scas annual report 2008-09 · transformational year for the south central ambulance service nhs...

South Central Ambulance ServiceNHS Trust

Annual Report and Accounts2008-09

Best service, equipment and CONTENTS

Chairman’s Foreword .......................................3

Chief Executive’s Introduction .........................5

Board Members ................................................9

Our Objectives ................................................11

What We Do and Where We Do It ................13

Our Family ......................................................15

Commercial Services .......................................21

Towards Excellence ........................................23

Highlights of The Year ..................................25 Clinical Services ................................................ 25

Operations ...................................................31 Finance, Estates and Environment .............38 Service Development ..................................39 Information Management and Technology ..40 Recruiting and Developing Our Workforce ..41 Corporate Affairs ........................................42

How We Performed .......................................44

Listening To The People We Serve ................46

Diversity ..........................................................47

Financial Review .............................................51 Financial Performance .................................51 Remuneration Report ..................................52

Statement on Internal Control 2008-09 ........64

Independent Auditor’s Report ......................73

Glossary of Financial Terms ............................77

Glossary of General Terms .............................79

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Cover: Zanae with her mother thanking Paramedic Richard Williams for helping with the birth of baby brother Aiden. See story page 18.

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CHAIRMAN’S FOREWORD

2008-09 was a transformational year

for the South Central Ambulance Service NHS Trust (SCAS).

The new Call Connect target, introduced in

April 2008, means that ambulance staff responding to

999 calls are getting to people in need of help 26% faster than in the previous year, which can only be of benefit to the patients that we serve.

We have had to achieve these targets while coping with a 6%increase in demand and we now deal with over a thousand 999 calls per day (approximately 400,000 a year).

We ended 2008-09 on a strong, and improving, trend and we intend to build upon this success in 2009-10.

Additionally, our modernisation programme, following the mergers of the Hampshire, Berkshire, Buckinghamshire and Oxfordshire ambulance services in 2006, continues to gather pace.

In November 2008, we introduced a new computer aided dispatch (CAD) system in Hampshire and, in March 2009, we moved into a new state of the art 999 call centre, in Otterbourne, near Winchester, Hampshire.

Since the year end, we have moved into a new corporate headquarters in Bicester, Oxfordshire, and later this year, our 999 call centre for Oxfordshire and Buckinghamshire will operate from the same building.

We also intend to upgrade the CAD systems in Bicester and in our Berkshire 999 call centre in Wokingham.

By October 2009, all of our ambulances will be ‘washed and stocked’ by specialist contractors at the end of each shift, thus freeing up time

transformational year for the South Central Ambulance Service NHS Trust (SCAS).

The new


The new target, introduced in

April 2008, means that


for the South Central

The new

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for frontline crews to focus on their clinical work.

Add to this a recently placed order for 29 brand new ambulances and you can see our continued determination to modernise and upgrade the infrastructure from which we operate and to continually improve the service we provide to the approximately four million inhabitants across the South Central area.

The demanding new Call Connect targets, and the pace of change within SCAS, has put unprecedented pressure on staff at all levels within the organisation and I would like to thank everyone across the organisation, for their dedication and professionalism.

In 2009 Val Woods, a non-executive director and chair of our Audit Committee, left the SCAS Board to pursue a full time executive career in the NHS. We all wish Val every success in her new role and thank her for her immense contribution to SCAS and, prior to that, to the

Oxfordshire Ambulance Service NHS Trust. On 1 July 2009 we will be welcoming Eddie Weiss to the Board as a non-executive director.

The current economic climate will undoubtedly, and rightly, put pressure on public services to become even more efficient. Given the undoubted commitment of our staff, and the investment we are making to modernise our infrastructure, I have no doubt SCAS will rise to the challenges ahead and continue to improve the service we provide to the people of Berkshire, Buckinghamshire, Hampshire and Oxfordshire.

Neil GouldenChairman

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HEADINGCHIEF EXECUTIVE’S INTRODUCTION

Our vision is Towards Excellence, saving lives

and taking healthcare to our patients and our commitment is that we are with

you when you need us, providing help

and professional mobile healthcare to you and your community. We have developed this vision and commitment to drive the work we do. I hope it resonates with our stakeholders as much as it does with all at South Central Ambulance Service NHS Trust (SCAS).

There is widespread support for the work we are undertaking to provide a safe, reliable, sustainable and equitable emergency ambulance service across the whole of the four counties covered by SCAS. Thank you to all of our stakeholders for your ongoing support.

During 2008-09 we have moved to measuring our response time performance to the moment a call is connected to our control rooms. With 480 seconds to achieve a ‘first response’ to the patient’s side this is now the most exacting standard operated anywhere in the world.

SCAS has shown tremendous improvement in this area, 26% better than last year. Just as important is that improvements have been made in both rural, and urban areas for the benefit of the whole community. We recognise how important a fast reliable response is to our patients, and the rest of our community, and we will go on improving our reliability and resilience.

I will remember 2008-09 as the year we created Towards Excellence - a programme of transformational change and improvement underpinned by strong values - that has provided the focus for all of us to embrace, understand and become a part of the new organisation. I have learned that rapid and sustained improvement is best achieved by

Our vision is Excellence, saving lives

and taking healthcare

you when you need us, providing help

and professional mobile

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Best service, equipment and

encouraging and harnessing the passion and innovation of our people, and working with our stakeholders. We have focused on creating a culture where teamwork, innovation, professionalism and caring can flourish. I would like to thank the whole team at SCAS who have responded so positively to this new style of leadership.

There have been so many positive improvements and new developments within SCAS over the last 12 months that it would be wrong of me to single out any particular one here.

I hope that, as you read through this annual report, you get a sense of the scale of change and improvement we are undertaking. Within the next 12 months we will have completed the full integration and harmonisation of the four counties into a single seamless service with significantly improved resilience.

Going forward, we will be guided by the following strategic themes:

• Clinical excellence – improving clinical outcomes, ensuring patient safety, and providing a positive patient experience.

• Operational excellence – achieving response time performance standards, resilience and efficiency.

• Effective stakeholder relationships – developing whole system solutions and seamless pathways of care.

• Sound governance, value for money and a strong financial standing.

• Leadership, staff engagement and a learning culture – developing the workforce, motivating and enabling our people to deliver excellence.

• A network of profitable and high quality non emergency contracts.

We would be happy to discuss our work, ongoing development and any issues of interest you may have arising out of our annual report.

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On behalf of the Board, I would like to thank all at SCAS. As ever, they have shown tremendous dedication, loyalty, and worked hard, despite all the challenges this year has thrown at them, to maintain high standards of service to the community.

Will HancockChief Executive

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Winchester

Bicester

•Oxford

Wokingham

• Otterbourne

Milton Keynes

Southampton•

•Portsmouth

Reading•

Illustration of the areas covered by South Central Ambulance Service NHS Trust (SCAS).

Early in 2009 some SCAS operations will be located in Otterbourne, Hampshire, and Bicester, Oxfordshire.

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BOARD MEMBERS


Jackie NeylonNon Executive Director

Charles PorterDirector of Finance and Estates

Will Hancock Chief Executive

Colin HazellNon Executive Director

Valerie WoodsNon Executive Director

John DivallDirector of Corporate Affairs

Ian FergusonDirector of Operations

FizzThompsonDirector of Clinical Services

SharonWaltersDirector of HR & OD

June MayNon Executive Director

Alastair Mitchell-BakerNon Executive Director

Lisa HodgsonDirector of Service Development

Vince WeldonDirector of IM&T

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Best service, equipment and HEADING

10

HEADING

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OUR OBJECTIVES

In 2007 the Board of South Central Ambulance Service NHS Trust (SCAS) approved a five-year strategy and business plan. This includes the following priorities:

• Improving response times and operational performance.

• Improving outcomes – including the treatment and care of more people in the community.

• Improving capability through leadership, governance and sustainability.

To address these priorities, the Board has set core objectives to:

• Deliver benefits to patients as a result of focusing on clinical effectiveness and education of frontline staff.

• Strengthen emergency operations in all respects to improve speed of response; quality of vehicles, equipment and facilities; and aim to become an internationally-recognised ambulance service that is

comparable with the best service delivery and patient care anywhere in the world.

• Extend the range of urgent care services across the whole area by, for example, providing more clinical advice by telephone, offering patients a wider range of options than the traditional accident and emergency department (A&E), and more face-to-face assessment and treatment.

• Protect existing non-emergency services and extend coverage across the whole area.

• Develop and integrate corporate functions ensuring they are resourced, capable and so equipped as to deliver the highest levels of support.

• Achieve organisational sustainability through excellent financial, clinical and corporate governance and monitor developments in line with the needs of patients, stakeholders and commissioners.

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Implementation of this plan is already well-advanced, as demonstrated by the many new initiatives mentioned in this report. In summary, the practical benefits of this plan are fourfold:

• For patients - they experience a faster response; improved assessment of their need, including clinical requirements; more effective treatment and management of symptoms; less likelihood of being taken to hospital and a general improvement in health and well-being.

• For employees - better training and education to maximise individuals’ potential, a clear career pathway and greater variety of work.

• For SCAS - greater efficiency and speed of response to 999 calls throughout the whole organisation.

• For the NHS - fewer patients being taken inappropriately to A&E; fewer inappropriate admissions to acute care hospitals; greater support given to those involved with care in the community; closer partnership working with healthcare professionals and the development of new pathways for treatment and care.

� More details can be obtained from the Strategy and Business Plan, which is available on the SCAS website:www.southcentralambulance.nhs.uk Freedom of Information Publication Scheme/‘What are our priorities and how we are doing ’ section.

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WHAT WE DO AND WHERE WE DO IT

SCAS has two principal functions: the provision of accident and emergency care in response to 999 calls (these totoal over 400,00 a year), and the transportation of non-emergency patients to attend hospital appointments. The ambulance service is an intrinsic part of the NHS and makes a vital contribution to healthcare provision.

SCAS works across the four counties of Berkshire, Buckinghamshire, Hampshire and Oxfordshire which cover an area of 3,554 square miles with a population of approximately four million. This is the same area as covered by the strategic health authority, NHS South Central. Within the area are high density urban locations such as Portsmouth, Southampton, Reading, Slough, Oxford and Milton Keynes, as well as large rural countryside areas, for example the New Forest, North Hampshire and West Oxfordshire.

The focus of patient care is to ensure that each individual patient receives the most appropriate treatment. Although many will be taken by ambulance to a hospital’s accident

and emergency (A&E) department, a significant number will be treated in their homes, or referred to another location, such as walk-in clinics, GP surgeries or other treatment centres in their locality. The purpose of this is to help relieve the ever-increasing burden on hospitals and provide the patient withcare appropriate to their individual needs. However, there are occasions when life-saving procedures have to be carried out by ambulance crews as they take a patient to hospital and enhanced clinical training in such procedures is part of the continuing professional development of SCAS ambulance crews.

The SCAS people who work on the frontline, providing face-to-face care to patients, are the service’s greatest asset and SCAS is committed to equipping these men and women with greater knowledge, new skills and the most advanced technology to assist them in their work. This also involves closer liaison with other healthcare partners in the community so that the best possible outcomes can be achieved.

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OUR FAMILY

SCAS employs over 2,300 people. These include approximately 1,200 clinical practitioners of various grades and 300 people working in three emergency operations centres at Otterbourne in Hampshire; Wokingham in Berkshire; and Deanshanger near Milton Keynes.

With the fast-changing approach to clinical treatment, and the development of new techniques and procedures, the role of frontline staff is constantly changing.

SCAS is committed to providing the best possible support for staff to enable them to acquire new skills and to enhance their professional capabilities.

The following paragraphs give an indication of some of our staff roles, although this is by no means the whole picture.

Road StaffThese include:

Ambulance care assistants - transfer non-emergency patients between home and hospital for pre-arranged appointments, or between hospitals.

Emergency care assistants - work alongside clinical staff and have been specially trained in advanced driving skills to respond to both routine calls and emergencies, using blue lights and sirens. They also support clinical practitioners as patients are treated.

Ambulance technicians - are qualified to respond to emergency calls and also non-emergency cases. They are trained to support more skilled clinicians in the diagnosis and treatment of patients. They are also qualified in life-saving skills and the use of special equipment.

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Case study - Call handler - A rewarding job

Hello, my name is Ben and I am an Emergency

Response Assistant (call handler) in the emergency

operations centre at Southern House, Hampshire.

I have been working for SCAS for the last 18 months

taking 999 calls from the members of the public and

health care providers.

I find my role very fulfilling as I am able to help people

and give instructions for people to help others before

the ambulance arrives. Also every day is different and

you never know what is coming next.

I find the most rewarding part is providing help to

people who need support until the ambulance arrives.

I recently took a call from a partner of a woman who

was having a baby on the living room floor. I was able

to give instructions over the phone so he could deliver

the baby as it wasn’t going to wait for the ambulance.

These types of jobs make my work very rewarding and

every single minute enjoyable.

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Paramedics - take the lead in an emergency situation by assessing a patient’s condition and initiating pre-hospital care when necessary. This can include the use of defibrillation to treat cardiac arrest and also invasive procedures, such as giving intravenous injections, administering drugs and intubating a patient’s airway.

Paramedics are state-registered in the same way as nurses.

Emergency care practitioners - are an advanced role and individuals working in this role have additional clinical training to enable a more advanced level of clinical assessment and practice than paramedics.

Emergency operations centre staffWhen a person dials 999 and asks for the ambulance service, they are answered by a call handler. Following a nationally-set list of questions, the call handler ascertains the location of the patient and, as much as possible, their condition. This enables the call to be prioritised and placed in a category that ranges from life-threatening to non urgent.

Call handlers also deal with requests from other healthcare professionals for patients to be taken to hospital from, for example, a GP surgery or a care home.

Emergency medical dispatchers are also part of the EOC team. They are responsible for passing information to front line crews and ensuring that the nearest vehicle is sent in response, and, also, that other support, such as the air ambulance or a doctor, is mobilised. Technology allows this to be done at the same time as the call handler is dealing with the call, so no time is lost.

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Case study - Rapid response paramedic

A call from Langley near Slough proved to be

especially eventful for Paramedic Richard Williams.

An anxious father reported that his wife had just gone

into labour, so Richard was sent on his way by fast car

and reached the address within two minutes.

Like many calls, things were not straightforward: the

patient was up two flights of stairs and her waters

broke as Richard arrived. The baby was well on the

way and a back-up ambulance called.

However, a quick assessment of the situation told

Richard that even when the expectant mother was

calmed, she would not be able to get down the stairs

to the ambulance. Babies wait for no-one, so Richard

had to make some snap decisions. The baby would

have to be delivered immediately. But when Richard

carried out an examination, he discovered it was in

breech and would emerge feet first and with the

umbilical cord wound

around its neck.

Delivering a baby in

this state at home is

extremely rare and

could threaten the

life of both mother

and child. The usual

procedure is for an

emergency caesarean

operation. Richard’s

skills and training,

combined with his

experience as a

paramedic, resulted in a happy ending and a tribute

from the parents. The mother said: “I couldn’t have

done it without you guys. I don’t believe my baby

would have made it if it wasn’t for you.”

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Community First RespondersA large group of volunteers has been formed to provide the first response in some emergencies.

Working within their own locality, the community first responders (CFRs) are provided with thorough training and equipment, such as automated defibrillators and oxygen.

They are extremely valuable since they are able to provide immediate first aid treatment to a patient before the ambulance arrives at the scene.

After training, candidates undertake a short test and are re-examined every six months.

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Case study - Community responders save one of their own

For one Berkshire man, Christmas

almost proved fatal.

Ian Cheshire suffered a cardiac

arrest and within seven minutes

of the 999 call the first assistance

arrived. Not only was an

ambulance dispatched, but local

volunteer community responders

attended. Ironically, the patient

was, himself, a volunteer

community responder and it

was one of his colleagues David

Gregory who arrived to find Ian

collapsed, unconscious on the

floor.

Also sent to the scene was a team

of specially-trained fire fighters

who provide support to the

ambulance service.

Mark Pryor

from this

team was

able to work

with David

to continue

the effort to

resuscitate Ian.

The use of a

defibrillator

meant that this was successful and

David said he realised this when

“suddenly I heard what I thought

was a snore and it registered that

this was a breath in.”

When the ambulance arrived,

further procedures were given

to assist treatment. He was

defibrillated again in the

ambulance and taken to hospital

for admission to the intensive

care unit. After he was released

from hospital, Ian met his

rescuers and told them what an

emotional experience it had been,

wondering: “How do you say

thank you to someone who has

brought you back from the brink

of death?”.

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COMMERCIAL SERVICES

When SCAS receives a 999 call, the imperative in life-threatening situations is to reach the patient as fast as possible and to provide the most appropriate treatment. To meet this, SCAS has a range of responses including, the air ambulance helicopter, motorcycles, double manned ambulances, single manned rapid response cars, bicycle responders for pedestrianised town centres, and community responders, including volunteers. In many cases this will necessitate the transfer of the patient to a hospital A&E department or a specialist ward, such as for cardio-vascular conditions. Wherever possible, and

increasingly, patients are given alternative treatment to hospital admission. This can be the provision of care at home, reference to a GP surgery or by attendance at a walk-in centre or a minor injuries unit.

As well as responding to emergencies, SCAS also provides a range of other services, which form the Commercial Services. These include:

Patient Transport Service – is a dedicated service providing various levels of transport for patients who have a medical need for transport to and from an NHS treatment centre but do not require the skills of a qualified clinical person. PTS has 550 members of staff operating 250 vehicles of various sizes and configurations, and is responsible for 650,000 patient journeys each year.

Out-of-Hours – handles overnight and weekend calls from patients needing to make contact with on-call GPs or other healthcare pathways. This service is currently operating in Berkshire and Buckinghamshire. The two centres handle almost 400,000 calls every year.

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Logistics Services – provides secure transport of equipment, patient records and samples. Personnel are also transported and each month 64,000 documents and 33,000 samples are moved between hospitals, GPs’ surgeries, laboratories and ambulance stations.

Community Equipment Service – provides a wide range of mobility and other aids loaned to patients to assist them at home. Items can range from a walking frame to an electronic bed and there are 54,000 items issued per year, with 99% of urgent items delivered within 24 hours.

Commercial Training – delivers general first aid and specialist training to public and private sector organisations to enable them to meet statutory requirements and extend individuals’ competencies. In 2008 over 8,000 people attended courses ranging from general first aid to specialisms such as paediatrics and dealing with hazardous environments. Continuation training is also provided to maintain and update skills.

Events Management – ensures provision and control of medical and emergency treatment services at public events. This is a new venture for SCAS and will meet the emergency care needs of the 2.5 million people who attend public events in the SCAS area each year. Treating people at the location will reduce the number of 999 calls, as well as the requirement for hospital admissions, from these events.

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TOWARDS EXCELLENCE

Launched in the spring of 2008, the Towards Excellence programme brings together a wide range of projects and initiatives for change aimed at making SCAS a more caring, professional and innovative organisation.

While these are all our current attributes, they are also core values that can always be improved through better teamwork.

The programme has two key objectives:

• Respond to calls in a clinically,

appropriate and timely manner, which requires a faster response to some patients.

• Introduce a culture of staff engagement and continuous improvement to harness the wealth of experience, knowledge and enthusiasm of staff.

Towards Excellence is coordinated through six thematic workstreams, each with teams working to achieve the required changes:

Delivering the workforce – this is looking at how SCAS can use its human resources, including private providers, more effectively; how to improve workforce planning for the future; how to recruit, train and retain the right staff; and how to improve working arrangements for staff, for example through better rostering.

Enabling people to deliver - this stream looks at ways of giving supervisors greater support, such as in relation to the effective use of appraisals to improve personal and professional development and to encourage better teamwork.

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Releasing more time for care – this concentrates on improving processes so staff can spend more time on patient care, for example by reducing the time spent on cleaning and restocking vehicles; improving vehicle fleet management; reducing the number of vehicles taken off the road for repairs; and improving liaison between the frontline crews and control rooms.

Releasing more funds for care – the emphasis here is on minimising overheads across the organisation and making greater use of IT for procurement.

Improving the infrastructure – this work is to upgrade and strengthen the infrastructure across the three EOCs to provide more efficient and resilient systems. It includes introducing a new computer-aided dispatch system, upgrading to a digital telephone system and relocating administration and control centres. Preparations are also being made for introducing the national project to replace radio systems in ambulances.

Developing a service delivery model for the future – the purpose of this workstream is to design, agree and implement an integrated service delivery model in conjunction with commissioners and stakeholders. A major element of this work is to develop ways of providing alternative pathways to patient care, for example in the way urgent calls from GPs are handled, and using the clinical support desks to assist EOC staff and frontline crews in giving the most appropriate advice and care to patients.

The principle of continuous improvement means that this work is on-going: it is always possible to find ways of making improvements. Staff are being given opportunities to contribute to the work by participating in project teams or being seconded to manage change initiatives. This contribution is at the heart of Towards Excellence and means that ideas for change are based on the practical experience of staff.

The cost of Towards Excellence and the implementation of change is being met by special funding from the commissioners of SCAS.

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CLINICAL SERVICES

Patient care - delivering clinical excellence

The Clinical Directorate has continued to build on its key purpose to ensure that all patients receive the highest possible level of care based on the latest research, clinical evidence and best practice by trained and competent staff.

The year 2008-09 has been a time of consolidation, development and delivery to ensure common practice and clinical processes are consistent and embedded into everything we do.

The directorate aims to support the safe and effective delivery of the operational service by focusing on improving clinical outcomes and the quality of care, and preventing harm to the patients we look after.

Measuring clinical standards and outcomes

SCAS has been able to measure clinical standards and care to patients in five key symptom areas:

• heart attack• stroke• diabetic emergencies• asthma• cardiac arrest.

Results from the audits are shared nationally and SCAS performs better than the national average in 18 out of the 17 criteria measured. Action plans are in place to continually improve performance over the next year so that SCAS is seen as a centre of clinical excellence.

In 2008-09 we ensured patients with heart attacks received their thrombolysis within 60 minutes, 60% of the time. This falls slightly short of the national target, but several hospitals are now providing an angioplasty service so numbers of patients receiving

HIGHLIGHTS OF THE YEAR

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thrombolysis is reducing because of the better outcomes from angioplasty. Work has been ongoing across the local health economy to move towards a 24 hour consistent angioplasty model.

Developing new pathways of care

Alongside the work to improve the outcomes and care for patients with heart attacks, new pathways of care are being developed for patients with acute stroke symptoms. This work is being done in partnership with the strategic health authority, primary care and acute trusts.

Finding the right place for patients and their health needs is also a key workstream. Nurses and ECPs working on a clinical support desk in our EOCs provide assessment and advice over the telephone to make sure patients receive appropriate care. Staff working in the frontline are also assessing and helping patients get to the right place at the right time.

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Case study - The Clinical Support DeskHello, my name is Debbie Diffey and I am the Clinical Support Desk Manager for SCAS (Hampshire).

The Clinical Support Desk (CSD)has been fully operational for over a year and is staffed 24 hours a day. The purpose of the desk is to provide clinical triage to calls coming into the 999 service.

This triage process provides the effective and safe management of all calls, ensuring the most appropriate response in the most appropriate timeframe; this provides clinical safety for the

patient and for the service.

The role of the CSD is constantly expanding and many new aspects are now included in the day to day work of the desk.

These roles include welfare checks on GP urgent bookings, management of frequent callers to the service, referrals to other agencies, clinical advice to crews, clinical advice for CFRs, support and advice to the EOC staff, ECP referrals, clinical audit and training.

Working on the CSD is a challenging, but rewarding role. It allows clinicians to work

with patients and with other healthcare professionals, while ensuring the users of the service get the best possible care and advice.

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Infection control

National priorities for the protection of patients and prevention of harm have focused on the prevention and control of health acquired infections.

Work over the year with the Operations and Finance directorates has led to the successful bid for the provision of a Make Ready Service.Following a procurement and planning project, SCAS has appointed a contractor to provide a Trust-wide service for the stocking and washing of all clinical vehicles. The service specification has been developed in line with national policy and guidance.

SCAS is looking forward to the implementation and delivery phase of the project to provide a safer, cleaner environment for patient care.

Supporting the delivery of clinical excellence

Developing the workforce is a core objective for SCAS and the education department has been key in providing programmes of education, development and training for all groups of staff.

Work continues to develop our partnership working with higher education institutions to further develop and refine foundation degrees in paramedic science and BSc programmes for advanced practice.

Other educational practices have focused on the continuous professional development of clinical staff and the preparation of new staff to work in front line and support positions.

The year 2008-09 has seen a busy schedule for the education departments which have undertaken the training of the following number of individuals:

New vehicle training ............................. 1,065Driver Update ............................................. 31

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Any Solo Response Vehicle ...................... 391Clinical Development Course ................... 204Conflict Management .............................. 183Induction (All new staff) .......................... 317Emergency Care Assistant ........................ 108Ambulance Nurse ....................................... 14NEPTS FPOS/Refresher ................................ 75EOC FPOS Training ..................................... 43Full IHCD Driving ...................................... 164Core Driving Course only ........................... 25Post Incident/Accident Driving support ...... 2Support sessions, ie return to work .......... 18Foundation Degree Paramedic Science .... 91BSc Emergency Care Practice (ECP) ........... 61Other Higher Education course (MSc, etc) 13NVQ - Care, Health, Business .................. 104Category C1 Driving Licence Lessons & Test 11CBRN Lorry Familiarisation ........................ 19Building Bridges / Breaking Barriers ......... 37Mental Health Champions ......................... 24EOC Mental Health Training ...................... 25

SCAS is committed to providing equality of access to all staff and ensuring that training

and development supports its strategic aims and values.

SCAS continues to work with NESC to provide initiatives for staff in Agenda for Change Bands 1-4 and staff in non clinical support roles, to work towards personal and professional development and nationally recognised qualifications.

Non clinical education

During the year the Education Department has provided support and training to staff in all directorates and the development of the non clinical education sector continues to increase.

During the year, 104 members of staff were able to achieve NVQ or equivalent qualifications – this was supported by funding from the strategic health authority (SHA) and through the government sponsored Train to Gain initiative.

A further 15 members of staff were awarded Individual Learning funding to support

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personal development, which was undertaken in their own time. These included funding for Open University courses, counselling certificated courses and various IT training courses.

Various leadership development initiatives were introduced during the year, and managers throughout SCAS attended the SHA promoted Leadership Development Centres.

Several managers are nearing completion of their Masters programmes, supported mainly though the NESC initiative and three managers will be Certificated Professional Coaches by summer 2009.

The department, in conjunction with the Human Resources Directorate, provides team building training based on the Myers Briggs programmes, which assists staff to develop effective communications and decision making skills. These are proving very popular with staff. The department also offers other internally developed courses, including the communications course Building Bridges, which

has been particularly welcomed by all who have attended.

It is the intention of the department to continue to widen the variety of in-house courses offered in the coming year, to include training in finance for budget holders and presentation skills for staff.

The aim is to increase SCAS’s support of non clinical education and to provide a platform for staff to develop their knowledge and skills in all areas and in all professions.

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OPERATIONS

Last year saw huge improvements in response times across SCAS for patients with life- threatening conditions. Speed of response is a patient’s top priority and minutes can be vital for the seriously ill. The faster response times are therefore great news for patient care and the patient experience. The average time taken to reach a patient with a life-threatening condition fell from 08.37 to 06.56 minutes, a fantastic achievement by all our road and emergency operation centres (EOC) staff.

Performance management

Just over a year ago, SCAS embarked on a programme of performance management, engaging external consulting support.

Their methodology involved dividing the area into zones, deploying and managing resources within these zones and monitoring and measuring performance.

We also introduced a new framework and discipline for the management of performance within the organisation.

While more work remains to be done in 2009-10 to embed these practices fully, a transformational change has been seen in responding to patients: an improvement of 31% for patients experiencing a potentially life-threatening episode.

In the most challenging rural areas, the gains have been even larger at 55%. A lot of this improvement is because of the way the new performance tools have been used.

Fleet

The extreme weather conditions experienced in southern England during January and February 2009 demonstrated a shortfall in four-wheel drive vehicle capability across SCAS.

To address this a number of Land Rover Discovery vehicles have been ordered to replace some of the standard two-wheel-drive

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This will increase frontline 4x4 capacity by at least 22 by the end of 2009.

The final batch of replacement front line dual manned ambulances, based on the Iveco Daily chassis with Wilker bodies, has been introduced into Berkshire (19) and Oxfordshire (6). This completes the planned Iveco/Wilker build programme.

To avoid over reliance on a single manufacturer, the next batch of vehicles will be based on the Mercedes 516 chassis. There are four options of body builders and these are being assessed to obtain the best available build quality and value for money.

Commercial Services

SCAS has created a new focus for the important businesses that support the activities of emergency response crews.

The Commercial Services department has been brought together as a single unit to grow,

improve and develop the wide range of activities provided to the wider healthcare community.

In addition to the well-known Patient Transport Service that carries people to and from their treatment centre, SCAS has a training operation to provide expert knowledge to a wide range of people and businesses. Support is provided at major events with first aid provision; medical loan equipment is provided to people in their home to allow them to return from hospital or avoid admittance in the first place.

33

An out-of-hours GP service is operated to allow patients to obtain medical advice and treatment 24 hours a day.

SCAS also operates a secure and efficient transport system for medical samples, records and hospital staff.

All of these varied services are a vital part of the overall healthcare provision of SCAS throughout the region, and are designed and operated to enhance the lives of patients in many different ways. They all play a part in supporting the emergency service operations of SCAS.

Emergency operations centres

SCAS started the formal tender process for a regional computer aided dispatch (CAD) system in February 2008.

The CAD is an essential piece of technology used within an ambulance control room to deploy the nearest and most appropriate response to patients.

The solution purchased is extremely advanced and is also used by other emergency services in the UK, as well as the RAC.

The CAD enables dispatchers to deploy a response to patients often as the call is being answered by the emergency call handlers.

All three emergency operations centres (EOCs) in SCAS will eventually be using the same CAD and telephony equipment, which will provide staff with the ability to share resources effectively and improve deployment to all patients across the region.

34


All improvements in EOC deployment mean a faster response to patients and support improvement in clinical outcomes.

Hampshire EOC was the first to go live with the new CAD on 4 November 2008.

This was extremely successful and a great achievement by everyone involved. It is planned to introduce the system to the Berkshire EOC during September 2009, and then to the Oxfordshire and Buckinghamshire EOC.

On 17 March 2009 the Hampshire EOC relocated to Southern House, Otterbourne, and new advanced telephony equipment was also introduced. All staff were involved with the design of the new EOC and the relocation was an extremely exciting and successful project.

Performance was actually improved during the process and has continued to excel. Staff in Hampshire now have a modern environment with state of the art technology to allow them to respond to patients in a far more effective manner.

35

Indirect Resources

Indirect Resources is the name given to all the groups used to supplement the main A&E response to patients with life-threatening conditions. The development of Indirect Resource initiatives are within an approved clinical and governance framework. Over 1,200 people now contribute to this effort to improve patient care, demanding an organisational infrastructure that is professional and supportive along with a heavy requirement for induction training and re-qualification.

Indirect Resources covers many different groups, such as:

• Static sites• Shopping centres• Police custody suites• Nursing homes• Doctors’ surgeries• Motorway service stations• Railway stations• Docks

• Airports• Volunteer community responders• Dynamic deployment volunteer responders,

including junior doctors• Coastguard co-responders• Military co-responders• Fire co-responders• Non shift operational managers/qualified

staff • NHS staff responders.

These groups play an absolutely vital role in supplementing response to seriously ill patients, particularly in rural areas, which can be difficult to reach in eight minutes with an ambulance.

The last year has seen a number of exciting developments:

• Indirect Resource Support Desks have been introduced. These are staffed by ambulance service dispatchers specifically focusing on community first responders (CFRs), ensuring safe and appropriate activations along with responder welfare follow-ups.

36


37

The introduction of these desks has increased the activations of community responders significantly enabling more responders to provide direct patient care.

• An agreement has been signed with Thames Valley Police to place automated defibrillators in key police premises and locations. This development ensures that there is an automated external defibrillator in every custody suite within SCAS.

• Work has been done with the RAF in a number of locations, including RAF Brize Norton. A strong team has been developed, which contributes to delivering direct patient care across Oxfordshire.

• A formal partnership agreement with Hampshire Fire and Rescue Service provides a patient service above and beyond both services’ normal resources, extending six existing Fire co-responding schemes to 14 fully operating schemes throughout Hampshire.

• Funds have been made available to provide recruitment/demonstration trailers. They are designed to be eye catching and stand out at any public event. These help to provide a professional image and assist in the recruitment of volunteers.

The great majority of indirect resources come through people who kindly donate their personal time to help their local community.

This commitment and dedication during the course of the year is reflected in the gratitude of patients and family members for the care and compassion received. Specifically, during the course of the year, five patients who benefited from early defibrillation by a community first responder may well have lost their lives had it not been for the volunteers.

38


FINANCE, ESTATES AND ENVIRONMENT

Key developments are the two new emergency operations centres in Otterbourne, Hampshire, and Bicester, Oxfordshire, the latter planned to open during 2009.

Related to this, the investment evaluation process and the control of capital costs have significantly improved during 2008-09.Management information has been further developed during the year and will be enhanced during 2009 with the full roll-out of the new Proactis e-procurement system.

Environment

SCAS recognises its responsibilities towards minimising the environmental impact of its work. As a service provider for local communities, we particularly note the importance of protecting the environment in which our patients and staff live.

By its very nature, SCAS requires a large fleet of vehicles travelling high mileages, making green issues a particular challenge. However, we are committed to making a difference.

A review has been undertaken by the Carbon Trust and the Energy Saving Trust showing opportunities to reduce CO2. An Action plan to deliver these CO2 reductions is being produced. This will show the key projects to be delivered to reduce the carbon footprint from its current level on 9,999 tonnes CO2 and to reduce costs.

A Green Club has been set up and environmental improvements are being led by green champions at ambulance resource centres.

39

SERVICE DEVELOPMENT

The Service Development Directorate supports SCAS to achieve our vision of becoming a mobile healthcare provider through:• Ensure existing services provided by SCAS are

sustainable, ie high quality and efficient.• Exploring, and where possible, developing

new service opportunities with our stakeholders and the public.

• Understanding how we can improve services for those requiring emergency or urgent healthcare, ensuring care is delivered as close to home as possible.

• Seeking to continually improve the services we provide to the public.

• Providing support and facilitation to ensure changes are well managed.

Key successes during 2008-09 included:• Re-negotiated a three-year contract for the

Oxford Out of Hours Service.

• Programme managed the emergency control room and administration relocation into Southern House.

• Developed an educational package for tools and techniques of service improvement.

• Developed a scheme in Portsmouth and South East Hampshire in partnership with local GPs to ensure patients dialling 999 who do not require admission to hospital receive appropriate care in the community.

• Agreed 20 new care pathways, which could be used as an alternative to admission to and accident and emergency hospital.

40


INFORMATION MANAGEMENT AND TECHNOLOGY

Major achievements during the year have been the:

• introduction of a monthly information pack, issued on the tenth working day of each month. This contains all current facts and figures about SCAS including performance rates and attendance levels. The pack has become an invaluable aid to both SCAS managers and external stakeholders.

• move of all SCAS staff to a single email account.

• introduction of the first phase of a single telephony solution for the Trust to coincide with the move of Hampshire operations to Otterbourne. The system will be introduced to other sites and lead to reduced costs and improved efficiency.

• agreement of standard Information Management and Technology policies to replace existing out of-date and non-integrated policies.

41

RECRUITING AND DEVELOPING OUR WORKFORCE

Recruitment

The recruitment process and literature have seen a major review and improvement during the year and details of career pathways and information about the roles within SCAS can now be found on the website, as well as being available in paper form to prospective candidates. For more information about our staff, see pages 47-50.

First line manager programme

The vital importance of people management skills within SCAS - and the fact that a lot is asked of managers at the front line - has received special focus. A new training programme has been introduced that aims to give them an understanding of key policies and procedures, as well as a suite of transferable skills.

Appraisal

The completion of appraisals is often challenging and this is particularly so with a mobile workforce like SCAS.

The appraisal processes has been reviewed and a simple new appraisal process for use by all staff has been developed and introduced.

The focus is now on ensuring an improved uptake and a well-structured, meaningful and developmental appraisal process for all staff.

42


CORPORATE AFFAIRS

Foundation Trust

SCAS has an aspiration to become a foundation trust. We have, along with all other English ambulance services, recently embarked on a diagnostic programme to ascertain our readiness to proceed with an application.

The diagnostic process will be completed by the end of June 2009. The final report will inform the Board of the projected timescale and the developments that will be necessary to be successful in our application.

We believe that becoming a foundation trust, and the scrutiny that surrounds the application process, will bring further improvement to the organisation, staff and patients. In particular:

• Greater financial freedom

• Wider public and patient involvement and influence in the development of new services.

• Higher quality governance arrangements.

Communications

In February 2009 the new SCAS intranet was launched in Southern House, Hampshire. This was the first of many planned local launches designed to train representatives from every department on how to use the new system and to disseminate the information to all staff.

Initial uptake has been good and we look forward to building on the enthusiasm of the Southern House users in 2009-10.

43

Case study - ‘The new intranet... an invaluable tool’

As any incident commander will tell you, good communication is vital. That’s why the new intranet is such an invaluable tool for the Emergency Preparedness Department.

During the current swine flu situation the intranet has enabled me and my team to get information out to staff quickly and in a form that is easily accessed.

But communication during a crisis is not the only use of the intranet. Being interactive and easy to use, the intranet allows me to put information out that staff find useful and that is important to them.

We haven’t even scratched the surface of what we can do with it. Easy access to major incident plans, polls to gauge people’s opinions and level of understanding, discussion forums, e-learning and online exercises are just a few of the things me and the emergency preparedness team plan to develop over the coming months.

John DyerHead of Emergency Preparedness

44

Best service, equipment and HOW WE PERFORMED

2008-09 was the first year of the new Call Connect target for measuring ambulance performance. Previously, the clock had started ticking from the point at which we identified the patient’s chief complaint.

From April 08, the clock starts when the call hits SCAS’s telephone switch. On average, this advanced the clock start time by 90 seconds, which may not sound much but is a very significant proportion of the eight minutes we are allowed to reach patients with life threatening conditions.

This change presented a huge challenge to all ambulance services. In the case of SCAS, we had to improve performance by 25% just to stand still.

Our plans to address the challenge involved a complete review of all our processes, both in the emergency operations centres (EOCs) and out on the road.

We also focused heavily on increasing the contribution we received to our performance

from Indirect Resources - that is, community volunteers, health care professionals, colleagues from other emergency services and our own off duty staff.

We train and equip these volunteers who play a vital role in helping patients until we arrive on scene. In addition, we secured a significant increase in funding from our commissioners,which enabled us to recruit extra staff both for EOCs and the road.

Despite these efforts, which delivered a 26% performance improvement in A8, we missed the national targets. The main reasons for this were that we were unable to recruit the new staff fast enough to give us the full benefit early enough in the year.

In addition, we were badly hit by exceptionally high demand over winter, exacerbated by ambulances being delayed at hospital and the learning experience of the installation of the new computer aided dispatch system in Hampshire.

45

Our performance trend leaving the year, however, was very encouraging and showed how much progress we had made. We

exceeded the A8 target cumulatively in the last three months of the year and the A19 target in March.

SCAS RESPONSE TIME TARGETS

0 20 40 60 80 100

SCAS 2007-08 performance

SCAS 2008-09 performance

National target

61.0%72.6%75.0%

93.0%94.4%95.0%

88.8%88.0%95.0%

Category Aresponse

within8 minutes

Category Aresponse

within19 minutes

Category Bresponse

within19 minutes

%

Graph for illustration purposes only

46

Best service, equipment and LISTENING TO THE PEOPLE WE SERVE

SCAS welcomes feedback from patients and the public and we are proud that our compliments currently outweigh complaints by more than four to one.

Any communication from a member of the public – the community served by SCAS – is dealt with by the SCAS Patient Advice and Liaison Service (PALS).

PALS has a number of core functions and these include:

• giving advice on the ambulance service and other heath services.

• listening to any concerns and answering queries; helping patients to get information about useful services and support groups

• obtaining the views of patients as to how to help improve services.

PALS is also responsible for managing the Patient and Public Involvement arrangements.

This is a key aspect of engaging with the communities served by SCAS and a

Public Involvement Panel is made up of representatives of the community.

The panel is able to provide an objective insight into the way SCAS is working. Members sit on all core Trust’s committees and carry out surveys among patients.

SCAS has a separate procedure to deal with any complaints, in line with current Department of Health requirements. This process is aimed at providing the complainant with the satisfactory resolution of any issues and also ensuring that appropriate lessons are learned by SCAS.

In 2008-09 there were 128 complaints made against the service and 599 compliments were received.

47

DIVERSITY

SCAS serves a rich and diverse population and is committed to working with individuals and local communities to ensure we meet the different needs of our patients.

Every individual has their own unique needs and also their own unique skills, talents and experiences. Through working to understand and support difference, we can provide support and advice for staff to enable them to care for people in a way that is sensitive to their needs. For example, we provide regular diversity bulletins, which provide knowledge to help staff understand more about patients and colleagues with different backgrounds. These bulletins also provide practical information useful for clinical staff, such as when patients may be fasting.

During 2007, SCAS established an Equality and Diversity Steering Group under the chairmanship of the Chief Executive. This group sets policies for SCAS on equality and diversity issues. It also produces relevant documents, such as the Equal Opportunities

Statement and Single Equality Scheme that are published on the SCAS website.

From this group a number of themed working groups have been set up to explore the needs of specific areas of difference and work to ensure SCAS represents and supports these groups in the best possible way. These groups, already working, are looking at: Age and Carers; Disability and Mental Health; Gender and Sexual Orientation; Race, Ethnicity, Faith and Belief. These are chaired by a member of the Steering Group and include staff members with an appropriate interest in, or experience and knowledge of, the relevant theme. They also include a representative of the SCAS communications team who is able to advise on promoting the work of the focus group to staff as a whole.

SCAS recognises that building a diverse workforce will enable us to represent and support communities more effectively and, as such, is committed to taking positive steps to ensure that not only is no member of staff

48


discriminated against, but also that staff feel recognised and respected for the unique contribution they bring to the organisation. In 2008 a group of SCAS staff took part in the Reading Pride festival, a celebration of Reading’s Lesbian, Gay, Bisexual and Transgender (LGBT) community. Plans are already underway to encourage staff to participate in Pride events during 2009 and to explore the associated recruiting opportunities.

Moving forward the relevant steering groups will also be exploring appropriate events and recruiting activities related to their areas.

Our duty to our staff extends far beyond any statutory responsibility and aims to take advantage of the experiences of people and to encourage the sharing of skills and knowledge so as to make SCAS an exemplary employer.

0 500 1000 1500 2000 2500

SCAS

Berks

OxfordBucks

Hants

1273

324

477

472 363

403

283

1049

Male

Female

SCAS GENDER PROFILE


49

0 500 1000 1500 2000 25000% 20% 40% 60% 80% 100%

SCAS

Berks

OxfordBucks

Hants

WORKFORCE: FULL TIME / PART TIME STATUS

Female

Male

Full time Part time

Percentage of employees Number of employees

SCASBerksOxford/BucksHants

34%29%38%

34.5%

11%18%8%9%

50%45.5%49%

53.5%

5%7.5%5%3%

797175333289

2521087074

1158278431449

115464623


50


0

100

200

300

400

500

600

700

800

20-30<20 30-40 40-50 50-60 60-70 70-80

Nu

mb

er o

f st

aff

Age range

SCAS PROFILE BY AGE AND DIVISION

SCAS Berkshire Buckinghamshire and Oxfordshire Hampshire

SCAS BERKS BUCKS/OXON

HANTS

<20 17 11 3 3

20-30 391 106 155 130

30-40 736 194 270 272

40-50 644 163 234 247

50-60 372 85 146 141

60-70 150 44 67 39

12 4 5 370-80

2322 607 880 835Total


51

FINANCIAL REVIEW

Financial Performance

SCAS again fulfilled all statutory financial duties in 2008-09.

1 - On Income and Expenditure the Trust reported a surplus of £559,000 for the year, and therefore did better than the break even target set for it by the Department of Health for 2007-08.

2 - SCAS achieved its external financing limit (EFL) for the year.

3 - A return on assets (the capital cost absorption duty) of 4.1% was achieved, which is in excess of the target.

4 - In the capital programme £15.6m was spent on a range of projects, including new ambulances, and the fit out and investment in technology in two new offices and emergency operations centres. Overall, SCAS underspent by £1.5m against the Capital Resource Limit of £16.5m, which it is permitted to do.

SCAS also received a clean bill of health from our external auditors. The audit for the 12 month period was carried out by the Audit Commission at a total cost of £137,000.

Total revenue income to meet pay and other day to day running costs reached £125m, of which the majority was secured through various Service Level Agreements with primary care and hospital NHS trusts.

Total fixed assets (land, buildings and capital equipment) of SCAS were valued at £65m in the balance sheet as at 31 March 2009.

SCAS was able to pay by value 86% of its non-NHS and 83% of its NHS trade invoices respectively within 30 days, which was below the 95% target set for it by the Department of Health. This represents an improvement from last year. It will improve further during 2009-10 following the completion of the implementation of an electronic procurement system which will address this issue.

52


Looking forward to 2009-10, revenue expenditure plans totalling £128m have been approved by the Board. £10m of capital expenditure has also been identified, which relates to the continuing investment in upgrading the infrastructure. This includes further investment in the front line vehicles and investment in two emergency operations centres.

Summary financial statements, which are extracted from the full accounts, are included within this annual report. The full accounts are available free of charge from the finance department at the address given at the end of this annual report.

Remuneration Report

This report contains details of the senior managers’ remuneration and pensions which includes those on the SCAS executive team. All senior managers listed have given their consent for the information shown to be displayed.

The following information is also disclosed.

a) There is a Remuneration Committee who determine the inflation award on base pay for executive directors, taking into account any national pay award for very senior managers. This committee is made up of non executive directors and for 2008-09 membership was Mrs June May (Chair); Mr Neil Goulden, and Mrs Val Woods.

b) In addition to the annual inflation uplift, the Remuneration Committee, also consider

53

a non superannuable and non-recurrent performance element, based on a range of measures in respect of achievement of individual and corporate objectives and Healthcare Commission assessments.

c) Executive directors are appointed under open competition, these appointments are permanent and termination arrangements are consistent with NHS guidelines and employment legislation.

d) Benefits in kind in all cases relate to the provision of lease cars, plus professional subscriptions, where applicable.

e) The tables overleaf show, for each senior manager who served during the year, their respective remuneration and pension information.

54


Senior managers - Salaries and allowances

Name and Title 2008-09 2007-08

Salary (bands

of £5,000)

Other remunera-tion (bands of £5,000)

Benefits in kind

(rounded to the

nearest

Salary (bands

of £5,000)


Benefits in kind

(rounded to the

nearest

£000 £000 £000 £000 £000 £000Will HancockChief Executive

135-140 9.4 135-40 9.1


100-105 7.0 95-100 5.2


95-100 8.5 95-100 7.1

John DivallDirector of Corporate Affairs

70-75 5.7 70-75 5.5

Sharon WaltersDirector of HR & OD

70-75 7.2 70-75 4.0

Lisa Hodgson Director of Service Development

80-85 5.8 70-75 5.2


70-75 5.2 70-75 4.7

Fizz ThompsonDirector of Clinical Services

90-95 4.9 85-90 4.8

55

Senior managers - Salaries and allowances, continued

Name and Title 2008-09 2007-08

Salary (bands

of £5,000)


Benefits in kind

(rounded to the

nearest

Salary (bands

of £5,000)


Benefits in kind

(rounded to the

nearest

£000 £000 £00 £000 £000 £00


0-5 0-5

Colin HazellNon Executive Director

5-10 5-10

Jackie NeylonNon Executive Director

5-10 5-10

June MayNon Executive Director

5-10 5-10

Alastair Mitchell-BakerNon Executive Director

5-10 5-10

Val WoodsNon Executive Director

5-10 5-10

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SCAS senior managers pension benefits consolidated 31 March 2009

Name and Title

Total accrued pension at age 60 at 31 March 2009 (bands of

£5,000)

Lump sum at age 60 related

to accrued pension at 31 March 2009 (bands of £5,000)

Cash equivalent

transfer value at 31 March

2008

Cash equivalent

transfer value at 31 March

2009

£000 £000 £000 £000Will HancockChief Executive 27 - 30 80 - 85 268 370

Fizz ThompsonDirector of Clinical Services

10 - 15 40 - 45 192 279


5 - 10 20 - 25 96 157

John DivallDirecor of Corporate Affairs

25 - 30 85 - 90 480 706

Sharon WaltersDirector of HR & OD

20 - 25 60 - 65 289 395

Lisa HodgsonDirector of Service Development

0 - 5 5 - 10 12 29


0 - 5 5 - 10 13 37


0 - 5 5 - 10 17 40

A significant reason for the increase in Cash equivalent transfer values is the change in calculation method and the regulations from the Department for Work and Pensions, which came into force on 13 October 2008.

57

Income and expenditure account for the year ended Tuesday 31 March 31 2009

2008/09 2007/08£000 £000

Income from activities 118,772 103,770

Other operating income 6,165 6,371

Operating expenses (122,355) (108,905)

OPERATING SURPLUS/(DEFICIT) 2,582 1,236

Cost of fundamental reorganisation/restructuring* 0 0Profit/(loss) on disposal of fixed assets 122 444

SURPLUS/(DEFICIT) BEFORE INTEREST 2,704 1,680

Interest receivable 294 308Interest payable (154) (53) Other finance costs - unwinding of discount (125) (19)

SURPLUS/(DEFICIT) FOR THE FINANCIAL YEAR 2,719 1,916

Public Dividend Capital dividends payable (2,160) (1,886)

RETAINED SURPLUS/(DEFICIT) FOR THE YEAR 559 30

58


Balance sheet as at Tuesday 31 March 2009

31 March, 2009 31 March 2008

£000 £000FIXED ASSETSIntangible assets 485 568Tangible assets 64,549 57,859Investments 0 0

65,034 58,427CURRENT ASSETSStocks and work in progress 722 715Debtors 8,288 5,033Investments 0 0Cash at bank and in hand 3,516 3,827

12,526 9,575CREDITORS: Amounts falling due within one year (10,434) (7,120)NET CURRENT ASSETS/(LIABILITIES) 2,092 2,455TOTAL ASSETS LESS CURRENT LIABILITIES 67,126 60,882CREDITORS: Amounts falling due after more than one year (5,776) 0PROVISIONS FOR LIABILITIES AND CHARGES (4,182) (2,303)TOTAL ASSETS EMPLOYED 57,168 58,579FINANCED BY:TAXPAYERS’ EQUITYPublic dividend capital 53,662 53,540Revaluation reserve (13) 2,505Donated asset reserve 1,357 1,596Government grant reserve 45 62Other reserves (350) (350) Income and expenditure reserve 2,467 1,226

TOTAL TAXPAYERS’ EQUITY 57,168 58,579

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Statement of total recognised gains and losses for the year endedTuesday 31 March 2009

2008/09 2007/08£000 £000

Surplus/(deficit) for the financial year before dividend payments 2,719 1,916

Fixed asset impairment losses (2,850) 0

Unrealised surplus/(deficit) on fixed asset revaluations/indexation 933 3,685

Increases in the donated asset and government grant reserve due to receipt of donated and government grant financed assets

0 55

Defined benefit scheme actuarial gains/(losses) 0 0

Additions/(reductions) in “other reserves” 0 (350)

Total recognised gains and losses for the financial year 802 5,306

Prior period adjustment 0 0

Total gains and losses recognised in the financial year 802 5,306

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Cash flow statement for the year ended 31 Tuesday March 2009

2008/09 2007/08£000 £000

OPERATING ACTIVITIESNet cash inflow/(outflow) from operating activities 8,735 11,066

RETURNS ON INVESTMENTS AND SERVICING OF FINANCE:Interest received 317 289Interest paid (138) (53)Interest element of finance leases (16) 0

Net cash inflow/(outflow) from returns on investments and servicing of finance

163 236

CAPITAL EXPENDITURE(Payments) to acquire tangible fixed assets (14,075) (6,035)Receipts from sale of tangible fixed assets 610 2,948(Payments) to acquire intangible assets (38) (180)Receipts from sale of intangible assets 0 0(Payments to acquire)/receipts from sale of fixed asset investments 0 0

Net cash inflow/(outflow) from capital expenditure (13,503) (3,267)

DIVIDENDS PAID (2,160) (1,886)

Net cash inflow/(outflow) before management of liquid resources and financing (6,765) 6,149

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MANAGEMENT OF LIQUID RESOURCES2008/09 2007/08

(Purchase) of investments with DH 0 0(Purchase) of other current asset investments 0 0Sale of investments with DH 0 0Sale of other current asset investments 0 0

Net cash inflow/(outflow) from management of liquid resources 0 0

Net cash inflow/(outflow) before financing (6,765) 6,149

FINANCINGPublic dividend capital received 301 0Public dividend capital repaid (not previously accrued) (179) (2,066)Loans received from DH 7,005 0Other loans received 483 0Loans repaid to DH (1,071) (558)Other loans repaid 0 0Other capital receipts 0 55Capital element of finance lease rental payments (85) 0Cash transferred (to)/from other NHS bodies 0 0

Net cash inflow/(outflow) from financing 6,454 (2,569)

Increase/(decrease) in cash (311) 3,580

62


Breakeven performance2008/09 2007/08

£000 £000

Turnover 124,937 110,141Retained surplus/(deficit) for the year 559 30

Better Payment Practice Code - measure of compliance2008/09

Number £000

Total Non-NHS trade invoices paid in the year 34,939 52,322Total Non NHS trade invoices paid within target 28,734 44,815Percentage of Non-NHS trade invoices paid within target 82.2% 85.7%

Total NHS trade invoices paid in the year 1,914 3,874Total NHS trade invoices paid within target 1,570 3,198Percentage of NHS trade invoices paid within target 82.0% 82.6%

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.

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The Late Payment of Commercial Debts (Interest) Act 19982008/09 2007/08

£000 £000

Amounts included within Interest Payable arising from claims made under this legislation

0 0

Compensation paid to cover debt recovery costs under this legislation 0 0

2008/09 2007/08£000 £000

Management costs 7,203 6,332

Income 123,573 108,845

Summary Financial Statements

These accounts for the year ended 31 March 2009 have been prepared by South Central AmbulanceNHS Trust under section 98 (2) of the National Health Service Act 1977 (as amended by section 24 (2) schedule 2 of the National Health Service and Community Care Act 1990) in the form which theSecretary of State has, with the approval of the Treasury, directed.

The financial statements above are only a summary of the information contained in the Trust’sAnnual Accounts. A full copy of the Accounts is available, free of charge, on request.

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Best service, equipment and STATEMENT ON INTERNAL CONTROL 2008-09

1 - Scope of responsibility

The Board is accountable for internal control. As Accountable Officer, and Chief Executive of this Board, I have responsibility for maintaining a sound system of internal control that supports the achievement of the organisation’s policies, aims and objectives. I also have responsibility for safeguarding the public funds and the organisation’s assets for which I am personally responsible as set out in the Accountable Officer Memorandum.

The SCAS Board has, under its “Scheme of Reservation and Delegation”, delegated authority to the Governance Committee (formerly Clinical Governance Committee) and Audit Committee, to support, monitor and review risk, controls and associated assurance.

The Executive Directors are personally accountable for the management of risks within their respective directorates. Executive leadership of governance and risk management is designated to the Director of Corporate Affairs. Executive leadership

of financial governance is designated to the Director of Finance.

As Chief Executive, I work within a performance management framework. The framework includes monthly chief executive performance and management meetings with the strategic health authority, NHS South Central (SHA); meetings with our lead commissioner; and local partnership meetings which are attended by myself and/or responsible executive directors. During this financial year SCAS has also attended an executive to executive meeting with the SHA where the Trust’s performance and future strategy has been discussed.

2 - The purpose of the system of internal control

The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore

65

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 organisation’s policies, aims and objectives.

• 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 Central Ambulance Service NHS Trust for the year ended 31 March 2009 and up to the date of approval of the annual report and accounts.

3 - Capacity to handle risk

Governance and risk management are led and monitored by the Director of Corporate Affairs, who also acted as Trust Secretary until the appointment of a full time Corporate Secretary

in January 2009. The Director of Corporate Affairs reports directly to the Chief Executive who is the Accountable Officer.

SCAS has adopted an integrated approach to Risk Management, bringing together Governance, Complaints, Patient Advice and Liaison Service (PALS), Patient & Public Involvement (PPI), Health and Safety, and Claims Management under the leadership of the Director of Corporate Affairs. This centralised approach enables close monitoring of performance and provides for the linking of risks arising from different sources.

The Director of Clinical Services is the designated Executive lead for Child Protection, Infection Control and Clinical Audit and Effectiveness, and works closely with the Director of Corporate Affairs in delivering effective Clinical Governance. The Director of Clinical Services is the designated Caldicott Guardian and accountable officer for the management of medicines and controlled drugs.

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The Director of Corporate Affairs is assisted in his leadership role by a team comprising: the Head of Governance and Risk Management, three Divisional Risk Managers, a Complaints Manager, a PALS & PPI Manager and an Information Governance Manager. See Figure 1 – Risk Management Structure opposite.

SCAS has in place an overarching Risk Management Strategy which is reviewed annually by the Board, together with a Risk Management Policy and Health and Safety Policy, which provides specific guidance to managers and staff in respect of reporting and investigating, and the risk assessment of adverse incidents and risks. SCAS actively encourages both reactive and pro-active risk reporting from staff in order that learning can take place and continual improvements be made. We are working closely with our managers and staff to develop a fair and open reporting culture which encourages health professionals to report errors and “near misses” without fear of blame or reprisal.

Director ofCorporate

Affairs

PALS & PPIManager

Berkshire Risk Manager

ComplaintsManager

InformationGovernance

Manager

Hampshire Risk Manager

Oxfordshire &Buckinghamshire Risk Manager

CorporateSecretary

Head ofGovernance &

RiskManagement

Figure 1 – Risk management structure

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SCAS has in place a trust-wide corporate induction training programme for all new staff, which includes health and safety, awareness of risk, and incident reporting and investigation at appropriate levels. A range of other mandatory risk related courses has been identified which will be delivered in line with the training needs analysis of each post.

We recognise the need to develop the skills of our managers and to standardise processes across SCAS. Risk specific training has been provided which includes:

• Investigating and managing complaints.

• Major Incident - Gold Command training for directors.

• Coaching Skills.

4 - The risk and control framework

It is SCAS’s view that risk management is the responsibility of all staff. It forms part of our daily lives and work ethic and is integral to

every aspect of SCAS’ s business and activity. Individual responsibilities are clearly defined within our policies and job descriptions.

The Board has in place a committee and meeting structure (see figure 2 below), which enables it to adequately and effectively

3 x Health,Safety and

Risk ManagementGroups*

Trust Board

Financeand Investment

Committee

GovernanceCommittee

AuditCommittee

Fixed AssetManagement andStrategy Group

RemunerationCommittee

CharitableFunds

Committee

ClinicalReview Group

InformationGovernance

Group

PatientExperience

Review Group

StrategicHealth, Safetyand Risk Group

*There is a Berkshire, a Hampshire and an Oxfordshire and Buckinghamshire group

Figure 2 – Committee and meeting structure

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discharge its responsibilities in relation to risk management.

SCAS’s Governance Committee is responsible for developing risk management and for monitoring performance on behalf of the Board. The Committee is chaired by a non-executive director and its membership comprises the Director of Corporate Affairs, Director of Clinical Services, Director of Operations, Director of Human Resources, Head of Governance and Risk Management, Complaints Manager, PALS & PPI Manager, Information Governance Manager, Head of Education, Head of Clinical Effectiveness, three non-executive directors, two staff representatives and two Patient and Public Forum representatives.

The Audit Committee, in addition to reviewing and providing assurances on financial matters as part of its work plan, reviews the Trust Assurance Framework and its Governance and Risk Management arrangement. The Audit Committee approves the Annual Audit Plan,

receives audit reports and monitors delivery of the associated action plans.

The Risk Management and Health & Safety policies clearly define responsibilities for directors, managers and staff across SCAS. The Risk Management Policy provides guidance for managers and staff on incident reporting, investigation and risk assessment.

SCAS has in place an effective incident reporting system. There is evidence of a good level of staff both pro-actively and reactively reporting risks and incidents. SCAS is committed to creating a culture which encourages reporting and is supportive of any member of staff that does so. Evidence from the 2008 Staff Survey has shown a significant improvement in this area.

SCAS has in place a Whistleblowing policy.

A comprehensive web-based risk management database is in place which enables analysis and divisional benchmarking of adverse incidents, complaints and PALS enquiries.

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During 2008-09 the database has been expanded to include vehicle accidents and the SCAS risk register.

A Strategic Risk Register is in place, which has been reviewed by the Board, Audit Committee and Clinical Governance Committee during the year. The risk register is also reviewed monthly by the executive management team. The register shows a trend of decreasing risk scores. Divisional Risk Registers are also in place reflecting new and residual risks occurring at a local level.

SCAS has in place an Assurance Framework which informs the Board of the primary risks, control measures, and external assurances in relation to the delivery of the Trust’s Annual Business Plan and objectives. A common referencing system has been used throughout the Business Plan, Assurance Framework and Milestone Tracker linking the three documents together; strategic aims, objectives and risks are thus clearly identifiable. Likewise, there is a reference through the Assurance Framework

back to the Healthcare Commission Core Standards.

In addition the Board receives assurance from:

• Performance reports against key objectives via the Milestone Tracker.

• Review of Assurance Framework.

• Directorate reports from executive directors

• Reports from Clinical Governance and Audit Committees.

• Ad hoc reports from specialist project groups.

SCAS has taken the decision not to develop a separate action plan specific to the Assurance Framework document. The Board believes it has adequate assurance from the monthly performance reports from each directorate, and from its review of the Business Plan milestone tracker.

The Board Assurance Framework document and Strategic Risk Register have been reviewed by the Audit Committee and the Governance

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Committee throughout the year. Reports from both these committees have been made to the Board. The Board formally reviewed and approved the Assurance Framework at its meeting in April and October 2008, January and February 2009.

Over the year there has been a general downward trend in risk scores as each of the strategic risks have been addressed.

There were no other significant control weaknesses during this period.

Throughout the year SCAS has worked closely with the Patient and Public Involvement Forum (PPIF) who are represented at the Board, Governance Committee and Health, Safety and Risk Working Groups, and Complaints and PALS Review Group.

Patients, carers, relatives and other members of the public are encouraged to report any concerns or complaints they may have, or to suggest areas for improvement. Advice on how to register a compliment or complaint

is available on our website. A Patient Advice and Liaison Service (PALS) is in place providing support and advice to patients and the public experiencing difficulties or requiring information on any aspect of their contact with SCAS or the wider NHS. The nature of PALS enquiries and any patterns emerging are reviewed quarterly by the Patient Experience Group.

SCAS is aware of the importance of protecting the security of patient related information. It has undertaken the annual information governance self assessment toolkit achieving a score of 62% (Amber) which is a 10% improvement on the 2007-08 results. There remains scope for further improvement and the Trust has an approved action plan in place. Internal Audit has reviewed the self assessment results and has agreed the results to be a fair reflection of the Trust’s position

SCAS has participated in the Information Governance Assurance Programme (IGAP). As part of this process the movement and transfer of patient related information

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has been mapped and assurance provided that risks associated with such transfers are controlled. Over the past year there have been two reported adverse incidents relating to information security within SCAS, both of them related to the theft of laptops. These incidents were fully investigated and steps taken to improve security. New encryption software has been purchased and this will be rolled out across the organisation during the coming year.

SCAS is fully compliant with the core standards for better health. SCAS’s 2008-09 declaration has been audited by our internal auditors and has been verified as being an accurate declaration against the sample of core standards audited.

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 in to

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.

Control measures are in place to ensure that all the organisation’s obligations under equality, diversity and human rights legislation are complied with.

5 - Review of effectiveness

As Accountable Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review is informed in a number of ways. The head of internal audit provides me with an opinion on the overall arrangements for gaining assurance through the Assurance Framework and on the controls reviewed as part of the internal audit work. Executive managers within the organisation who have responsibility for the development and maintenance of the system of internal control provide me with assurance.

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The Assurance Framework itself provides me with evidence that the effectiveness of controls that manage the risks to the organisation achieving its principal objectives have been reviewed. My review is also informed by

• Internal and External Audit Reports.

• Annual Audit Letter.

• Reports to the Board from the Governance and Audit Committees.

• Monthly Board Performance Report which covers Corporate Affairs, Clinical Services, Operational, Service Development, Financial and Human Resource issues.

• Bi-Monthly Business Plan Progress Report (Milestones) to the Board.

• Head of Internal Audit Opinion Statement for 2008-09.

• The Board Assurance Framework.

• Staff Satisfaction Survey.

• Information Governance Toolkit compliance report and associated action plan.

• Standards For Better Health Core Standards Self-Assessment and Declaration.

• Auditors Local Evaluation Scores (ALE) self assessment.

I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Director of Corporate Affairs and executive team. A plan to address weaknesses and ensure continuous improvement of the system is in place.


21 April 2009


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INDEPENDENT AUDITOR’S REPORT

Opinion on the financial statementsI have audited the financial statements of South Central Ambulance Service NHS Trust for the year ended 31 March 2009 under the Audit Commission Act 1998. The financial statements comprise the Income and Expenditure Account, the Balance Sheet, the Cash Flow Statement, the Statement of Total Recognised Gains and Losses and the related notes. These financial statements have been prepared in accordance with the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service set out within them. I have also audited the information in the Remuneration Report that is described as having been audited.

This report is made solely to the Board of Directors of South Central Ambulance Service NHS Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 49 of the Statement of Responsibilities of Auditors and of Audited Bodies prepared by the Audit Commission.

Respective responsibilities of Directors and auditorThe directors’ responsibilities for preparing the financial statements in accordance with directions made by the Secretary of State are set out in the Statement of Directors’ Responsibilities.

My responsibility is to audit the financial statements in accordance with relevant legal and regulatory requirements and International Standards on Auditing (UK and Ireland).

I report to you my opinion as to whether the financial statements give a true and fair view in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England. I report whether the financial statements and the part of the Remuneration Report to be audited have been properly prepared in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England. I also report to you whether, in my opinion, the information which comprises the commentary on the financial performance included

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within the Financial Review included in the Annual Report, is consistent with the financial statements.

I review whether the directors’ Statement on Internal Control reflects compliance with the Department of Health’s requirements, set out in ‘Guidance on Completing the Statement on Internal Control 2008-09’ issued 25 February 2009. I report if it does not meet the requirements specified by the Department of Health or if the statement is misleading or inconsistent with other information I am aware of from my audit of the financial statements. I am not required to consider, nor have I considered, whether the directors’ Statement on Internal Control covers all risks and controls. Neither am I required to form an opinion on the effectiveness of the Trust’s corporate governance procedures or its risk and control procedures.

I read the other information contained in the Annual Report and consider whether it is consistent with the audited financial statements. This other information comprises the Foreword, the unaudited part of the Remuneration Report, the Chairman’s Statement and the remaining elements of the operating and financial review. I consider the

implications for my report if I become aware of any apparent misstatements or material inconsistencies with the financial statements. My responsibilities do not extend to any other information.

Basis of audit opinionI conducted my audit in accordance with the Audit Commission Act 1998, the Code of Audit Practice issued by the Audit Commission and International Standards on Auditing (UK and Ireland) issued by the Auditing Practices Board. An audit includes examination, on a test basis, of evidence relevant to the amounts and disclosures in the financial statements and the part of the Remuneration Report to be audited. It also includes an assessment of the significant estimates and judgments made by the directors in the preparation of the financial statements, and of whether the accounting policies are appropriate to the Trust’s circumstances, consistently applied and adequately disclosed.

I planned and performed my audit so as to obtain all the information and explanations which I

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considered necessary in order to provide me with sufficient evidence to give reasonable assurance that:

• the financial statements are free from material misstatement, whether caused by fraud or other irregularity or error; and

• the financial statements and the part of the Remuneration Report to be audited have been properly prepared.

In forming my opinion I also evaluated the overall adequacy of the presentation of information in the financial statements and the part of the Remuneration Report to be audited.

OpinionIn my opinion:

• the financial statements give a true and fair view, in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England, of the state of the Trust’s affairs as at 31 March 2009 and of its income and expenditure for the year then ended;

• the part of the Remuneration Report to be audited has been properly prepared in accordance with the accounting policies directed by the Secretary of State as being relevant to the National Health Service in England; and

• information which comprises the commentary on the financial performance included within the Financial Review, included within the Annual Report, is consistent with the financial statements.

Conclusion on arrangements for securing economy, efficiency and effectiveness in the use of resources

Directors’ ResponsibilitiesThe directors are responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in the Trust’s use of resources, to ensure proper stewardship and governance and regularly to review the adequacy and effectiveness of these arrangements.

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Auditor’s ResponsibilitiesI am required by the Audit Commission Act 1998 to be satisfied that proper arrangements have been made by the Trust for securing economy, efficiency and effectiveness in its use of resources. The Code of Audit Practice issued by the Audit Commission requires me to report to you my conclusion in relation to proper arrangements, having regard to the criteria for NHS bodies specified by the Audit Commission. I report if significant matters have come to my attention which prevent me from concluding that the Trust has made such proper arrangements. I am not required to consider, nor have I considered, whether all aspects of the Trust’s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively.

ConclusionI have undertaken my audit in accordance with the Code of Audit Practice and having regard to the criteria for NHS bodies specified by the Audit Commission and published in December 2006.

I am satisfied that, in all significant respects, South Central Ambulance Service NHS Trust made proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ending 31 March 2009.

CertificateI certify that I have completed the audit of the accounts in accordance with the requirements of the Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit Commission.

Maria GrindleyOfficer of the Audit CommissionAudit Commission, Unit 5, ISIS Business Centre, Horspath Road , Oxford OX4 2RD11 June 2009

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GLOSSARY OF FINANCIAL TERMS

Annual accountsThe annual accounts of an NHS body provide the financial position for a financial year, ie 1 April to 31 March. The format of the annual accounts is set out in NHS accounts manuals and includes financial statements and notes to the accounts.

Audit CommitteeA mandatory sub-committee of all trust Boards. The Audit Committee’s primary role is to conclude upon the adequacy and effective operation of the Trust’s internal control system. This involves independently monitoring, reviewing and reporting to the Board on the processes of governance.

Average net relevant assetsRelevant net assets are calculated as the total capital and reserves of NHS trusts less the donated asset reserve and cash balances in the Office of the Paymaster General accounts. The average is the average of the opening and closing figures.

Better payments practice codeThe target of the better payments practice code is to pay all NHS trade creditors within 30 calendar days of receipt of goods or a valid invoice (whichever is later) unless other payments terms have been agreed.

BreakevenWhere income equals expenditure.

Capital cost absorption rateThe financial regime of NHS trusts recognises that there is a cost associated with the maintenance of the capital value of the organisation. NHS trusts are required to absorb the cost of capital (effectively the dividend paid on public dividend capital) at a rate of 3.5% of average net relevant assets. If the capital cost absorption rate is not within the 3-4 % range then the trust is deemed to have failed in this duty.

Capital resource limit (CRL)The amount of money an NHS body is allocated to spend on capital schemes in any one financial year.

Donated asset reserveThis reserve includes the value of all assets donated by an external provider at no cost to the NHS organisation.

External financing limit (EFL)A cash limit on net external financing . The purpose of the EFL is to assist with the control of cash expenditure by NHS trusts. The EFL for each trust is set by the Department of Health and determines how much a trust must borrow externally, over and above the internal resources it generates, to meet its

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expenditure commitment, funding for capital schemes, for example.

Financial statementsThe main statements in annual accounts of an NHS body. These include an income and expenditure account, statement of recognised gains and losses, balance sheet and cash flow statement. The format of these statements is specified in NHS accounts manuals.

GovernanceThe framework of accountability to users, stakeholders and the wider community, within which organisations take decisions and lead and control their functions to achieve their objectives.

Government grant reserveIncludes all Government grants from Government bodies other than funds provided from NHS bodies or funds awarded by Parliamentary vote.

OutturnThe final financial position, which could be the actual or forecast position.

Public dividend capital (PDC)PDC is a form of long-term government finance which was initially provided to NHS trusts when they were first formed to enable them to purchase trust’s assets from the Secretary of State. Additional capital expenditure can be funded as PDC. A dividend is payable by trusts to the exchequer to cover the expected return on the Secretary of State’s involvement.

Revaluation reserveWhere a revaluation takes place of any asset held by the Trust and a resulting gain/or loss occurs, this reserve accounts for these changes.

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GLOSSARY OF GENERAL TERMS

Acute trustAcute trusts, ie hospitals, provide planned and unscheduled health care.

AED – Automated external defibrillator A machine which gives an electric shock to a heart that is quivering, instead of pumping.

A&EAccident and Emergency departments in acute hospitals. Also known as Emergency Departments (EDs)

CAD – computer aided dispatchCAD is a sophisticated system of software used within a control room environment for emergency services such as police fire and ambulance services. The CAD is used to provide highly accurate mapping and dispatch information to ensure that the nearest and most clinically appropriate resource is sent to patients.

Call ConnectCall Connect is the national performance calculation for ambulance services, introduced 1 April 2008. Response times

are measured from the moment the call is connected to the switchboard.

Category A – known as cat A - Immediately life-threatening callsThere are two performance measures for Cat A calls.Cat A8 - The emergency response arrives on scene within eight minutes of initial 999 call The national target for all ambulance services is to respond to 75% of all call category A incidents within the eight-minute target.

Cat A19 - The emergency response capable of transporting the patient arrives on scene within 19 minutes of initial 999 call The national target for all ambulance services is to respond to 95% of all call category A incidents within the 19-minute target.

Category B – known as cat B - Serious but not life-threatening callsThere is one performance measure for Cat B calls.Cat B19 - The emergency response capable of transporting the patient arrives on scene within 19 minutes of initial 999 call. The national target for all ambulance services is to respond to 95% of all call category B incidents within the 19-minute target.

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Category C - Known as cat C - Not life-threatening and not serious 999 callsAll incidents that do not require an immediate or urgent response. There is no official national target for ambulance services.

CBRNChemical, biological, radioactive and nuclear. Part of the emergency planning process through the Civil Contingency Act, which allows organisations to respond to the above type of incidents.

Doctors’ Urgent CallsThese are calls made by GPs or midwives, to the ambulance control room, who want their patients to be admitted to hospital within a specified time period.

Emergency callsAn emergency call can be either a call received via a 999 line or received from a GP, a midwife or other clinician.

EOC – Emergency operation centreA control room where 999 and Urgent calls are received.

FPOS – First person on scene FPOS is a nationally recognised basic life support course for members of the public.

GP – General practitioner

NESC – NHS Education South CentralNESC provides high quality and relevant education and training that meets the changing needs of the NHS and its workforce and leads to measurable improvements in patient care. For more information visit www.nesc.nhs.uk

NHS - National Health Service. The NHS provides health care in the UK and is funded by taxation.

PTS – Patient Transport ServicesPatient Transport Services is the non emergency part of the ambulance service. Ambulances are booked for these patients by either a hospital or a GP when the patient has a clinical need for transport.

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Response timeThis is the total elapsed time between a 999 call being connected to the ambulance switchboard and the emergency response arriving at the incident. All calls that are received by the ambulance control room are prioritised by control operators who ask a number of structured questions to determine the seriousness of an injury or illness. From the results, they can dispatch a faster response to a life-threatening (Cat A) 999 call.

SHA – Strategic health authorityStrategic health authorities are part of the NHS. They are the interface between the Department of Health and the local health economy.

NHS South Central Strategic Health Authority provides the assurance that the local health economy, for example acute hospital trusts, mental health trusts, learning disability trust, primary care trusts and the ambulance service trust, are meeting their standards and are delivering health services to the local community in accordance with agreed plans.

SCAS – South Central Ambulance Service NHS TrustAlso referred as the Trust.

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Best service, equipment and HOW WE CAN HELP

This annual report and summary financial accounts is available on our website at: www.southcentralambulance.nhs.uk

If you require a hard copy, please contact us and we will print and send it to you.

This document can also be provided in braille, on audio-cassette tape and in large print on request.

If you require this document in a different language or format, please call 0118 936 5511 stating your language, when the phone is answered. We will transfer you to an interpreter, which may take some time so please be patient.

Produced bySouth Central Ambulance Service NHS Trust

Unit 7 and 8 Talisman Business CentreTalisman Road, Bicester, Oxfordshire OX26 6HR

Tel 01869 365 000 - Fax 01869 322 814

www.southcentralambulance.nhs.uk

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©2009

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