scottish ambulance service 2011-12 heat delivery …scorecard to ensure on-going routine monitoring...

SASLDP201011(Final).docBoard Approved [March 2011]] © Scottish Ambulance Service 2011

SCOTTISH AMBULANCE SERVICE 2011-12HEAT DELIVERY PLAN

Scottish Ambulance ServiceNational HeadquartersTipperlinn RoadEdinburghEH10 5UUTel: 0131 446 7000

www.scottishambulance.com

25tht March 2011

SASLDP201011(Final).docBoard Approved [March 2011]] © Scottish Ambulance Service 2011

List of Contents

Introduction Purpose of Plan Working Together for Better Patient Care – SAS Strategic Framework

2010-15 The HEAT Targets and Standards - Summary

Annex 1 -Supporting the quality ambitions and wider outcomes-based approach

Annex 2 - Risk Management Plans Delivery, workforce, finance, improvement and equalities related risks for

each target / standard, where appropriate Other Activity in Support of NHS Board HEAT targets Monitoring Progress

Core HEAT targets SAS Quality Scorecard

Annex 3 - SAS trajectories for NHSS HEAT targets NHSS E5 financial target NHSS E6 cash releasing efficiency target

Annex 4 - Financial template

Annex 5 - Summary of Main Workforce Issues Facing Board

SASLDP201011(Final).doc Introduction - Page 1Board Approved [March 2011) © Scottish Ambulance Service 2011

Introduction

Purpose of Plan

This HEAT Delivery Plan sets out the planned service delivery objectives andperformance for the Scottish Ambulance Service (SAS) in 2011/12, building onperformance achievements in 2010/11. It is designed to:

Set out the contribution that SAS will make to the Government’s NationalPerformance Framework outcomes

Enable the Board to fulfil its corporate governance role within NHS Scotland Allow the Board to be specific about its implementation and performance plans

for the forthcoming year Promote a robust planning process, including the involvement of stakeholders in

the development of the Plan Promote accountability by enabling progress against the Plan to be measured.

This document also meets our requirement, as for each NHS Board, to produce andpublish an annual Local (HEAT) Delivery Plan in agreement with the ScottishGovernment. This document will be incorporated into the SAS Corporate Plan for2011/12.

Working Together for Better Patient Care –SAS Strategic Framework 2010-15

This HEAT Delivery Plan is set firmly in the context of our wider Strategic Framework,“Working Together for Better Patient Care 2010-15”, published in 2010. The Service isone year into its five year programme to deliver this strategy. In developing anddelivering our strategy we have sought to align closely with the NHS Healthcare QualityStrategy, and the quality ambitions within that.

Our strategy sets out clearly our aims to be

Patient centred Clinically excellent Leading-edge

This year will see the launch of our Clinical Strategy, which sets out in more detail howwe will ensure we deliver patient and person centred services in a pre-hospitalenvironment and enhance the capabilities and skills of our staff to build on our supportof the shifting the balance of care agenda and treat people safely and appropriately inthe community.

We have strengthened our partnership working in the last year and will continue to buildupon that as we deliver this year’s plans. Specifically, we will continue to workalongside our NHS Board partners towards more integrated unscheduled care as wedevelop with NHS 24 and out of hours providers a single common triage tool, roll outnew ways of working such as retained ambulance service, community paramedics and

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anticipatory care models, embedding decision support through further roll out ofprofessional to professional lines with NHS Boards, and work in tandem with the LongTerm Conditions Collaborative to address strategically the management of patients witha long term condition in the community.

We will also continue to improve our scheduled care service taking forward a number ofhigh impact changes developed with our key stakeholders to reduce variation inpractice and process across Scotland, ensure we deliver a genuinely clinically focusedPTS service, improve direct patient access and involvement and the informationavailable to inform choices around access to services. We will introduce mobiletechnology across our fleet which will allow for a more demand responsive scheduledcare service and we will work with staff, patients and partners to identify how best todevelop and use the capacity we gain through greater efficiency, such as discharge orspecialist services.

We will move forward with the procurement of the next generation of air ambulance andfully engage in the review of Specialist Retrieval Services for Scotland where we play apivotal role. And we will continue to engage with partners and communities as weimplement our Community Resilience Strategy in the coming year, furtherstrengthening the capacity and capability of SAS, partners and communities to respondand build on the work we have already progressed in developing with communities andNHS Boards appropriate models of care in line with the Strategic Options Framework.

Underpinning our service delivery will be the continuation of our learning &development, organisational development and e-Health strategies. 2011/12 will see theestablishment of the new Scottish Ambulance Service Academy in partnership withGlasgow Caledonia University and completion of a careers framework for SAS, whichensures we have the right skills to offer the most appropriate clinical responsedepending on patient needs and gives our staff greater opportunity to develop.

We will continue to make best use of the latest technology to support service delivery,linking in with the national tele-health agenda through the Scottish Centre forTelehealth and Scottish Government e-Health programmes. In 2011/12 this will not onlysee the introduction of mobile technology into the PTS fleet, but also completion of theroll out of the Airwave radio system, continued pilot and eventual roll out of theEmergency Care Summary access in cab for A&E crews and extension in partnershipwith NHS Boards of real time transfer of patient report forms to A&E receiving units.

This Local HEAT Delivery Plan is set firmly in the context of “Working Together forBetter Patient Care” and the NHS Quality Healthcare Strategy and the work we haveundertaken in the first year with stakeholders and partners has reinforced that for SAS.We will continue to build upon that in 2011/12.


The HEAT Targets and Standards

The delivery plan confirms what SAS is planning to deliver in terms of performance. Itcontains a manageable number of indicators, which are aligned to the three strategicgoals of the organisation. These indicators have been specifically chosen to provide abalanced summary of the organisations activities and performance. It is theseindicators that will be used to report performance externally.

The performance objectives of the HEAT Delivery Plan are not the only indicators ofperformance of the Service. Although core key performance objectives and indicatorshave been identified to represent a summary of the Service performance externally,there are other aspects of performance that will continue to be measured and managedinternally.

The Executive Directors and the Board have reviewed the risks raised in the plan, asoutlined in the risk narrative for each target (and where appropriate these will bemanaged through our standard risk management process).

Note The ‘SAS’ prefix below denotes a target specific to the Scottish AmbulanceService. The ‘NHSS’ prefix denotes a target for all NHS Boards

HEALTH

SAS H1: Between 12-20% of eligible cardiac arrest patients with Return ofSpontaneous Circulation (ROSC) on arrival at hospital.

SAS H2: Reach 80% of cardiac arrest patients within 8 minutes (mainland).

SAS H3: Reach 75% of Category A (life-threatening) emergency incidents within 8minutes (mainland)

SAS H4: Reach 95% of Category B (serious but not life-threatening) incidents within 1419 or 21 minutes (mainland)

SAS H5: Reach 55% of all emergency incidents within 8 minutes (Island NHS Boardareas)

EFFICIENCY

NHSS E1: NHS Boards to operate within their agreed revenue resource limit; operatewithin their capital resource limit; meet their cash requirement

NHSS E2: NHS Boards to deliver a 3% efficiency saving to reinvest in frontline services

SAS E3: Reduce energy consumption by 2.5% per annum in line with NHSSE3

SAS E4: Achieve sickness absence rate of less than 5% for full year continuingdirection of progress towards the national HEAT Standard of 4%


ACCESS

SAS A1: Reach 93% of 1-hour urgent calls within target time

SAS A2: Ensure 72% of all PTS Patients arrive at hospital 30 minutes or less beforeappointment time

SAS A3: Ensure 90% of all PTS Patients are picked up within 30 minutes of agreedtime after appointment

SAS A4: Ensure that no more than 0.5% of booked PTS journeys are cancelled bySAS

TREATMENT

SAS T1: Treat 12% of emergency incidents at scene

SAS T2: Convey 80% of hyper acute stroke patients to hospital within 60 minutes ofreceipt of call at SAS

SAS QUALITY SCORECARD

For 2011/12, SAS will implement a local quality scorecard, which sets out the full rangeof performance monitoring across SAS, and represent important aspects of our servicedelivery and development. These measures offer a balanced performancemanagement approach and support delivery of the NHS Quality Strategy and SASstrategy. The core targets set out in the HEAT LDP are incorporated into the qualityscorecard to ensure on-going routine monitoring of progress.

Reporting and reflecting upon these measures and our performance against themregularly at all levels within the organisation, will help to ensure that there is anappropriate focus on these areas, and facilitate the creation of appropriate benchmarksfor performance. A number of these quality indicators have emerged from the progressacross SAS’ strategic programme in 2010/11 and the review of services, such as airambulance and they build on the development targets set out in the 2010/11 Local(HEAT) Delivery Plan.

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Annex 1 - Supporting the Quality Ambitions and wider outcomes-based approach

An outcomes-based approach encourages us all to focus on the difference that we make to people using the service, their families,carers, staff and all who work with NHSScotland in delivering the vision of world-leading healthcare quality. It is about far more than justthe inputs or processes over which we have control. Success is about impact and should be judged by tangible improvements in thethings that matter to the people of Scotland. SAS has been working in partnership across NHSScotland, with Community PlanningPartners and with the Scottish Government to embed an outcomes-based approach by identifying key priority areas. This has enabledSAS to:

i. Align activity to explicitly contribute to the Government’s over-arching purpose of sustainable economic growth through theNational Performance framework.

ii. Better integrate activities with local government, with other Public Bodies, and in partnership with the Third and private sectors toaddress the Government’s Purpose Targets and National Outcomes through Single Outcome Agreements (SOAs).

iii. Focus activity and spend on achieving real and lasting benefits for people and as such minimise the time and expense onassociated tasks which do not support the national outcomes and purpose.

iv. Create the conditions to release innovation and creativity in delivering better outcomes.

In 2008, the Scottish Government introduced a National Performance Framework, which set out, for the first time, an ultimate purpose ofGovernment, supported by 7 high-level targets, and 15 National Outcomes. Of these, 6 are particularly relevant to the work of the NHS:-

o We have tackled the significant inequalities in Scottish society

o Our children have the best start in life and are ready to succeed

o We have improved the life chances for children, young people and families at risk

o We live longer, healthier lives

o Our public services are high quality, continually improving, efficient and responsive to local people’s needs

o We reduce the local and global environmental impact of our consumption and production

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In 2010, the Healthcare Quality Strategy for NHSScotland set out the overarching aim of achieving world-leading quality healthcareservices across Scotland, underpinned by the 3 Healthcare Quality Ambitions;

Healthcare Quality Ambitions

Person-centred - Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respectindividual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making.

Safe - There will be no avoidable injury or harm to people from healthcare they receive, and an appropriate, clean and safe environmentwill be provided for the delivery of healthcare services at all times.

Clinically Effective - The most appropriate treatments, interventions, support and services will be provided at the right time to everyonewho will benefit, and wasteful or harmful variation will be eradicated.

The Quality Strategy included a commitment to develop a Quality Measurement Framework to support our shared vision of healthcarequality. It was proposed that progress towards the three Quality Ambitions would be assessed by reference to a number of QualityOutcome Measures, and that these measures would be based on a combination of patient and staff perspectives, alongside measures ofsafety and effectiveness. These measures would be used to assess direction of travel, and would not be set as targets.

As part of the proposal for the Quality Measurement Framework, the Quality Strategy made a commitment that the HEAT targets wouldbe aligned to the Quality Ambitions. The HEAT targets would therefore reflect the agreed areas for specific accelerated improvementeach year, contributing to progress towards the Quality Ambitions.

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Quality OutcomeMeasures

HEAT

Supporting local and nationalquality indicators

Quality AmbitionsSafe Clinically Effective Person-Centred

SAS welcomes the recent discussion of the Quality Alliance Board (QAB) in relationto the proposals for the Quality Measurement Framework and for Quality OutcomeMeasures. SAS is now working on the basis of the following:

The QAB agreed the need for alignment within the Quality MeasurementFramework, with HEAT targets demonstrating how they positively support theQuality Ambitions

A small number of high-level Quality Outcomes describe our priority objectives inlanguage which is inclusive across NHSScotland and with our delivery partners.These will be based on the current provisional set;

o People have a positive experience of healthcareo Staff feel supported and engagedo Healthcare is safeo People are supported to live well at home or in the community with

access to appropriate treatment when they need ito People live longer healthier liveso There is no inappropriate variation

A set of Quality Outcome Measures are being established which we will use asproxy measures to reflect the Quality Outcomes, and to track progress towardsachieving our Quality Ambitions. These are reflected in the SAS QualityScorecard detailed in Annex 2 of our Local Delivery Plan

As the Quality Outcomes/measures are further developed over the year ahead,we will work with SGHD and partners to ensure that the set of HEAT targets arealigned with and underpin progress towards our Quality Ambitions. In addition,we will work to ensure that all our measurement at local or national level, forimprovement activity, monitoring or reporting purposes, becomes aligned with the


Quality Ambitions, as envisaged in Level 3 of the Quality MeasurementFramework.

Through our Local Delivery Plan, we set out how we will be judged in terms ofperformance on our operational targets, which have been agreed with Governmentand across NHSScotland to support delivery of the outcomes and Quality Ambitions.

Progress has been made in reviewing the HEAT targets so that they reflect the NHScontribution to the National Outcomes, and this process continues each year. Inaddition, we can demonstrate how the HEAT targets positively support the 3 QualityAmbitions. Achievement of HEAT targets will demonstrate progress and contributetowards delivery of the Scottish Government’s national outcomes and the QualityAmbitions.

We have also made a range of contributions towards the delivery of the local singleoutcome agreement over and above the HEAT targets and these are set out in ourLocal Delivery Plan. This focuses on our Board’s contributions to the 4 nationalpriority areas:

o Health inequalitieso Early yearso Tackling povertyo Economic recovery

These areas have been identified as requiring major contributions from a range ofpartners, but are also areas where there is the potential for significant collaborativegain.


HEAT TARGETSCONTRIBUTING TOWARDSCOTTISH GOVERNMENT’SNATIONAL OUTCOMES

We have tackled

the significant

inequalities in

Scottish society

Our children have

the best start in

life and are ready

to succeed AND

We have improved

the life chances for

children, young

people and

families at risk

We live longer,

healthier lives

Our public

services are high

quality, continually

improving,

efficient and

responsive to local

people’s needs

We reduce the

local and global

environmental

impact of our

consumption and

production

We have strong,

resilient and

supportive

communities

where people take

responsibility for

their own actions

and how they

affect others.

SAS H1 Cardiac arrest ROSC rates

SAS H2 Cat A cardiac arrest patientsresponse times

SAS H3 Category A response times

SAS H4 Category B response times

SAS H5 Island Board emergency responsetimes

E1 Financial Balance

E2 Cash efficiency

SAS E3 Carbon emissions and energyconsumption

SAS E4: Sickness Absence Rates

SAS A1 A&E 1-hour urgent calls responses

SAS A2 PTS punctuality for appointment

SAS A3 PTS punctuality for pick up

SASA4 PTS journeys cancelled by SAS

SAS T1 Reducing Hospital Admissions

SAS T2 Conveyance of hyper-acute strokepatients to hospital

clear line of sight in supporting short term

indirect or longer term contribution


Healthcare Quality Ambitions

Person-centred - Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs andvalues and which demonstrate compassion, continuity, clear communication and shared decision-making.

Safe - There will be no avoidable injury or harm to people from healthcare they receive, and an appropriate, clean and safe environment will be provided for thedelivery of healthcare services at all times.

Clinically Effective - The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, andwasteful or harmful variation will be eradicated.

HEAT TARGETSCONTRIBUTING TOWARDSCOTTISH GOVERNMENT’SNHS QUALITY AMBITIONS

People livelonger

healthier lives

Peoplesupported tolive at home /community

with access totreatment

Healthcare issafe

People have apositive

experience ofhealthcare

Staff feelsupported

and engaged

There is noinappropriate

variation

SAS H1 Cardiac arrest ROSC rates

SAS H2 Cat A cardiac arrest patientsresponse times

SAS H3 Category A response times

SAS H4 Category B response times

SAS H5 Island Board emergency responsetimes

E1 Financial Balance

E2 Cash efficiency

SAS E3 Carbon emissions and energyconsumption

SAS E4: Sickness Absence Rates

SAS A1 A&E 1-hour urgent calls responses

SAS A2 PTS punctuality for appointment

SAS A3 PTS punctuality for pick up

SASA4 PTS journeys cancelled by SAS

SAS T1 Reducing Hospital Admissions

SAS T2 Conveyance of hyper-acute strokepatients to hospital

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Annex 2: Risk Management Plans

SAS H1: Between 12-20% of eligible cardiac arrest patients with Return ofSpontaneous Circulation (ROSC) on arrival at hospital

NHS BOARD LEAD: Medical Director

DeliveryRisk Management of RiskThere is a risk that we fail to achieve 12-20% ROSC in eligible patients.

Continue to work with NHS Boards andpartners to improve treatment of cardiacarrest patients.

Work to increase levels of first respondersand public access defibrillators availableacross Scotland.

Continued prioritisation of cardiac arrestpatients by EMDC to improve responsetimes.

Continue to develop the research aroundICECAP and TOPCAT to ensure we are atthe forefront of Cardiac Arrest management

WorkforceRisk Management of RiskThere is a risk that staff are not fullytrained and developed to provide theappropriate care for cardiac arrestpatients.

ALS training as part of all mandatorytraining.

Strengthen capacity of PTS staff as FPOSand availability of defibrillators in PTS fleet

Develop best practice for crews falling fromresearch and pilot studies ongoing.

FinanceRisk Management of RiskThere is a risk that funding for further jointworking and roll out of defibrillators incommunities is not available.

Explore funding opportunities for researchand improvement.

Explore funding opportunities withvoluntary organisations to support roll outof community public access defibrillators.

ImprovementRisk Management of RiskAs above As above

EqualitiesRisk Management of RiskNone Known


SAS H2: Reach 80% of cardiac arrest patients within 8 minutes (mainland)

BackgroundNHS BOARD LEAD: Medical Director

DeliveryRisk Management of Risk80% of cardiac arrest patients are notresponded to within 8 minutes

There is a risk that we continue toexperience significant adverse weatherwhich impacts on our response times toemergencies.

Clinical Decision Making processes identifyand give priority to patient in or at risk ofcardiac arrest.

Work to increase levels of first respondersand public access defibrillators availableacross Scotland.

Ensure effective winter planningarrangements are in place including use ofspecialist vehicles and support from otheragencies.

WorkforceRisk Management of RiskThere is a risk that we do not necessarilyhave first responder schemes in the rightplaces deemed appropriate to the SAS asopposed to areas communities want themto be set up

Implementation of plans developed inresponse to SOF targeting vulnerablecommunities

Targeted engagement with vulnerablecommunities through communications andengagement plans in place acrossDivisions

FinanceRisk Management of RiskAs per SAS H1 As per SAS H1

ImprovementRisk Management of RiskNone Known

EqualitiesRisk Management of RiskThere is a risk that communication linkswith 999 are not accessible for allcommunities.

Communication support facilities areutilised where appropriate, e.g. SMSmessaging, Type Talk and Language LineService. Work with staff and communitiesto ensure we raise awareness regardingthese facilities and continue to monitortheir use in practice.


SAS H3: Reach 75% of Category A (life-threatening) emergency incidents within 8minutes (mainland)

NHS BOARD LEAD: Director of Service Delivery

DeliveryRisk Management of Risk

The current AMPDS triage tool is riskaverse and the Service has experience asignificant increase in the number ofalcohol related incidents which areinappropriately categorised as Cat A. Assuch, there is a risk that finite A&Eresources will not be appropriatelytasked.

There is a risk that we continue toexperience significant adverse weatherwhich impacts on our response times toemergencies

Ensure EMDC make full use of all availableresources to respond to demand, includingtactical deployment and furtherdevelopment of first responder schemes.

Continue progress in specification andprocurement of single common triage tool.

Ensure effective winter planningarrangements are in place including use ofspecialist vehicles and support from otheragencies.

WorkforceRisk Management of RiskThere is a risk that all resources are notfully utilised.

There is a risk that on call activity impactson availability of staff during on dutyperiods.

There is a risk that any changes to staffdeployment will take longer than requiredto deliver performance

Ensure that rosters match demand profileacross all divisions and that staff aredeployed appropriately geographically andto match demand.

Continue to review on call working as partof national discussions and through on-callproject.

Fully engage with partnership nationallyand locally.

FinanceRisk Management of RiskThere is a risk that existing resources arenot sufficient to meet demand andadditional funding may be required.

Ensure effective deployment and utilisationof existing resources.

Tight management of overtime, non-productive hours and sickness absencerates.

Opportunities through cash releasingefficiency savings to generate efficienciesfor A&E resources.


ImprovementRisk Management of RiskThere is a risk that changes in NHSservice provision impact on normalpatient flows displacing A&E resourceswithin and between Health Board areas.

There is a risk that progress towardsdelivery of SAS strategy will be impactedon by funding constraints in currenteconomic climate.

Work with NHS Boards during anyreconfiguration of services to assess andmitigate impact for SAS.

Ensure effective generation of efficiencysavings to allow for strategy programmesto be taken forward which will have positivebenefits on demand management, ensuringappropriate response and onward referral.

EqualitiesRisk Management of RiskEnsuring equity of access. Ensuring appropriate response to meet

individual patient needs.

Working with partners to exploreopportunities to develop more integratedhealthcare provision in line with SASstrategy.


SAS H4: Reach 95% of Category B (serious but not life-threatening) incidentswithin 14, 19 or 21 minutes (mainland)


BackgroundThe Scottish Ambulance Service currently reports performance against three timestandards for Category B calls dependent upon population density in a Health Boardarea. SAS is also cognisant of work ongoing across UK Ambulance Services to movetowards a suite of clinical indicators for serious but not immediately life-threateningincidents and we will work with Scottish Government in the coming year to assess theappropriateness of such a suite of indicators for Scotland.

DeliveryRisk Management of RiskAs per SAS H3 As per SAS H3

WorkforceRisk Management of RiskAs per SAS H3 As per SAS H3

FinanceRisk Management of RiskAs per SAS H3 As per SAS H3

ImprovementRisk Management of RiskAs per SAS H3 As per SAS H3

EqualitiesRisk Management of RiskAs per SAS H3

There is a risk that the variation inresponse time target for Cat B calls isperceived as inequitable service, e.g. 14minutes in Glasgow and 19 minutes inEdinburgh.

As per SAS H3

Look to review with Scottish Governmentthe appropriateness of variance withpotential to move to clinical suite ofperformance indicators for serious but notimmediately life-threatening incidents


SAS H5: Reach 55% of all emergency incidents within 8 minutes (Island NHSBoard areas)


DeliveryRisk Management of RiskAs per SAS H3 applied to all emergencycalls

There are specific geographicalchallenges for the 3 Island Boards

As per SAS H3 applied to all emergencycalls

Work with NHS partners to exploreopportunities to maximise use of jointresources

Further development of SOF models ofservice for remote & rural communities

WorkforceRisk Management of RiskAs per SAS H3 AS per SAS H3


FinanceRisk Management of Risk

As per SAS H3

There is a risk that NHS Boards will beunwilling or unable to share resources incurrent financial climate

As per SAS H3


Further development of SOF models ofservice for remote & rural communities.

ImprovementRisk Management of RiskAs per SAS H3

There is a risk that NHS Boards will beunwilling or unable to share resources incurrent financial climate

As per SAS H3



EqualitiesRisk Management of RiskAs per SAS H3 As per SAS H3


NHSS E1: NHS Boards to operate within their agreed revenue resource limit;operate within their capital resource limit; meet their cash requirement

NHS BOARD LEAD: Director of Finance and Logistics

BackgroundThe Service recognises that this year will be particularly challenging financially. Specificareas of concern are: the volatility of the economy in respect of fuel and related costs,this also impacts on the air ambulance service, where demand and contract pricing areadding to the cost pressure. In respect of other non – pay areas there are significantcost pressures from VAT and CNORIS contributions increases that are outwith thecontrol of Ambulance Service. The service has in place a stretching CRES programmethat will be required to enable financial balance to be met, however some of theprogrammes are high risk and the full benefit may not be achieved in year.

The Service is acutely aware that redesign of services will require to be cost neutral asa minimum and wherever possible deliver cash efficiencies as part of the redesignprocess.

DeliveryRisk Management of RiskThere is a high risk that the increase infinancial allocation will be insufficient tomeet pay award for staff and non- payinflation increases.

There is a risk that the economic climateis producing volatility in fuel costs whichis creating cost pressures and makesfinancial planning challenging. There is arisk that the continued volatile nature offuel prices, specifically in light of ongoingpolitical crisis outwith the UK, willincrease pressure on revenue spending.

There is a risk that the economic climateis also leading to financial instability ofkey suppliers which in turn has lead toless favourable pricing when tenderingfor goods or services

There is risk that the growth in demandfor patient services has lead to additionaloperating costs which are utilising cashefficiencies funding thus reducingavailability of resources for serviceredesign and strategy implementation.

There is a risk that pay terms andconditions are not yet known withcertainty for 2011/12 and future years.

Robust Budget Setting, Achievement of theCRES programme that will be required toenable status quo.

Fuel and energy projections used in budgetsetting. Management of Energy usage.Escalation of the introduction of fuelefficient vehicles.

Review of Tender specifications anddialogue with suppliers to stimulatecompetition. Prompt payment of suppliersto ease cashflow issues.

Understanding of demand profiles dialoguewith Regional Planning groups and NHSboards in relation to opportunities tomanage demand.

Scenario planning relating to future payawards. Dialogue with national terms andConditions groups relating to unresolved


Therefore financial planning for futureyears is more challenging. There are stillunresolved terms and conditions issuesin relation to on-call and meal breaks

There is a risk that the CNORIScontributions which have alreadyexceeded budget figure will escalatebeyond the projections provided.

There is a risk that demand for airambulance services, including specialistretrieval services, cannot be managed tolevels within available funding enveloperesulting in services not able to beprovided.

issues and impact on SAS.

Continued dialogue with centre remethodology for contributions and ways inwhich Scotland wide the risks can bereduced.

Debate with Health Boards re methodologyfor Risk Sharing in respect of AirAmbulance Services and agreement as toway forward, supported by the centre.Completion of the Business case forspecialist retrieval services across Scotlandwith clear governance and fundingsystems.

WorkforceRisk Management of RiskThere is a risk that staff will notappreciate the impact of tighteningfinancial resources and change ineconomic environment

That the economic environment thatresults in tightening pay settlements andany impact on pensions will lead to IRissues that are not able to managedwithin the Service.

Training and awareness raising session tobe held at all levels throughout theorganisation

Open debate in partnership of the issuesboth locally and Nationally to gain anunderstanding of staff expectations andintended actions.

FinanceRisk Management of RiskAs Above As Above

ImprovementRisk Management of RiskThere are unquantifiable risks emanatingfrom service redesign within other NHSBoards which have un intendedconsequences on Scottish AmbulanceService.

New Risks or those that are not able tobe mitigated internally may impact onsustainability of target.

Regular and early dialogue at all levels withNHS Boards on future service changes.

Constant risk monitoring and contingencyplanning.

EqualitiesRisk Management of Risk


Insufficient funds available to ensure weare able to sustain involvement andengagement with communities and areable to provide communications supportwhere required.

Financial plan are reviewed for EQIA.


NHSS E2: NHS Boards to meet their cash efficiency target


DeliveryRisk Management of RiskThere is a risk that CRES programme willnot be delivered at required level or torequired timeframes.

There is a risk that efficiencies made willbe subsumed by additional expenditure inother areas

Plans will be identified prior tocommencement of year and key staff willbe held to account for delivery

Plans for future years are being progressedearly such that they can be advancedshould 2011/12 plans lag.

Robust financial management of areaswhere internal control can be exerted.

WorkforceRisk Management of RiskThere is a risk that staff will notappreciate the impact of tighteningfinancial resources and change ineconomic environment

That the economic environment thatresults in tightening pay settlements andany impact on pensions will lead to IRissues that are not able to managedwithin the Service.

Training and awareness raising session tobe held at all levels throughout theorganisation

Open debate in partnership of the issuesboth locally and Nationally to gain anunderstanding of staff expectations andintended actions.

FinanceRisk Management of RiskAs Above As Above

ImprovementRisk Management of RiskThere is a risk that efficiencies are notperceived as mechanism to invest in theservice

The Learn and Improve workstreams havestaff buy in and support and staff arebeginning to appreciate significantimprovements are not financially resourcedependant.

EqualitiesRisk Management of RiskNone known The CRES programme has been reviewed

for EQIA impacts to reduce this risk.


SAS E3: Reduce energy consumption by 2.5 % per annum, in line with NHSS E3


BackgroundAlthough this is not a mandatory target for Special Boards during 2011/12 SAS iscommitted to contributing to the reduction in emissions. We will therefore aim to put inplace measures to reduce our dependence on fossil fuels and move towards renewableenergy sources. In addition we aim to reduce our overall energy consumption by 2.5%year on year. We aim to ensure our fleet have as low as possible C02 emissions. Weare also actively engaged in exploring alternative fuel sources.

DeliveryRisk Management of RiskThere is a risk that reductions in energyconsumption may not be achieved due toextreme weather conditions.

There is a risk that initial funding may notbe available to change to renewableenergy sources

There is a risk that vehicle manufacturersmay not be able to combine SASspecifications and reductions in Co2emissions

Aim for higher reductions in the lighterconsumption months of the year

Business case to identify benefits ofrenewable energy sources

Partnership working with suppliers toidentify requirements

WorkforceRisk Management of RiskThere is a risk that staff awareness ofenergy reduction measures may not besufficient to achieve desired impact

Training Education and feedback onprogress

FinanceRisk Management of RiskThere is a risk that funding fordevelopment of renewable energysources is restricted or unavailable

Business case development as appropriate

ImprovementRisk Management of RiskThere is a risk that progress of vehiclemanufacturers may be slower thandesired

Partnership working with suppliers



SAS E4: Achieve sickness absence rate of less than 5% for full year continuingdirection of progress towards the national HEAT Standard of 4%

NHS BOARD LEAD: Director of Human Resources and OrganisationalDevelopment

DeliveryRisk Management of RiskThere is a risk that we fail to reducesickness absence below 5%.

Continued focused management ofsickness absence across all divisions anddepartments following revision of absencemanagement policy.

Ensure continued use of employeecounselling, occupational health and fast-track physiotherapy services for staff.

Further exploration of a single dedicatedsickness absence line for all staff to reportin absent.

Further roll out of workforce planningsystem to all staff to better manageresources on a day to day basis.

Improve information available to managersto manage sickness absence in a moretimely manner.

WorkforceRisk Management of RiskThere is a risk that staff are not fullysupported to return to work as timeouslyas possible.

There is a risk that high absence levelshave an effect on the management ofrelief staff and/or overtime usage

As above

Further exploration of areas of risk andissues raised within Learn and ImproveWorkforce Project

FinanceRisk Management of RiskThere is a risk that sickness absenceimpacts on overtime budgets andreduced benefits of efficiency savings.

As above.

ImprovementRisk Management of RiskNone known

EqualitiesRisk Management of RiskNone known


SAS A1: Reach 93% of A&E 1-hour urgent calls within target time


BackgroundSAS has agreed response time targets for all urgent calls which are agreed with theGP, NHS 24/out of hours service or hospital at the time the request is made. Currently,calls are requested with a one, two or four hour response dependent on theassessment of the clinician at scene. Whilst SAS monitors performance against thesecalls internally, we have included performance against the one hour urgent calls in thetargets for 2010/11 to reflect the greater acuity level for patients.

DeliveryRisk Management of RiskThere is a risk that there are insufficientresources to meet all the demandsplaced upon the A&E fleet.

There is a risk that the proportion of onehour requests increases in directcorrelation to performance in NHSBoards against the 4 hour waiting target.

There is a risk that where resources arediverted from one hour urgent requests,calls will increasingly be upgraded toemergencies further impacting theproblem, or target will not be met.

There is a risk that we continue toexperience significant adverse weatherwhich impacts on our response times tourgent calls

Ensure maximum availability and utilisationof dedicated mid-tier vehicles for urgenttransfers and calls.

Work with NHS Boards to developappropriate inter-hospital transfer anddedicated discharge capacity.

Ensure EMDCs liaise closely with cliniciansrequesting transfer to review timescalesappropriately for clinical need and avoidunnecessary upgrading of calls toemergencies.

WorkforceRisk Management of RiskThere is a risk that dedicated urgentresources are not fully utilised puttingadditional pressure on emergency A&Eresources.

Ensure maximum availability and utilisationof dedicated mid-tier vehicles for urgenttransfers and calls.

Where appropriate, make use of scheduledcare service ensuring robust clinicalgovernance is in place.

FinanceRisk Management of RiskThere is a risk that existing resources arenot sufficient to meet demand andadditional funding may be required.

Ensure effective deployment and utilisationof existing resources.

Tight management of overtime, non-


productive hours and sickness absencerates.

Opportunities through cash releasingefficiency savings to generate efficienciesfor urgent resources.

ImprovementRisk Management of RiskThere is a risk that developments acrossthe NHS in respect of out of hoursservices, waiting time targets andchanges to existing patient flows willimpact on SAS’ ability to meet urgentdemand effectively.

Work in partnership with NHS colleagues toensure robust protocols are in place andconsistently applied.



SAS A2: Ensure 72 % of all PTS patients arrive at hospital 30 minutes or lessbefore appointment time


BackgroundIn 2010/11, the SAS established a Scheduled Care Programme Board as one of fivestrategic programme boards. During the year, a comprehensive Learn & Improveprogramme using LEAN methodology has reviewed the delivery of scheduled careservices across SAS and developed a business case and improvement plan to take thisforward in 2011/12 in partnership.

DeliveryRisk Management of RiskThere is a risk that developments flowingfrom the Service’s Scheduled CareProgramme do not deliver the serviceimprovement identified.

There is a risk that the projections ofreduced demand do not materialise andthe Service is unable to generate thepredicted efficiency savings to reinvest inthe service improvements identified.

There is a risk that public and patientperceptions of the scheduled care serviceis negatively affected by perceivedchanges to service delivery resulting fromconsistent application of eligibility criteria.

Continue high profile of scheduled care askey strategic programme managedaccordingly.

Implementation across all NHS Boardareas of agreed eligibility criteria forambulance transport.

Implementation of agreed booking,planning & day control procedures andstructure to support service delivery.

Roll out of mobile data solution to PTS fleetto allow for real time management anddeployment of resources and maximiseefficiency.

Working with NHS and other transportpartners to develop integrated transport tohealthcare models.

Build on public and patient involvement inthe review of scheduled care anddevelopment of SAS strategic framework.

A comprehensive programme ofcommunication is critical to effectiveimplementation and will be undertakenjointly with NHS Boards and key partners toensure consistency of message andsupport consistency of service delivery.


WorkforceRisk Management of RiskThere is a risk that changes to the servicedelivery model will impact on staff rolesand responsibilities and managementstructures.

Fully engage with partnership nationallyand locally and adhere to servicemanagement of change policies andprocedures.

Ensure staff continue to be involved ateach stage in the design and developmentof the scheduled care service.

FinanceRisk Management of RiskThere is a risk that efficiencies identifieddo not generate sufficient resources toreinvest in service improvements

Business case developed to take forwardagreed improvements.

Effective management and monitoring ofimplementation across Service throughlocal delivery plans and programme board.

ImprovementRisk Management of RiskThere is a risk that key partners acrossNHS, transport organisations andvoluntary sector are unable to supportjoint improvement initiatives due to lack ofnecessary funding or resources.

There is a risk that partner expectationschange in light of economic constraintsand conflicting priorities.

Ensure partner involvement continues andexplore opportunities for joint improvement.

EqualitiesRisk Management of RiskThere is a risk that rigid application ofeligibility criteria could leave patients withsocial need for transport unable to attendfor appointments for financial reasons.

Work with local NHS Board Transport Co-ordinators, Regional TransportPartnerships and other transport providersto implement eligibility criteria and developprotocols for referral of non-medical needspatients as appropriate in line with SASstrategy and NHS Scotland HealthcareTransport Framework.

Explore ICT system links between SAS andtransport information service providers.


SAS A3: Ensure 90 % of all PTS patients are picked up within 30 minutes ofagreed time after appointment


DeliveryRisk Management of RiskAs per SAS A2 As per SAS A2

WorkforceRisk Management of RiskAs per SAS A2 As per A2.

FinanceRisk Management of RiskAs per SAS A2 As per SAS A2

ImprovementRisk Management of RiskAs per SAS A2 As per SAS A2

EqualitiesRisk Management of RiskAs per SAS A2 As per SAS A2


SAS A4: Ensure that no more than 0.5% of booked PTS journeys are cancelled bySAS


DeliveryRisk Management of RiskAs per SAS A2 As per SAS A2

WorkforceRisk Management of RiskAs per SAS A2 As per SAS A2

FinanceRisk Management of RiskAs per SAS A2 As per SAS A2

ImprovementRisk Management of RiskAs per SAS A2

There is a risk that improvements in NHSBoard waiting time targets is not realiseddue to high levels of cancelled journeysby SAS and/or that this does not reflectthe full impact of all aborted andcancelled scheduled care journeys

As per SAS A2

Work closely with NHS Boards to improveprocesses and target specific ‘hotspots’.

EqualitiesRisk Management of RiskAs per SAS A2 As per SAS A2


SAS T1: Treat 12% of emergency incidents at scene


BackgroundIn 2010/11, the SAS established an Unscheduled Care Programme Board as one offive strategic programme boards. Whilst the Service has seen as continuousimprovement in the number and percentage of emergency incidents treated at scene,SAS believes there is still scope to extend this further in partnership and to strengthenthe Service’s contribution to further reducing inappropriate attendance at A&E andimprove the quality of patient care in the community.

DeliveryRisk Management of RiskThere is a risk that we are unable toaccess or develop joint pathways toreduce hospital admissions

There is a risk that the existing scope ofconditions where see and treat protocolsapply will be insufficient to generatequantifiable performance gain.

Working with partners to develop jointpathways to reduce hospital admissions

Explore opportunities for appropriatedevelopment of clinical pathways toincrease levels of see and treat.

Development of single-common triage toolin partnership with NHS 24, A&E andOOHs services which delivers improvedtriage and clinical assessment, deploymentof appropriately skilled resource to attendand referral to appropriate care.

WorkforceRisk Management of RiskThere is a risk that staff awareness andconfidence is not sufficient to increaselevels of see and treat.

Update training to commence as newguidelines are published and competenciesidentified.

FinanceRisk Management of RiskThere is a risk that the efficiency gains forthe NHS through reduced attendance atA&E are not fully realised.

Work with NHS Boards and partners toensure appropriate referral pathways areavailable and appropriately applied.

ImprovementRisk Management of RiskThere is a risk that the development ofSAS strategy, including development of acommon triage tool with NHS 24 andother out of hours providers, does notdeliver the anticipated benefits in respect

Working in partnership to deliver SASstrategy and ensure specification for singlecommon triage tool is approved by allstakeholders.


of better demand management andimproved referral pathways.

EqualitiesRisk Management of RiskNone identified


SAS T2: Convey 80% of hyper acute stroke patients to hospital within 60 minutesof receipt of call by SAS


DeliveryRisk Management of RiskThere is a risk that we fail to convey 80%of hyper acute stroke patients to hospitalwithin 60 minutes of symptom onset

Development and liaison with ManagedClinical Networks to ensure access to stokeservices.

Ongoing monitoring of performance at NHSBoard level.

Engage effectively with the development oftele-health decision support for effectivemanagement of hyper-acute strokepatients.

Clinical decision-making to quickly assesspatients and minimise delays inconveyance to hospital through dispatch ofappropriate ambulance resource.

WorkforceRisk Management of RiskThere is a risk that staff awareness ofstroke protocols is not sufficient.

All staff trained in FAST assessment,including EMDC call taking and dispatchstaff.

Awareness for staff of local and regionalstroke services and agreed pathways.

FinanceRisk Management of RiskNone Known

ImprovementRisk Management of RiskNo improvement takes place. Audit and feedback as part of the

continuous improvement cycle.



Other Activity in Support of NHS Board HEAT targets

In addition, in order to support territorial boards meet their LDP targets, SAS willcontinue to support boards where appropriate. Examples of this activity includes, but isnot restricted to, the following:

2011/12 HEAT Target Reference CommentEfficiencyH3: Reduce suicide rate between 2001and 2013 by 20%.

SAS will continue to promote suicideawareness and mental health first aidtraining amongst front line crews.

AccessA2 Deliver 18 week referral to treatmentfrom 31 December 2011

SAS will work with NHS Boards toimplement improvements to scheduledcare service to reduce the number ofaborted and cancelled journeys whichimpact on levels of ‘did not attend’. SASachieved fewer than 1% cancellations in2010/11 and aims to further reduce thisbelow 0.5% in 2011/12.

Targets to increase the percentage ofcalls transferred from SAS to NHS 24(5% increase) and the recording of CHIfor all emergency calls transferred fromNHS 24 to SAS. (95%)

Both these targets featured in NHS 24and SAS plans in 2010/11 and willcontinue to be monitored in 2011/12.There has been a 40% increase in thevolume of calls transferred from SAS toNHS 24 in 2011/11 through improvedclinical decision-making and better use oftechnology to transfer calls.

TreatmentT1: Reducing the need for emergencyhospital care, NHS Boards will achieveagreed reductions in emergencyinpatient bed day rates for people aged75 and over between 2009/10 and2011/12 through improved partnershipworking between the acute, primary andcommunity care sectors..

Shared lead of national task and finishgroup with LTC collaborative looking atdevelopment of care pathways, includinga specific focus on frail and elderlypatients SAS will continue to develop thescope of community paramedics andanticipatory care models to support thisand the use of tele-health whereappropriate.

T4: To support shifting the balance ofcare, NHS Boards will achieve agreedreductions in the rates of attendance atA&E.

SAS will continue to work towardsincreased treatment of patients at homethrough development of better triage andassessment, continuing to growcommunity paramedic capability,embracing the tele-health agenda anddeveloping alternative care pathways inline with our strategic framework.

In line with our Strategy, “Working Together for Better Patient Care”, the ScottishAmbulance Service is also committed to working with NHS Boards and other partnersto develop joint action plans and more integrated healthcare provision. These include:


Developing appropriate models of healthcare for remote and rural communitiesin response to the Remote & Rural Implementation Group’s Framework

Developing integrated transport to healthcare solutions

Development of a common triage tool with NHS 24 and other out of hoursproviders to ensure an appropriate and consistent response and referral

As we take forward our strategy we will work with the wider NHS to identify furtheropportunities to support NHS Boards to meet their HEAT targets and evidence thepositive impact that SAS can have to that.


Monitoring ProgressThe table below sets out the core targets for the Scottish Ambulance Service. These will be submitted monthly to the Executive Team,SAS Board and SGHD.Progress against Local Delivery Plan – Core Targets

Performance Indicator20011/12 fullyear targets

SAS H1 Save more livesROSC Return of Spontaneous Circulation

12%-20%

SAS H2 Cat A cardiac arrest patients% of cardiac arrest patients responded to within 8 minutes (mainland)

80%

SAS H4 Response to Cat A incidents% Cat A incidents responded to within 8 minutes (mainland)

75%

SAS H5 Response to Cat B incidents% of Cat B incidents responded to within 19 minutes

95%

SAS H6 Response to emergencies on Island Boards% emergency incidents responded to within 8 minutes

55%

NHSS E1 Meet financial targetsOperate within revenue and capital limits; meet the cash requirement

Meet target

NHSS E2 Meet cash efficiency targetCash releasing savings achieved

3%

SAS E3 Reduce emissionsReduce energy consumption

2.5%

SAS E4 Sickness absenceRate of sickness absence

<5%

SAS A1 Response to urgent incidents% of 1 hour urgent calls responded to within 1 hour

93%

SASA2 PTS Punctuality for appointment% of patients at hospital 30 minutes prior to appointment

72%

SASA3 PTS Punctuality for pick up after appointment% of patients at hospital 30 minutes after appointment

90%

SAS A4 PTS: journeys cancelled by SAS% PTS journeys cancelled by SAS

< 0.5%

SAS T1 Reduce hospital admissions% of emergency incidents treated at scene

12%

SAS T2 Hyper acute stroke% hyper acute stroke patients taken to hospital within 60 minutes

80%


SAS QUALITY SCORECARDIn addition, SAS is developing a quality scorecard which will encompass the core targets and asuite of developmental measures and will be used internally to monitor performance and providea balanced scorecard approach to performance management in line with the expectations setout in the Quality Measurement Framework.

Access & Referral

Unscheduled

AR1: Response to Cat A Incidents within 8 Minutes

AR2: Response to Cat A Cardiac Arrest Incidents within 8 Minutes

AR3: Response to Cat B Incidents within 14, 19 or 21 Minutes

AR4: Response to Emergencies on Island Boards

AR5: Response to Urgent Incidents within 1hour

Scheduled

AR6: PTS Punctuality for Appointment

AR7: PTS Punctuality for Pickup After Appointment

AR8: PTS Journeys Cancelled by SAS

Air Ambulance

AR9: Coverage within 60 Minutes

AR10: Average Time to Patient

AR11: Average Time to Hospital

AR12 95% of planned transfers within time agreed with clinician

Clinical Excellence

CE1: ROSC

CE2: Health Acquired Infection

CE3: Hyper Acute Stroke to Hospital in 60 mins

CE4: % SEWS Score > 4 Taken to Hospital

CE5: Treatment of Asthma

CE6: Treatment of Diabetes

CE7: Treatment of STEMI Patients

CE8: % of Chest Pain Patients Receiving Oxygen or Entonox

CE9: % of Chest Pain Patients Receiving Nitrates

CE10: Average Call to Needle Time for Patients Receiving Thrombolysis

Engaging With Partners

EP1: DNA - PTS Aborts and Cancels

EP2: % Emergency Incidents Treated at Scene

Organisational Development

OD1: Sickness Absence

OD2: Meet Financial Targets

OD3: Meet Cash Efficiency Targets

SASLDP201011(Final).doc Annex 5 Page 1Board Approved [March 2011] © SAS 2011

Annex 5 - Summary of Main Workforce Issues Facing Boards

In 2010/11, the Scottish Ambulance Service launched its Learning and DevelopmentStrategy “Realising our Potential” and its Organisational Development Strategy“Doing the Right Thing”. These are key enablers to the delivery of “Working Togetherfor Better Patient Care” and lay the foundations for the Service into the future. Theyare underpinned by a firm commitment to the values of SAS, not least puttingpatients at the heart of everything we do, and as such, closely align and support thewider NHS Quality Ambitions.

2011/12 will see the Scottish Ambulance Service College relocate to GlasgowCaledonia University and the continued extension of professional qualifications andleadership development for staff and managers. “Doing the Right Thing” has beenestablished as strategic programme board in its own right with an ambitiousprogramme of work continuing from 2010/11 into 2011/12.

The Service recognises that 2011/12 will be a challenging year for staff as we takeforward our strategy and the development of emergency, unscheduled andscheduled care services. In view of the financial challenges and constraints theService will face, SAS will continue to work in partnership across the NHS andidentify opportunities for better use of shared resources. Through the continuation ofour Learn and Improve Programme, we will look to improve the efficiency andeffectiveness of our scheduled care, administrative and support functions andworkforce planning arrangements. And, as our strategy moves forward, we will seethe development of new roles and models of service and recognise the opportunitiesand challenges this presents for staff. Partnership and staff across the Service haveand will continue to be involved at all stages in the development and implementationof plans.

WORKSTREAM AIMS/OBJECTIVES OF WORKSTREAMReview & modernisationof the unscheduled andscheduled careworkforce

Building on the work completed in 2010/11 as part of theService strategic programmes, recommendations fallingfrom, for example, the Learn and Improve work aroundPTS, will be taken forward. The Service is also continuingto explore with partners, the skills and resources requiredto improve emergency and unscheduled care, such asanticipatory care models, care pathways and decisionsupport for crews and extension of community paramedicroles, for example.

Review and exploreskills and roles requiredto deliver moreintegrated healthcaremodels in line withRRIG

To inform the skills, competencies & education requiredby the workforce in relation to the delivery of RRIG modelsof healthcare for remote and rural communities inpartnership. This builds on work carried out in 2010/111,such as piloting of anticipatory care and retainedambulance service and continued expansion of firstresponder capability across Scotland.

Having achieved the Investing in Volunteers Award we willcontinue to work towards improving the volunteer

SASLDP201011(Final).doc Annex 5 Page 2Board Approved [March 2011] © SAS 2011

experience and maintaining the standard.

Development of SingleCommon Triage Toolwith NHS 24

A key element of the development of the single commontriage tool will be ensuring the right skills in the EMDC tosupport effective decision-making. As part of the work ofthis project in 2011/12, we will review current practicesand processes in EMDC, including dispatch andtelephone triage and identify any additional roles andclinical skills required to deliver the triage tool effectively.

Continue to takeforward ‘Doing the RightThing’ OrganisationalDevelopmentProgramme andLearning andDevelopment strategy

2011/12 will see learning & development transfer to a newfacility based at Glasgow Caledonia University, which willoffer new and existing staff access to high-tech moderntraining facilities and strengthen links with the university.We will complete development of the careers frameworkwhich will ensure we have the right roles and skills acrossthe Service to support delivery of our strategy foremergency, unscheduled and scheduled care goingforward.

Having achieved the Investing in Volunteers Award we willcontinue to work towards improving the volunteerexperience and maintaining the standard.

Complete a review ofworkforce planning andadmin as part of theSAS Learn and ImproveProgramme.

Using LEAN methodology the Service will complete areview of the workforce planning and administrationarrangements across Scotland with a view to streamliningthese and minimising variation and inefficiency in thedeployment and management of staff and effective use ofsystems, processes and staff to maximise administrativeefficiencies. Staff and partnership are fully engaged intaking this programme forward.

scottish ambulance service 2011-12 heat delivery …scorecard to ensure on-going routine monitoring...

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