Committee

A N N U A L R E P O R T 2 0 1 3 / 1 4 195

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

Process for recruitment of Non-executive Directors


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

Terms of reference for Remuneration and Recommendations Panel


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

Trust Constitution

Annual declaration of Directors’ interests


B.5.1 The board and the Council of Governors should be provided with high-quality information appropriate to their respective functions and relevant to the decisions they have to make

Comply

Annual cycles of business for Board of Directors and Council of Governors

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

Challenge record in Board minutes

Deep dives into key areas by Quality and Governance Committee

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

Trust Constitution and all directors aware that this option is available

Trust Secretary in post to signpost external advice as appropriate

Board / Committees

B.5.4 Committees should be provided with sufficient resources to undertake their duties

Comply

Trust Secretary

Board and Committee secretaries

Annual cycles of business

Chair

B.6.3 The senior independent director should lead the performance evaluation of the chairperson

Comply

Appraisal framework

Non-executive Director Group

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

Appraisal framework

Non-executive Director Group

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

Annual self-assessment by Council of Governors

Members newsletter within 24/7 communication


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

Process within Trust Constitution

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

Associate/Deputy Directors’ Group for resilience

Interim Executives appointed as required

Board

C.1.2 The directors should report that the NHS Foundation Trust is a going concern with supporting assumptions or qualifications as necessary

Comply

Going concern status confirmed annually at Audit Committee

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

Need to check where included in annual report

A N N U A L R E P O R T 2 0 1 3 / 1 4 197

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 - new requirement

Audit Committee terms of reference requires a membership of four independent Non-executive Directors. The Chair has recent and relevant financial experience

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

Process in place between Council and Audit Committee

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

Explain

Speak Up, Speak Out Policy in place but process not routinely reviewed by Audit Committee.

Audit Committee approves and monitors the work of the Local Counter Fraud Specialist

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

Remuneration Policy and Committee


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


Terms of reference for Remuneration Committee


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

Terms of reference for Remuneration Committee

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

Explain

Public engagement and involvement activities are described in relevant sections of the annual report. The Trust is reviewing its Communications and Engagement Strategy, which will address these issues in full. The Strategy will be published when approved by the Board

Board

E.1.3 The chairperson should ensure that the views of governors and members are communicated to the board as a whole

Comply

Trust Chairman chairs both forums and the Trust Secretary attends both

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

Third party body schedule updated and approved annually by Board of Directors

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

Third party body schedule updated and approved annually by Board of Directors

A N N U A L R E P O R T 2 0 1 3 / 1 4 199

Corporate Governance Statement

Monitor requires all NHS Foundation Trusts to provide an annual Corporate Governance Statement setting

out any risks to compliance with the governance condition; and actions taken or being taken to maintain

future compliance. 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 three months prior to the year end. An auditor statement may

be requested to provide additional assurance.

The Trust’s Corporate Governance Statement was provided to and approved by the Board at the end of

Quarter 3, 2013/14. Monitor has now confirmed that the Statement should be included within the Trust

Annual Report for 2013/14 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 in April 2014, and signed off at the May

2014 meeting.

The Corporate Governance Statement will also be submitted as one of the governance returns to Monitor

during Quarter 1, 2014/15.

Statements Risks and Mitigating Actions

The Board is satisfied that South Western Ambulance Service NHS Foundation 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

None

The Board has regard to such guidance on good corporate governance as may be issued by Monitor from time to time

The Trust has consistently applied the principles within Monitor’s Code of Governance and responded to Monitor’s consultation on the revised Code in December 2013. A briefing paper on the changes was considered at the Board Seminar in December 2013.

A plan of compliance will continue to be monitored by the Trust Quality and Governance Committee for assurance.

All relevant Code of Governance disclosures have been included within the Trust annual report, together with a comprehensive statement of all disclosures and their location as required

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 those committees; and

(c) clear reporting lines and accountabilities throughout its organisation.

(a) The Board robustly reviewed and agreed its Board and Committee reporting and responsibilities during acquisition of Great Western Ambulance Service in early 2013

(b) A Non-executive Director appointment and reappointment process is followed by the Trust Council of Governors, and although there was an element of Executive turnover in 2013 the Board took swift action to recruit interims to any vacancies to ensure there was no lack of continuity. These vacancies have now been filled. Monitor has been kept advised of these changes and has not raised concerns. There is currently one Non-executive vacancy on the Board

(c) The Trust organisational structure was reviewed, consulted upon, and revised for the enlarged organisation, including a Deputy Director tier and a new Performance Management Framework, including Annual Accountability Agreements for each individual Director.

A N N U A L R E P O R T 2 0 1 3 / 1 4 201


The Board is satisfied that South Western Ambulance Service NHS Foundation Trust NHS Foundation Trust effectively implements systems and/or processes:

(a) to ensure compliance with the Licence holder’s duty to operate efficiently, economically and effectively

(b) for timely and effective scrutiny and oversight by the Board of the Licence holder’s operations

(c) to ensure compliance with health care standards binding on the Licence holder including but not restricted to standards specified by the Secretary of State, the Care Quality Commission, the NHS Commissioning Board and 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 Licence holder’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

(h) to ensure compliance with all applicable legal requirements

(a) The Trust’s systems and processes were the subject of significant scrutiny during the acquisition process and the Annual Governance Statement for 2012/13 was supported by a Head of Internal Audit Opinion of significant assurance. The draft Annual Governance Statement for 2013/14 has been reviewed by the Audit Committee and is (at April 2014) again supported by a Head of Internal Audit Opinion of significant assurance. The Annual Governance Statement included full details of the process put in place by the Board of Directors for recovery of performance against the Red 1 target during Quarter 4, 2013/14

(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

(c) The Board receives assurance from the Quality and Governance Committee, chaired by the Trust’s Vice Chairman. Deep dives are reviewed at each meeting including, in 2013/14, for Governance, Risk and CQC Compliance

(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 subject to individual annual cycles which are fed by the Trust Regulatory Framework which records all statutory and regulatory targets

(f) A monthly Light Touch monitoring meeting is chaired by the Deputy Chief Executive/ Executive Director of Finance to identify any risk to compliance. All Trust meeting agendas include an item to identify any New Risks or Exception Reporting Triggers. Where performance concerns are raised (eg breach of Red 1 performance during 2013/14) recovery plans are developed and achievement monitored by Directors’ Group with an agreed escalation process to the Board of Directors of Directors

(g) The Board engages in the development of the Trust Annual Plan and Integrated Business Plan

(h) A Trust Secretary was appointed in 2013 with responsibility for legal compliance


The Board is satisfied:

(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 South Western Ambulance Service NHS Foundation Trust including its Board actively engages on 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 South Western Ambulance Service NHS Foundation Trust including but not restricted to systems and/or processes for escalating and resolving quality issues including escalating them to the Board where appropriate

(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

(c) The agenda of the Quality and Governance Committee was reviewed for 2013/14 to focus more on deep dives into key areas such as medicines management and patient experience, supported by exception reporting

(d) As well as reports from 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 Patients Association

(f) The Trust quality focus is led by the Quality and Governance Committee to which those responsible for key areas of quality report. The Committee has an agenda item to allow for escalation of issues. The Trust also has a well-used incident reporting system and Learning from Experience Group which supports focused reviews where trends are identified

The Board of South Western Ambulance Service NHS Foundation Trust effectively implements systems to ensure that it has in place personnel on the Board, reporting to the Board and within the rest of the Licence holder’s organisation who are sufficient in number and appropriately qualified to ensure compliance with the Conditions of this Licence

The Board has approved a sound process for recruitment of its Executives and Non-Executives and this includes review of skills and experience wherever 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

A N N U A L R E P O R T 2 0 1 3 / 1 4 203

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 Memorandum, 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 2014 and endorsed by a Head of Internal Audit

Opinion of significant assurance.

O V E R V I E W O F A R R A N G E M E N T S F O R G O V E R N A N CE O F S E R V I CE Q U A L I T YQuality governance is defined as the combination of structures and processes at and below Board level to

lead on Trust-wide quality performance including:

❙ 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):

M O N I T O R ’ S Q U A L I T Y G O V E R N A N CE F R A M E W O R K

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 patients, staff and other key stakeholders on quality?

4C

Is quality information used effectively?

To demonstrate compliance with the Framework, a Board Memorandum on Quality Governance is developed

annually. This also supports production of the Trust Annual Plan and the Board’s quarterly submissions

against the requirements of Monitor’s Risk Assessment Framework. A new Memorandum was approved by

the Board of Directors at its March 2014 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

A N N U A L R E P O R T 2 0 1 3 / 1 4 205

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 208.

A plan to ensure continuous quality improvement was approved at Quality and Governance Committee in July

2013 and monitored thereafter at each meeting by exception.

We can report that there are no material inconsistencies between the following:

❙ The Annual Governance Statement

❙ The quarterly statements submitted by the Board of Directors against the requirements of Monitor’s Risk

Assessment Framework (from quarter 3, 2013/14 – previously the Compliance Framework)

❙ The Corporate Governance Statement, included within this Annual Report at page 200

❙ The Quality Report for 2013/14

❙ The Annual Report for 2013/14, and

❙ Reports arising from Care Quality Commission planned and responsive reviews of the Trust.

Details of ongoing breach by the Trust of the Category A8 Red 1 target (for a fourth consecutive quarter) at

the start of Quarter 4, 2013/14, have been reported within the Annual Governance Statement. This report

includes action taken to improve the position (as well as discussions with Monitor) and performance against

the Red 1 target for the final quarter of 2013/14 was achieved at 76.86%. The Trust maintained its Monitor

green governance risk rating throughout the year. Information on the performance issue was included within

the Annual Governance Statement and taken directly from the quarter 3 and quarter 4 Board assurance

papers. It was mirrored within the Board Assurance Framework, and the Quality Report for 2013/14.

Additional assurance on the maintenance of a quality service, despite issues with performance, can be

taken from the positive outcome of the unplanned Care Quality Commission inspection which took place in

February 2014. No compliance conditions or recommendations resulted from the inspection.

A N N U A L R E P O R T 2 0 1 3 / 1 4 207

annual governance statement

S CO P E O F R E S P O N S I B I L I T Y 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.

T H E P U R P O S E O F T H E S Y S T E M O F I N T E R N A L CO N T R O L 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 2014 and up to the date of approval of the annual report and accounts.

C A PA C I T Y T O H A N D L E R I S K 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 team leader, supported by the Risk and Litigation Manager as the senior manager

responsible for risk. Risk management is a core component of the job descriptions of senior managers.

During 2013/14 the Executive Director of HR and Governance (who was the director responsible for risk

management until January 2014) and the Head of Governance attended the national ambulance Quality

Governance and Risk Directors group (QGARD), with the Risk and Litigation Manager 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 six-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 and the Risk Management

International 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 2013/14 was reviewed by Internal Audit in February 2014 as presenting

a low risk to the Trust with one recommendation which has been incorporated into the new Framework

for 2014/15. 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 a new 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 2013/14 and in the new Framework for 2014/15 approved by the SWASFT Board of

Directors in March 2014.

A N N U A L R E P O R T 2 0 1 3 / 1 4 209

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. The Committee also reviewed them again in January 2013 and changed

its approach to monitor more by exception, and also using deep dives into key quality areas and to review

areas of identified risks. During 2013/14 the areas covered by the deep dives have included risk management,

patient experience, safeguarding, education and human resources.

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.

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 was included within the Board Development Programme for 2012/13. During 2013/14 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 2014/15 is being developed by the Chairman, Chief Executive and Trust

Secretary and will specifically include risk management.

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. Trends in incidents, complaints, claims and other feedback mechanisms are also considered in

depth by the Learning from Experience Group (LFEG) and lessons disseminated through training, newsletters

and publications. A review of the terms of reference of LFEG in February 2013 (approved at the March 2013

Quality and Governance Committee) resulted in the strengthening of both clinical membership and links with

the clinical working groups. The revised LFEG, chaired by the Deputy Clinical Director, was launched in June

2013 and is a sub-group of the Quality and Governance Committee.

The Quality and Governance Committee receive the Trust’s bi-monthly Patient Safety and Experience Report

which is shared with Commissioners. This report includes examples of learning, and during 2013/14 was

further developed to include focussed reviews of areas of risk identified by analysing incidents, serious

incidents and patient feedback. Focussed reviews undertaken during 2013/14 included management of

spinal injuries, defective skylights, triage of calls involving children with burns and incidents involving the

Clinical Hubs. To share learning across the organisation the Trust has developed and launched a bi-monthly

newsletter which includes lessons and recommendations identified from serious incidents, moderate harm

incidents and other feedback mechanisms.

The terms of reference for each committee have been reviewed against the requirements of Monitor’s

updated Code of Governance (December 2013).

T H E R I S K A N D CO N T R O L F R A M E W O R K 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 4360:1999 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) contain local risks

rated up to and including 9. The risk categorisation matrix is reviewed regularly by the Quality Risk Watch

Group (a working group reporting to the Quality and Governance Committee), with changes considered and

signed-off by the Board of Directors. The risk management process is reviewed annually by Internal Audit and

twice yearly by the Audit Committee.

A N N U A L R E P O R T 2 0 1 3 / 1 4 211

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 very effective in focusing attention on risk. Any risks identified or amended are passed to the Risk and

Litigation Manager and 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: Risk and Litigation Manager, Head of Governance, 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 amendment 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.

The Quality and Governance Committee receives the Corporate Risk Register and the 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 resulting in: 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 among others

such as: 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

must have been verified as controls at an appropriate forum or by a recognised external/regulatory body.

These are continually reviewed at the Directors Group for Corporate or Directors’ Risks; or by the designated

lead for directorate risk registers with guidance and support from the Risk and Litigation Manager.

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 contained within the Corporate Risk Register during the full year, which

remain in March 2014 and carry forward to 2014/15

Risk Description Key Mitigating Actions

Delays experienced by ambulance clinicians in handing over patients at acute trusts impacting on the resources available to respond to emergency calls

Implementation of revised delayed handover Standard Operating Procedure to introduce a 30 minute handover when there is a risk to patient safety

Logistics Cell in place to escalate handover delays

Joint working with acute trusts to address issues through local action plans

The increase in Resource Escalatory Action Plan (REAP) levels which could impact on the delivery of objectives

Revised REAP escalation plan implemented with divisional REAP levels

Business continuity arrangements and processes in place

Performance management arrangements in place to monitor achievement of objectives

Changes to funding priorities and commissioning structures as a result of NHS reform

Regular meetings with Commissioners

South West CSU leading on contract negotiations for 2014/15

Ongoing engagement with Clinical Commissioning Groups

Contracts to be signed for 2014/15

Terrorist activity which could affect the delivery of Trust services and impact on its business continuity

Major Incident Plan in place which is reviewed annually

National agreement on mutual aid

Trust HART teams in place

Implementation of National Ambulance Service Command and Control guidance

Dedicated on call tactical advisors within Resilience team

The potential failure to deliver the Trust’s Cost Improvement Strategy as a result of interventions

Implementation plans developed with clear accountability identified and implemented

Recognition Agreement in place and ongoing dialogue with staff side

Finance and Investment Committee monitor the Cost Improvement Strategy at each meeting

The impact of NHS 111 on A&E Delivery as a result of the wide landscape in working with a variety of providers and interfacing services, both in terms of growth in activity and the ability of 111 providers to dispatch Trust resources

Review of Demand Management Plan

REAP escalatory arrangements in place

Dedicated 111 Liaison team in place

Ongoing discussions with providers and commissioners

Changes in weekly spread of demand impacting on ability to respond, funding, patient care and experience, performance and staff experience

Monthly activity reports produced for Commissioners

Red Performance Recovery Action Plan in place with regular monitoring

Escalatory Management Plan reviewed and updated

Independent review of performance activity

The potential for the Trust not retaining or winning tenders which could impact negatively on service delivery.

Appointment of Business Development Manager

Regular performance meetings with commissioners

Tender Steering Group to be established to oversee tendering activity

A N N U A L R E P O R T 2 0 1 3 / 1 4 213

Significant and newly identified risks during the year and added to the Corporate Risk Register,

which remain in March 2014 and carry forward to 2014/15

Risk Description Key Mitigating Actions

The potential for not achieving performance targets which could result in a breach of compliance conditions*

Red 1 Performance Recovery Action Plan containing key actions to address performance

Independent review of performance activity

Performance ‘deep dive

Establishment of Incident Command Cell to monitor daily issues

The potential for not delivering statutory and mandatory education to all relevant staff as a result of REAP levels, activity and vacancies

Weekly monitoring by the Resource Management Group

Divisional REAP levels

Trajectory in place with monthly reporting to the Directors Group

The potential for a major ICT service failure of the Clinical Hub, and /or radio and mobile data which could impact on the business continuity of the Trust’s A&E, Urgent Care, 111 or PTS service

Business Continuity Strategy and associated monitoring system approved

Clinical Hub Business Continuity Lead in place

Fallback plans in place which cover minor, major and critical faults

Card system and manual practices defined and in place to support any loss of computer systems

Reduced workforce levels as a result of vacancies, abstractions, implementation of new projects and availability of third party providers affecting Trust performance, staff morale and organisational reputation

Establishment of Resources Operations Centre

Implementation of Workforce Planning Establishment Group to review workforce forecasting, plans and actions

Provision of staff by third parties, agencies, bank and overtime

Ongoing review of abstractions

The potential for not achieving the internal KPI for completion of appraisals.

Appraisal management included within the Leadership Development Programme

Updated appraisal system launched

Regular reporting to Quality and Governance Committee

*see Quality Governance Section

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 4,500 incidents reported in 2012/13 and an

increase of 100% is expected at the end of 2013/14. The Trust continues to encourage incident reporting

from staff at all levels and during 2013/14 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 they will no longer be conducting their assessments, however, to ensure

best practice, the Trust has continued to ensure that all policies and processes meet the existing standards.

Q U A L I T Y G O V E R N A N CE A R R A N G E M E N T SBoard Memorandum

The conditions of the Trust’s provider licence require the Board of Directors to ensure that a number of

obligations are met concerning governance of the quality of care provided by the Trust.

Monitor’s new Risk Assessment Framework, like the Compliance Framework before it (in place until the end

of quarter two, 2013/14) requires ongoing compliance with the Quality Governance Framework and requires

Boards to demonstrate how they derive assurance on the quality of service their Trust provides and how they

safeguard patient safety. The Board of Directors continues to demonstrate these assurance mechanisms by

the production of a comprehensive Board Memorandum on Quality Governance.

During 2013/14, the Board Memorandum was updated in May 2013 to support the Trust’s Annual Plan. A

further update was then approved by the Board in November 2013 to present the Trust position six months

post-acquisition (as required by Monitor following significant transactions). A new Board Memorandum

(version 7) was developed at the end of 2013/14 to support the Trust’s 2014/15 Annual Plan and this was

approved by the Board in March 2014.

The Board Memorandum addresses the 10 questions posed by Monitor’s Quality Governance Framework.

Compliance with this Framework is a requirement of:

❙ The Trust Annual Governance Statement;

❙ The Trust Annual Plan;

❙ Monitor’s Risk Assessment Framework (Quality Governance Indicators and the Corporate Governance

Statement);

❙ The Board self-assessment aspect of the future external Governance Reviews recommended by Monitor.

Quarterly Board Assurance

The Board Memorandum provides an ongoing record of compliance with the Quality Governance Framework

and supports the Trust’s quarterly submissions to Monitor.

During the first two quarters of 2013/14, an assurance report was approved by the Board of Directors to

enable them to sign the governance statement within Monitor’s Compliance Framework. From Quarter 3

onwards, assurance was measured against the new Monitor Risk Assessment Framework and the Board was

required to sign the following:

For governance, that:

“The Board is satisfied that plans in place are sufficient to ensure: ongoing compliance with all existing targets

(after the application of thresholds) as set out in Appendix A of the Risk Assessment Framework; and a

commitment to comply with all known targets going forwards.”

And to confirm that:

Otherwise

“The Board confirms that there are no matters arising in the quarter requiring an exception report to Monitor

(per the Risk Assessment Framework page 21, Diagram 6) which have not already been reported.”

The assurance reports to the Board of Directors also include evidence of compliance with a series of targets

and indicators and various information requirements related to the conditions of the Trust’s provider licence:

A N N U A L R E P O R T 2 0 1 3 / 1 4 215

❙ Access and outcomes standards

❙ CQC judgments on the quality of care provided

❙ Third party relevant information

❙ Quality governance information

❙ Degree of risk to continuity of services and other aspects of risk relating to financial governance, and

❙ any other relevant information.

P O T E N T I A L B R E A CH O F P E R F O R M A N CE TA R G E T ( S E E R I S K S E C T I O N A B O V E )For the first two quarters of 2013/14, the Board of Directors felt sufficiently assured to agree the signing of

the Governance statement (as set out within the former Compliance Framework), including the commitment

to ‘…comply with all known targets going forwards’. A considerable amount of work was undertaken by

Directors and at the Board to establish and implement plans to improve the performance position to enable

the statement to be signed off and it was approved for Quarter 1 and Quarter 2. However, the Trust did not

meet the Red 1 target for Quarter 1 and 2, nor did it achieve the Red 2 target for Quarter 2.

In December 2013 an issue relating to the consistency of Red incident performance reporting was identified,

specifically relating to the categorisation of incidents where an ‘Early Exit’ from the triage process was

recorded. A paper providing detail specific to this issue, the impact on Trust performance reports and the

changes made to correct the consistency in Trust reporting, was received by the Directors’ Group and Quality

and Governance Committee in order to approve the changes on the 6 January and 8 January respectively. In

addition the process and recalculation of Red 2 performance was audited by Internal Audit with an overall

opinion that the new Red 2 calculation process was accurate, valid and in line with national guidance. The

Trust notified Monitor of this issue in December 2013 and subsequently provided a copy of the paper and

audit opinion letter.

The technical adjustment was implemented by the Trust retrospectively from 1 April 2013. As a result Red 2

performance significantly improved for all quarters with the Trust achieving Category A8 Red 2 in all quarters

in 2013/14. In response Monitor confirmed ‘at this time, we do not intend to amend retrospectively the

Trust’s Q2 2013/14 submission to Monitor to reflect the revised performance results, as this would not lead to

any change to the Trust’s Governance Risk Rating for that quarter.

A significant effort continued through Quarter 3 to provide assurance, to both the Board of Directors of

Directors and Commissioners, against forecast performance for the remainder of 2013/14. However, the Trust

did not meet the standard for Red 1 performance in Quarter 3.

The improvement work was underpinned by on-going national discussions, with additional work carried out

to review the definition of Red 1 calls within the Trust’s triage systems. Material differences exist between

the definition and subsequent categorisation of Red 1 incidents within the two triage systems used by

English ambulance services. In light of this the ambulance service, through its Association of Ambulance

Chief Executives (AACE) and supporting directors’ networks, has for some time been reviewing the definition

set of Red 1 as it applies to NHS Pathways to improve consistency across the two systems.

The Board of Directors reviewed its position in January 2014 and approved a retrospective application of the

extended Red 1 definition, with effect from 1 November 2013 being the date at which it was introduced in

shadow form. The Medical Director, at the Board meeting held on 30 January 2014, advised that the move

to a wider definition of Red 1 provides a more positive patient experience as evidenced by live Return of

Spontaneous Circulation (RoSC) data.

The position at the start of Quarter 4 2013/14 was that the Trust had breached the Category A8 Red 1

target for four consecutive quarters (including Quarter 3 of 2013/14). Under the Risk Assessment Framework,

repeated breach of healthcare targets could trigger a concern for Monitor to consider whether further action

would be appropriate, or an investigation required to assess if there has been a formal breach of the licence.

More detail on Monitor’s response is provided in the following paragraphs.

Q U A R T E R T H R E E B O A R D A S S U R A N CE - G O V E R N A N CEThe Quarter 3 Board assurance report in January 2014 included details of the Trust’s position against the

Access and Outcome targets and indicators, as well as updating the Board on the following mitigating action

planned and underway to correct the Red 1 performance position:

❙ The significant operational initiatives developed during Quarter 3 to address and correct Red 1

performance to meet future quarterly and year end targets

❙ Further action proposed following a deep dive into performance, undertaken following Monitor’s visit to

the Trust

❙ Detail of assurance previously provided to and taken by the Board of Directors demonstrating its scrutiny

of the performance position

❙ An adjusted position, following the application of technical changes relating to Early Exit Triage, which

showed achievement of three out of four of the Access and Outcome targets and indicators.

Other Indicators

The paper also included assurance of compliance with all other indicators:

❙ CQC compliance exceptions

The Trust received a second consecutive annual unplanned CQC inspection with no compliance conditions

or recommendations

❙ Quality governance metrics

Executive director turnover – no issues

❙ Board Memorandum on Quality Governance

new document approved at March 2014 Board

❙ Risk Assessment Framework diagram 6

No exceptions

❙ Risk Assessment Framework diagram 13

No governance concerns

M O N I T O R I N F O R M A L I N V E S T I G AT I O N SMonitor’s Regional Director scheduled a call with the Trust in December 2013 to discuss the Trust’s

performance against the response time targets and seek assurance as to the actions being taken by the

Trust to address performance issues. Following the Trust’s failure to achieve Category A8 Red 1 in Quarter 3

2013/14 Monitor scheduled a site visit on Tuesday 14 January 2014 to commence an informal investigation

and assess whether there were any formal governance concerns or breaches of the Trust’s licence conditions.

The Trust shared with Monitor an information pack that contained a range of information on the ambulance

response time targets, in particular Red 1, and the Trust’s current position. In addition, the pack contained

details on the Trust response, including the Red Recovery Plan as agreed with commissioners.

A N N U A L R E P O R T 2 0 1 3 / 1 4 217

Following Monitor’s site visit the Trust undertook further activities to review and develop actions to

address current Red 1 performance including a ‘deep dive’ on Friday 17 January to examine in more

detail those specific areas that contribute materially to the delivery of the Red 1 target, and to test and

provide confidence in the Red Recovery Plan, an assessment of performance versus rurality and costing the

sustainable performance differential.

In advance of the Quarter 3 monitoring call Monitor sought additional information and assurance regarding

the forecast Quarter 4 position and the sustainability of Red 1 delivery moving into 2014/15. Subsequently

as part of the Quarter 3 call Monitor confirmed that the Trust’s Quarter 3 Governance Risk Rating would

remain Green with no governance concerns noted. In addition Monitor confirmed that the Trust would not

be under formal investigation. Monitor did request a site visit on the 18 March 2014 to carry out an ‘informal

investigation’ where they discussed the reasons for failure of the Red 1 target in more detail and sought to

understand the processes and controls in place for recording, reporting and quality assuring performance

against the national targets. At the time of writing the Trust is awaiting a formal outcome letter from

Monitor in respect of the March site visit.

Q U A R T E R F O U R B O A R D A S S U R A N CEDirectors’ Group and senior management responded to external scrutiny from both Monitor and

Commissioners with rigour, reviewing key systems and processes. Significant action was taken to secure the

Red 1 performance target for Quarter 4 (see Quarter 3 Board assurance above).

Significant action was taken to secure the Red 1 performance target for Quarter 4. This involved a review of

internal performance trajectories for Red 1 to incorporate all the identified improvements from the actions

within the Red Performance Recovery Plan (CAP) during Quarter 4. This work was led by the Deputy Director

of Delivery with a senior management team and monitored through a Red 1 Recovery Plan scrutinized at

weekly meetings throughout January and February. The Directors’ Group monitored the position on a weekly

basis and a process was agreed for timing and frequency of reports to the Board of Directors, including

escalation of any concerns.

As a result of delivery of the robust Red 1 Recovery Plan and the high level focus given to it, performance

was achieved against the Red 1 target, at 76.86% at the end of Quarter 4. The Trust did not however

forecast or achieve the Red 1 target for the full year 2013/14, incurring a minor financial penalty from

commissioners as a result. The adjusted performance position against all four indicators for each quarter of

2013/14 is set out below:

Quarter 1 to Quarter 4

Quarter 1 Quarter 2 Quarter 3 Quarter 4

Red 1 A8 (target 75%) 73.69% 71.07% 70.36% 76.86%

Red 2 A8 (target 75%) 78.34% 76.56% 76.34% 77.71%

A19 (target 95%) 96.06% 95.39% 95.76% 95.83%

Learning Disability* Compliant Compliant Compliant Compliant

*compliance monitored by Quality and Governance Committee

A new A&E CAP (consolidated action plan) has been developed for 2014/15 to maintain the focus on

achieving performance by quarter.

O T H E R S U B M I S S I O N S ❙ Corporate Governance Statement

A compliant Corporate Governance Statement is included within the Trust Annual Report (a separate

statement is included within this document 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 agreed that the first such review would be

scheduled for 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.

CO N D I T I O N 4 , F O U N DAT I O N T R U S T G O V E R N A N CECorporate Governance Statement

The Board of Directors approved a Corporate Governance Statement of assurance as part of its review of

provider licence compliance at the end of Quarter 3, 2013/14.

No significant risks to compliance with Condition 4 of the provider licence were identified during

development of the Statement which was prepared at the end of the first year following acquisition of the

Great Western Ambulance Service NHS Trust. As the acquisition had constituted a ‘significant transaction’,

the Trust’s Corporate and Quality governance arrangements had been the subject of considerable scrutiny

prior to and during integration. For the first year therefore, as an enlarged Trust, the corporate governance

position was robust. The following arrangements in particular are worth noting:

❙ Effective Board and committee structures

Reviewed and approved in early 2013, retaining the structure in place within SWASFT.

❙ Clear responsibilities for the Board, its committees and staff reporting to them

Process agreed for recruitment and reappointment of NEDs; swift action by the Board to manage any

Board vacancies; and ongoing communication with Monitor about any changes. The Board and each of

its committees manage their business with annual cycles which are aligned and set the agendas for each

meeting.

❙ Clear reporting lines throughout the Trust

Trust organisational structure reviewed as part of the acquisition including a new tier of Associate/Deputy

Directors and a new Performance Management Framework, with Annual Accountability Agreements for

each individual Director and their teams.

❙ Timely and accurate information to assess risks to compliance with the Trust’s licence

The Board reviews the Trust Integrated Corporate Performance Report at each meeting and receives a

quarterly assurance report on all indicators which impact upon the conditions of the provider licence.

❙ Degree and rigour of Board oversight of performance

See above in relation to the ICPR. The Board Assurance Framework and Corporate Risk Register containing

principle risks are reviewed by the Board of Directors at each meeting. Quarterly Board Assurance Reports

are presented and scrutinised to support submissions to Monitor against the requirements of the provider

licence (see Quality Governance arrangements). Each Trust committee is also chaired by a Non-executive

Director which allows for challenge and assurance provided to the rest of the Board. Each working group

A N N U A L R E P O R T 2 0 1 3 / 1 4 219

and committee agenda contains a standing item relating to the Identification of Exception Reporting

Triggers. In addition, the Quality and Governance Committee has introduced annual deep dives into key

quality and performance functions, with exception/highlight reports provided to the remainder of its

meetings.

The Board of Directors reviewed and agreed the first Corporate Governance Statement at its January 2014

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 200.

C A R E Q U A L I T Y CO M M I S S I O N R E G I S T R AT I O NThe Foundation Trust is fully compliant with the registration requirements of the Care Quality Commission.

The CQC commenced an unannounced inspection of SWASFT on Tuesday 11 February 2014. The lead

inspector confirmed it was a routine inspection, and not triggered as a result of any concern.

The inspection occurred over five days, involved a total of four inspectors and assessed the Trust’s compliance

with five outcomes:

❙ Outcome 2 – Consent to Care and Treatment

❙ Outcome 4 – Care and Welfare of people who use service

❙ Outcome 10 – Safety and Suitability of Premises

❙ Outcome 16 – Assessing and monitoring the quality of service provision

❙ Outcome 17 – Complaints.

The outcome of the inspection was very positive with the Trust confirmed as compliant with all five outcomes.

The report includes some really positive comments made by our patients, and there are also many references

within the report to the positive way staff have responded to the inspectors explaining what, why and how

they do their role.

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; these contain information relating to the Quality and Risk

Profile. 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 four

outcomes. This report, by Audit Southwest, presented a low risk to the organisation.

DATA S E CU R I T YFurther 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 2013/14, one

information security incident was classified as a serious incident, this was investigated using the Trust’s

Serious Incident process and was reported on the new national information governance reporting system

hosted on the Information Governance website. The Trust achieved compliance with level 2 of the NHS

Information Governance Toolkit in 2012/13 and work has taken place to maintain this level of compliance

during 2013/14.

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.

S TA K E H O L D E R E N G AG E M E N TThe 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.

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.

A N N U A L R E P O R T 2 0 1 3 / 1 4 221

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. Following the serious incident review meeting, each individual serious

incident report and associated action plan is presented to the Directors’ Group for final sign off, who

then monitor completion of actions. During 2013/14 regular meetings took place with the Trust’s lead

Commissioner regarding completion of serious incidents and associated actions, these will be held with the

Commissioning Support Unit in 2014/15.

The following serious incidents and their type and number were identified during 2013/14:

Clinical assessment issues 20

Telephone clinical triage issues 11

Ambulance delay 7

Coding error resulting in ambulance delay 7

IT / System / Power failure 7

Non-conveyance following assessment 6

Delay in the arrival of secondary resource 5

Address issues 4

Treatment and procedure 4

Allegation of abuse 2

Road traffic collision 2

Staff welfare issue 1

Data protection issue 1

Media 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 2013 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 Management Plan) 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. A deep dive into the Trust’s environmental

responsibilities will be presented to the Quality and Governance Committee in May 2014. 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.

R E V I E W O F E CO N O M Y, E F F I C I E N C Y A N D E F F E C T I V E N E S S O F T H E U S E O F R E S O U R CE S 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:

❙ 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 includes a cashflow statement and performance against the cost

improvement programme by individual scheme.

A N N U A L Q U A L I T Y R E P O R T The 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 Board of Directors 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 Medical Director (a GP) leads on the Trust Quality Report and the Executive Director of Nursing

and Governance is the Board lead on Governance. A Trust quality group compiled the Quality Account

indicators for 2013/14 and their review, together with first draft of the 2014/15 priorities has enabled cross

A N N U A L R E P O R T 2 0 1 3 / 1 4 223

directorate and multi-disciplinary input to the quality priorities. The Trust Quality Report for 2013/14 includes

all mandatory statements and statements of assurance from mandatory key stakeholders.

The Board will sign off the Quality Report for 2013/14 in May 2014 after receiving the draft document and a

full briefing paper.

The Trust Quality Account for 2013/14 has been reviewed and the Council of Governors consulted on

assurance that the indicators have been addressed in year. The Council will select a local indicator for special

review by the external auditors (who also review at least two mandated indicators).

Quality Account priorities for 2014/15 were drafted in consultation with the Council of Governors and these

will be informed by commissioners from the East/West and North divisions, 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

were met for 2013/14 other than for Red 1 (see Quality Governance section on Targets and Indicators

above). These were reported to the Board monthly within the Integrated Corporate Performance Report

with exception reports and action planning re-addressing any off plan performance in year. This report is

published on the Trust internet site for public scrutiny.

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 2013/14 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 2013/14 by Audit

Southwest. The reports will not be published until June 2014.

R E V I E W O F E F F E C T I V E N E S S 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 of Directors, the Audit Committee, Finance and Investment

Committee, and 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 (2013)

❙ Reports from external auditors

❙ Assurances on process provided by the Audit Committee and its officers, including twice yearly review of

the process for risk management, and annual review of 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 which was demonstrated by the positive outcome of the

unannounced inspection of the Trust in February 2014

❙ Care Quality Commission Quality and Risk Profile

❙ 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;

❙ Peer reviews by other organisations

❙ Deep dives to the Quality and Governance Committee.

The Board of Directors regularly reviews its governance reporting structure. The Board of Directors, Audit,

Finance and Investment 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 by the Board of Directors. 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 four 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; HR activity; clinical and non-clinical training; policy register;

compliance; safeguarding updates; 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, during 2013/14 the

Committee focused its attention on deep dives into key areas and reporting by exception. The deep dives

that took place during 2013/14 included the Ambulance Clinical Quality Indicators (ACQIs), risk management,

patient experience, 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

A N N U A L R E P O R T 2 0 1 3 / 1 4 225

as part of the internal audit programme for 2013/14 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.

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. The Audit Committee

also has a responsibility for reviewing the effectiveness of processes in place for the management of clinical

assurance. 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 Local Security Management

Service lead. They lead the Health and Safety Group and associated work programme, under the line

management of the Head of Governance. The Audit Committee includes the attendance of 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 the

shortfall in performance on Red 1 and Red 2 targets (see Quality Governance section above). 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 22 May 2014. It is based on these

assurances that the Annual Governance Statement is approved.

CO N CL U S I O N 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

Chief Executive

Date: 22 May 2014

A N N U A L R E P O R T 2 0 1 3 / 1 4 227

auditors’ report

A N N U A L R E P O R T 2 0 1 3 / 1 4 229

Independent auditors’ report to the Council

of Governors of South Western Ambulance

Service NHS Foundation Trust

R E P O R T O N T H E F I N A N C I A L S TAT E M E N T SOur opinion

In our opinion the financial statements, defined below:

❙ give a true and fair view of the state of the NHS Foundation Trust’s affairs as at 31 March 2014 and of its

income and expenditure and cash flows for the year then ended to 31 March 2014; and

❙ have been prepared in accordance with the NHS Foundation Trust Annual Reporting Manual 2013/14.

This opinion is to be read in the context of what we say in the remainder of this report.

W H AT W E H AV E A U D I T E DThe financial statements, which are prepared by South Western Ambulance Service NHS Foundation Trust,

comprise:

❙ the Statement of Financial Position as at 31 March 2014;

❙ 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 Taxpayers’ Equity for the year then ended; and

❙ the notes to the financial statements, which include other explanatory information.

The financial reporting framework that has been applied in their preparation is the NHS Foundation

Trust Annual Reporting Manual 2013/14 issued by the Independent Regulator of NHS Foundation Trusts

(“Monitor”).

In applying the financial reporting framework, the directors have made a number of subjective judgements,

for example in respect of significant accounting estimates. In making such estimates, they have made

assumptions and considered future events.

W H AT A N A U D I T O F F I N A N C I A L S TAT E M E N T S I N V O LV E SWe conducted our audit in accordance with International Standards on Auditing (UK and Ireland) (“ISAs

(UK & Ireland)”). 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 NHS Foundation 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.

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.

O P I N I O N O N O T H E R M AT T E R S P R E S CR I B E D B Y T H E A U D I T CO D E F O R N H S F O U N DAT I O N T R U S T SIn 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 2013/14.

O T H E R M AT T E R S O N W H I CH W E A R E R E Q U I R E D T O R E P O R T B Y E XCE P T I O NWe have nothing to report in respect of the following matters where the Audit Code for NHS Foundation

Trusts requires us to report to you if:

❙ in our opinion the Annual Governance Statement does not meet the disclosure requirements set out in the

NHS Foundation Trust Annual Reporting Manual 2013/14 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 not been able to satisfy ourselves that the NHS Foundation Trust has made proper arrangements

for securing economy, efficiency and effectiveness in its use of resources; or

❙ we have qualified, on any aspect, our opinion on the Quality Report.

R E S P O N S I B I L I T I E S F O R T H E F I N A N C I A L S TAT E M E N T S A N D T H E A U D I TOur responsibilities and those of the directors

As explained more fully in the statement of accounting officer’s responsibilities set out on page 185 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 2013/14.

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 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.

The maintenance and integrity of the South Western Ambulance 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.

CE R T I F I C AT EWe 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

23 May 2014

A N N U A L R E P O R T 2 0 1 3 / 1 4 231

annual accounts

A CCO U N T S F O R T H E Y E A R E N D E D 31 M A R CH 2 014

Foreword to the accounts

These accounts for the year ended 31 March 2014 are prepared in accordance with paragraphs 24 and 25 of

Schedule 7 to the NHS Act 2006 and comply with the annual reporting guidance for NHS Foundation Trusts

within the NHS Foundation Trust Annual Reporting Manual.

Signed:

Ken Wenman

Chief Executive and Accounting Officer

22 May 2014

A N N U A L R E P O R T 2 0 1 3 / 1 4 233

STATEMENT OF COMPREHENSIVE INCOME FOR THE YEAR ENDED 31 MARCH 2014

Year ended 31 March 2014


Note £000 £000

Operating income from continuing operations 4.1 225,618 147,210

Operating expenses from continuing operations 5.1 (223,335) (143,962)

Operating surplus 2,283 3,248

Finance costs:

Finance income 8 89 74

Finance costs - financial liabilities 9 (147) (71)

Finance costs - unwinding of discount on provisions 19 (65) (62)

PDC Dividends payable (1,827) (1,311)

Net finance costs (1,950) (1,370)

Gain from transfer by absorption 2 0 35,056

Surplus for investment from continuing operations 333 36,934

Other comprehensive income

Impairments 10.1 (1,259) (313)

Revaluations 10.1 1,943 320

Transfers by absorption: transfers between reserves 0 (247)

Total comprehensive income 1,017 36,694

The notes on pages 239 to 279 form part of these accounts.

STATEMENT OF FINANCIAL POSITION AS AT 31 MARCH 2014

31 March 2014

31 March 2013

Note £000 £000

Non-current assets

Property, plant and equipment 10.1 81,974 82,927

Trade and other receivables 13 0 27

Total non-current assets 81,974 82,954

Current assets

Inventories 12 2,036 1,832

Trade and other receivables 13 6,367 5,113

Cash and cash equivalents 21 30,449 25,893

Total current assets 38,852 32,838

Current liabilities

Trade and other payables 14.1 (20,287) (17,731)

Borrowings 16 (504) (976)

Provisions 19 (7,876) (9,210)

Other liabilities 15 (141) (210)

Total current liabilities (28,808) (28,127)

Total assets less current liabilities 92,018 87,665

Non-current liabilities

Borrowings 16 (3,221) (3,684)

Provisions 19 (3,952) (3,553)

Total non-current liabilities (7,173) (7,237)

Total assets employed 84,845 80,428

Financed by taxpayers’ equity:

Public Dividend Capital 42,455 39,055

Revaluation reserve 20 7,115 6,868

Income and expenditure reserve 35,275 34,505

Total Taxpayers’ Equity 84,845 80,428

The accounts on pages 232 to 279 were approved by the Board on 22 May 2014 and signed on its behalf by:

Ken Wenman

Chief Executive

A N N U A L R E P O R T 2 0 1 3 / 1 4 235

STATEMENT OF CHANGES IN TAXPAYERS’ EQUITY FOR THE YEAR ENDED 31 MARCH 2014

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 2013 39,055 6,868 34,505 80,428

Surplus for the period 0 0 333 333

Transfers between reserves 0 (432) 432 0

Impairments 10.1 0 (1,259) 0 (1,259)

Revaluations - property, plant and equipment

10.1 0 1,943 0 1,943

Asset disposals 0 (5) 5 0

Public Dividend Capital received 3,400 0 0 3,400

Other reserve movements 0 0 0 0

Taxpayers’ Equity at 31 March 2014

42,455 7,115 35,275 84,845

STATEMENT OF CHANGES IN TAXPAYERS’ EQUITY FOR THE YEAR ENDED 31 MARCH 2013

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 2012 37,855 3,529 1,150 42,534

Surplus for the period 0 0 36,934 36,934

Transfers by absorption: transfers between reserves

0 3,681 (3,681) 0

Impairments 0 (313) 0 (313)

Revaluations 0 320 0 320

Asset disposals 0 1 0

Public Dividend Capital received 1,200 0 0 1,200

Other reserve movements 0 (348) 101 (247)

Taxpayers’ Equity at 31 March 2013

39,055 6,868 34,505 80,428

STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31 MARCH 2014

Note



£000 £000

Cash flows from operating activities

Operating surplus from continuing operations 2,283 3,248


Non cash income and (expense)

Depreciation 5.1 12,094 7,248

Impairments 5.1 3,508 243

Reversals of impairments 4.1 (679) (179)

Loss on disposal 5.1 (77) (41)

Dividends accrued and not paid or received 13.1 0 130

Increase in trade and other receivables 13.1 (1,353) (2,572)

Increase in Inventories 12.1 (204) (452)

Increase in trade and other payables 14.1 1,879 5,901

(Decrease) in other liabilities 15 (69) (206)

(Decrease) / increase in Provisions 19 (1,000) 9,763

Net cash generated from operations 16,382 23,083

Cash flows from investing activities

Interest received 8 89 74

Purchase of property, plant and equipment 10.1 & 14.1 (12,747) (8,297)

Sales of Property, Plant and Equipment 4.1, 5.1 & 10.1 215 40

Net cash used by investing activities (12,443) (8,183)

Cash flows from financing activities

Public dividend capital received 3,400 1,200

Loans received 16 0 124

Loans repaid to the Department of Health 16 (872) (489)

Loans repaid 16 (60) (40)

Interest paid (86)

Interest element of finance lease (64) (50)

PDC Dividend paid (1,701) (1,607)

Net cash used in financing activities 617 (862)

Net Increase in cash and cash equivalents 4,556 14,038

Cash and cash equivalents at the start of the year 25,893 9,055

Cash and Cash equivalents changes due to transfers by absorbtion 0 2,800

Cash and cash equivalents at 31 March 30,449 25,893

A N N U A L R E P O R T 2 0 1 3 / 1 4 237

N O T E S T O T H E A CCO U N T S

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 2013/14 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.

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 Trust has made a provision for estimated legal costs arising from ongoing Employment Tribunal

cases.

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.

Following the acquisition of Great Western Ambulance Service (GWAS) on 1 February 2013 the Trust

continues to work through outstanding legacy issues. The 2012/13 accounts included a redundancy

provision for the subsequent restructure. In 2013/14 a new provision has been made to take into

account the continuing review of the Trust’s organisational structure.

A restructuring provision has been made relating to the Trust’s Operational Structure Change

Programme.

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 2014. Indexation has not been applied to any non current assets (i.e. vehicles and

equipment). The key assumptions for the valuation is set out in note 1.9.

Due to the loss of PTS contracts the Trust has revalued its PTS fleet based on the auction price received

for a sample of the surplus vehicles.

The Trust has agreed the sale of its Marybush site to the Homes and Communities Association (HCA).

As a result the site has been revalued from Depreciated Replacement Cost (DRC) to market value.

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.

Other critical judgements

The Trust reviews all lease contracts to determine whether they are operating or finance leases.

The bad debt provision has been calculated based on a detailed review of each balance over 60 days.

Income has been deferred where expenditure will take place during the year ended 31 March 2015.

A N N U A L R E P O R T 2 0 1 3 / 1 4 239

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 1.8% (2013: 2.35%) has been used to calculate the Injury Benefit provision of

£3.972 million (2013: £3.629 million).

Non current asset lives have been reassessed by the District Valuer at 31 March 2014.

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

2013/14.

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. The

income is measured at the agreed tariff for the treatments provided to the injured individual, less a

provision for unsuccessful compensation claims and doubtful debts.

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.

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.

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

A N N U A L R E P O R T 2 0 1 3 / 1 4 241

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 2014.

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.

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.

Specialised buildings - depreciated replacement cost

Until 31 March 2009, the depreciated replacement cost of specialised buildings has been estimated

for an exact replacement of the asset in its present location. 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.

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.

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.

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.

A N N U A L R E P O R T 2 0 1 3 / 1 4 243

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.

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.

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.

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.

Present obligations arising under onerous contracts are recognised and measured as a provision. An

onerous contract is considered to exist where the Trust has a contract under which the unavoidable

costs of meeting the contractual obligations exceed the economic benefits expected to be received

under it.

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.

A N N U A L R E P O R T 2 0 1 3 / 1 4 245

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 19 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 22, 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.

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.

For financial assets carried at amortised costs, the amount of the impairment loss is measured as the

difference between the asset’s carrying amount and the present value of the revised future cash flows

discounted at the asset’s original effective interest rate. The loss is recognised in the Statement of

Comprehensive Income and the carrying amount of the asset is reduced directly.

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.

A N N U A L R E P O R T 2 0 1 3 / 1 4 247

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 2014

❙ 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.

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) for 2013/14 only, net assets and liabilities transferred from bodies which ceased to exist on 1

April 2013, and (iv) 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 2014/15

IFRS 10 Consolidated annual report and accounts

IFRS 11 Joint Arrangements

IFRS 12 Disclosure of Interests in Other Entities

IAS 27 Separate annual report and accounts

IAS 28 Associates and Joint Ventures

IAS 32 Financial Instruments

IFRIC 21 Levies

Standards applicable from 2015/16

IFRS 13 Fair Value Measurement

IAS 36 (Amendment) Recoverable amounts disclosure

Other standards in issue

IFRS 9 Financial Instruments

A N N U A L R E P O R T 2 0 1 3 / 1 4 249

2 Transfer by Absorption

The Trust acquired Great Western Ambulance Service NHS Trust (GWAS) on the 1 February 2013.

“Accounting by Absorption” was used to account for this transaction, resulting in a set of accounts for

2012/13 incorporating 12 months operational trading for SWASFT and two months for GWAS.

This section has been included as the 2012/13 comparable figures were prepared on this basis.

STATEMENT OF COMPREHENSIVE INCOME FOR THE YEAR ENDED 31 MARCH 2013

SWASFT 2012/13 GWAS Comparatives

SWASFT without GWAS

GWAS GWAS GWAS


2 month period ended 31 March 2013

10 month period ended 31 January 2013


£000 £000 £000 £000

Operating income from continuing operations 130,920 16,290 74,654 89,766

Operating expenses from continuing operations (128,205) (15,757) (73,594) (89,838)

Operating surplus 2,715 533 1,060 (72)

Net finance costs (1,140) (230) (851) (1,178)

Surplus for investment from continuing operations

1,575 303 209 (1,250)

Other comprehensive income

Impairments (313) (471) (340)

Revaulations 320 77 1,555

Total comprehensive income 1,582 303 (185) (35)

STATEMENT OF FINANCIAL POSITION AS AT 31 JANUARY 2013 GWAS

31 January 2013

£000

Non-current assets

Intangible assets 248

Property, plant and equipment 36,536

Trade and other receivables 676

Total non-current assets 37,460

Current assets

Inventories 623

Trade and other receivables 3,934

Cash and cash equivalents 12,650

Total current assets 17,207

Current liabilities

Trade and other payables (7,193)

Borrowings (910)

Provisions (7,184)

Total current liabilities (15,287)

Total assets less current liabilities 39,380

Non-current liabilities

Borrowings (3,436)

Provisions (888)

Total non-current liabilities (4,324)

Total assets employed 35,056

Financed by taxpayers’ equity:

Public Dividend Capital 35,169

Revaluation reserve 3,681

Income and expenditure reserve (3,794)

Total Taxpayers’ Equity 35,056

The effect the transaction has had on the annual report and accounts are: £000

Income and expenditure reserve has increased transferring the GWAS total Public Dividend Capital and income and expenditure reserve.

31,375

Revaluation reserve has increased transferring the GWAS total revaluation reserve. 3,681

Total GWAS transferred due to Absorption Accounting 35,056

A N N U A L R E P O R T 2 0 1 3 / 1 4 251

3 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 segmentaal 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 Ambulance and Emergency income (A&E) service line accounts for 77.5% (2013:77.9%)of total

income received by South Western Ambulance Service NHS Foundation Trust during the year ended

31 March 2014. Urgent Care Services (UCS) including Out of Hours and 111 accounts for 9.9%

(2013:10.1%) of the total income received by South Western Ambulance Service NHS Foundation

Trust during the same period.

31 March 2014 31 March 2013

£000 £000

A&E income 174,825 109,592

PTS income 10,389 8,265

UCS income 22,438 14,845

Other income 17,966 14,508

Total income 225,618 147,210

Operating expenses (223,335) (143,962)


Other income include the Olympics (2012/13 only), HART, hosting of the Ambulance Radio

Programme (ARP) team, Winter Pressures, Road Traffic Accident (RTA), 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.

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

out-patient 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.

4.1 Operating income (by classification)Year ended 31 March 2014


£000 £000

Income from activities

Income from Commissioner Requested Services

A&E income 174,825 109,592

PTS income 10,389 8,265

Income from non-Commissioner Requested Services

Other income 35,020 26,286

Private patient income 2 7

Total income from activities 220,236 144,150

Other Income

The other income from non-Commissioner requested Services of £35.020 million (2013: £26.286

million) can be further broken down as follows:



£’000 £’000

Urgent Care Services (UCS) 17,878 14,845

Hazardous Area Response Team (HART) 6,432 4,332

111 4,560 62

Other 6,150 7,047

Total Other Income 35,020 26,286

Other operating income

Research and development 128 45

Education and Training 501 656

Other 3,163 1,406

Profit on disposal of property, plant and equipment 131 47

Reversal of impairments of property, plant and equipment 679 179

Rental revenue from operating leases 110 2

Income in respect of staff costs 670 725

Total other operating income 5,382 3,060

Total operating income 225,618 147,210

Included in other income £3.163 million (2013: £1.406 million) is £2.390 million Ambulance Radio

Programme (ARP) Funding (2013: £0 million).

A N N U A L R E P O R T 2 0 1 3 / 1 4 253

4.2 Income from patient care activities

£000 £000

NHS Foundation trusts 5,078 5,642

NHS trusts 1,397 2,536

Strategic Health Authorities 0 6

Primary care trusts 0 134,458

Clinical Commissioning Groups and NHS England 212,201 0

Department of Health 618 966

Non-NHS

Private patients 2 7

Injury costs recovery 746 443

Other 194 92

220,236 144,150

4.3 Operating lease income

In 2012/13 the Trust sublet part of a property in Paignton to a third party. This contract ended on the

31 March 2013.

Operating lease incomeYear ended 31 March 2014


£000 £000

Rents recognised as income in the period 110 2

Total 110 2

Future minimum lease payments receivableYear ended 31 March 2014


£000 £000

Not later than one year 0 2

Later than one year and not later than five years 0 0

Total 0 2

4.4 Income from sale of goods

Income is wholly from the supply of services, there is no income from the sale of goods.

4.5 Income generation activities

The Trust undertakes income generation activities with an aim of reinvesting any profit in patient care.

No income generation activities exceeded £1million.

5.1 Operating Expenses (by type)Year ended 31 March 2014


£000 £000

Services from NHS Foundation Trusts 1 37

Employee Expenses - Executive directors 734 696

Employee Expenses - Non-executive directors 130 125

Employee Expenses - Staff 158,061 103,440

Drug costs 596 915

Supplies and services - clinical (excluding drug costs) 6,097 2,788

Supplies and services - general 1,589 973

Establishment 4,714 3,417

Transport 19,691 11,260

Premises 8,316 5,140

Increase in provision for impairment of receivables 119 (3)

Change in provision discount rate and increase in other provisions 510 0

Inventories write down 168 138

Rentals under operating leases - minimum lease receipts 2,184 2,115

Depreciation on property, plant and equipment 12,094 7,248

Impairments of property, plant and equipment 3,508 243

Audit services - statutory audit 56 83

Other auditor remuneration 0 2

Clinical negligence 126 136

Loss on disposal of property, plant and equipment 54 6

Legal fees 356 206

Other professional fees 929 634

Training, courses and conferences 1,058 773

Car parking and Security 48 42

Redundancy 556 1,991

Early retirements 10 6

Insurance 220 111

Other services, eg external payroll 338 259

Losses, ex gratia and special payments 100 647

Other 972 534

223,335 143,962

The Trust’s contract with its auditors, as set out in the engagement letter signed 19 February 2014,

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 (2013: £1

million).

A N N U A L R E P O R T 2 0 1 3 / 1 4 255

5.2 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 eight years remaining. The longest lease relates to land at Torpoint.



£000 £000

Minimum lease payments 2,184 2,115

Future minimum lease payments due Year ended 31 March 2014

£000 £000 £000 £000 £000

Land Buildings Plant and machinery

Other Total

Not later than one year 33 1,147 29 335 1,544

Later than one year and not later than five years

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


£000 £000 £000 £000 £000

Land Buildings Plant and machinery

Other Total

Not later than one year 34 889 113 404 1,440


131 1,603 85 392 2,211

Later than five years 2,009 2,755 0 0 4,764

Total 2,174 5,247 198 796 8,415

6.1 Employee benefits Year ended 31 March 2014 Year ended 31 March 2013

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£000 £000 £000 £000 £000 £000

Salaries and wages 127,907 119,100 8,807 85,416 78,483 6,933

Social Security Costs 8,896 0 8,896 5,882 5,651 231

Employer contributions to NHS Pension scheme 15,788 0 15,788 10,371 9,748 623

Pension cost - other contribution 0 0 0 6 6 0

Termination benefits 0 0 0 1,991 1,991 0

Agency/contract staff 6,204 0 6,204 2,467 0 2,467

Total 158,795 119,100 39,695 106,133 95,879 10,254

6.2 Average number of employees (WTE basis)

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Number Number Number Number Number Number

Medical and dental 77 7 70 46 2 44

Ambulance staff 2,499 2,455 44 1,710 1,642 68

Administration and estates 853 806 47 557 474 83

Healthcare assistants and other support staff

328 328 0 286 277 9

Nursing, midwifery and health visiting staff

58 58 0 37 30 7

Bank and agency staff 258 0 258 19 0 19

Total 4,073 3,654 419 2,655 2,425 230

A N N U A L R E P O R T 2 0 1 3 / 1 4 257

6.3 Staff sickness absence Year ended 31 March 2014


Number Number

Days lost (long term) 30,731 13,225

Days lost (short term) 13,671 6,310

Total days lost 44,402 19,535

Total staff years 3,763 2,198

Average working days lost 11.80 8.89

Total Staff Employed In Period (Headcount) 4,094 2,428

Total Staff Employed In Period with No Absence (Headcount) 1,420 961

Percentage Staff With No Sick Leave 34.7% 39.6%

The sickness days reported are for the period from January to December each year and therefore the

2012/13 figures do not include the North Division.

6.4 Remuneration and other benefits received by Directors

The aggregate of remuneration and other benefits received by Directors during the year to March

2014 was £0.864 million (to 31 March 2013; £0.821 million).

In the year ended 31 March 2014, 6 directors (2013: 6 directors) accrued benefits under a defined

benefit pension scheme.

During the year to 31 March 2014, 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 £0.002

million. During the financial year 2012/13 the Chief Executive was seconded part time to Great

Western Ambulance Trust.

6.5 Retirements due to ill-health

During the year to 31 March 2014 there were 10 early retirements from the Trust agreed on the

grounds of ill-health (31 March 2013: 7 early retirements). The estimated additional pension liabilities

of this ill-health retirements will be £0.648 million (31 March 2013: £0.496 million). The cost of these

ill-health retirements will be borne by the NHS Business Services Authority - Pensions Division.

6.6 Exit Packages for staff leaving during the year ending March 2014

Fifty three staff (£2.402 million) left South Western Ambulance Service NHS Foundation Trust during

the year ending 31 March 2014 (2013: £0.542 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.

6.7 Exit Packages


Exit package cost band (including any special payment element)

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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


Exit package cost band (including any special payment element)

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Number £000s Number £000s Number £000s

Less than £10,000 5 40 2 13 7 53

£10,001 - £25,000 3 39 0 0 3 39

£25,001 - £50,000 1 40 1 37 2 77

£50,001 - £100,000 4 246 0 0 4 246

£100,001 - £150,000 1 127 0 0 1 127

£150,001 - £200,000 0 0 0 0 0 0

>£200,000 0 0 0 0 0 0

Total 14 492 3 50 17 542

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.

A N N U A L R E P O R T 2 0 1 3 / 1 4 259

There were sixteen other departures agreed for the year ended 31 March 2014, thirteen were

Mutually Agreed Resignation Scheme (MARS) and three were Compromise agreements.

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

period.

7 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.

The scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an

accounting valuation every year. An outline of these follows:

a) 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 to be paid by employers and scheme members. The last such valuation, which determined

current contribution rates was undertaken as at 31 March 2004 and covered the period from 1 April

1999 to that date. The conclusion from the 2004 valuation was that the scheme had accumulated a

notional deficit of £3.3 billion against the notional assets as at 31 March 2004.

In order to defray the costs of benefits, employers pay contributions at 14% of pensionable pay and

most employees had, up to April 2008, paid 6%, with manual staff paying 5%.

Following the full actuarial review by the Government Actuary undertaken as at 31 March 2004

and after consideration of changes to the NHS Pension Scheme taking effect from 1 April 2008, his

valuation report recommended that employer contributions could continue at the existing rate of 14%

of pensionable pay, from 1 April 2008, following the introduction of employee contributions on a

tiered scale from 5% up to 8.5% of their pensionable pay depending on total earnings.

On advice from the scheme actuary, scheme contributions may be varied from time to time to reflect

changes in the scheme’s liabilities.

b) Accounting valuation

A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the

reporting period by updating the results of the full actuarial valuation.

Between the full actuarial valuations at a two-year midpoint, a full and detailed member data-set

is provided to the scheme actuary. At this point, the assumptions regarding the composition of the

scheme membership are updated to allow the scheme liability to be valued.

The valuation of the scheme liability as at 31 March 2011, is based on detailed membership data as

at 31 March 2008 (the latest midpoint) updated to 31 March 2011 with summary global member and

accounting data.

The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which

forms part of the annual NHS Pension Scheme (England and Wales) Resource Account, published

annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained

from The Stationery Office.

c) Scheme provisions

The NHS Pension Scheme provides defined benefits, which are summarised below. This list is an

illustrative guide only and is not intended to detail all the benefits provided by the Scheme or the

specific conditions that must be met before these benefits can be obtained:

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.

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.

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.

A N N U A L R E P O R T 2 0 1 3 / 1 4 261

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% of pensionable pay and employer contributions

were also 1% 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.

8 Finance incomeYear ended 31 March 2014


£000 £000

Interest on bank accounts 89 74

Total 89 74

9 Finance costs - interest expense

£000 £000

Loans from the Department of Health 86 12

Finance leases 60 58

Interest on late payment of commercial debt 1 1

Total 147 71

10.1 Property, plant and equipment

For the year ended 31 March 2014

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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 charged to operating expenses

0 0 0 0 0 0 0 0

Impairments charged to the revaluation reserve

(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 period 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

Revaluation (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

A N N U A L R E P O R T 2 0 1 3 / 1 4 263

10.2 Property, plant and equipment (cont)

For the year ended 31 March 2013

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£000 £000 £000 £000 £000 £000 £000 £000

Cost or valuation at 1 April 2012

5,769 15,134 4,022 2,892 38,821 3,995 561 71,194

Transfers by Absorption 10,581 13,171 1,207 2,649 24,532 5,792 245 58,177

Additions purchased 0 382 233 471 5,351 1,465 51 7,953

Impairments (15) (298) 0 0 0 0 0 (313)

Reversal of impairments 0 0 0 0 0 0 0 0

Reclassifications 0 0 (4,002) 1,697 2,296 9 0 0

Revaluation 0 320 0 0 0 0 0 320

Disposals 0 0 0 0 (3,986) 0 0 (3,986)

At 31 March 2013 16,335 28,709 1,460 7,709 67,014 11,261 857 133,345

Accumulated depreciation at 1 April 2012

0 0 0 2,738 20,207 2,051 417 25,413

Transfers by Absorption 94 674 0 1,861 13,685 5,091 235 21,640

Provided during period 0 854 0 264 5,338 713 79 7,248

Impairments 13 230 0 0 0 0 0 243

Reversal of impairments 0 (179) 0 0 0 0 0 (179)

Reclassifications 0 0 0 0 0 0 0 0

Disposals 0 0 0 0 (3,947) 0 0 (3,947)

Accumulated depreciation at 31 March 2013

107 1,579 0 4,863 35,283 7,855 731 50,418

Net book value

Owned 16,228 26,900 1,460 2,846 31,568 3,406 126 82,534

Finance leased 0 230 0 0 0 0 0 230

Donated 0 0 0 0 163 0 0 163

Total at 31 March 2013 16,228 27,130 1,460 2,846 31,731 3,406 126 82,927

10.3 Property, plant and equipment (cont.)

The Trust’s land and buildings were revalued by the District Valuer at 31 March 2014. 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 2014. Where the improvement 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 2014.

No other classes of non-current assets were revalued during the year.

The District Valuer also provided a market value at 31 March 2014 for all specialised properties. These

values were not significantly different to the Depreciated Replacement Cost used in the accounts. 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 0 15

Transport equipment 0 12

Information technology 2 8

Furniture and Fittings 5 7

The Gross carrying amount of fully depreciated assets still in use at 31 March 2014 was £21.663

million (2013: £12.200 million).

11 Contractual capital commitments

As at 31 March 2014

As at 31 March 2013

£000 £000

Property, plant and equipment 3,969 1,528

3,969 1,528

A N N U A L R E P O R T 2 0 1 3 / 1 4 265

12 Inventories

12.1 Inventories 31 March 2014 31 March 2013

£000 £000

Drugs 161 99

Consumables 999 770

Energy 276 283

Other 600 680

Total 2,036 1,832

12.2 Inventories movementYear ended 31 March 2014


£000 £000

Carrying Value at 1 April 1,832 1,380

Transfers by absorption 0 623

Additions 386 6,299

Inventories recognised in expenses (14) (6,332)

Write-down of inventories recognised as expenses (168) (138)

Carrying Value at 31 March 2,036 1,832

13 Trade and other receivables

13.1 Trade and other receivables CurrentNon-current

CurrentNon-current

£000 £000 £000 £000

NHS receivables 1,924 0 2,188 0

Other receivables with related parties 77 0 30 0

Provision for impaired receivables (283) 0 (164) 0

Prepayments 3,530 0 1,806 27

Accrued income 117 0 131 0

PDC receivable 4 0 130 0

VAT receivable 367 0 210 0

Other receivables 631 0 782 0

Total 6,367 0 5,113 27

The majority of trade receivables is 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.

13.2 Provision for impairment of receivables 31 March 201431 March2013

£000 £000

Balance at 1 April 2013 (164) (23)

Transfers by absorption 0 (164)

Increase / (decrease) in provision (119) 3

Amounts utilised 0 20

Unused amounts reversed 0 0

Balance at 31 March 2014 (283) (164)

Majority of the provision relates to aerial Site income and the recovery of overpaid salaries.

13.3 Receivables past their due date

£000 £000

Ageing of impaired receivables

0-30 days 0 0

30-60 days 3 0

60-90 days 12 2

90-180 days (was “In three to six months”) 33 88

180-360 days (was “Over six months”) 235 74

Total 283 164

Ageing of non-impaired receivables past their due date

0-30 days 131 723

30-60 days 26 57

60-90 days 56 19

90-180 days (was “In three to six months”) 26 77

180-360 days (was “Over six months”) 227 (32)

Total 466 844

A N N U A L R E P O R T 2 0 1 3 / 1 4 267

14.1 Trade and other payables CurrentNon-current

CurrentNon-current

£000 £000 £000 £000

NHS payables 655 0 199 0

Amounts due to other related parties - revenue 61 0 213 0

Other trade payables - capital 2,967 0 2,290 0

Other trade payables - revenue 5,773 0 4,136 0

Social Security costs 1,469 0 1,480 0

Other taxes payable 1,420 0 1,490 0

Other payables 934 0 493 0

Accruals 7,008 0 7,430 0

PDC dividend payable 0 0 0 0

Total 20,287 0 17,731 0

14.2 Better Payment Practice Code - measure of compliance

31 March 2014 31 March 2013

Number £000 Number £000

Total Non-NHS trade invoices paid in the year 48,088 55,532 32,486 34,506

Total Non NHS trade invoices paid within target 46,857 54,452 31,750 32,012

Percentage of Non-NHS trade invoices paid within target

97% 98% 98% 93%

Total NHS trade invoices paid in the year 931 6,183 818 3,961

Total NHS trade invoices paid within target 884 6,064 781 3,754

Percentage of NHS trade invoices paid within target 95% 98% 95% 95%

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 period in relation to claims under this

legislation (2013: £nil). £0.001 million compensation has been paid during the period to cover debt

recovery costs under this legislation (2013: £nil).

15 Other liabilities CurrentNon-current

CurrentNon-current

£000 £000 £000 £000

Deferred income 141 0 210 0

Total 141 0 210 0

16 Borrowings CurrentNon-current

CurrentNon-current

£000 £000 £000 £000

Loans from Department of Health 428 2,574 876 2,998

Other loans 43 48 56 93

Obligations under finance leases 33 599 44 593

Total 504 3,221 976 3,684

A loan was taken out by Great Western Ambulance Service NHS Trust (GWAS) and was transferred as

part of the acquisition.

There is one loan with the Department of Health, the loan was a Working Capital loan (£4.500

million) taken out in 2010 at an interest rate of 2.31% due to expire 2021.

The Trust has an agreed £16.0 million Working Capital Facility in place which has not been utilised

during the year.

17 Finance lease obligations

Finance lease liabilities relate to four leasehold premises with lease periods ranging from 57 to 76

years and sixteen vehicles which expire the period ended 31 March 2015.

Amounts payable under finance leases:

Buildings and vehiclesGross lease liabilities

Net lease liabilities

Gross lease liabilities

Net lease liabilities

31 March 2014

31 March 2014

31 March 2013

31 March 2013

£000 £000 £000 £000

Not later than one year; 49 33 60 44

Later than one year and not later than five years; 104 40 104 38

After five years 1,469 559 1,495 555

Less future finance charges (990) 0 (1,022) 0

Present value of minimum lease payments 632 632 637 637

Included in:

Current borrowings 33 44

Non-current borrowings 599 593

632 637

A N N U A L R E P O R T 2 0 1 3 / 1 4 269

18 Finance lease commitments

The Trust has no new finance lease commitments as at 31 March 2014 (2013: £nil). The obligation

Note 17 lays out the existing financial lease details.

19 Provisions

CurrentNon-current

CurrentNon-current

£000 £000 £000 £000

Pensions relating to other staff 237 3,735 233 3,396

Other legal claims 473 0 402 0

Workforce Integration 5,628 0 5,628 0

Restructurings 664 0 0 0

Redundancy 786 0 2,676 0

Other 88 217 271 157

Total 7,876 3,952 9,210 3,553

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At 1 April 2013 3,629 402 5,628 0 2,676 428 12,763

Transfers by absorption 0 0 0 0 0 0 0

Change in the discount rate 215 0 0 0 0 0 215

Arising during the period 313 474 0 664 1,200 119 2,770

Used during the period (233) (167) 0 0 (2,389) (79) (2,868)

Reversed unused (17) (236) 0 0 (701) (163) (1,117)

Unwinding of discount 65 0 0 0 0 0 65

At 31 March 2014 3,972 473 5,628 664 786 305 11,828

Expected timing of cash flows:

Not later than one year 237 473 5,628 664 786 88 7,876


948 0 0 0 0 52 1,000

Later than five years 2,787 0 0 0 0 165 2,952

Total 3,972 473 5,628 664 786 305 11,828

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 1.8% (2013: 2.35%).

An estimated redundancy provision is included as the Trust continues to review its organisational

structure following the acquisition of GWAS. This figure includes £0.028 million for Mutually Agreed

Resignation Schemes (MARS).

A provision has been made for the potential outcome of outstanding workforce integration issues.

This provision has been maintained at the same level as the 2012/13 accounts following Board

consideration and legal advice. This is expected to be resolved during 2014/15.

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 restructuring provision has been made relating to the Trust’s Operational Structure Change

Programme.

Included with the provisions of the NHS Litigation Authority at 31 March 2014 is £9.692 million

(2013: £12.790 million) in respect of clinical negligence liabilities of the Trust.

20 Revaluation reserve

£000 £000

Property, plant and equipment

Property, plant and equipment

At 1 April 6,868 3,529

Transfers by absorption 0 3,681

Impairments (1,259) (313)

Revaluations 1,943 320

Transfers to other reserves (432) 0

Asset disposals (5)

Other reserve movements 0 (348)

At 31 March 7,115 6,868

A N N U A L R E P O R T 2 0 1 3 / 1 4 271

21 Cash and cash equivalents

£000 £000

Balance at 1 April 25,893 9,055

Transfers by absorption 0 12,650

Net change in year 4,556 4,188

30,449 25,893

Represented by: £000 £000

Cash at commercial banks and in hand 7 4

Cash with the Government Banking Service 30,438 25,888

Other current investments 4 1

Cash and cash equivalents as in statement of financial position and statement of cash flows

30,449 25,893

22 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 2013, £nil).

23 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 6.1. 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 below:

Income Income Receivables Receivables

31 March 2014

31 March 2013

31 March 2014

31 March 2013

£000 £000 £000 £000

Bath and North East Somerset CCG 6,229 0 2 0

Bath and North East Somerset PCT 0 1,084 0 118

Bristol CCG 16,642 0 411 0

Bristol PCT 0 2,969 0 438

Kernow CCG 23,317 0 325 0

Cornwall And Isles Of Scilly PCT 0 22,810 0 33

Department of Health 3,101 1,038 25 0

NEW Devon CCG 30,530 0 8 0

Devon PCT 0 25,475 0 2

Plymouth Teaching PCT 0 8,389 0 (2)

Dorset CCG 34,376 0 199 0

Dorset PCT 0 17,472 0 70

NHS Bournemouth and Poole 0 14,161 0 0

Gloucestershire CCG 26,368 0 78 0

Gloucestershire PCT 0 5,796 0 462

North Somerset CCG 7,839 0 143 0

North Somerset PCT 0 1,314 0 110

Gloucester Hospitals NHS Foundation Trust 1,443 365 2 10

Somerset CCG 25,409 0 155 0

Somerset PCT 0 24,017 0 47

South Gloucestershire CCG 8,215 0 372 0

South Gloucestershire PCT 0 1,330 0 99

Swindon CCG 6,350 0 53 0

Swindon PCT 0 1,136 0 88

South Devon and Torbay CCG 11,121 0 0 0

Torbay PCT 0 6,914 0 4

Wiltshire CCG 16,044 0 102 0

Wiltshire PCT 0 2,750 0 395

Other NHS organisations 5,529 8,300 49 491

222,513 145,320 1,924 2,365

A N N U A L R E P O R T 2 0 1 3 / 1 4 273

Expenditure Expenditure Payables Payables

31 March 2014

31 March 2013

31 March 2014

31 March 2013

£000 £000 £000 £000

Department of Health 121 17 95 0

Dorset Health Care NHS Foundation Trust 62 85 16 0

Dorset CCG 240 0 220 0

Dorset PCT 0 240 0 0

Great Western Hospitals NHS Foundation Trust

146 68 12 53

NHS Litigation Authority 932 597 2 0

Portsmouth Hospitals NHS Trust 351 297 25 34

Plymouth Hospitals NHS Trust 212 162 7 6

Avon And Wiltshire Mental Health Partnership NHS Trust

137 0 0 3

Yorkshire Ambulance Service NHS Trust 70 0 11 2

South Devon Healthcare NHS Foundation Trust

170 152 338 431

Other NHS organisations 483 574 253 95

2,924 2,192 979 624

23 Related party transactions (cont)

The Trust has entered into the following contracts for 2014/15:

Lead Commissioner Service line Comments

NHS South Devon and Torbay CCG A&E ambulance services

Comparable with the value of the 2013/14 contract

NHS Somerset CCG Urgent Care Services Comparable with the value of the 2013/14 contract

NHS Dorset CCG Urgent Care Services Comparable with the value of the 2013/14 contract

NHS Gloucestershire CCG Urgent Care Services Comparable with the value of the 2013/14 contract

NHS Dorset CCG 111 Comparable with the value of the 2013/14 contract

NHS NEW Devon 111 Contract commenced in June 2013-first full year

NHS Kernow CCG 111 Contract commenced in February 2014-first full year

NHS Somerset 111 Contract commenced in November 2013-first full year

NHS South Gloucestershire CCG Patient Transport Services

Contract expires September 2014

Charitable Funds

As at 31 March 2014 South Western Ambulance Service NHS Foundation Trust had charitable funds of

£0.214 million (2013: £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

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.

A N N U A L R E P O R T 2 0 1 3 / 1 4 275

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.

24 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 395 0 5,088 0

Balances with local authorities 36 0 20 0

Balances with NHS Trusts and FTs 55 0 228 0

Balances with Public Corporations and Trading Funds

1,869 0 427 0

Intra government balances 2,355 0 5,763 0

Balances with bodies external to government 4,012 0 14,524 0

At 31 March 2014 6,367 0 20,287 0

25 Financial Instruments

25.1 Financial assets by categoryLoans and receivables

Total

£000 £000

Trade and other receivables excluding non financial assets 2,350 2,350

Other Financial Assets 0 0

Cash and cash equivalents 30,449 30,449

Total at 31 March 2014 32,799 32,799

Trade and other receivables excluding non financial assets 2,837 2,837

Other Financial Assets 171 171

Cash and cash equivalents 25,893 25,893

Total at 31 March 2013 28,901 28,901

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.

25.2 Financial liabilities by categoryOther financial liabilities

Total

£000 £000

Borrowings excluding finance lease and PFI liabilities 3,093 3,093

Obligations under finance leases 632 632

Trade and other payables excluding non financial liabilities 16,752 16,752

Provisions under contract 7,855 7,855

Total at 31 March 2014 28,332 28,332

Borrowings excluding finance lease and PFI liabilities 4,024 4,024

Obligations under finance leases 637 637

Trade and other payables excluding non financial liabilities 14,730 14,730

Provisions under contract 8,842 8,842

Total at 31 March 2013 28,233 28,233

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.

26 Financial risk management

Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had

during the period 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 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.

A N N U A L R E P O R T 2 0 1 3 / 1 4 277

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 2014 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.

27 Losses and Special Payments

There were 627 (2013: 664) cases of losses and special payments totalling £0.205 million (2013:

£0.342 million) paid during the year ended 31 March 2014.

Number of Cases

Value of Cases

Number of Cases

Value of Cases

2013/14 2013/14 2012/13 2012/13

£’000 £000

Losses

Salary Overpayments 184 62 224 144

Bad Debt 32 2 7 0

Other 392 83 419 157

Total Losses 608 147 650 301

Special payments

Personal Injury with advice 16 45 14 41

Special Severance Payments 3 13 0 0

Total Special Payments 19 58 14 41

Total Losses and Special Payments 627 205 664 342

Other losses include insurance excess payments for vehicles and damage to property.

28 Prudential Borrowing Limit

The prudential borrowing code requirements in section 41 of the NHS Act 2006 have been replaced

with effect from 1 April 2013 by the Health and Social Care Act 2012. The financial statements

disclosures previously provided are no longer required.

A N N U A L R E P O R T 2 0 1 3 / 1 4 279

glossary

Glossary of terms and acronyms

Term Description

111New national phone number for people to access non-emergency healthcare and advice

A&E Accident and Emergency

ACA Ambulance care assistant

Acute Myocardial Ischaemia Painful heart condition caused by lack of blood flow to the heart

Adastra Clinical reporting tool used for out-of-hours urgent care services

AED Automated external defibrillator

AfC or A4C Agenda for Change – NHS-wide pay and banding system

AGM Annual general meeting

ALE Auditors’ local evaluation

ACQI Ambulance Quality Indicator

ARPAmbulance Radio Project – digital voice and mobile data radio service supporting all front-line communications

Board of directorsExecutive body responsible for the operational management and conduct of the organisation

CCA Civil Contingencies Act

CCGs Clinical commissioning groups – GP-led commissioners of local healthcare services

CCN Critical-care network

CCP Critical-care paramedic

CDM Clinical delivery model

CETV Cash equivalent transfer value – accountancy term

CFRCommunity first responder – volunteers who respond to medical emergencies in their local community to provide essential life-saving care while ambulance response is en route

CIMA Chartered Institute of Management Accountants

CIP Cost improvement programme

CIPD Chartered Institute of Personnel and Development

Clinical hub SWASFT term for control room

CMS Capacity management system – integral product of NHS Pathways. Suite of modules which consistently and clearly measures capacity

CNST Clinical Negligence Scheme for Trusts

CoGCouncil of Governors – elected body that acts as guardians of NHS Foundation Trust, holding the board of directors to account and representing views of staff, public and other stakeholders

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Term Description

Co-responders Members of other organisations – typically local fire-service – who respond to life-threatening emergencies on behalf of the ambulance service while an ambulance response is en route

CoSHH Control of Substances Hazardous to Health

CPD Continuous professional development

CPIsClinical Performance Indicators – national measures of ambulance service performance

CQC Care Quality Commission

CQI Clinical quality indicator

CQUIN Commissioning for Quality and Innovation

CRES Cash releasing efficiency savings – accountancy term

CRL Capital resource limit

DATIX National software programme for risk management

DCA Double-crewed ambulance

DH Department of Health

EBITDAEarnings before interest, taxation, depreciation and amortisation – accountancy term

ECA Emergency care assistant

ECG Electrocardiogram

ECP Emergency care practitioner

EDS Equality delivery system

EFL External financing limit – accountancy term

e-KSF Electronic Knowledge and Skills Framework – assessment framework for AfC

EMG Environmental Management Group

EMMA Electronic Medication Management Assistant

ERIC Estates Return Information Collection

ESR Electronic staff record

EWTD European Working Time Directive

Executive directorsSenior 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

FAST testFace, Arm, Speech, Time – brief but effective test to determine whether or not someone has suffered a stroke

FE/HE Further education/higher education

FIMC Fellowship in Immediate Medical Care

FLEET Front-line emergency equipment trust

FT Foundation Trust

FTE (WTE) Full-time equivalent (whole-time equivalent)

Term Description

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

GTN Glyceryl trinitrate – drug used during the treatment of heart-attack patients

GWAS Great Western Ambulance Service (acquired by SWASFT on 1 February 2013)

H&S Health and safety

HART Hazardous Area Response Team

HCP Healthcare professional

HCPCHealth & Care Professions Council – body that regulates and registers professionals working in healthcare

HealthwatchFrom April 2013, representing the views of people who use services, carers and the public on the Health and Wellbeing boards set up by local authorities

HOSCsHealth overview and scrutiny committees – local council committees with powers to scrutinise local health services to ensure improvements are made and inequalities reduced.

HSE Health & Safety Executive

IAS 23 Accounting terms relating to capitalisation of borrowing costs

IBPIntegrated business plan – document setting out an organisation’s ambitions and expectations for how it will develop typically over the next five years

ICA Intermediate care assistant

IFRS International financial reporting standards – accountancy term

IHCD Institute of Healthcare Development

IM&T Information management & technology

ISS Injury severity score

JCB Joint Commissioning Board

JNCCJoint Negotiating Consultative Committee – committee made up of Trust and staff-side representative to discuss changes to the organisation (GWAS version was JCNC

– Joint Consultative and Negotiation Committee)

KA34National reporting requirement for all ambulance trusts – completed annually and submitted to the DH to show and compare volume of service and performance against required standards

KPIs Key performance indicators

LCFS Local Counter Fraud Service

LFEG Learning from Experience Group

LINks

Local Involvement Networks – groups made up of community and patient representatives to ensure the interests of local people are taken into account in planning and implementing healthcare services. LINks were replaced by a new body, Healthwatch, in April 2013

LTC Local Treatment Centre

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Term Description

LTFM Long-term financial model – accountancy term

MEAPMitigating Escalatory Action Plan – developed to provide a flexible approach to managing risks with a significant resource consequence.

MI Myocardial infarction – heart attack

MINAP

Myocardial Infarction National Audit Project – established in 1999 to examine the quality of heart attacks pre-hospital and in hospitals in 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

NEDsNon-executive directors – members of the Board of directors, but not part of the executive management team

NHSD NHS Direct

NHSLA NHS Litigation Authority

NIC National Innovations Centre

NICE National Institute for Health and Clinical Excellence

NPSA National Patient Safety Agency

OD Organisational Development

OoH Out-of-Hours

PALS Patient Advice and Liaison Service

PbR Payment by Results

PCR Patient Clinical Record

PDC Public dividend capital – accountancy term

PEFRPeak expiratory flow rate – measures how fast a patient can exhale, helping to alleviate chest pain

PMO Programme Management Office

PPCIPrimary percutaneous coronary intervention (often referred to as primary angioplasty) – surgical treatment for heart attack patients which unblocks affected arteries by insertion of a balloon (stent) which is then inflated.

PPI Patient and Public Involvement

PRF Patient report form

PROMIS Personnel Rostering and Overtime Management Information System

PSIAM Priority Solutions Integrated Access Management

PSV Patient Support Vehicle

PTS Patient Transport Service

QA Quality Account

QI Quality improvement

QIPPQuality, Innovation, Productivity and Prevention – NHS-wide transformation programme aimed at improving quality of care while making up to £20billion of efficiency savings by 2014/15

Term Description

QMM Quality Monitoring Meeting

R&D Research and development

RAG rating Red, amber, green - system for measuring, assessing and reporting risk

RCI Reference cost indices

RCRPRT Right Care, Right Place, Right Time

REAP Resource Escalation Action Plan – national method of identifying and planning for operational challenges

RIDDOR Reporting of Injuries, Diseases and Dangerous Occurrences Regulations

RoSCReturn of spontaneous circulation – desirable clinical outcome of a patient in cardiac arrest

SJA St John Ambulance

SPoA Single point of access

Standards for Better HealthSet of standards monitored by the Care Quality Commission as part of the annual health check and audit

STEMIST elevation myocardial infarction – particular type of heart attack determined by an ECG test

SWASFT South Western Ambulance Service Foundation Trust

ThrombolysisDrug that can dissolve blood clots, used for patients who have suffered a heart attack or stroke

TriageProcess for assessing and sorting patients based on their need for or likely benefit from immediate medical treatment to ensure a fair, appropriate allocation of resources

TUPETransfer of Undertaking (Protection of Employment) Regulations – important part of UK labour law that protects staff whose employment is being transferred to another organisation

UCS Urgent care services

VACS Voluntary Ambulance Car Service

VFM Value for money

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© South Western Ambulance Service NHS Foundation Trust 2014

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 261560

Post: Marketing and Communications Directorate, South Western Ambulance Service NHS Foundation Trust, Abbey Court, Eagle Way, Exeter, Devon, EX2 7HY

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