BOARD OF DIRECTORS MEETING · 3/29/2017 · The Company Secretary would advise NHS Improvement of...

BOARD OF DIRECTORS MEETING MEETING IN PUBLIC

DATE: Wednesday 29 March 2017

TIME: 10.00am – 13.00pm VENUE: Dolman Room 1, Shaw House, Church Road, Newbury, Berkshire, RG14 2DR

VOTING BOARD MEMBERS:

Trevor Jones Chairman

Alastair Mitchell-Baker Non-Executive Director/Deputy Chairman/SID Sumit Biswas Non-Executive Director Ilona Blue Non-Executive Director Nigel Chapman Non-Executive Director Mike Hawker

Keith Nuttall Non-Executive Director Non-Executive Director

Prof. David Williams Non-Executive Director Lena Samuels Non-Executive Director/Chair (Designate) Will Hancock Chief Executive James Underhay Director of Strategy & Comms/Deputy CEO Philip Astle Chief Operating Officer John Black Medical Director Charles Porter Director of Finance Melanie Saunders Director of Human Resources & Organisational

Development Deirdre Thompson Director of Patient Care IN ATTENDANCE: Steve Garside Company Secretary APOLOGIES: Prof. David Williams Non-Executive Director John Black Medical Director

AGENDA Board of Directors Meeting – Meeting in Public Date: Wednesday 29 March 2017 Time: 10.00am – 13.00pm Venue: Dolman Room 1, Shaw House, Newbury

Item Outcome

OPENING BUSINESS 1 Chairman’s Introduction and Apologies for

Absence Trevor Jones – Chairman

Note Verbal

2 Declaration of Directors’ Interests including Fit and Proper Persons Test Trevor Jones – Chairman

Note Verbal

3 Minutes from the 27 January 2017 Meeting Trevor Jones – Chairman

Approve

Paper

4 Matters arising from the 27 January 2017 Meeting Steve Garside – Company Secretary

Note Paper

CHAIRMAN AND CHIEF EXECUTIVE REPORTS 5 Chairman’s Report

Trevor Jones – Chairman

Note Verbal

6 Chief Executive’s Report including STP Update Will Hancock - Chief Executive

Note Paper

QUALITY AND SAFETY 7

999 Service – Headline Measures Deirdre Thompson – Director of Patient Care; Philip Astle – Chief Operating Officer; Charles Porter – Director of Finance

Approve Paper

8

Quality and Patient Safety Report including CQC and Hospital Handover Delays Deirdre Thompson – Director of Patient Care

Note

Paper

9 Quality Accounts and Quality Improvement Priorities Deirdre Thompson – Director of Patient Care

Approve Paper

PERFORMANCE AND RESOURCES 10a Operational Performance and Improvement

Report – 999, 111, and Fleet Services Philip Astle – Chief Operating Officer

Note Paper

10b Operational Performance and Improvement Report – Patient Transport Services James Underhay – Director of Strategy

Note Paper

10c Finance and Estates Report including 2016/17 Forecast Charles Porter – Director of Finance

Note Paper

11 Workforce Report including Staff Survey Update Melanie Saunders – Director of Human Resources and Organisational Development

Note Paper

OTHER ITEMS FOR INFORMATION / QUESTIONS BY EXCEPTION

12 Integrated Performance Report Charles Porter - Director of Finance, and Director leads

Note Paper

13 SCAS Operational Plan 2017-19 James Underhay – Director of Strategy

Note Paper

14 Board Assurance Framework Deirdre Thompson – Director of Patient Care

Note Paper

15 Board Committee Upward Reports Keith Nuttall for Prof. David Williams (Quality and Safety - paper); Keith Nuttall (Charitable Funds - paper); Mike Hawker (Audit - verbal)

Note Paper

CLOSING BUSINESS

16 Any Other Business Trevor Jones – Chairman

Note Verbal

17 Questions from governors, members and the public (notified no later than 48 hours prior to meeting) Trevor Jones – Chairman

Note Verbal

18 Date and Time of Next Meeting held in Public: Time TBC, 25 May 2017, Shaw House, Newbury, Berkshire

Note Verbal

To resolve that the representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity of which would be prejudicial to the public interest Section 1 (2) of the Public Bodies (Admissions to Meetings Act 1960) refers.

Unapproved minutes – 27 January 2017 Page 1 of 7 Author: SG

ITEM 3 - UNAPPROVED MINUTES FROM THE 27 JANUARY 2017 BOARD MEETING IN PUBLIC

Unconfirmed minutes of the public meeting of the South Central Ambulance Service NHS Foundation Trust Board of Directors held on 27 January 2017 at Shaw House, Newbury, Berkshire Present Trevor Jones (Chairman); Alastair Mitchell-Baker (NED); Sumit Biswas (NED); Ilona Blue (NED); Nigel Chapman (NED); Mike Hawker (NED); Keith Nuttall (NED); Lena Samuels (NED); Professor David Williams (NED); Will Hancock (Chief Executive); Charles Porter (Director of Finance); Melanie Saunders (Director of Human Resources); Deirdre Thompson (Director of Patient Care); James Underhay (Director of Strategy, Business Development, Communications and Engagement) In attendance Steve Garside (Company Secretary); Mark Ainsworth (Director of Operations) Apologies Philip Astle (Chief Operating Officer); John Black (Medical Director) _________________________________________________________________________ OPENING BUSINESS

16/089- Chairman’s Introduction and Apologies for Absence The Chairman welcomed all to the meeting, including introducing Lena Samuels (NED/Chair Designate) who was attending her first Board meeting in public. Apologies were noted from John Black and Philip Astle, with the Chief Executive providing an update on the former. 16/090 - Declaration of Directors’ Interests It was noted that Lena Samuels had declared her interests and that these were on the Trust’s public website; they included being an Associate Non-Executive Director (NED) at Isle of Wight NHS Trust until 31 March 2017. No issues impacting on the fit and proper person requirements were declared. 16/091 - Minutes of the Board meeting held in public on 30 November 2016 The minutes were approved without amendment. 16/092 - Matters arising from the Board meeting held in public on 30 November 2016 The Company Secretary asked for an update on the action point regarding a review of Trust volunteers. Melanie Saunders advised that SCAS had recently been successful in a bid to receive some funding as the part of the Volunteering in Health and Social Care initiative; this would be used to review and improve arrangements for the Trust’s volunteers. The Board asked for an update at an appropriate future meeting. Action 16/092 An update on the review of Trust volunteers to be provided at an appropriate future Board meeting.


CHAIRMAN AND CHIEF EXECUTIVE REPORTS

16/093 - Chairman’s Report The Chairman advised that, with the appointment of Lena Samuels, SCAS would have nine NEDs until 31 March 2017 against an establishment of eight, and that an amendment to the Trust’s Constitution had been accordingly approved by both the Board of Directors and Council of Governors. The Chairman added that from 1 April 2017, the number of NEDs on the Board would reduce to seven until further NED recruitment took place. It was noted that, with an equal number of voting Executive Directors, the Chair would have a casting vote in the event that this was required. The Company Secretary would advise NHS Improvement of this short-term arrangement. The Chairman advised that the Council of Governors meeting on 12 January had been postponed due to adverse weather, and that the next meeting was the joint Council of Governors and Board of Directors strategy workshop on 1 February. The Board was informed that six new public governors had been elected as part of the recent elections, but that neither of the two Buckinghamshire vacancies had been filled. Finally, the Chairman updated on his recent stakeholder engagement activity. 16/094 – Chief Executive’s Report including Sustainability and Transformation Plan (STP) Update The Chief Executive reported that, despite a very busy winter period so far for both 999 and NHS111, the Trust had performed well throughout December. He noted the forthcoming mobilisations of two very important Patient Transport Service (PTS) contracts in Surrey and Sussex, and presented some key headlines from the 2016 Staff Survey - there had been a 60% response rate and some significant improvement areas such as reporting culture. Sumit Biswas asked about the staff survey. Melanie Saunders responded that the results were still under embargo and would be published by NHS England at some point in February. The Board noted that a high-level analysis of SCAS’ results, together with details of the emerging action plans, would be presented at the March Board meeting. Action 16/094 Melanie Saunders to present an initial report on the findings of the 2016 Staff Survey, and the Trust’s action plans, at the March Board meeting.

The Board discussed a number of issues: • Surrey and Sussex PTS – James Underhay explained that feedback would come

through a variety of mechanisms, including Health Overview and Scrutiny Committees (HOSCs), local patient groups, patient experience surveys, and the routine commissioner contract management arrangements. It was noted that the Sussex contract would be particularly challenging given the problems SCAS had inherited, and that additional resource had been secured for both contracts to help with mobilisation. The Chairman asked the NEDs to make themselves visible in meeting and engaging with staff who would be working on these two new contracts

• demand over the Christmas period – the Chief Executive noted that demand had been

particularly high at times when other parts of the NHS were ‘closed’ (e.g. in primary care). He added that SCAS had also taken some overflow calls from neighbouring Trusts

• STPs – the Chief Executive stated that the STPs represented, in effect, everything that

the Trust currently did and would do in the future. It was noted that there were likely to be a number of consultations (e.g. Horton Hospital in Oxfordshire) and that governance arrangements would need to be worked up


• hospital handover delays – the Chief Executive acknowledged that the problems at

Queen Alexandra Hospital (QAH) in Portsmouth continued to be frustrating, impacting both on patients and staff. He noted that there were regular interactions between the respective management teams, but that the pace of cultural change at the hospital was proving to be somewhat slow. The Chairman remarked that the national data on hospital handover delays reported in the recent National Audit Office report – “NHS Ambulance Services” – was very concerning. He added that the Trust had been active in sharing best practice with Portsmouth on patient flow issues, and Nigel Chapman commended SCAS staff for their skill and leadership having recently undertaken a crew ride-out in the Portsmouth area.

DIRECTORS REPORTS

16/095 – Patient Story The Chairman welcomed Mark Ainsworth-Smith (SCAS Consultant Pre-Hospital Care Practitioner) and Mr and Mrs Sutton for today’s patient story. Mark Ainsworth-Smith opened the item by providing some background information on SEPSIS, which he described as an extremely serious condition from which over 20,000 people died each year. He noted that it was difficult to detect, particularly in the early stages, and that SCAS had developed a recognition tool to help in this respect. Mark Ainsworth-Smith outlined Mr Sutton’s case, noting that his survival chances had been low, and that SCAS had pre-alerted the hospital in order to have vital medicines and anti-biotics on hand at arrival. Mr Sutton described the symptoms he had experienced (e.g. very cold, laboured breathing, shaking etc), and the fact that these had been recognised by the SCAS call taker. He also noted the quick arrival of the paramedic, who provided some initial treatment, and the ambulance crew. The Board noted that there was a ‘golden hour’ for treating SEPSIS and that the response to Mr Sutton had been swift in transferring him to Winchester Hospital; he spent four days in hospital and was discharged feeling well. The Board asked a number of questions, including whether there had been any prior health issues (a urine infection about a month before), the actual cause (largely unknown), and the process followed by call takers and paramedics to diagnose and treat SEPSIS. The Board thanked Mark Ainsworth-Smith and Mr and Mrs Sutton for providing a very informative patient story. 16/096 – Quality and Patient Safety Report including Care Quality Commission (CQC) and Hospital Handover Delays Deirdre Thompson highlighted a number of issues from her report, including: • the Trust’s CQC action plan, and plans for the Executive Team to hold a ‘master class’ in

order to understand in greater detail what is required for an ‘outstanding’ rating

• handover delays at QAH; it was noted that a ‘perfect week’ initiative had recently been held, and although this had required a considerable amount of additional management time, there had been some very positive outcomes. Deirdre Thompson explained that the extent to which this could become business as usual was being assessed

• the CQC report into the learning from the review of deaths had been welcomed, and had

already resulted in some positive actions in terms of shared learning across organisations and better engagement in general

• the Trust’s Patient Forums continued to be valuable in terms of patient experience, and

had included a recent meeting in Hampshire


The Board discussed flu vaccinations and the overall take-up of 55%, noting that the challenge for next winter was going to be even greater (target of 70%) and would require looking into good practice elsewhere. Ilona Blue stated that the Board needed to maintain a close eye on long waits, and particularly understand the ‘tail’ element of the graphs in the report, and the outcomes of the audits. Action 16/096 Deirdre Thompson to present some additional information in the next Quality and Patient Safety Report on long waits (e.g. more detail about the ‘tail’ and the outcomes of audits).

The Board noted that Wycombe General Hospital would be providing acute stroke care services for those patients who would have previously attended Wexham Park Hospital, and that there had been some recent problems with scanners at Wycombe resulting in further diverts. Deirdre Thompson advised that Wycombe had been struggling to manage demand, and that this might explain John Black’s view that hyper acute stroke units should not be operated on sites without Accident and Emergency. Professor Williams asked about Buckinghamshire and Berkshire emergency departments diverting patients to the major trauma centre in Oxford as opposed to local trauma units in their area. Deirdre Thompson responded that the Thames Valley Trauma Network had reviewed this and identified some relevant learning. The Board discussed RIDDOR incidents and physical assaults. Deirdre Thompson explained that assaults (which were increasing) did not necessarily lead to injury or staff being off work. Mark Ainsworth highlighted a zero tolerance approach to such behaviour, and explained the training that was in place to support staff and identify risk. 16/097 – Balanced Scorecard – Key Performance Measures The Chairman stated that, in addition to the national response time standards, the Board required a more sophisticated way of monitoring how effectively patients were being looked after. It was noted that the balanced scorecard was a proposal from the Executive Team as to how this could be done. Mike Hawker asked whether the time related element of long waits should be included. Charles Porter highlighted the importance of identifying a relatively small number of indicators, and noted that the information suggested by Mike Hawker was included in the Quality and Patient Safety Report. Ilona Blue advised that a full definition of each metric should be provided, and Sumit Biswas offered a view that each metric in the scorecard should be capable of drilling down to a further set of supporting indicators. Alastair Mitchell-Baker suggested that it would be helpful to include some context such as activity/demand and non-conveyance rates. Ilona Blue questioned the term ‘Board threshold’, both in terms of how it had been set and the false perception it may give that the Trust was not necessarily aiming to achieve the national response time standards in full. Given that there was not necessarily a consensus as to the indicators which should be included in the scorecard, and how it should be used, it was agreed that a small working group would be established to review the proposed scorecard in greater detail and make some recommendations to the full Board. A number of NEDs volunteered to support this work, and Charles Porter was charged with finalising the arrangements outside of the meeting.


Action 16/097 Charles Porter to establish a small working group of Board members to develop proposals around a balanced scorecard, and make recommendations to the full Board.

16/098 – Operational Performance and Improvement Report – 999, 111, and Fleet Services Mark Ainsworth reported an error in the report, with red 1 performance in December being 74.5% rather than 94.5%. He then presented an overview of key issues, including handover delays, private providers, and staff retention. The Board discussed the increase in acuity – which was also acknowledged in the National Audit Office report – and the adverse impact on cycle times. It was noted that the Accident and Emergency Delivery Boards were considering the issue of acuity and the impact on the wider healthcare system. In response to a question from Sumit Biswas, Mark Ainsworth discussed the problems London Ambulance Service had experienced with their CAD over Christmas, resulting in staff needing to revert to paper based systems and some calls flowing through to SCAS. Finally, in terms of the co-production of the new Integrated Urgent Care and NHS111 contract in Thames Valley, James Underhay highlighted an important event on 9 March which would see clinicians and patients come together to help shape the new service. 16/099 – Operational Performance and Improvement Report –PTS James Underhay discussed some of the issues behind the limited progress with online booking of journeys, including the lack of compatibility with smart phones. He also highlighted problems with hospitals seeking to make discharge bookings at very short notice; as a result, SCAS was negotiating with Thames Valley commissioners over a more realistic set of key performance indicators. 16/100 – Finance and Estates Report including 2016/17 Forecast and 2017/18 Financial Plan Ilona Blue noted that the cost improvement programme (CIP) target for 2016/17 would not be achieved, and asked what this would mean for next year. Charles Porter advised that the CIP target for 2017/18 was lower, and that additional CIPs would need to be identified for contingency purposes. Mike Hawker asked about the financial impact of the Trust failing to recruit to plan and the associated implications for expenditure on private providers. Charles Porter explained about the 15% premium for private providers, but agreed to circulate a reconciliation to Board members. Action 16/100 Charles Porter to circulate a reconciliation of additional expenditure on private providers against lower expenditure on staff, as a result of failing to achieve the recruitment target.

The Board noted that the Trust was in segment 2 under NHS Improvement’s Single Oversight Framework and Charles Porter highlighted the importance of delivering the 2016/17 control total. He updated on the risks to the forecast, which largely related to operational performance. Alastair Mitchell-Baker enquired as to the expected timing of the Battle site disposal. Charles Porter responded that the likelihood of finalising this by the end of the financial year was 50%, rising to 100% by the end of July. 16/101 – Workforce Report Melanie Saunders highlighted the recruitment open days that were being held in Bicester and Otterbourne. She also updated on the national paramedic band 6 role profile, noting that this was a major development for paramedics and that a review was shortly to be


undertaken to take this forward, as well as consider the implications for other roles (for example, specialist paramedics). The Chairman stated that he was aware that SCAS had lost some specialist paramedics to other organisations in the health service. Melanie Saunders responded that attrition was a challenge for the Trust, and that there was a mixed picture elsewhere in terms of the pay grades being offered. Lena Samuels highlighted the importance of exit interviews in understanding the rationale for people leaving. The Company Secretary advised that he had received a question from James Birdseye about the impact of the national paramedic band 6 role profile on specialist paramedics, and explained that he felt that it had been answered in broad terms by Melanie Saunders’ response (i.e. this will be the subject of a review). 16/102 – Equality and Diversity Report Ludlow Johnson, Equality and Diversity Manager, provided an overview of the paper, and the Board noted that equality and diversity would be a topic at the April Board Seminar. Ludlow Johnson explained that the relative likelihood of white staff being appointed from short listing was now 1.21 times greater than BME staff compared to 2.88 previously, which he considered to be good progress and reflective of improved awareness. Nigel Chapman acknowledged that, in terms of SCAS being representative of the population it served, the Trust workforce comprised 9% BME compared with 17% for the population. It was agreed that progress still needed to be made in this respect. The Chairman advised that he would ask Sue Thomas, Appointed Partner Governor and Chair of the Membership and Engagement Committee, to assess how governors could help further on delivery of the equality and diversity priorities. ITEM FOR APPROVAL

16/103 – Risk Management Strategy Mike Hawker detailed the role the Audit Committee was playing in respect of risk management, including carrying out deep-dives into individual risks on the corporate risk register. He added that the risk descriptor table and risk scoring system were to be refined, and it was agreed that the Board should have an input to this process through a Board Seminar. Action 16/103 Deirdre Thompson and Mike Hawker to lead a Board Seminar discussion on the methodology for assessing risk (e.g. impact and likelihood scoring).

The Board asked for two amendments to the draft strategy: • Appendix 2 (Board committee structure) – the Charitable Funds and Remuneration

Committees should be added to the diagram, which should clarify that the committees shown are those with the most relevance to risk management

• Section 6.2 (role of the Audit Committee) – it was considered that this needed to be a

clearer and more up-to-date narrative on the role of the Audit Committee in relation to risk management.

The Risk Management Strategy was APPROVED subject to the two amendments above. FOR INFORMATION / QUESTIONS BY EXCEPTION

16/104 – Integrated Performance Report Charles Porter noted that most of the red rated items had been discussed.


Ilona Blue commented that sickness absence was a major concern (e.g. 10.4% in 999 during December). Melanie Saunders responded that the Executive Team was due to review this in detail next week, but early indications were that stress related illness, musculoskeletal problems, and general coughs and colds were the main contributing factors. The Chairman asked Melanie Saunders to present an analysis of sickness absence, and the actions being taken to improve it, at the March Board meeting. Action 16/104a Melanie Saunders to present further details on sickness absence at the March Board meeting, including contributing factors and action being taken.

The Board also discussed long waits (which had a strong correlation with red performance), cycle times, complaints, and NHS111 call backs. On this last point, Mike Hawker stated that the action plans in place to improve performance did not appear to be particularly robust. Action 16/104b Philip Astle to review the action plans for improving performance on the NHS111 ‘time taken for call back’ key performance indicator.

16/105 – Board Assurance Framework (BAF) It was noted that all red rated risks had been discussed. 16/106 – Board Committee Upward Reports The reports were taken as read. On the Audit Committee report, Mike Hawker and Charles Porter stated that cyber security would feature as part of the next IT resilience review. Keith Nuttall provided a verbal report on the work of the Charitable Funds Committee, who had met two days prior to the Board meeting. The Chairman supported Keith Nuttall’s view that good progress had been made to date in implementing the new charity strategy, and advised that Nigel Chapman would be chairing the Charitable Funds Committee from 1 April. CLOSING BUSINESS

16/107 – Any Other Business The Chairman advised that some interim changes had been made to NED roles in recognition of Keith Nuttall and himself leaving the Trust on 31 March. The Chairman advised that he had received a question from a public governor about members of the public present at Board meetings being able to ask questions. It was noted that this had been discussed with the Board and, for the time being, no changes were to be made to the current approach (i.e. questions can be submitted up to 48 hours prior to the meeting and will be answered in the meeting). 16/108 – Questions from Governors, Trust members, and members of the public The Company Secretary advised that one question had been received – from James Birdseye, Staff Governor – and had been answered during the course of the meeting. 16/109 – Date and time of next meeting The next Board meeting in public was confirmed as taking place at 10.00am on Wednesday 29 March 2017 at Shaw House, Newbury. 16/110 - Resolution by the Chairman To resolve that the representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section 1 (2) of the Public Bodies (Admissions to Meetings) Act 1060 refers).

SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST

Agenda Item 4 TRUST BOARD MEETING IN PUBLIC 29 MARCH 2017

MATTERS ARISING FROM PREVIOUS BOARD MEETING IN PUBLIC (27 JANUARY 2017)

Public Board 29 March 2017 Page 1 of 3 Author: SG

No. Minute ref.

Agenda Item Action Resp Target Due Date

Comments/Outcome

1. Action 16/092

Matters arising from the Board meeting held in public on 30 November 2016

Melanie Saunders to provide an update on the review of Trust volunteers at an appropriate future Board meeting.

MS TBC Action ongoing The SCAS Charity has successfully bid for a grant of £150k to develop volunteering in the Trust. As part of this, we will be running a major new volunteer recruitment campaign across all four counties – from which we hope to recruit 165 additional and more diverse charity volunteers, CFRs and Volunteer Car Drivers.

2. Action 16/094

Chief Executive’s Report including Sustainability and Transformation Plan (STP) Update

Melanie Saunders to present an initial report on the findings of the 2016 Staff Survey, and the Trust’s action plans, at the March Board meeting.

MS 29/03/17 Action completed Initial report circulated by email on 3 March to NEDs and disseminated to staff via Hot News. See also item 11 on today’s agenda.

3. Action 16/096

Quality and Patient Safety Report including Care Quality Commission (CQC) and Hospital Handover Delays

Deirdre Thompson to present some additional information in the next Quality and Patient Safety Report on long waits (e.g. more detail about the ‘tail’ and the outcomes of audits).

DT 29/03/17 Action completed See item 8 on today’s agenda.

4. Action 16/097

Balanced Scorecard – Key Performance Measures

Charles Porter to establish a small working group of Board members to develop proposals around a balanced scorecard, and make recommendations to the full Board.

CP ASAP Action completed A sub-group met on 23/02/17 to discuss the scorecard – see item 7 on today’s agenda.





No. Minute ref.


Comments/Outcome

5. Action

16/100

Finance and Estates Report including 2016/17 Forecast and 2017/18 Financial Plan

Charles Porter to circulate a reconciliation of additional expenditure on private providers against lower expenditure on staff, as a result of failing to achieve the recruitment target.

CP ASAP Action completed A reconciliation was circulated on 21/02/2017. The main explanation for expenditure on private providers being greater than budget is due to the additional activity, lower Unit Hour Utilisation, and lower staffing.

6. Action 16/103

Risk Management Strategy

Deirdre Thompson and Mike Hawker to lead a Board Seminar discussion on the methodology for assessing risk (e.g. impact and likelihood scoring).

DT, MH TBC Action in hand This has been added to the Board seminar forward programme – date to be confirmed.

7. Action 16/104a

Integrated Performance Report

Melanie Saunders to present further details on sickness absence at the March Board meeting, including contributing factors and action being taken.

MS 29/03/17 Action in hand Sickness has improved since the last Board meeting. HR continue to work with local teams to understand trends in sickness levels and underlying causes, and to identify actions to be taken.

8. Action 16/104b


Philip Astle to review the action plans for improving performance on the NHS111 ‘time taken for call back’ key performance indicator.

PA 29/03/17 Action completed This KPI is reliant on the ratio of clinicians to calls and SCAS is seeking additional funding from commissioners. We also





No. Minute ref.


Comments/Outcome

have challenges recruiting nurses and the workforce team is assessing new ways of recruiting and retaining staff.

PA Philip Astle CP Charles Porter MS Melanie Saunders MH Mike Hawker DT Deirdre Thompson

of 5

ITEM 6

BOARD OF DIRECTORS PUBLIC MEETING 29 MARCH 2017

CHIEF EXECUTIVE’S REPORT

PURPOSE 1 The purpose of my report is to keep the Board abreast of key issues and

developments since the last Board meeting. RESPONSE TIMES, PERFORMANCE STANDARDS, RESILIENCE & EFFICIENCY NHS 999 performance 2 In spite of the significantly challenging environment we are facing, SCAS

continues to be one of the leading ambulance services in the country with performance consistently above the national average.

3 I am delighted that in the month of February we achieved all three national

response time standards (both at overall SCAS level and for Thames Valley and Hampshire), which is down to the hard work of the Trust’s staff and volunteers.

NHS 111 performance 4 Demand for the NHS111 service continues to increase, and call answering

performance generally remains below the 95% target of calls answered within 60 seconds. Staff sickness and a failure to recruit/retain staff to the required level has impacted on performance, and this represents a key area of management focus. Following recent management action, the introduction of a Clinical Advice Service has further reduced the proportion of patients requiring a 999 ambulance response.

Patient Transport Services (PTS) performance 5 The Trust has been extremely busy in recent months mobilising new PTS

contracts in Surrey and Sussex, and early feedback has been very positive. Communication is a real focus of both mobilisations, and it is of significant credit to the management and staff in PTS that they have been able to do this whilst maintaining a good level of service on our other contracts. It is estimated that around 20% of the Sussex contract activity has been delivered by SCAS since 1 March.

Financial performance 6 Financially, we remain on track to deliver a significantly better outcome than

the deficit budget for 2016/17 of £4.15m, which is after cost improvements of £6m. The position has been helped by a number of technical (non-operating)

of 5

adjustments, and means that the financial challenge as we go into 2017/18 should not be underestimated.

CLINICAL OUTCOMES, PATIENT SAFETY AND PATIENT EXPERIENCE Care Quality Commission (CQC) inspection 7 We continue to make good progress in implementing our action plans to

address the ‘must do’ and ‘should do’ recommendations from the CQC inspection last year, and are also focused on taking the action required to improve our rating from ‘good’ to ‘outstanding’ at the next inspection.

Serious Incident Requiring Investigation (SIRI) – 999 call recording 8 Board members will be aware that a recording of a 999 call to SCAS relating

to an incident with high national profile was obtained by a national journalist and resulted in a number of newspaper and online media articles in the national press over the weekend of 11/12 February. This has been classified as a SIRI and is currently the subject of an independent investigation.

PORTFOLIO OF COMMERCIALLY VIABLE NON EMERGENCY CONTRACTS New integrated NHS111 and Urgent Care Services contract in the Thames Valley 9 We continue to proceed with the co-production stage, working with

commissioners and partners to design a new, high quality service for Thames Valley residents.

10 It is expected that the new service will begin in September; this, however,

remains subject to SCAS and commissioners successfully agreeing a contract.

New integrated NHS111 and Urgent Care Services contract in Hampshire 11 Board members will be aware that the tender/contract process for the new

contract in Hampshire (and neighbouring Surrey Heath) is now underway, with the contract likely to be awarded in December 2017. As the provider of the current service in Hampshire, this represents a strategically important contract for SCAS.

LEADERSHIP, STAFF ENGAGEMENT AND WORKFORCE Trevor Jones, Chairman, and Keith Nuttall, Non Executive Director 12 This Board meeting will be the last for Trevor Jones and Keith Nuttall. I would

like to pay tribute, on behalf of the Board, to the significant contribution they have made since joining the Trust – Trevor in April 2011, and Keith in April 2010. They will be greatly missed, although I know they will both continue to support the Trust in different ways going forward.

13 I would also like to take this opportunity to welcome Lena Samuels into the

Chair position from 1 April, and I look forward to working closely with her over the coming years.

of 5

Director of Patient Care position 14 This will be Deirdre Thompson’s last Board meeting in public ahead of her

retirement in May, and arrangements to appoint a successor to the role are progressing.

National Paramedic Profile update 15 The current SCAS band 5 operational paramedic job description has now

been reviewed and job matched (successfully) against the new national band 6 profile.

16 The new profile is welcomed by the Trust and reflects the evolving demands

and requirements faced by ambulance services in the modern NHS. It also recognises the increased educational requirements of the role, and the greater depth of judgement and expectations required of staff to meet the needs of the urgent and emergency care agenda in terms of ‘see and treat’ and ‘hear and treat’.

National Staff Survey 17 SCAS took part in the annual national NHS staff survey last year. I am

delighted with the 60% response rate, and the results which demonstrate some really significant improvements compared to the previous year. I was particularly pleased with the results around staff recommending the Trust as a place to work, the extent to which the care of patients/service users is regarded as our top priority, and the perception of staff that we take positive action on the health and well-being agenda.

GOVERNANCE, VALUE FOR MONEY AND FINANCIAL STANDING Planning 18 NHS England and NHS Improvement (NHSI) are due to shortly publish their

Five Year Forward View Delivery Plan, which will set out what the NHS will deliver in the next two to three years within the resources available. The Delivery Plan will describe the changes to urgent and emergency care that patients can expect to see in the coming years, and the focus on technology. It will also aggregate some of the changes planned in the 44 Sustainability and Transformation Plan (STP) areas.

19 Our own final operating plan for 2017-19 is included on today’s meeting

agenda, and has been developed through consultation with key stakeholders including governors. The strategic priorities highlighted in the plan reflect the contribution we will be making to the four STPs we are involved in.

NHSI ‘Single Oversight Framework’ 20 We remain in segment 2 (targeted support) under NHSIs Single Oversight

Framework regulatory approach, but consider that we are now in a strong position to progress into segment 1 (maximum autonomy) given that we are delivering the relevant performance standards, are rated as ‘good’ by the CQC, and have a financial use of resources rating of 2.

of 5

CQC and NHSI ‘Use of Resources’ Assessment 21 The CQC and NHSI have been consulting over a new ‘use of resources’

assessment which will look at the ability of providers to deliver high quality and safe patient care within financial balance, whilst also striving to operate more efficiently and effectively.

22 Whilst publication of a finalised assessment process is awaited, it is

anticipated that the key elements will be:

• finance – how effectively is the Trust managing its financial resources? • clinical services – how well is the Trust maximising patient benefit, given

its resources? • people – how effectively is the Trust using its workforce to maximise

patient benefit? • operational – how well is the Trust maximising its operational productivity?

New NHS England (NHSE) guidance - ‘Managing Conflicts of Interest in the NHS’ 23 NHSE has just issued new guidance for organisations and staff on Managing

Conflicts of Interest in the NHS – this comes into force on 1 June 2017 and will apply to SCAS (having due regard to the guidance is a condition in the standard NHS contract).

24 Whilst we consider that we have robust arrangements in place for the various

elements covered by the guidance (e.g. gifts, hospitality, sponsorship etc), the Trust is undertaking a review to ensure that all policies are consistent with this and reflect the good practice that NHSE has outlined.

Cyber security 25 In January there were reports in the media that 34% of all NHS organisations

had been subject to “ransomware attacks”. These are attempts by persons, usually external to those organisations, to block access to Trust systems by the deployment of illicit software which will not be removed until payment has been made.

26 Our own internal assurance review has concluded that, whilst we are not

immune to such attacks, our ICT infrastructure represents a highly resilient network, and is subject to annual network penetration testing. However, we are not complacent - attempts have been made but the systems deployed have trapped any breaches and limited their impact – and this will be an area of continued focus for SCAS.

Board meetings in public – 2017/18 27 The dates for next year’s Board meetings are as follows: 25 May, 13 July, 28

September, 30 November, 25 January 2018, and 29 March 2018. Further details can be found on the Trust’s websites.

28 The September meeting will incorporate the formal Annual General Meeting

at which we will present our 2016/17 Annual Report. Separate arrangements will be made for the Annual Members Meeting.

of 5

PARTNERSHIPS, STAKEHOLDER RELATIONSHIPS AND MEDIA Stakeholder engagement 29 The Trust continues to actively engage with key stakeholders. The Chairman

has met/held discussions with a number of Trust/CCG chairs, and has attended meetings involving NHSI and The Association of Ambulance Chief Executives. I continue to actively engage both nationally and regionally. My recent engagement activity has included the following meetings and events:

• NHS Providers and NHSI • Association of Ambulance Chief Executives • Sustainability and Transformation Planning meetings and workshops • other various health economy / local authority / blue light services system

meetings • station visits/ride-outs to engage with staff

Media coverage 30 Recent media focus has included coverage of a number of major incidents

that the Trust has responded to; for example, the property explosion/collapse that occurred in Oxford in February.

31 The alternative transport scheme that SCAS is piloting in parts of South East

Hampshire has attracted some positive media attention, and more recently the BBC ran a feature about verbal abuse towards call takers, which focused on our Clinical Coordination Centre in Otterbourne.

Lead Director: Will Hancock, Chief Executive Author: Steve Garside, Company Secretary Date: March 2017

Agenda Item: 7

BOARD MEETING IN PUBLIC 29 MARCH 2017

Details of the paper

Title 999 Headline Measures

Responsible Director Philip Astle, Chief Operating Officer; Deirdre Thompson, Director of Quality and Patient Care; and Charles Porter, Director of Finance

Recommendation (eg. note, approve, endorse) For approval

Links to SCAS Business & Risks

Strategic theme to which the paper relates (please mark in bold)

To deliver clinical excellence by improving clinical outcomes

To achieve operational excellence

To deliver effective stakeholder relationships

To deliver sound governance, VFM & financial standing

To deliver leadership, staff engagement & a learning culture

To develop the portfolio of commercially viable non emergency commercial contracts

Please provide details of the risks associated with the subject of this paper (x-reference to the corporate risk register / Board Assurance Framework)

There are a range of performance/safety related risks on the Trust’s Board Assurance Framework (see item 14).

Implications Regulatory and legal implications / impact (e.g. provider licence and segmentation ratings, CQC essential standards, competition law etc)

A number of the KPIs relate to performance on regulatory matters e.g. NHSI single oversight framework risk ratings

Financial implications / impact (e.g. CIPs, revenue/capital, year-end forecast)

No direct implications for this paper.

Council of Governor implications / impact (e.g. links to governors statutory role, significant transactions etc)

The Council of Governors receive an overview of performance at each Council of Governors meeting. They also receive the papers for each Board meeting in public.

Patient / staff implications (e.g. linked to NHS Constitution, equality and diversity)

The KP’s relate directly to patients and the implications of the 999 service being provided to them.

Other Previous considerations by the Board

Draft scorecard presented at the January 2017 Board meeting in public

Background papers / supporting information

Integrated Performance Report, the Quality and Safety Board Report and the Operational Performance Report

of 2


999 HEADLINE MEASURES

PURPOSE

1 Recognising that the national response time standards are not always being delivered by SCAS each month (although they were in the month of February), the purpose of this report is to agree the 999 headline measures to enable the Board to monitor patient quality and safety.

2 It should be noted that although the national response time standards are not always being achieved, the Trust fully aims to achieve the standards (i.e. as opposed to the ‘alert thresholds’ highlighted below) and plans accordingly.

EXECUTIVE SUMMARY

3 Following the discussions at the January Board meeting in public a sub group

of Executive and Non-Executive Directors met to review the proposed scorecard. The revised version is shown below, and the ‘alert threshold’ is a level of performance which, if not met, the Board would seek to obtain even greater assurance

999 Headline measures National target

Alert threshold

Actual Feb Actual YTD

Red 1 75% 72% 76.7% 73.2%

Red 2 75% 72% 75.2% 73.0%

Red 19 95% 94.5% 95.2% 94.7%

Red 1 75th percentile 8 mins 35s 7 mins 50s 8 mins 16s



Red 8 long waits (over 30 mins) 1.2% 0.6% 0.5%

Red 19 long waits (over 30 mins) 2.0% 0.1% 1.1%

Green 30 long waits (>60 mins) 23.0% 13.3% 18.4%

Green 60 long waits (>2 hours) 13.9% 7.0% 11.2%

Complaints mthly (999) 0.07% 0.05% 0.05%

SIRIs 999 (last 3 months) 4 2

4 The following changes are proposed by the sub group to the full Board: • Changes to row and column headings (i.e. ‘alert threshold’ rather

than ‘Board threshold’)

of 2

• SIRIs to be shown as last 3 months • The Executives were asked to review how to show Green long

waits. It is proposed to separate Green 30 and 60, to continue with % of long waits. This is supported by further analysis at the Quality and Safety Committee.

RECOMMENDATIONS TO THE BOARD 5 The Board is asked to approve an updated set of proposed 999 headline

measures and the inclusion going forward into the front cover of the Integrated Performance Report on a monthly basis.

Author: Philip Astle, Deirdre Thompson, and Charles Porter Date: March 2017


Agenda Item: 8


Title

Quality and Patient Safety Report

Responsible Director

Deirdre Thompson, Director of Quality and Patient Care John Black, Medical Director

Recommendation (e.g. note, approve, endorse)

The Trust Board is asked to receive and note the report








To develop the portfolio of commercially viable non-emergency commercial contracts

Please provide details of the risks associated with the subject of this paper

All clinical risks are detailed in the Trust Corporate Risk Register and Integrated Performance Report that link to the quality work streams. Key issues and risks that are outlined in the paper are BAF risks: 1.1, 1.2, 1.3, 1.5, 1.6, 4.4, & 5.1

Implications Regulatory and legal implications / impact (e.g. provider licence and segmentation ratings, CQC essential standards, competition law etc.)

All quality related work streams aid and enhance compliance with the CQC regulations 9, 12, 13, 15, 16 and 17. Information provided in this paper provides evidence of compliance


Cost of undertaking preparations or actions relating to the CQC inspections

Other


The Council of Governors receives this Board paper and discusses quality and safety issues on a regular basis.


Links to all elements of NHS constitution of patient and staff rights.

Previous considerations by the Board

Quality and Safety report is presented at every board meeting


Berwick (2013) A promise to learn – a commitment to act. Improving the safety of patients in England. National Advisory Group on the Safety of patients in England. London. Hyperlink for the guidance on new CQC regulations April 2015: http://www.cqc.org.uk/sites/default/files/20150324_guidance_providers_meeting_regulations_01.pdf Hyperlink for the 2015 CQC ambulance provider handbook: http://www.cqc.org.uk/sites/default/files/20150326_ambulance_provider_handbook.pdf Hyperlink for the 2015 CQC NHS111 provider handbook: http://www.cqc.org.uk/sites/default/files/20150630_nhs111_provider_handbook.pdf Department of Health (2012/13) The NHS Outcomes Framework Monitor (2013) Quality Governance. How does a board know that its organisation is working effectively to improve patient care. National Quality Board (NQB) (2012) Quality in the new health System NHSI (2017) The NHS Foundation Trust Annual Reporting Manual 2016/17

http://www.cqc.org.uk/sites/default/files/20150324_guidance_providers_meeting_regulations_01.pdf

http://www.cqc.org.uk/sites/default/files/20150324_guidance_providers_meeting_regulations_01.pdf

http://www.cqc.org.uk/sites/default/files/20150326_ambulance_provider_handbook.pdf

http://www.cqc.org.uk/sites/default/files/20150326_ambulance_provider_handbook.pdf

http://www.cqc.org.uk/sites/default/files/20150630_nhs111_provider_handbook.pdf

http://www.cqc.org.uk/sites/default/files/20150630_nhs111_provider_handbook.pdf

of 32


QUALITY AND PATIENT SAFETY REPORT

PURPOSE

1. This report provides the Board with information, updates and assurances on progress with work streams to maintain clinical excellence and high standards of care for our patients.

2. Details and information on the delivery of performance can also be found

in the Integrated Performance Report. 3. Following on from an initial executive summary highlighting the key issues and

updates, the report follows on with updates for three dimensions of quality: • Patient Safety and Risk • Patient Experience • Clinical Effectiveness

4. The report outlines figures, narrative and actions taken in regard to

risks identified through incidents and work streams and in the Corporate Risk Reg is ter and Board Assurance Framework (BAF). The information provided within the paper demonstrates evidence of compliance against Care Quality Commission (CQC) regulations where appropriate.

EXECUTIVE SUMMARY SCAS CQC Update BAF Risk 4.4 Good to Outstanding CQC Action plan

5. The good to outstanding action plan (version 3.9) continues to maintain traction and make progress and at the time of writing the report 108 actions are completed, 41 are in progress and in date and 18 have missed the deadline date set last September (see chart below).

CQC actions

of 32

6. The Director of Quality and Patient Care and Head of Compliance have reviewed the red actions and will continue to support Accountable Executives to achieve resolution of these as a priority.

7. The Head of Compliance also continues to meet with key staff responsible for delivering actions and the action plan remains under constant review.

Other CQC activity

8. All of the NHS Ambulance services have now been rated, with West Midlands Ambulance Service NHS Foundation Trust being the only trust to be rated ‘Outstanding’. A gap analysis has been completed from this report to identify any possible learning for our journey to outstanding.

9. On the 7th March the Executives reviewed the steps required to progress the Trust from moving from a high end rating of ‘Good’ to ‘Outstanding’ and also the draft proposed changes to the assessments / inspections of Trusts by the CQC going forward.

10. Following an inspection London Ambulance Service NHS 111, their NHS

111 service has been rated as ‘Good’.

11. Following a re-inspection, Yorkshire Ambulance Service NHS (T) has been rated ‘Good’ (previously ‘Requires Improvement’).

12. Following a re-inspection, Queen Alexandra Hospital in Portsmouth has

been rated ‘Requires Improvement’ (previously ‘Inadequate’).

13. We continue to engage at national levels and at the most recent national CQC co-production group the following areas were covered:

a. CQC website updates - (to become easier to search, more integrated and mobile friendly)

b. CQC Insight tool - (the planned intelligence tool which will identify potential changes in quality of care to support decision making about the CQC regulatory response)

c. Public engagement strategy - (including making more use of digital channels and new technologies, developing Experts by Experience role to support the CQC wider)

d. Quality in a place - (understanding the quality of care that specific population groups experience and how well care is coordinated across organisations)

e. New approaches to registration - (existing registration approach needs to evolve to be fit for the future)

14. The event included plenary sessions, presentations and testing new concepts and models in preparation for new CQC Key Lines of Enquiry (KLOE) and guidance (due to be published in April 2017) and the regulation of any new; ‘models of care’, ‘networks’, ‘corporate HQs’, STP’s and thematic reviews.

15. During our recent CQC ‘Keep in Touch’ meeting with our local inspection

team, the Director of Quality and Patient Care and the Head of Compliance have been invited to make the presentation on End of Life that was made at the recent ‘Strategic Challenges in Urgent & Emergency Care: Supporting

of 32

Patients in their Last Months of Life’ regional event to the next CQC regional team meeting.

Update Portsmouth Health System BAF Risk 1.6 – Deirdre

16. Hospital handovers delays continue to impact on our ability to respond with some delays in excess of 5 hours to handover the patient to the Portsmouth Hospitals NHS Trust (PHT) staff and release SCAS resources.

17. The CEO and the Chief Operating Officer continue to engage with the teams

within PHT and the Director of Quality and Patient Care continues to actively raise concerns with the Clinical Commissioning Groups (CCG) and the CQC. The risk remains at a red 16 on the risk register to reflect the increased risk to delivery of patient care and impact on staff morale. In terms of Actions:

SCAS

• We have seconded (and funded) 2 HALO’s for a 12 week period to support the patient flow and the crews at the front door. This has until now been a task undertaken by the duty Bronze which, due to the amount of time it takes up has meant they have been unable to fulfil their Bronze roll and Team Leader functions such as staff welfare etc.

• Use of the immediate handover and escalation process. • Extending shifts and buying in additional resources to support patient care

in terms of outstanding calls / long waits. • Paper to Accident and Emergency (AE) Delivery Board requesting

additional funding to buy in Private Providers’ (PP) hours to cover hours lost at PHT – nothing forthcoming at the time of writing the report.

• Significant amount of ‘management’ time on a daily basis, both locally and out of hours through the on call system.

• Continued focus on increasing non conveyance. • CCC additional clinical triage for ED/999 dispositions from 111 during high

demand times.

PHT • Ongoing challenges with discharges – new system in place with some

ongoing IT issues. Also significant issues with community beds and care packages resulting in ‘bed blockers’.

• Agreement that PHT staff will manage cohorted patients within the hospital – awaiting final confirmation.

CCG

• Convening and Chairing system ‘Gold’ conference calls during times of challenge to ensure the whole system is focused on key actions to support and improve the flow.

of 32

Below are the weekly figures for the period between January and February:

Private Provider Framework and visits. BAF no: 1.4, 6.7, 6.8

18. South Central Ambulance Service NHS FT (SCAS) is committed to ensuring that the same high levels of patient care that are offered by our own staff are available to any service user who is attended to by SCAS sub-contracted provider.

19. The SCAS PP Governance framework has been revised to ensure all

services are covered (Patient Transport Services (PTS), NHS111, Emergency and Urgent Care (E&UC) 999). The framework aims to:

• Protect the interests of all those affected by Trust business such as

patients, the public, staff and stakeholders. • Ensure the Trust Board and the other interested parties are provided

with evidence that demonstrates the clinical quality standards are assessed, addressed, and monitored.

• Ensure a coordinated, standard methodology is adopted by every department in relation to the provision of private provision and monitoring of the provision.

20. The services each require a slightly different strategy for assurance visits

depending upon the contract and number of sub-contractors and activity levels. For Non- Emergency Patient Transport Services (NEPTS), there are a large number of providers particularly in the Sussex area. The reviews are all being aligned with the CQC KLOEs to ensure compliance.

21. An in-house workshop took place on 27th February 2017 to work through a

cohesive and integrated approach to managing sub-contractors and information in relation to KLOE’s and assurance processes.

22. The validation process for sub-contractors across all services is conducted

by two SCAS managers with input from the Clinical Governance Lead of each service when requested. Validation sign off can only be given by a relevant Senior Manager.

23. The CQC are now beginning to report on private provider inspections and

SCAS are reviewing the reports as they are published. Going forward, each report will be scrutinised and actions created with the sub-contractor using a joined up approach.

of 32

24. SCAS reserves the right to reassess the provider against the initial validation requirements based on the CQC KLOE’s and hold the provider to account.

25. The new Surrey and Sussex contract for NEPTS has had all sub-contractors

visited and assessed in January 2017 (including all taxi companies validated by the Local Authorities) – those companies that did not meet the required standards have not been recommended for use.

Mortality and Morbidity Group (MMRG)

26. Business Intelligence (BI) produces a daily data set of all cardiac arrests which have been attended by the Trust. These are reviewed daily by the clinical team to assess whether the Trust needs to refer externally or review in-depth at the quarterly Mortality and Morbidity Review Group. Any serious concerns regarding treatment are escalated immediately and dealt with using the Serious Incidents Requiring Investigation (SIRI) process.

27. MMRG is due to meet again at the end of March 2017.

RISK - CURRENT PERFORMANCE Risk (CQC REG- 12 & 15 KLOE- S1, S2, S4, S5, E2, W2, W3 & W5)

Key Performance Indicators (KPIs) for Risk

28. In November 2016 the Trust declared one serious incident requiring

investigation there were none reported in December and one reported in both January and February 2017.

29. The incident categories were self-inflicted harm, treatment delay (2) and one

serious Information Governance (IG) issue. SIRIs declared by SCAS in 2015/16 and 2016/17

30. In 2015/16 there were 15 SIRIs declared. Year to date (February 2017) for 2016/17 there has been 11 SIRI declared by SCAS.

of 32

Clinical incidents reported each month in 2015/16 to 2016/17

Top Ten categories of Clinical incidents reported in December 2016 & January 2017 Medication 154 Delayed Treatment/Transport 56 111 Call Centre Issues 41 Other 39 GPs 38 Make Ready 31 Hospitals 30 Clinical Equipment 30 Patient Treatment 26 EOC Issues 25 Total 470

Number of clinical incidents reported in December 2016 & January 2017 vs 2015/16 in relation to the number of operational contacts December 2016 & January 2017

December 2015 & January 2016

Total number of patient contacts 429, 148 405, 334

Total number of clinical incidents reported 643 506 Number of incidents as a percentage of the number of contacts

0.15% 0.12%

of 32

Figure 1 December & January 2016/17

Figure 2 December & January 2016/17 Key Performance Factors for Risk

31. NHS 111 call centre issues is a catch-all category with issues around queue management, call assessment and communication, mainly centred on report content, to the forefront. This includes individual errors causing delays, such as the wrong address or telephone number being entered or inappropriate referrals caused by poor pathway selection.

32. NHS 111 also identified an issue with delays in the management of dental cases when the Hampshire dental team not on duty in the call centre.

of 32

The number and category of incidents reported to the National Reporting and Learning System (NRLS) in January 2017 The total number of incidents reported to the NRLS in January 2017 The number of incidents reported to the NRLS

January

Number of incidents reported to the NRLS

10

Number of incidents reported to the NRLS within 30 days

8

Percentage of incidents reported to the NRLS in each month within 30 days

80%

Total number of alerts received from the Central Alerts System in January 2017 The total number of alerts received from the Central Alerts System (CAS) in January 2017 Total number of alerts received from the Central Alerts System (CAS)

January

Number of Alerts received from CAS

4

Number of Alerts which were applicable to SCAS

0

Number of Alerts acknowledged by SCAS within two days

4

The total number of non-clinical incidents reported in January 2017

33. The total number of non-clinical incidents reported in January 2017 was 157. Total number of Non-Clinical incidents reported between January 2016 and January 2017

of 32

The top ten categories of non-clinical incidents reported in January 2017 The top ten categories of non-clinical incidents reported in January 2017 Categories Total Manual Handling 32 Slip, Trip, Fall 23 Physical Assault 17 Vehicle 12 Feature Request 12 Other 9 Information Governance 8 Security 6 Contact with/struck by object/vehicle (including hot liquids) 4 Welfare 4 Total 127

The severity of the non-clinical incidents reported in January 2017 as graded by managers

27

57

30

6

0

20

40

60

Low Risk Minor Risk Moderate Risk Significant Risk

Severity of non-clinical incidents in January 2017 as graded by Managers

34. With regards to the severity of the 157 non-clinical incidents reported in January 2017, 120 of these incidents have been examined and re-graded by managers investigating the incidents and 27 were deemed as low risk, 57 were minor risk, 30 were moderate risk, six were significant and none were graded as high risk.

of 32

Non-Clinical incidents reported by each service in January 2017

7 4

108

4 1

29

1 1 1 10

20

40

60

80

100

120

Total number of non-clinical incidents reported by each Service area in January

2017

Themes of top three categories of non-clinical incidents reported in January 2017

35. The top three categories of non-clinical incidents were ‘manual handling’; ‘slip, trip, fall’ and ‘physical assault’.

36. The top three sub-categories of manual handling incidents were: ‘manual

handling – involving patients’; ‘manual handling – non-patient handling’ and ‘manual handling - patient injury’.

37. The main theme of the ‘manual handling - involving patients’ incidents were

staff sustaining musculoskeletal injuries and other minor injuries when moving, handling, transferring and/or assisting patients in stretchers, carry sheets and chairs, wheelchairs, scoops, Southampton slings and Mangar Elks often in restricted surroundings.

38. The main theme of the ‘manual handling – non-patient handling’ incidents

consisted of staff sustaining musculoskeletal injuries when lifting or carrying response bags.

39. The main theme of the ‘manual handling – patient injury’ incidents consisted

of patients sustaining minor injuries when being conveyed on a carry chair and a wheelchair.

40. In January 2017, 12 of the manual handling incidents were reported to the

Health and Safety Executive (HSE) in accordance with the Reporting of injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995. All of these incidents are investigated and, where possible, recommendations are made to prevent recurrence.

41. The top three categories of the ‘slip, trip, fall’ incidents were ‘Slip, trip, fall –

employee’; ‘Slip, trip, fall – patient’; and ‘Slip, trip, fall – third party’.

of 32

42. The main theme of the ‘Slip, trip, fall – employee’ incidents was staff slipping or tripping on icy, wet or slippery surfaces and on miscellaneous equipment.

43. There was no main theme to the ‘Slip, trip, fall –patient’ incidents other than

patients sustaining minor injuries when slipping or falling.

44. There was no discernible theme to the ‘slip, trip, fall – third party’ incidents.

45. The top three sub-categories of the ‘physical assault’ incidents were: ‘Staff assault (by patient/third party) – no treatment required’; ‘Staff assault (by patient/third party) – treatment required’; and ‘Staff assault with a weapon (by patient/third party) – treatment required’.

46. The main theme of the ‘Staff assault (by patient/third party) – no treatment

required’ incidents was members of staff being punched, kicked or grabbed by patients under the influence of alcohol/drugs and/or who had mental health issues.

47. There was no discernible theme to the ‘Staff assault (by patient/third party) –

treatment required’ incidents other than staff requiring first aid treatment following an assault. In one incident the member of staff had to attend the Minor Injuries Unit for treatment. However, this was a precautionary measure as a minor injury was sustained.

48. There was only one incident in the ‘Staff assault with a weapon (by

patient/third party)’ sub category and this consisted of a patient throwing an Electronic Patient Record (EPR) unit and it striking the hand of a member of staff who sustained minor injuries.

Total number of RIDDOR incidents reported to the Health and Safety Executive (HSE) in January 2015/16 and 2016/17

49. In January 2017, there were 13 incidents reported to the HSE in accordance with RIDDOR, whereas in the same period in 2016 there were eight incidents reported to the HSE. Therefore, when comparing the two periods there has been an increase in the number of incidents reported. For further details see the chart below.

8

109

4

6

1011

89

10

3

6

13

0

2

4

6

8

10

12

14

RIDDOR incidents reported between January 2016 and January 2017

of 32

Total number of physical assaults reported in 2015/16 and 2016/17

50. In January 2017, there were 17 physical assault incidents reported whereas in the same period in 2016 there were 10 incidents reported. Therefore, when comparing the two periods there has been an increase in the number of incidents reported. For further details see the chart below.

10

21

1215

1914

31

17 15

9 9

2017

05

101520253035

Total number of physical assault incidents reported between January 2016 and January

2017

Total number of non-physical assaults reported in 2015/16 and 2016/17

51. In January 2017, there were 15 non-physical assault incidents reported whereas in the same period in 2016 there were 13 incidents reported. Therefore, when comparing the two periods there has been a slight increase in the number of incidents reported. For further details see the chart below.

13

1915

1114

1116

10

19 19 20

26

15

05

1015202530

Total number of non-physical assault incidents reported between January 2016 and January

2017

of 32

Total number of security incidents reported in 2015/16 and 2016/17

52. In January 2017, there were nine security incidents reported whereas in the same period in 2016 there were 11 incidents reported. Therefore, when comparing the two periods there has been a slight decrease in the number of incidents reported. For further details see the chart below.

RISK - FUTURE PERFORMANCE Plans for Sustaining/Improving Performance for Clinical and Non-clinical Risk

53. Updated Trust-wide versions of clinical pathways for STEMI and stroke are soon to be released to staff; the pathway for stroke includes a flowchart developed by E&UC to assist staff in making a timely decision to convey these patients. There is also a complete directory of receiving units for both conditions to aid staff who may be working out of area. This is part of the ongoing E&UC work to reduce call cycle times and delays.

54. Staff involved in clinical incidents are supported by both their area

management teams and clinical directorate. Learning from these incidents is shared with staff through publications such as SCASCade and Safety Matters as well as via face to face presentations at team training and station organised CPD sessions.

55. There is further development of the relationship between E&UC senior

management and Clinical Governance Leads with one to one meetings of each Head of Operations and Clinical Governance to discuss Datix compliance and other issues on a monthly basis.

56. The clinical governance team are spending time each month working from

stations to ensure access to clinical governance at ‘grassroots’ level. These days have been well received by staff who have shown a real interest in the work being done by the team.

57. The Non-clinical Risk Manager continues to place special situations

features/alerts on the addresses of patients or others who either assault staff or subject them to physical assault and/or abusive or aggressive behaviour.

11

5 5 6 6

3

8

12 11 10 10

16

9

02468

1012141618

Total number of security incidents reported between January 2016 and January 2017

of 32

The details of these special situation features/alerts are shared with PTS so that they can place them on their patient address database.

58. The Non-clinical Risk Manager continues to liaise with the Police about

physical assaults and also security matters and works with them to try and obtain a sanction against those who either assault Trust staff or commit crimes against the Trust.

59. The Head of Risk and Security and the Non-clinical Risk Manager are

carrying out health and safety inspections and crime reduction surveys of Trust premises.

60. The Head of Risk and Security is currently working with Operations to carry

out ‘task’ based risk assessments and manual handling assessments. 61. The Head of Risk and Security has provided training to Managers in NHS

111 in the Clinical Contact Centre (South) on how to carry out a display screen equipment assessment.

62. The Head of Risk and Security has provided training to Managers within

Operations on how to carry out a stress risk assessment. Further training sessions to Managers within Operations are scheduled to take place during 2017.

63. In the interim, the Risk Team continues to carry out display screen

equipment risk assessments and the Head of Risk and Security continues to carry out stress risk assessments.

64. The Risk Team continue to provide training on the Trust’s Induction course.

65. Face to face training this year for frontline staff includes training on conflict

resolution to enhance staff knowledge and skills in de-escalation of situations at scene.

66. All RIDDOR incidents are investigated and, where possible, measures are

put in place to prevent a recurrence. SAFEGUARDING - CURRENT PERFORMANCE Safeguarding Adults and Children (CQC REG- 12 &13, KLOE- S3, E2, W3 & W5) Key Performance Indicators (KPIs) for Safeguarding Numbers of referrals by Trust, by adults, by children, by service area and versus Activity

67. Please see the three tables below to see the information related to referrals for December 2016 and January 2017

of 32

Table 1 Number of referrals by service area Referral Source Number

Activity

Referrals from EOC 111 18 820527 Referrals from EOC 999 59 423740 Referrals from PTS Contact Centre Referrals from operational 999 crews 1551 423740 Referrals from operational PTS crews Referrals from Private Provider crews 7 86277 Referrals where the source is not recorded

264

Total 1899 Table 2 Number of referrals sent to partner agencies Organisation referrals have been sent to

Number of referrals

Adult Services 2964 Children’s Services 778 Both Adult and Children’s Services 585 Sent to Police 121 Sent to Fire and Rescue Service 253 Total 4701 Table 3 Number of referrals by type Type of referral Number Domestic Abuse 104 Domestic Violence 328 Physical Abuse 340 Sexual Abuse 40 Emotional/Psychological Abuse 361 Financial Material Abuse 82 Neglect and Acts of Omission 2160 Discriminatory Abuse 17 Fire Risk 253 Total 3685 * Relates to the fact that there are referrals generated which highlights more than one concern, hence a higher total number in table 3 than that in table 1. Serious Case Review (SCR) and Individual Management Review (IMR) numbers received in the month and our responsiveness to deadlines for open requests

68. During the months of December and January the safeguarding team were asked to submit reports for 3 cases which was being considered for a serious case review and 0 Serious Adult Review. They were not asked to submit any Domestic Homicide Reviews (DHR) but have received a further 5 requests for the completion of a DHR.

69. There were 10 section 42 requests during December and January

of 32

Audits of the appropriateness of referrals

70. During December and January SCAS has completed two joint agency audits these where with West Berkshire and Hampshire Clinical Commissioning Groups (CCGs) and Local Authorities. As a group we looked at the referral process holistically from the SCAS completion of a safeguarding referral through to the response of social care including their actions taken following our referral. The highlighted areas with regard to the initial referral from SCAS where around ensuring that details of siblings and parents/guardians details are recorded and not just the child’s details that was the subject of the referral and with regard to adult referral ensuring that our referral includes what the patient would like as an outcome from any safeguarding referral made on behalf of the patient. On the whole all the SCAS safeguarding referrals where appropriate as they either highlighted a safeguarding or welfare issue that required intervention from the Local Authority.

Attendance at Boards that we have been requested to attend

71. SCAS representatives attended 3 safeguarding boards in December and 1 safeguarding board in January. Most safeguarding boards avoid December and January to hold these meetings as they have historically found that the attendance at these meetings during this period are far lower due to leave being taken.

72. Training figures

111 staff Level 1 safeguarding children 95%. Level 1 safeguarding adults 93% Level 2 safeguarding children 68%. Level 2 safeguarding adults 43% 999 staff Level 1 safeguarding children 95%. Level 1 safeguarding adults 95% Level 2 safeguarding children 81%. Level 2 safeguarding adults 81% PTS staff Level 1 safeguarding children 91%. Level 1 safeguarding adults 91% Level 2 safeguarding children 87%. Level 2 safeguarding adults 87% Corporate staff Level 1 safeguarding children 87%. Level 1 safeguarding adult 88% Level 2 safeguarding children 78%. Level 2 safeguarding adult 74%

SAFEGUARDING FUTURE PERFORMANCE Plans for Sustaining/Improving Performance for Safeguarding

73. The safeguarding team are continually attending team training days to highlight areas of good practice and strengthening areas of weakness to improve safeguarding understanding and the quality of referrals across all service areas of SCAS

of 32

74. We are working with the developers of Scribe (the new ePR system for private providers) in developing referral platforms for safeguarding, Domestic Abuse/Violence and Prevent referrals forms

75. Advising the contract teams responsible for the new PTS contracts now

undertaken by SCAS with regard to safeguarding. This includes ensuring that all staff working on these contracts are compliant with current levels of safeguarding training as stipulated in all intercollegiate documents. This includes all taxi firms working on our contract

76. Continuing to complete multi agency audits of safeguarding referrals. This

will ensure that SCAS staff are meeting the needs of vulnerable persons of all ages.

77. The Head of Safeguarding is looking at ways in which we can deliver

safeguarding training smarter and in a way that reduces staff abstraction from their daily duties while ensuring that they all meet the need to complete safeguarding training to the required standard

PATIENT EXPERIENCE CURRENT PERFORMANCE Patient Experience BAF Risk 1.5 (CQC REG 16 &13- KLOE- C, R4 & W4)

Key Performance Indicators (KPIs) for Patient Experience Patient Experience (PE) Contacts Received – rolling 14 months data

Concerns HCP

Feedback Complaints Total Compliments Dec-15 37 24 55 116 50 Jan-16 40 28 38 106 86 Feb-16 70 47 64 181 84 Mar-16 87 78 66 231 78 Apr-16 63 86 36 185 94 May-16 59 75 55 189 110 Jun-16 71 62 49 182 96 Jul-16 68 72 45 185 104 Aug-16 60 121 51 232 108 Sep-16 64 78 34 176 103 Oct-16 63 104 43 210 126 Nov-16 61 154 40 255 90 Dec-16 77 199 27 303 141 Jan-17 83 206 21 310 121

78. The increase in PE cases reported in December and January 2016/17 when

compared to the same period in 2015/16 is largely due to the increased numbers of Healthcare Professional (HCP) feedback now being recorded on the Trust’s Datix system.

79. HCP feedback recorded via Datix has increased significantly when comparing December 15 (24) with December 16 (199). The numbers of formal complaints and informal concerns received has remained consistent at around 100 per month over the previous 14 month period.

of 32

0

50

100

150

200

250 Patient Experience ContactsReceived Dec15 to Jan17

Concerns

HCP Feedback

Complaints

Compliments

Note: HCP Feedback has increased from January 2016 due to NHS111 HCP feedback now being recorded on Datix. These were previously being held on a separate spreadsheet. wef 01/11/2016 PTS HCP feedback is now being recorded on Datix – previously some PTS HCP data was held on Datix and some on a separate spreadsheet by PTS Team. Complaints/Concerns/HCP Feedback received Q3 2016/17 against Activity Q3 2016-17 Complaints Concerns HCPs

Total Activity

%* Q2

Q1

111

18

20

77

115

295,461

0.04%

0.04%

0.04%

999 Operations

30

39

31

100

112,026

0.09%

0.10%

0.10%

PTS

26

98

314

438

134,285

0.33%

0.18%

0.13%

EOC

31

29

31

91

141,186

0.06%

0.08%

0.09%

Private Provider

5

11

4

20

36,163

0.05%

0.06%

0.06%

Other

0

4

0

4

n/a

n/a

n/a

n/a

Trust Total

110

201

457

768

719,121

0.11%

0.08%

0.08%

*% relates to complaints, concerns and HCP against activity

80. The biggest increase in PE issues recorded via the Trust’s reporting system – Datix – when compared with service activity is seen in dissatisfaction raised by HCP’s regarding PTS Q3 314 / Q2 131 / Q1 65.

81. However, this is due to HCP feedback previously having been recorded on separate spreadsheets held locally. Following the training and support provided by PE Team over recent months, PTS are now recording and managing their HCP feedback using Datix which allows for clearer oversight of dissatisfaction against activity and clearer reporting and analysis of

of 32

themes and trends. Patient Experience Contacts Received by Service Area - December 2016 data December 2016 Total PE Complaint Concern HCP Feedback 111 41 5 15 21 999 Operations 32 6 15 11 PTS 190 5 32 153 EOC 30 9 9 12 Private Provider 10 2 4 4 Total 303 27 75 201

5 6 5 9 215 15

329 4

2111

153

12 40

20406080

100120140160180

111 999Operations

PTS EOC PrivateProvider

PE Contacts by Service Area December 2016

Complaint

Concern

HCP Feedback

Patient Experience Contacts Received by Service Area – January 2017 data January 2017 Total Complaint Concern HCP Feedback 111 69 2 10 57 999 Operations 41 6 16 19 PTS 165 5 47 113 EOC 29 8 6 15 Private Provider 6 0 4 2 Total 310 21 83 206

of 32

2 6 5 80

10 16

47

6 4

57

19

113

152

0

20

40

60

80

100

120

111 999Operations

PTS EOC PrivateProvider

PE Contacts by Service Area January 2017

Complaint

Concern

HCP Feedback

Patient Experience Contacts Received by Subject Area - December 2016 data

Dec-16 Total Complaints Concerns HCP Feedback Clinical Care 34 9 9 16 Communication 24 1 5 18 Driving Standards 0 0 0 0 Delay/Non-Attendance 181 9 32 140 Patient Care/Handling/ Property 23 3 10 10 Safeguarding 2 1 1 0 Staff Attitude 24 3 17 4 Other 15 1 3 11 Total 303 27 77 199

9 1 09 3 1 3 19 5 0

32

101

173

16 180

140

100 4 11

020406080

100120140160

PE Contacts by Subject December 2016

Complaints

Concerns

HCP Feedback

of 32

Top two subjects December 2016: Complaints: Delays/Non-Attendance and Clinical Care Concerns: Delays/Non-Attendance and Staff Attitude HCP feedback: Delays/Non-Attendance and Communication All PE contacts: Delays/Non-Attendance and Clinical Care Patient Experience Contacts Received by Subject – January 2017 data January 2017 Total Complaints Concerns HCP Feedback Clinical Care 44 2 13 29 Communication 53 1 6 46 Driving Standards 1 0 1 0 Delay/Non-Attendance 151 9 40 102 Patient Care/Handling/ Property 22 2 7 13

Safeguarding 0 0 0 0 Staff Attitude 34 7 16 11 Other 5 0 0 5 Total 310 21 83 206

2 1 09 2 0 7 0

13 6 1

40

7 016

0

2946

0

102

130

11 50

20

40

60

80

100

120

PE Contacts by Subject January 2017

Complaints

Concerns

HCP Feedback

Top two subjects January 2017: Complaints: Delays/Non-Attendance and Staff Attitude Concerns: Delays/Non-Attendance and Staff Attitude

of 32

HCP feedback: Delays/Non-Attendance and Communication All PE contacts: Delays/Non-Attendance and Clinical Care

82. Delay in treatment or transport continues to be the top theme in incidents, complaints, concerns and Health Carers Professional feedback (HCPF). SCAS deploys a number of strategies for learning from complaints, incidents, near misses, claims and coroner’s rulings; however this is a continuous learning process which is being embedded into the SCAS safety and learning culture. We are constantly looking for new and innovative ways to share learning.

83. In many cases the delays have been attributed to demand vs resources.

Investigations have also identified human factors and individual dispatch errors.

84. There are a number of activities being undertaken across the Trust to

ascertain the root cause of this dissatisfaction and identify improvements. Patient Experience Contacts Performance against Target Timescales 2016/17 Complaints acknowledged within 3 days: April - 86% May - 95%

June - 98% July - 97% August - 96% September - 100% October - 95% November - 100% December - 100% January - 100%

85. The number of complaints acknowledged within 3 days of receipt, in accordance with the NHS regulatory timescale, shows a sustained performance as a result of the new processes designed and embedded within Patient Experience Team (PE team).

Complaints closed within 25 days: April - 11%

May - 8.5% June - 13% July - 20% August - 29% September - 48% October - 44% November - 32% December - 36% January - 24%

86. It is recognised that performance remains unsatisfactorily below target, and has dropped in January. This is due to the continuing number of outstanding cases that the PE Team are reviewing, chasing, updating and closing as part of the ongoing improvement activities.

87. In Dec16 the Trust received 27 formal complaints, and closed 47, 20 more

than were received. In Jan17 the Trust received 20 formal complaints, and closed 70, 50 more than were received. Therefore, in this two month

of 32

reporting period the Trust closed 70 additional complaints than were received, many of which had exceeded timescale thus reducing performance to target for the month. There are currently 56 open complaints across the divisions of the Trust.

88. Although a formal complaint may have exceeded the target timeframe for a

response, assurance is provided that each complaint receives a full investigation undertaken by a manager in the relevant service area. PE Team review each draft response to ensure that all issues raised in the complaint are responded to clearly and comprehensively. PE Team will return a draft response for further work if it does not meet Trust requirements. Each formal complaint is reviewed and signed by the relevant Director of Service.

89. The PE team are working hard to improve communication with complainants

to agree timescales and to try to ensure complainants are kept updated with the progress of their investigation.

90. The PE team are working with all areas of the Trust to improve quality and

timeliness. The PE Team delivered a number of training sessions across the Trust during Q3 2016/17 which impacted our available resource to close cases within timescales during the quarter. The PE Team has embedded clear and regular weekly chase protocols within our processes.

PE Complaints closed December 2016 & January 2017 % Upheld / Partly Upheld / Not Upheld DECEMBER 2016 Complaints Closed 47 % Upheld 23 49% Partly Upheld 14 30% Not Upheld 10 21%

JANUARY 2017 Complaints Closed 70 % Upheld 35 50% Partly Upheld 12 17% Not Upheld 23 33%

Parliamentary & Health Service Ombudsman (PHSO):

91. 5 final decisions were received in Q3 2016/17 – 2 not upheld, 2 upheld, 1 partly upheld.

92. One upheld final decision has been challenged with the PHSO as the Trust does not share the view of the PHSO conclusions. The Trust is awaiting the outcome of further consultation on this case. As a result of one decision, the Trust has issued a PHSO case learning document in anonymised format to share the specific case learning trust wide. Two outstanding cases remain under investigation with the PHSO.

of 32

Surveys & Patient Feedback:

93. NHS111 Survey Plan for 2016/2017 was achieved which ensured surveys were distributed in a timely way, with responses uploaded to meet Commissioners reporting timescales.

94. PE Complaints Survey was issued in January 2017 to seek feedback from

complainants who had received a formal complaint response in Q3 2016/17. 101 surveys were issued, 25 responses were received. The feedback is under analysis and will enable us to assess the effectiveness of the new and revised processes which were designed and embedded in Q1 and Q2 and inform further review and improvement from Q1 2017/18.

95. A link to the online patient survey has now been added to three further

pages of the SCAS website; Contact Us, Social Media and Send Us Your Views. We hope this will encourage an increase in the number of patients providing feedback via this method.

96. The PE Team continues to monitor NHS Choices as a source of feedback

although contact received via this channel is minimal. Patient Experience Audit:

97. The Trust’s external auditors, BDO, carried out an audit of Patient Experience processes in November and December 2016. Their outcome report has not yet been presented to the Trust’s Audit Committee. We expect this to be presented to the next Committee.

Patient Forums:

98. Hampshire Patient Forum took place on 1st December 2016 in Basingstoke, Hampshire.

99. Head of PE has attended two Sussex PTS Patient Forums ahead of the PTS

Sussex contract going live on 1st April 2017. PTS patients in Sussex have been heavily engaged in monthly Patient Forums held by the Commissioners due to the number of ongoing issues with the outgoing PTS provider. The Head of PE has explored and acknowledged their issues and concerns, and ensured this is fed back via the SCAS Quality Lead and Senior Project Manager for the PTS Sussex Contract.

Patient Experience Activities:

100. New and improved processes continue to be designed and embedded to increase efficiency and performance.

101. The more extensive use of the Datix system in the management of complaints

/ concerns / HCP feedback continues to deliver enhanced data capture along with reducing the number of ‘touch points’ on each PE issue and ensure tracking and responses are completed in a more timely and efficient manner. Improved reporting of complaints, concerns and HCP feedback via Datix PE module, is allowing for clear identification of themes and trends. The process changes are also supporting the new ‘chase’ protocols that have been embedded with the intention of improving timeliness of complaint responses. The improvement work in this area continues. The PE team continue to promote the use of the Datix dashboards which have been set up and made

of 32

available to each service area. Each dashboard gives real time information on the status of each open PE case.

FUTURE PERFORMANCE Plans for Sustaining/Improving Performance for Patient Experience

102. The PE team has received further requests to attend Operations team meetings. Dates have been scheduled for Q4 16/17. Additionally, the two Senior Patient Experience Officers have worked from stations for the day, to be available to Team Leaders for deskside one to one support with current outstanding cases. These ‘work from station’ days have been very well received and will continue.

103. The PE team will continue to deliver training sessions across the Trust to

focus on providing clear guidance to record, manage timeliness, update and respond to complaints, concerns and Healthcare Professional (HCP) feedback in line with good practice. Through these sessions the PE Team will deliver guidance on enhanced Datix use. It is evident through the figures noted in this report that the PTS Team are improving their use of Datix following these sessions delivered in Q3. Additional training sessions / workshops will take place in Q1 17/18 for PTS Contact Centre staff, EOC and NHS111 investigating officers.

104. Further essential enhancements are required to Datix to mature the system to

meet the current needs of the Trust. The Trust has requested further technical support from Datix to support us with these changes. The Trust has also requested that Datix deliver a further training day specifically on reporting of Patient Experiences and Incidents. The training has been scheduled to take place in Q1 17/18.

Patient Stories Non-Emergency Patient Transport Service (PE7160) Subject: Staff Attitude

105. A renal patient complained about the attitude of a PTS driver on return journey home following treatment. The patient claimed to have offered to enter the ambulance via the side door but the driver abruptly refused. The patient also claimed that another patient was dropped off home first at an address which was much further away than the patient's own home. The patient said the driver did not give a reason for taking that route. In addition, the Patient claimed not to have liked the attitude of the driver and felt the driver was abrupt in dealing with the patients on the vehicle.

106. The Investigating Officer (IO) reviewed the journey details. This was a multi

pick up vehicle. There were three patients on board. One was going to a local address in Oxford, the other travelling to Abingdon. The reason for dropping one of the patients at their home address before the complainant was due to geographical area and the planning of the journey. Had the complainant been taken home first, the crew would have had to double back on themselves, meaning the other two patients would have been on board longer than necessary.

107. The member of staff was interviewed by the IO and explained that the

intention was to allow the complainant to enter the vehicle from the side step

of 32

for safety reasons. The member of staff assured the IO that the intention was not to come across as abrupt.

What we did:

• IO contacted complainant by telephone to apologise and to explain the reasons for planning the journey in that route.

• Sincere apology given for distress caused as a result of the incident. • Assurance given that crews will be reminded of the expected standard of

conduct towards patients. • Written response and apology issued and signed by Deputy Chief Executive.

NHS111 (PE7001) Subject Area: Clinical Care

108. Complaint received via West Hampshire Clinical Commissioning Group who asked for the response to be issued via their office and not direct to the complainant. The complainant claimed to be in severe pain with a compressed nerve in the neck following an accident and that the previous day patient was given Diazepam by an out of hours GP but it did not help. The complainant phoned NHS111 distressed and in pain and claimed to have been advised by NHS111 Call Handler that an out of hours GP would call back but complainant told the CCG no one did.

109. NHS111 Clinical Shift Manager reviewed the episode of care. The outcome of

the triage was to speak to an out of hours (OOH) GP within 24 hours. The call details were passed to the OOH provider and SCAS received an electronic return to confirm receipt. The call was audited and found to be non-compliant to NHS Pathways protocols in one area, however the outcome of the call was clinically safe. Patient called back to chase the OOH GP call. The NHS111 call handler advised that the call could not be quickened. This call was audited and it was found that the call handler did not follow local procedure for calls of this nature, and they failed to electronically transfer the details of the call back across to the OOH GP provider for a one hour call back.

What we did:

• Sincere apology given for distress caused by this incident. • Explanation given of how the NHS111 service works and interacts with other

service providers. • The result of the first non-complaint call audit was fed back to the NHS111

call handler to ensure learning takes place and to prevent recurrence. • The result of the second call handling error has been fed back to the NHS111

call handler to ensure learning takes place and improvements are being closely monitored.

• Unreserved apology given for the experience of the NHS111 service. • Assurance that we have taken the matter extremely seriously and actions are

in place with the staff members involved to ensure this does not happen in future.

• Response and apology was signed by the Director of Clinical Coordination Centre.

of 32

Operations (PE7700) Subject Area: Staff Attitude

110. We received a complaint from the patient’s child regarding the crew that attended to the patient. The patient’s child was unhappy with the attitude of the paramedic who attended, and claimed that the paramedic exuded stress, had a suspicious attitude and gave off a very negative vibe. The complainant also claimed to have felt that the paramedic’s 'bedside manner' was poor and lacked diplomacy.

111. The IO spoke to the staff involved and took statements. From the review of this case, the IO identified that the complainant’s sibling had requested a GP home visit from the patient`s surgery. The complainant was not aware of this and was concerned that an unsolicited ambulance had been sent, which was not the case. It was clear that when the Specialist Paramedic (SP) and the GP from a local GP surgery (not the patient`s own surgery) arrived in a marked SCAS vehicle, the complainant was annoyed as he had not requested an ambulance and felt that there was no problem with the patient.

112. The request for a GP visit had been passed to the newly commissioned GP morning visiting service that has not been running for long in the Basingstoke area (Early Bird GP Scheme EBGP – a partnership between SCAS and certain Basingstoke Group Practices to provide a GP or SCAS Practitioner for a home visit service). The poor communication experienced was due to confusion on the part of the GP and the SP as they both thought they had either visited the wrong patient or the wrong address. The misunderstanding may have given the impression of a poor attitude. The IO identified the SP and GP could have made the situation much clearer and explained fully about the new service. The SP was very apologetic for coming across in this manner and has assured the IO they will be extremely mindful in future about their attitude and the perception of this.

What we did:

• Offered a sincere unreserved apology to both the patient and the complainant.

• Assured the patient and complainant that lessons had been learned from this complaint.

• Response and apology was signed by the Director of the Service.

of 32

CLINICAL EFFECTIVENESS CURRENT PERFORMANCE Clinical Effectiveness BAF Risk 1.1 & 1.2 (CQC REG 17, KLOE- E1, E2, E3, E4, E5, W2, W3, W5, & S2) Key Performance Indicators (KPIs) for Clinical Effectiveness February 17 Longest Red 1 Wait 00:29:46

January 17 – 75% @ 00:08:02 – Missed by 4 Red 1-8min Incidents | Long Waits Over 30 Mins: 4| Total Incidents: 1247 There is no graph for the tail as the longest wait is less than 30 minute. Audit findings -: None identified in this category February 17 Longest Red 2 wait 02:32:04

January 17 - 75% @ 00:08:45 – Missed by 815 Red2-8min Incidents | Long Waits Over 30 Mins: 230 | Total Incidents: 19750

of 32

The graph below outlines the profile of the long wait cases in ten minute intervals that are in excess of 30 minutes for February 2017

Audit Findings-: 7 Incidents audited randomly in this category with no adverse harm found. February 17 Red 19 Longest wait 02:32:04

January 17 95% @ 00:23:09 ‐ Missed by 787 Red 19 Incidents ‐ Long Waits over 30 minutes: 479 ‐ Total Incidents: 20985. The graph below outlines the profile of the long wait cases in ten minute intervals that are in excess of 30 minutes for February 2017

Audit Findings -: No harm identified in this group

of 32

February 17 Green 60 Longest wait 05:44:41

January 17 ‐ 90% @ 02:14:00 ‐ Missed by 650 Green 60 Incidents ‐ Long Waits over 2Hours: 314 ‐ Total Incidents: 2694. The graph below outlines the profile of the long wait cases in 30 minute intervals that are in excess of 30 minutes for February 2017

Audit Findings -: 4 Incidents were identified audited and no harm was identified. National Clinical Performance Indicators (NCPI)

Clinical Quality Indicator Units East Midlands

East of England

Isle of Wight

LondonNorth East

North West

South Central

South East

Coast

South Western

West Midlands

Yorkshire

Asthma Care Bundle % 72.8 82.4 95.8 62.0 35.0 72.8 69.7 79.0 69.7 82.7 66.1Single Limb Fracture Care Bundle % 47.6 40.5 78.6 40.7 38.2 60 43.8 51 47.8 49.2 43.3Febrile Convulsion Care Bundle % 77.3 76.8 100.0 28.7 59.8 82.8 88.6 84.1 74.7 70.4 91.3Elderly Falls Care Bundle % 11.0 69.7 43.8 26.3 7.0 40.0 95.3 12.3 40.0 2.3 23.0Mental Health Self harm (Pilot) 13.6 74.3 56.3 43.3 57.3 44.0 69.7 69.7 48.7 22.3 64.3Rag key 1st 2nd 3rd 4th

National Clinical Performance Indicators Cycle 16 Year to Date Upper Quartile Rating December 2015 to June 2016

If highlighted represents within upper quartile


East of England

Isle of Wight

LondonNorth East

North West

South Central

South East

Coast

South Western

West Midlands

Yorkshire

Asthma Care Bundle % 64.9 86.7 66.7 65.7 64.8 77.9 66.4 74.0 59.3 84.7 69.0Single Limb Fracture Care Bundle % 28.6 51.4 66.7 30.7 67.3 53.5 58.4 54.3 70.0 55.8 44.7Febrile Convulsion Care Bundle % 69.4 100 0 40.3 72.7 82.3 92.3 56 86.5 89.3 84.4Elderly Falls Care Bundle % 17.4 69.3 50.0 48.7 26.5 46.3 89.3 4.0 12.0 10.6 12.3Mental Health Self harm (Pilot) %Rag key 1st 2nd 3rd 4th

National Clinical Performance Indicators Cycle 17 Year to Date Upper Quartile Rating June 2016 to December 2016

If highlighted represents within upper quartileCancelled

of 32

113. The two tables above show the care bundle compliance for all the English ambulance Trusts by National Clinical Performance indicator (NCQI), Cycle Rag rated for the upper quartile. SCAS has been rated in the upper quartile for three out of the five for cycle 16 and three out of the four audits completed for cycle 17. The Mental Health audit has been cancelled due to the review of the indicators being undertaken at a national level.

Ambulance Clinical Quality Indicators (ACQI)


East of England

Isle of Wight

LondonNorth East

North West

South Central

South East

Coast

South Western

West Midlands

Yorkshire

STEMI - Care % 85.06% 91.19% 61.54% 70.52% 81.73% 86.82% 70.50% 69.20% 77.61% 80.20% 87.09%Stroke - Care % 98.69% 99.13% 97.20% 96.76% 97.67% 99.67% 98.46% 96.00% 94.30% 97.69% 98.49%STEMI - 60 % - - - - - - - - - - - STEMI - 150 % 92.05% 91.24% 35.71% 91.63% 92.04% 81.92% 87.54% 90.86% 71.70% 87.62% 85.59%Stroke - 60 % 55.43% 50.80% 65.71% 63.69% 59.56% 53.76% 43.06% 67.27% 35.29% 56.69% 47.13%ROSC % 26.03% 28.81% 9.76% 29.61% 26.02% 36.43% 32.28% 27.89% 24.63% 31.33% 26.41%ROSC - Utstein % 49.06% 57.06% 23.08% 55.64% 69.41% 62.07% 45.13% 54.40% 44.62% 49.28% 51.29%Cardiac - STD % 7.29% 8.96% 7.32% 8.83% 8.53% 9.53% 13.23% 8.42% 7.86% 9.19% 10.08%Cardiac - STD Utstein % 20.28% 31.90% 15.38% 26.29% 44.30% 30.56% 24.40% 28.82% 20.66% 23.19% 32.02%Rag key 1st 2nd 3rd 4th If highlighted represents within upper quartile

Ambulance Clinical Quality Indicators YTD Apr to September 2016/17 Upper Quartile Rating

114. The table above shows SCAS in the upper quartile for two of the eight ACQI’s. This table relates to the six months of 2016/17 as there is a four month delay in the clinical reporting being published for the ACQIs.

115. The table below shows the lower and upper compliance rate for each of the indicators and the gap difference to demonstrate where national comparisons are difficult to draw (the wider the gap the least confidence). The national average is included and SCAS has equal to or greater than the national average in 4 of the 8 indicators and below average in 4.

Clinical Quality Indicator Lower Upper DifferenceNational Average

South Central

Greater or lower

than Average

STEMI - Care 61.54% 91.19% 29.65% 79.58% 70.50% Stroke - Care 94.30% 99.67% 5.37% 97.59% 98.46% STEMI - 60 -STEMI - 150 35.71% 92.05% 56.34% 86.33% 87.54% Stroke - 60 35.29% 67.27% 31.98% 54.87% 43.06% ROSC 9.76% 36.43% 26.67% 28.98% 32.28% ROSC - Utstein 23.08% 69.41% 46.33% 52.51% 45.13% Cardiac - STD 7.29% 13.23% 5.94% 8.98% 13.23% Cardiac - STD Utstein 15.38% 44.30% 28.92% 27.12% 24.40% Key Performance Factors for Clinical Effectiveness NCPI/ACQI themes and trends

116. Although SCAS is still above the national average in four of the eight ACQIs,

SCAS only remains in the upper quartile in two of the eight indicators after six months of data submission. The Stroke Care Bundle is where SCAS has just dropped out of the upper quartile however SCAS remains above average but with a range of just 5.4% across the country only a very small drop or increase can move a trust into or out of the upper quartile.

of 32

CLINICAL EFFECTIVENESS FUTURE PERFORMANCE Plans for Sustaining/Improving Performance for Clinical Effectiveness NCPI/ACQI improvements

117. The STEMI compliance tool was released into the live ePR system in early December 2016. The data has been reviewed and shows an improvement but not all the paper records are validated so the final figure will not be known until April 2017. The rest of the compliance tool Change Control Notices (CCN’s) are being drafted for submission to Ortivus for pricing, but there is potential that the Stroke care bundle and the mental Health audits will be dropped nationally.

RECOMMENDATIONS TO THE BOARD

118. The Board is asked to note the contents of this report and the ongoing activity to address any areas of concerns raised within the report and to further enhance learning across the Trust to continually improve the quality of service provided to patients.

Deirdre Thompson Director of Quality and Patient Care March 2017

Agenda Item: 9



Title Quality Accounts Progress and Quality Improvement Priorities for 2016/17 accounts

Lead Director Deirdre Thompson, Director of Quality and Patient Care

Purpose of the paper

To provide a draft version of the Quality Improvement Priorities for the 2016/17 Quality Report and report progress to date on the 2015/16 Quality Accounts.

Recommendation (eg. note, approve, endorse)

The Trust Board is asked to endorse the Quality Account priorities for 2016/17 in readiness for submission to this Board in May 2017 and NHS Improvement on 31st May 2017.









Please provide details of the risks associated with the subject of this paper

The Quality Priorities need to be developed and agreed in time for inclusion into the final Quality Report for submission to the May 2017 Trust Board. Stakeholder engagement with a wide range of our local community and staff has been undertaken for views on the proposed priorities including commissioners and HOSC’s. Ensuring the quality improvements identified are in line with SCAS clinical risks as detailed in the trust risk register. Links to BAF numbers: 1.1, 1.5

Implications Regulatory and legal implications / impact (e.g. provider licence and segmentation ratings, CQC essential standards, competition law etc.) Links to all CQC fundamental standards and outcomes. This report and Quality Accounts are a requirement of NHS Improvement and NHS England as outlined in the FT Annual Reporting Manual for NHSI.


Financial implications have been considered – none directly linked to this report.


The Trust is required to engage with the Council of Governors (CoG) in developing Quality Improvements through the Quality Accounts and the Council of Governors are invited to choose a mandated indicator for external assurance. This first part of the process will be undertaken at the CoG meeting in April 2017 (the indicator has already been selected).

Patient / staff implications (e.g. linked to NHS Constitution, equality and diversity) Links to all parts of the NHS Constitution on staff and patient rights; Supports patient, staff and public engagement through seeking feedback on the proposed quality initiatives; Quality Accounts support all Equality and Diversity parameters and indicators; Supports Annual Staff Survey results and subsequent actions.

Other

Author of the paper Debbie Marrs, Assistant Director of Quality

Presenter of the paper Deirdre Thompson, Director of Patient Care

Previous considerations

Council of Governors meeting 01/02/17 (for local quality indicator for testing); Executive Management Committee 21/02/17; Clinical Team meeting December 2016; Quality and Safety Committee November 2016 and 02/03/17; Letter to CCGs/HOSC’s and Healthwatch committees 21st February 2017


Mandatory reporting against a core set of quality indicators (NHS England) 2017 Gateway Reference: 06251; Monitor (2010) Quality Governance Framework; Francis (2013) Mid Staffordshire Hospital NHS FT Public Inquiry; Keogh. B (2013) Review into the quality of care and treatment provided by 14 hospital trusts in England; Berwick. D (2013) A promise to learn – a commitment to act. Improving the safety of patients in England; NHSI (2017) The NHS Foundation Trust Annual Reporting Manual 2016/17; NHSI (2017) Detailed Guidance for External Assurance on Quality Reports. February 2017

of 4


QUALITY ACCOUNTS PROGRESS AND QUALITY IMPROVEMENT PRIORITIES FOR 2016/17 ACCOUNTS

PURPOSE

1. The purpose of the paper is to outline the proposed quality improvement priorities for the 2016/17 Quality Report including mandated Quality Accounts. The Board is asked to note progress to date on the 2015/16 Quality Accounts and approve the priorities for the coming year.

EXECUTIVE SUMMARY

2. A quality account provides the public, our commissioners and staff information about South Central Ambulance Service’s quality of care to patients, carers and families. It is part of the Annual Reporting requirements for NHS Improvement (NHSI). It also provides a framework to assess the quality of the service on what matters to patients.

3. The Quality Accounts provide assurance about our commitment to improve the

quality of the services we provide and demonstrate a shared understanding of what is important. The Quality Report and Accounts set out our vision for quality improvements in a way that engages local communities, patients, key stakeholders and staff.

4. The accounts are publically available documents, are sent to NHS England and

NHSI, published on our website and NHS Choices, and are delivered through local clinical leadership, monitoring processes such as audit and surveys and analysis of incidents/complaints/claims as well as a range of other performance measures.

5. Quality reports encourage Foundation Trust Boards to focus on quality

improvements and take ownership for priorities and measures within them. It provides an opportunity for a wide debate on quality.

KEY ISSUES Review of progress to date. 6. The progress on the 2015/16 Quality Priorities to quarter 3 are outlined in the table

below showing an ‘at a glance’ RAG rating of achievement.

Priority Achieved 1a. Improve the recognition of sepsis in children under five years on in CCC

1b. To develop systems so that discharge summaries are sent electronically in all areas of SCAS

of 4

Mandated indicators (ambulance services) for the 2016/17 Quality Accounts.

7. For ambulance Trusts the mandated indicators for quality remain the same as the previous year as described in the detailed requirements for quality reports 2016/17 NHSI.

• To report on Ambulance response times (Red 1 and Red 2 calls 8 mins and

19mins) benchmarked nationally • To report on heart attack (STEMI) and stroke care bundles (benchmarked

nationally) • The data made available to the National Health Service Trust or NHS

Foundation Trust by NHS Digital with regard to the percentage of staff employed by, or under contract to, the Trust during the reporting period who would recommend the Trust as a provider of care to their family or friends.

• The data made available to the National Health Service Trust or NHS

Foundation Trust by NHS Digital with regard to the number and, where available, rate of patient safety incidents reported within the Trust during the reporting period, and the number and percentage of such patient safety incidents that resulted in severe harm or death.

Other recommended (not mandated) suggestions from NHSI • How you are implementing the Duty of Candour • The patient safety improvement plan as part of the Sign Up To Safety

campaign • Most recent NHS Staff Survey results for indicators KF26 (percentage of staff

experiencing harassment, bullying or abuse from staff in the last 12 months) and KF21 (percentage believing that Trust provides equal opportunities for career progression or promotion) for the Workforce Race Equality Standard1

• CQC ratings grid, alongside how you plan to address any areas that require

improvement or are inadequate, and by when you expect it to improve.

1c. To develop feedback mechanisms for health professionals who report incidents via the Datix system

Ongoing for PTS/999

2a.To ensure the long wait reviews have clear actions that are monitored and the effectiveness measured

On Track

2b. To proactively manage high intensity users to reduce reactive frequent calls and provide better support

On Track

2c. Improve compliance with limb fracture care bundle 3a. To improve the number of formal complaints responded to on time by the Trust

3b. To increase support for patients in their own home/care home when they are reaching the end of life

On Track

3c. To ensure the wide range of patient feedback including surveys in considered regularly. All reviews on NHS Choices website relating to the Trust will be responded to in two working days.

of 4

8. SCAS will be including the above as recommended in the 2016/17 Quality Account.

Proposed Quality Improvement priorities.

9. The priorities have been developed from engaging with staff and stakeholders and follow emerging themes identified throughout the year and address some of our challenges. They are also developed from feedback from users of our services including staff, patients and other professionals and our CQC actions.

10. They cover a range of topics selected as an ongoing process from identified

clinical risks, priorities from complaints and from our clinical committees. They include feedback and intelligence from a range of sources including: (not exclusive)

• Surveys from users • HCP feedback • Public feedback including complaints, concerns, compliments • Serious Incidents • Adverse incidents • CQC compliance actions • Audits (internal and external) • Committee reports and actions • Leadership walkrounds • Feedback from key stakeholders (Healthwatch/CQRM/Commissioners)

11. The priorities follow the three key elements of quality (safety, effectiveness and

experience) and are described below. Patient Safety

• To complete a clinical governance review of the E&UC 999 service and

implement recommendations. • To improve the recognition of sepsis in adults in CCC (call centres) and E&UC

(emergency and urgent care). • To continue to implement the workstreams in the national Sign up to Safety

campaign to improve patient safety across all services • To provide a consistent approach to medicines management which is compliant

with regulatory standards. Clinical Effectiveness • To report on the percentage of Category A telephone calls (Red 1 and Red 2

calls) resulting in an emergency response by the trust at the scene of the emergency within 8 minutes of receipt of that call during the reporting period. (mandated).

• To report on the percentage of Category A telephone calls resulting in an

ambulance response by the trust at the scene of the emergency within 19 minutes of receipt of that call during the reporting period. (mandated).

of 4

• To report on the percentage of patients with a pre-existing diagnosis of suspected ST elevation myocardial infarction who received an appropriate care bundle from the trust during the reporting period. (mandated).

• To review and improve call abandonment for PTS, 999, 111 (2 year priority). • To increase clinical assessments in CCC ensuring consistent methods and

application across the services (3 year priority).

Patient Experience • To report on the Friends and Family test (FFT), staff and patients, and to

continue to seek feedback and act on results. • To improve and learn from HCP (Healthcare Professional) feedback in all

services (NHS111, PTS and 999). • To ensure a service that is responsive to, and listens and engages with

feedback from all sources especially hard to reach groups.

CONCLUSIONS

12. External limited assurance will be required on a chosen indicator and the mandated indicators in line with the Annual Reporting Manual for Foundation Trusts.

13. Commissioners will provide a full report in response to the Quality Report and

Accounts which must be included in the final report. Any feedback from Healthwatch and HOSC’s will also be included.

14. The clinical data set for quarter 4 (Q4) is to be completed in April 2017 and the

measurement criteria for the new priorities will be developed at the end of Q4.

15. Quality Accounts will be uploaded onto NHS Choices and the SCAS website in June 2017.


16. The May 2017 Board meeting will be required to sign the Directors responsibilities statement and approve the final Quality Report and accounts.

17. The Trust Board is asked to approve the draft quality improvement priorities for the

2016/17 Quality Accounts thus far. Author: Debbie Marrs Title Assistant Director of Quality Date 14th March 2017

Agenda Item: 10a



Title Operational Performance Report – 999, 111 and Fleet Services

Responsible Director Philip Astle, Chief Operating Officer

Recommendation (eg. note, approve, endorse) To note










There are a range of operational performance risks on the Board Assurance Framework, including in relation to resources, handover delays, and emergency services performance.

Implications Regulatory and legal implications / impact (e.g. provider licence and segmentation ratings, CQC essential standards, competition law etc) Operational performance has particular regulatory implications; for example, reporting to NHS Improvement covers performance on the national response time standards, and is one of the five themes assessed under the Single Oversight Framework.


There are financial implications associated with delivering the required standards of operational performance; usually this applies to periods where demand is high and in excess of planned levels.

Council of Governor implications / impact (e.g. links to governors statutory role, significant transactions etc) Council of Governors typically receive an update on operational performance every meeting which is either by means of the monthly Integrated Performance Report or a report from the Chief Executive/Chief Operating Officer. Patient / staff implications (e.g. linked to NHS Constitution, equality and diversity)

Implications in terms of the services provided to patients, and a range of relevant issues in terms of staff (including workforce availability/utilisation, rota patterns, staff support etc)

Other Previous considerations by the Board Operational performance is discussed at every meeting

Background papers / supporting information N/A

of 10


OPERATIONAL PERFORMANCE REPORT – 999, 111 AND FLEET SERVICES

PURPOSE 1. The purpose of the paper is to update the Board on February 2017

performance and provide an update on plans in the 999 and 111 arenas. EXECUTIVE SUMMARY 2. The 999 team have achieved all three red targets for the month for the first

time in the financial year. An unexpectedly steep drop in demand during February helped with performance but has had a significant adverse impact on Trust income. We have been reducing private provider hours during the month, most significantly in Hampshire, to cut costs but unit hours utilisation (UHU) has been below the target. Call answer performance has also improved significantly and 95% of calls are now answered within 7 seconds. Hospital delays remained significant although down on January’s record setting figures. We are on target to hit Red 1 for the Quarter.

SCAS - Total Demand and Performance

Red Activity vs PY Red Activity / Day Total Activity vs PY Hospital Waits (hrs) Red 19 Waits Red2 75% (mins) Red 19 95% (mins) Call Answer 95% secs

4.53% 640 -7.45% 1501 123 07:57 18:11 7

Red 1 Red 2 Red 19 Green 30 Green 60Feb-17 76.7% 75.5% 95.7% 66.5% 92.7%

Quarter 1 74.3% 73.7% 95.1% 62.3% 91.1%

Quarter 2 70.4% 72.9% 94.4% 57.5% 90.0%

Quarter 3 73.0% 72.4% 94.4% 60.2% 90.8%

Quarter 4 75.6% 73.3% 94.7% 62.3% 91.4%

YTD (to Feb 17) 73.2% 73.0% 94.7% 60.4% 90.8%

of 10

SHP - Contract Demand and Performance


Quarter 1 73.1% 71.4% 94.7% 59.9% 91.4%

Quarter 2 71.2% 72.8% 95.1% 59.3% 91.8%

Quarter 3 74.3% 72.7% 95.2% 62.2% 91.8%

Quarter 4 76.3% 71.9% 94.7% 60.3% 90.6%

YTD (to Feb 17) 73.6% 72.3% 95.0% 60.4% 91.5%

TV & MK - Contract Demand and Performance


Quarter 1 75.2% 75.4% 95.4% 64.2% 90.9%

Quarter 2 69.8% 72.9% 93.9% 56.2% 88.4%

Quarter 3 72.1% 72.1% 93.8% 58.7% 89.9%

Quarter 4 75.1% 74.3% 94.8% 63.8% 92.1%

YTD (to Feb 17) 72.8% 73.6% 94.5% 60.0% 90.1%

* SCAS and contract level data includes all upgrades. Note Feb 2017 had one day less than Feb 2016, hence the drop in demand. 3. Demand has fallen away in February and was significantly lower than in

February 2016 – a fact that is only partially explained by 2016 being a leap year and February 2016 having 29 days.

42,00043,00044,00045,00046,00047,00048,00049,00050,00051,000

999 Total Demand - All IncidentsNote: Feb 16 had 29 days

4. 111 performance for February improved from January but call answer

performance is being hampered by high seasonal sickness and significant vacancy factors. Call abandonment rates are once again averaging below 2%.

of 10

30%

40%

50%

60%

70%

80%

90%

100%

70,000

80,000

90,000

100,000

110,000

120,000

130,000

Feb 1

6

Mar

16

Apr 1

6

May

16

Jun 1

6

Jul 1

6

Aug 1

6

Sep 1

6

Oct 1

6

Nov 1

6

Dec 1

6

Jan 1

7

Feb 1

7

Calls

Ans

were

d in

60 Se

cond

s

Calls

Ans

were

d

111 Projected vs Actual Calls Answered

Projected Call Answered Actual Calls Answered Calls Answered in 60 Seconds

0%1%2%3%4%5%6%7%8%9%

10%

Feb

16

Mar

16

Apr 1

6

May

16

Jun

16

Jul 1

6

Aug

16

Sep

16

Oct

16

Nov

16

Dec 1

6

Jan

17

Feb

17

111 Calls Abandonment Rate after 30 sec

5. The Integrated Workforce Plan has been revised to increase recruiting and

two recruitment open days have been hosted across the North and South of the Trust. These recruitment days achieved a high footfall of over 600 visitors with significant interest in the NHS 111 service. With little change in the manning forecasts over the next month, we are predicting a very challenging Easter even though we will have lost the two smaller contracts by then.

CURRENT PERFORMANCE 999 Performance 6. For the first time in 18 months, 999 performance was above target for all

three red targets across both contracts. Whilst this is to be celebrated the drop in demand has hit our income significantly and we have been cutting the supply of private providers to maintain financial performance. This has been most obvious in the South where our roster fill levels are almost at establishment levels. The year on year comparison shows performance ahead of 2016 performance and ahead of the trajectories agreed with commissioners. There is further evidence that our performance in the South is getting stronger and this month’s performance shows what can be done when hospital delays in Portsmouth return to seasonally normal levels. .

of 10

7. Year to date demand is up year on year but it is the increase in acuity that is

the most significant factor in our performance (Red % is up over 20% year on year) and we are behind plan with recruiting across the workforce, most notably in the North West of our area of operations.

500

1000

1500

2000

2500

3000

3500

2000

3000

4000

5000

6000

7000

8000

9000

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Red

Dem

and

Ove

rall

Dem

and

Demand profile by hour of day - Q3

Red Q3 2016/17 Red Q2 2015/16 Overall Q3 2016/17 Overall Q3 2015/16

Emergency Operations Centre (EOC) 999 Performance 8. Our most urgent recruiting challenge at the end of last year was to improve

999 call answer performance to achieve the required national standard of 95% within 5 seconds. That work has been successful and both Emergency Operations Centres are very close to full manning. Call answer has continued to improve throughout February with an outturn of 7 seconds for the 95th percentile and an abandonment rate of 0.23%. The 75th percentile for calls answered within 5 seconds has reduced to 3 seconds.

9. Hear and Treat rates have fallen in recent months as we have been

concentrating part of our clinical resources on reducing the flow from 111. We plan to increase hear and treat through the increase in clinical pathways that comes with the integration of urgent care systems and the green code review.

Staff Sickness 10. Staff sickness has improved considerably in 999 operations and is very close

to target after a bout of seasonal sickness combined with high stress and muscular skeletal incidents. EOC sickness has also improved but less markedly. The outlier is 111 sickness, which is still increasing and is

of 10

connected to the high vacancy rate leading to a high pressure environment with infrequent breaks between calls. This is the point of main effort for the management team and it is predicted that the influx of new staff will shortly have an effect.

Resources 11. Planning utilisation ratios have been amended to 0.395 reducing the hours

required by circa 1500 hours per week. Private provider hours have been cut by 2500 hours to ensure financial balance is maintained. This cutting of private provider hours carries the risk that we will lose some capability permanently and so we are managing this risk by keeping the best suppliers with the most business.

.

Hospital Handover Delays 12. Hospital handovers delays have decreased significantly with demand across

the system and this has flowed through into our success against targets. That said the improvement has not been maintained into March and we will see higher delays next month.

240:00:00

720:00:00

1200:00:00

1680:00:00

2160:00:00

2640:00:00

Delay

(hou

rs)

Handover and Clear Up Excess

Handover Excesses Clear Up Excesses Cycle Time 13. One of the key deliverables for the Operations team this year is to reduce the

cycle time. Without this being delivered we are having to spend more on

of 10

private providers to achieve performance. The chart below shows the scale of the challenge. The peak in February and March gives us a target to aim at and we are, for the first time, seeing that we have improved cycle time over last year. A significant factor is hospital delays (as can be seen by the shape of the curve compared to the hospital delay table above) and we are hopeful that the delays in March will not be so great that we slip back behind last year’s performance. In 2016/17 we have a target of a four minute improvement and it is no longer possible to hit that target. For 2017/18 we have a target of 2 minutes improvement over this year’s performance and we are in a good place at the start of the year.

1:24:00

1:25:00

1:26:00

1:27:00

1:28:00

1:29:00

1:30:00

1:31:00

Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17

Tota

l Job

Cyc

le

999 Total Job Cycle – Based on 2016/17 CIP logic

2017/18 Operations Planning 14. The draft 2017/18 operational plan for 999 has been considered by the

executive and is being negotiated with commissioners. It will be complete by the end of the month and the trajectories will be included in future Board papers.

NHS 111 Performance 15. SCAS NHS 111 performance remained challenging during February as

predicted. The monthly out turn for call answer within 60 seconds was 89.1% which is a small improvement on the January outturn. The abandonment rate remained strong at 1.34% which is an improvement on the January outturn of 2.56%. The national target is 5%. This indicates that again a safe service was delivered but with delays in calls answered. The weekends remain the most challenging periods, both for demand and short term abstractions. There are external pressures still evident across the health care economy especially in primary care with GP Out of Hours services having delays with calling patients back and home visiting. This was especially apparent in the Hampshire area. National contingency was again involved for Herts Urgent Care NHS 111 on 26 February; this was a Sunday and happened in the peak demand time between 0900 and 1030 hours. The Bedfordshire and Luton contracts come to an end at the end of March and this will help with the challenges of resourcing the 111 service. Meanwhile we seek alternative locations where we can lodge some staff with another service in an area of higher unemployment.

of 10

0.00%10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

Feb 1

6

Mar

16

Apr 1

6

May

16

Jun 1

6

Jul 1

6

Aug 1

6

Sep 1

6

Oct 1

6

Nov 1

6

Dec 1

6

Jan 1

7

Feb 1

7

Calls Answered In 60 Secs (%)

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

13 M

ar

27 M

ar

10 A

pr

24 A

pr

08 M

ay

22 M

ay

05 Ju

n

19 Ju

n

03 Ju

l

17 Ju

l

31 Ju

l

14 A

ug

28 A

ug

11 S

ep

25 S

ep

09 O

ct

23 O

ct

06 N

ov

20 N

ov

04 D

ec

18 D

ec

01 Ja

n

15 Ja

n

29 Ja

n

12 F

eb

26 F

eb

Calls Answered

NHS 111 to 999 Transfer Rate 16. The transfer rate of 111 calls to 999 is a key factor in the demand management

element of managing 999 performance. This transfer rate is improved for the third month in a row due to the active management of the flow by the clinical advice line. This group targets the green calls that are passed to 999 and is successful in diverting over 50% of these calls to another service. Our target is to transfer fewer than 10% of calls to ambulance crews. The chart below shows performance has improved and we achieved a transfer rate of 9.3%.

9.00%9.20%9.40%9.60%9.80%

10.00%10.20%10.40%10.60%10.80%11.00%

Feb 1

6

Mar 1

6

Apr 1

6

May 1

6

Jun 16

Jul 16

Aug 1

6

Sep 1

6

Oct 1

6

Nov 1

6

Dec 1

6

Jan 17

Feb 1

7

111 Referrals to 999

Another two key metrics that we need to improve in the 111 service are the warm transfer rates and the call back within 10 minutes rates. Both metrics are reliant on the ratio of clinicians to calls and we are seeking additional funding from commissioners to raise the ratio from 20% to 30% following guidance from NHS England that this should be provided. We also have a

of 10

significant problem recruiting nurses and the workforce team are seeking new means of recruiting and retaining staff. The new IR35 rules are a threat to this effort as many of the nurses are self-employed.

Integrated Urgent Care (IUC) NHS 111 Thames Valley (TV) Procurement 17. The TV 111 Partnership have agreed the following revised timeline with our

commissioners for the coproduction, mobilisation and service launch of the IUC service.

18. Negotiations are at a crucial stage and so no more detail will be given until

those negotiations are complete. OTHER KEY ISSUES Urgent & Emergency Care (U&E) Operational Support Activity 19. The Operations team have reviewed our Resource Escalation Action Plan

(REAP) 3 actions to ensure we are maximising our operational hours to offset the reduction in private provider hours during February and March. All non-essential meetings have been postponed; we have reviewed all secondments to identify staff to pull back into the system; and all operational managers are providing additional responding hours as well as covering bronze duties to release team leaders. We have, however, committed to keeping the team leaders on their protected time to ensure they deliver on our staff support and leadership.

Indirect Resources (IRs) 20. The contribution of our IRs continues to improve and the unique contribution

is now being sustained at over 10% for the first time ever. There are forty new Community First Responders (CFRs) being trained: this will add to our capability. The team are continuing with training Thames Valley Fire Co-responders and have started to train them in accordance with the new Intermediate Emergency Care package which is being adopted as a new national standard for co-responders. The rollout fire service no charge response to cardiac arrests has been delayed because their unions have objected and a new timetable is expected from them.

16/12/2016 01/11/201701/01/2017 01/02/2017 01/03/2017 01/04/2017 01/05/2017 01/06/2017 01/07/2017 01/08/2017 01/09/2017 01/10/2017

01/06/2017Start Mobilisation

18/05/2017Contract Signed by all parties

16/12 - 16/1TV111 Partnership formalised/

Co-production planning

1/6 - 5/9Service Mobilisation

16/3 - 16/03/2017CCG Board Approval

05/09/2017TV111 IUC Go-Live

(Tuesday)

01/03/2017 - 21/03/2017CCG March Governing Boards

5/9 - 1/10Transfer to BAU

1/10 - 1/11Mobilisation Project Close /

Lessons Learnt

18/5 - 1/6Standstill2/3 - 16/3

Output Creation

16/1 - 16/3Phase 3 - Co-production

of 10

21. The review of the IRs is being translated into an action and delivery plan

which will be considered by the Executive Team before being brought back to the next Board.

GP Support 22. We have commenced an Early Bird GP scheme in North Hampshire which is

being fully funded by North Hampshire Clinical Commissioning Group (CCG). Within the first three weeks of operating the scheme the team have attended over 120 incidents with a non-conveyance level of 75% which is an imporvement on the scheme last year. This is being seen by most CCGs as a key service which they require to release GP’s back into the surgery and we are working on a business case proposal to support this.

South Central Fleet Services (SCFS) Ltd 23. Overall the relationship between SCAS and SCFS Ltd is proving mutually

beneficial. SCFS Ltd are able to focus purely on core tasks and the operations planners have to be disciplined in their requirements. The vehicle availability over the holiday period was a marked improvement over previous years when this has been a limiting factor. The turnaround of vehicles from the workshops are within the timescales set within the Service Level Agreement and the % of vehicle off road (VOR) vehicles due to unscheduled maintenance has seen a reduction to around 16% on average compared to 18%.

24. The spend on unscheduled maintenance remains higher than budget. This is

mainly due to required maintenance on Patient Transport Service (PTS) vehicles whose leases are being extended but without contracted maintenance. The labour rate has been reduced to provide greater value for money and the company has made a small profit in line with expectations.

Alternative Transportation (private hire vehicles) 25. Following an executive review of the results of the pilot, it has been agreed to

continue to operate the scheme within the Portsmouth and South East Hampshire area and in addition, to make plans to take the opportunity to extend the scheme to other areas of SCAS operations which will be part of a phased rollout.

. 26. Plans are now underway for the next two areas to become operational in

Reading on 8 March and in the Southampton area in mid-March 2017; this is once both private hire companies have been fully validated and readiness checks have completed. When these areas become operational, day to day monitoring will continue to take place similar to the pilot scheme.

Ambulance Response Programme (ARP) 27. The ARP pilot and trial is now technically finished with the School of Health

and Related Research (ScHARR) at the University of Sheffield analysing the data in preparation for the final report (which is now expected in March). The report will build the case for permanent change in ambulance services through:

• dispatch on Disposition (at 240 seconds) and Nature of Call embedded in

all services (for Red 2 and Green Calls) • adoption of the new 4-category code set in all services

of 10

• adoption of a new set of outcome measures to support the interventions above.

28. The development of the impact assessment has been delayed; however this will be shared with the group for comment pre-publication. The National Ambulance Commissioners Network is supporting this work. An updated clinical code set is also being reviewed and plans to be approved during March and this will also result in a further reversion of Ambulance Quality Indicators’ (AQIs) clinical code set which will need to be developed in the coming months with all ambulance trusts having input. Within SCAS, a project brief is prepared and the initial focus will be to undertake an internal impact assessment / evaluation on the potential key changes with new response categories and in EOCs, Operations, fleet mix, staff skill resource mix. CAD system technical developments and reporting changes will need to be identified.

Global Rostering System (GRS) Implementation 29. The GRS system is now fully live in all operational, EOC and 111 areas.

Snagging continues and is reducing significantly. Phase I of the project has closed in February and we will move onto phase 2 which was approved at the last meeting of the Executive Team. Phase 2 concentrates on improving the user interface.

Adastra Implementation 30. The desktop PC rollout across the two clinical coordination centres is nearing

completion. Testing is still highlighting some issues and Advanced are supporting the resolutions. The system is fundamentally performing as the issues mainly relate to call flows and correct queuing although there is a significant issue with address matching between Adastra and Intergraph. Staff training will only begin once the system has tested sufficiently to ‘promise’ a stable and fully functional system. To date the system is not operationally ready. The timeline for the commencement of training has been slipped to mid-March but the completion date of July is still being projected.

RECOMMENDATIONS TO THE BOARD 31. The Board is asked to note the contents of this report and the ongoing activity

to support operational output. Philip Astle Chief Operating Officer March 2017

Agenda Item: 10b



Title Operational Performance Report – Patient Transport Services

Responsible Director James Underhay, Deputy Chief Executive Officer

Recommendation (eg. note, approve, endorse) Note









Please provide details of the risks associated with the subject of this paper (x-reference to the corporate risk register / Board Assurance Framework) • Maintenance of essential standards of care for patients • Failure to deliver financial plans and strategic aims • SCAS contractual arrangements with commissioners of its services


There are a range of regulatory implications associated with the delivery of patient transport services, including quality (regulated by the CQC) and certain provider license conditions (regulated by Monitor).


There are financial implications associated with delivering the required standards of operational performance, particularly in periods where demand is high and in excess of planned levels

Council of Governor implications / impact (e.g. links to governors statutory role, significant transactions etc) Council of Governors receive an update on operational performance at every meeting, and also receive the monthly Integrated Performance Report. Elements of PTS strategy are discussed in private with the governors as part of development of the Trust’s commercial strategy. Patient / staff implications (e.g. linked to NHS Constitution, equality and diversity)

Implications in terms of the services provided to patients, failure to deliver services in line with contract could result in patient harm, or a poor patient experience.

Other Previous considerations by the Board PTS performance is discussed at every meeting


of 10


OPERATIONAL PERFORMANCE REPORT – PATIENT TRANSPORT SERVICES

PURPOSE 1 The purpose of the paper is to give the Board an overview of the contract,

activity and performance across the Trust’s Patient Transport Services (PTS) for the months of December 2016 and January 2017.

EXECUTIVE SUMMARY 2 There continues to be challenges across the contracts reflecting the wider

NHS pressures, and often resulting from a wider NHS system change causing an increase in activity, particularly on the day ambulatory care resulting in increased on the day bookings. These journeys remain the most difficult to resource due to their unplanned nature, and this profile of activity is not reflected in current contract specifications. Negotiations continue to align contracts to current system requirements with escalations made from several acutes to commissioners requesting step changes.

3 The PTS Surrey Contract mobilisation continues with good engagement from colleagues at South East Coast Ambulance Service. The PTS Sussex transfer and discharge activity has gone live on the 1st March 2017; there have been some complications namely the estates and staffing. The mobilisation plans are continuing for the full roll out on 1st April 2017.

4 The Commercial restructure has commenced with rewriting of job descriptions to meet current work requirements, a full Board paper will be submitted for restructure review once final costings for restructure have been established.

5 The PTS management team continue to work closely with our 999 colleagues

to ensure briefings and current challenges are addressed through the urgent care Boards and system meetings.

6 There has been a varied performance picture across PTS in December and January with an improvement against the outpatients Key Performance Indicators (KPIs), but a slight drop against the time on vehicle KPI. The PTS contact centre reported two good months with call answer performance stabilising close to the target level.

of 10

CURRENT PERFORMANCE – PTS OPERATIONS

50,000

52,500

55,000

57,500

60,000

Demand v Budget

Budget Actual inc. Aborts & EscortsFig. 1

5.007.009.00

11.0013.0015.00

Ave miles v Budget

Budget ActualFig. 2

-2.00%-1.00%0.00%1.00%2.00%3.00%4.00%

Time on Vehicle Performance Variance %

Performance Variance +/-

-25.00%

-20.00%

-15.00%

-10.00%

-5.00%

0.00%

Outpatients Performance Variance %

Inward Performance Variance +/-

Outward Performance Variance +/-Fig. 4Fig. 3

of 10

CURRENT PERFORMANCE – PTS OPERATIONS (CONT)

-20.00%

-15.00%

-10.00%

-5.00%

0.00%

Renal Performance Variance %

Inward Performance Variance +/-

Outward Performance Variance +/-

40,00042,50045,00047,50050,00052,50055,000

SCAS ACA's hours Actual vs Budget

Budget Hrs Actual Hrs

0.00%

5.00%

10.00%

15.00%

Abstractions

A/L Sickness Training Other

Fig. 5 Fig. 6

Fig. 7

of 10

20,000

22,500

25,000

27,500

30,000

Calls Answered Actual v Budget

Budget Actual

75.00%

80.00%

85.00%

90.00%

95.00%

100.00%

CC Performance

Call Answered 60 Sec Call Answered 30 (/60) SecBudget

60.00%

65.00%

70.00%

75.00%

80.00%

% Online Bookings v Target

Budget Actual

050

100150200250300350

No. calls going to Voicemail

Actual

Fig. 8 Fig. 9

Fig. 10 Fig. 11

CURRENT PERFORMANCE – PTS CONTACT CENTRE

of 10

0:00:000:00:430:01:260:02:100:02:530:03:360:04:19

Call Duration

Baseline Actual

3,000

3,500

4,000

4,500

Call Handler Resources v Baseline

Budget Hrs Actual Hrs

0.00%

5.00%

10.00%

15.00%

20.00%

Abstractions for call centre

A/L Sickness Training Other

Fig. 12 Fig. 13

Fig. 14

CURRENT PERFORMANCE – PTS CONTACT CENTRE (CONT)

of 10

PTS Operations

Key Performance Indicators (KPIs) 7 Fig. 1 shows that demand (the number of journeys) has decreased in

December from November levels, which takes it under budget. Demand then increased in January returning to budget expectations. The decrease in December was expected due to the impact of the Christmas holidays.

8 Given that most of the contracts are based upon mileage, the number of journeys does not necessarily provide a direct correlation to income or cost.

9 In terms of the average miles per patient it is still consistently over the budgeted levels (Fig .2), this is in part due to inaccurate assumptions during contracting, but also as a result of changes in activity patterns and patients choice of hospital for treatments.

10 Fig. 3 shows that the performance for the time on vehicle KPI improved slightly in December but has slightly dropped in January; however we are 0.8% away from target.

11 For the inward outpatient journeys (Fig. 4) we saw an improvement on November’s levels for both December and January. For the outward performance, December has seen the lowest variance, at 2.4% away from the target. This improved performance was in part due to the reduced activity seen in December. In January performance dropped slightly for the outward KPI, but this is still a significant improvement on November levels.

12 Fig. 5 shows that renal inward performance has improved in December by nearly 4% on November levels but dropped slightly in January by 2%; however, the performance in December and January is the best it has been since the start of the financial year. For the outward renal KPI the performance slightly dropped from November’s levels in both December and January by 1%; however, we remain 1.55% away from hitting our target.

13 Within our Thames Valley contract, we have agreed and finalised a number of KPI changes. The new performance regime went live from 1st December 2016. These changes are intended to improve the transfer and discharge service that we provide by balancing and refocussing resources differently against the outpatient service. It also requires and relies upon acute performance meeting a minimum standard with respect to ’on the day booking’ performance.

14 Within our Milton Keynes contract, we have agreed and finalised a number of KPI changes, these were brought in from the 1st January 2017. Workforce

15 Fig. 6 shows that the number of operational Ambulance Care Assistant (ACA) hours dropped in December; this was due to vacancies, higher annual leave abstraction as a result of the Christmas holidays (Fig. 7), increased training and lower bank uptake. The shortfall would have been filled with private providers and taxi services; however, this has had a consequential impact on financial performance. The hours slightly increased in January but have not quite returned to budget levels.

of 10

16 Although we are showing a gap in the number of actual hours vs budgeted hours, the budgeted hours do not take into account the impact of the average journey mileage which was much higher than expectation. The additional journey length requires significantly more hours than budget, which is made up with additional private provider hours. Therefore the gap in hours is higher operationally than shown in Fig. 6.

17 There continues to be a challenge with high attrition specifically ACAs transferring to Emergency Care Assistants (ECA) within SCAS along with high retirement in the north area. A revised Integrated Workforce Plan is currently being developed to reflect the higher than expected volumes of movers between areas.

18 As expected the annual leave hours increased in December due to the

Christmas holidays and have then dropped in January. Sickness has also increased in December and January from November levels; this is again expected over the winter months and normally higher levels of absence are due to cold/flu like sickness. Training abstractions increased; this is reflective of the increase in recruitment seen across the patch and is expected to continue for the next few months with increased level of recruitment taking place.

PTS Contact Centre

Key Performance Indicators (KPIs) 19 Fig. 8 shows that the number of calls reduced in December from November

levels in line with the Christmas holiday expectation. The number of calls then significantly increased to the highest levels year to date in January; this may have been a flow through from the reduced appointments over the Christmas holiday causing additional bookings to be made in January. Call volumes are still showing above budget expectation, this is primarily due to the reduced online uptake which continues below budget (Fig. 10) and has further reduced in December and January. Work continues with organisations booking transport to encourage use of the online functionality of ‘Cleric’.

20 The general phasing by month is also broadly in line with the number of

journeys, this is expected as this tends to have a linear relationship under normal operational circumstances.

21 Performance of the PTS contact centre, Fig. 9 shows the call answer

performance slightly reducing in December and January from November levels; however, we were within 1% of the target of 95%.

22 Fig. 11 shows the number of calls going to voicemail has continued to remain

low throughout the year. This correlates with the improved call answer performance meaning less calls are being left unanswered and therefore being forwarded to the voicemail facility. This results in a better service being provided to patients and Healthcare Providers.

23 The call duration in both December and January has continued to reduce

(Fig. 12); it is now at its lowest levels year to date and is lower than budget expectations.

24 This improved performance allows the call handlers to answer more calls in

an hour due to the shorter call duration. The call length is now significantly

of 10

below budget which is as a result of the recent performance management focus within the contact centre, reviewing outliers and allowing new staff to gain experience.

Workforce 25 Fig. 13 shows the number of operational call handler hours dropped in

December from November’s level due to the Christmas holiday and therefore an increase in annual leave abstraction. The operational call handler hours increased again in January and continues to remain above the budget expectation; however, this is required due to the increased number of calls being taken due to the low uptake of online bookings.

26 Similarly to PTS operations, the annual leave spiked in December and then

dropped in January (Fig. 14). Sickness reduced in December by 2.5% from November levels but then increased in January back up by 2.5% to return to November levels. However, overall the sickness in the PTS contact centre remains low.

SUSSEX PTS MOBILISATION 27 Phase 1 of the contract for PTS Sussex went live on Wednesday 1st March

and work is progressing in readiness for Phase 2 of the transition to take place on 1st April 2017.

Phase 1 Go Live 28 Activity for discharges, transfers, repatriations and Out of Area journeys went

well with private provider dedicated vehicles in place at all of the acute hospitals in the area.

29 New SCAS staff are being utilised as they become compliant.

30 A dispatch hub has been set up in Havant to deal with planning and dispatching of activity above the contract. Agency staff have been sourced for this and it is working well.

31 An issue arose with the Cleric system whereby Sussex addresses were not being accepted. Cleric are aware of the issue and it is being worked through.

Contract 32 Service specification and KPIs have been signed off by both the Clinical

Commissioning Group (CCG) and SCAS. Contract negotiations are nearing completion and the contract should be signed in time for Phase 2.

Additional Contact Centres 33 Estates lease negotiations are underway at Durrington (West Sussex) and

lease agreement is in place for the Eastbourne Contact centre.

of 10

Resource Centres 34 Another unit has been secured at the Eastbourne site which offers sixteen

parking spaces to park hire vehicles. A base in West Sussex is still being sourced, and the Business Manager is arranging visits to other potential sites which could be a base for vehicles in the longer term.

Vehicles 35 Thirty-two vehicles were hired for the start of the contract on 1st March. New

SCAS staff (ex-Docklands Medical Services staff) will use these. HR Transfer of Undertaking Protection of Employment Regulations (TUPE) 36 Docklands Medical Services Staff Status (Now SCAS Staff)

Operationally Ready 21 East; 11 West One check outstanding 21 Two or more checks outstanding 3 Will not be operational (OH/DBS) 15

37 Coperforma

Consultation is underway and 1:1s have been carried out with all Coperforma staff. Training is to take place over the next three weeks. Due diligence has now been received and is being worked through.

ICT 38 Fibre connectivity is now installed in both Durrington and Eastbourne sites.

However, the status report for Eastbourne is still outstanding. 39 Equipment for the newly acquired sites has been ordered and a plan to

establish the logistics of installing equipment into these sites (and those for the Surrey mobilisation) is being developed and tested in readiness for training and go live.

40 Smart phones have been ordered and configured for both SCAS staff and

private provider usage.

Communications and Stakeholder engagement 41 Meetings with Acutes and clinics are underway to introduce key service users

to the new contract and discuss how it will work. Communications have been prepared and are being distributed to all stakeholders and service users. Patient leaflets have been prepared and distributed to CCG Communication leads for further distribution.

SURREY PTS MOBILISATION Stakeholder Engagement 42 Engagement from East Surrey Hospital has been good, very proactive and

supportive. However, no correspondence has been received from Epsom and St Hillier; this has been raised with the CCGs. There has been minimal turn out for training at St Peters and Ashford. However, this is being resolved with significant encouragement from the hospital. Frimley and Royal Surrey already have access to the online system and we are on site as agreed.

of 10

43 All communications have been shared with the hospitals to promote the new

service and raise awareness of the online system further. Additional dates are being made available to the hospital, dependent on meeting room availability or for more floor walking.

44 There has been very good support from GMB, Unite and Unison who have supported all group consultations with team members.

45 The final contract went to the Community Transport Providers (CTPs) for agreement. We are awaiting final review at which point signatures can be obtained from all parties.

Fleet 46 Bariatric vehicles are due to arrive on the week commending 8th May 2017.

Eighteen seater vehicles will be delayed in delivery until the end of April and hire vehicles are being sourced to mitigate this. All CTPs are to plan and only the agreement on the livery is to be completed.

Estates 47 Site plans have been signed off for estates and works have been agreed. The

Redhill site has been located and estates are now progressing this. SCAS will be buying the existing furniture from Dorking and SCAS will confirm costs once this has been agreed with estates. A meeting has been arranged with Surrey Fire Service to discuss partnership arrangements for cleaning of vehicles.

Contact Centre 48 Training commenced in the week of 6th March 2017. Basic training will be

given and followed up with further training and support post go-live. There has been a reduction in call takers to only one agency member. Work is underway with the agency to recruit additional call handlers. It has been identified that there are a number of Band 3 ACAs who currently work in the Contact Centre handling Estimated Time of Arrival calls. However, this is not a formal arrangement and therefore a measure letter has been sent and we will redeploy these staff.

OTHER KEY ISSUES 49 There continues to be a focus nationally on PTS services in part linked to the

ongoing issues in the Sussex area. The Care Quality Commission (CQC) have focussed inspections on smaller private ambulance providers and SCAS have supported these inspections sharing our end to end validation processes for third party providers.

RECOMMENDATIONS TO THE BOARD 50 To acknowledge the report and continue to support with actions which enable

the team to improve performance across all contract areas. Author P Stevens and C Micallef Title Director of Commercial Services/ Commercial Finance Manager Date 8 March 2017

Agenda item: 10c



Title Finance and Estates Report for the month ended 28 February 2017

Responsible Director Charles Porter, Director of Finance


To note the current financial position of the Trust.










Corporate Risk 17 – Non achievement of financial targets and CIPs

Implications

Regulatory and legal implications / impact (e.g. NHS Improvement provider licence and Continuity of Services risk ratings, CQC essential standards, competition law etc.)

The paper covers our NHS Improvement use of resource metric – our current metric rating is a 2, which is in line with the plan.

Financial implications / impact (e.g. CIPs, FRR, year-end outturn)

The paper covers all aspects of our financial position (e.g. CIPs, FRR and year-end outturn)

Council of Governor implications / impact (e.g. links to governors statutory role, significant transactions etc.)

The Public Finance Board papers are shared with the Council of Governors. In addition, periodic workshops for governors are held to develop their understanding of finance and the financial environment in which the Trust operates.


The paper should be read in conjunction with the Quality and Patient Safety Report, recognising that the Trust’s objective is to ensure clinical quality whilst maintaining a sound financial position.

Other


January 2017 and every bi-monthly Board meeting in public


This paper is presented as part of the process of the Board undertaking a continuous review of the Trust’s financial position. Background reading can be found at: NHS Improvement Risk Assessment Framework http://www.monitor.gov.uk/raf

http://www.monitor.gov.uk/raf

of 5


FINANCE AND ESTATES REPORT FOR THE MONTH TO 28 FEBRUARY 2017

PURPOSE

1 The purpose of the paper is to:

Present an update on the Trust’s latest financial position, covering income

and expenditure; cash, capital and liquidity; NHS Improvement financial

risk rating; and cost savings.

provide assurance to the Board that actions are in place to address any

areas where the Trust’s financial performance is adversely behind plan at

this stage of the financial year.

EXECUTIVE SUMMARY

2 Income and expenditure - the Trust shows a deficit of £348k for the month

which was £21k better than the budget deficit for the month but £164k worse

than the forecast.

3 Cash and capital - The Trust’s cash balance at the end of February was £19.5m which was £0.3m above the cash balance forecasted in January. The year-end cash forecast has increased from £18.9m to £19.5 due principally to additional property proceeds in 2016/17 and further slippage in capital (reduced from £4.8m to £4.6m). The 90 day debtor figure is down from £41k to £8k.

4 NHS Improvement Use of Resource – the NHS Improvement Use of

Resource Rating overall is 2. This comprises a capital service cover (debt interest cover) rating which is a 2, a liquidity rating which is a 1, I&E Margin rating is a 3 and I&E Margin variance from plan rating, which is a 1 for February 2017. The Agency Rating is 1.

5 Cost savings – overall the savings were £0.5m in the month, £0.3m below

budget.

of 5

CURRENT PERFORMANCE

INCOME AND EXPENDITURE

6 As can be seen from the table below, the Trust made a deficit of £348k in the

month which was £21k better than budget but it was £164k worse than the forecast.

Income was £494k higher than budget with £274k related to emergency services and £220k relating to commercial services. Overall costs were £473k above budget with £811k in emergency services and £99k non-emergency services offset by £437k in corporate. Non-emergency profitability was £93k above budget for the month.

7 Further information can be seen in the following appendices:

Appendix A1 – income and expenditure monthly position

Appendix A2 – income and expenditure quarterly position

Appendix B – analysis of income

Appendix C – key operational ratios for income and expenditure

CASH AND CAPITAL

8 The Trust’s cash balance at the end of February was £19.5m which was £0.3m above the level forecast in January. Receipts from sales income were £0.2m better with no major variances to report. Cash payments were broadly in line with a small reduction in payments for non - pay revenue expenditure offset by slightly higher payments in capital and payroll. In month capital expenditure was low at £0.4m mainly due to lower than expected payments on vehicles, IT related projects and the Bone Lane Project. A review of March capital spend has been undertaken and year end capital forecast has been reduced by a further £0.2m to £4.6m.

Actual Forecast

at P6

Forecast

Variance

Budget Budget

Variance

Actual Forecast

at p6

Forecast

Variance

Budget Budget

Variance

Forecast

(Current)

Budget

Profitability

SCAS Income £k 14,837 15,370 (533) 14,343 494 164,021 163,584 437 158,369 5,652 179,449 172,566

SCAS Contribution £k 2,241 2,714 (473) 2,657 (416) 27,499 28,049 (550) 29,486 (1,987) 30,213 32,170

% Contribution % 15% 18% (3%) 19% (3%) 17% 17% (0%) 19% (2%) 17% 19%

Corporate overheads £k 2,589 2,898 309 3,027 437 31,516 32,022 506 33,294 1,778 34,363 36,320

EBITDA £k 356 564 (208) 435 (79) 4,267 4,355 (88) 5,044 (777) 4,754 5,506

EBITDA % % 2.4% 2.9% (1%) 3% 3% 3% 3% 3% 3%

Net Surplus/(Deficit) £k (348) (184) (164) (369) 21 (4,017) (3,972) (45) (3,807) (210) (4,151) (4,150)

% Surplus/(Deficit) % (2%) (1%) (1%) (3%) 0% (2%) (2%) (0%) (2%) (0%) (2%) (2%)

NHSD 0 0 0 0 0 2,067 0 2,067 0 2,067 2,384 0

STF Funding 0 0 0 0 0 803 0 803 0 803 1,070 0

Overall Surplus/(Deficit) (348) (184) (164) (369) 21 (1,148) (3,972) 2,825 (3,807) 2,660 (697) (4,150)

Month Year to date Full Year

of 5

9 The 90 day debtor figure is down to £8k (down from £41k in January). The 90

day category debt as a percentage of total sales debt now stands at 0.33% (down from 1.37% in January). There is a residual debt of £7k slipping into the 90 day category for March.

10 Further information can be seen in the following appendices:

Appendix D – key financial ratios, including liquidity

Appendix E1 & 2 – cash flow forecast and reconciliation to 31 March 2017

Appendix F – capital expenditure 2016/17

Appendix G – balance sheet and forecast to 31 March 2017

NHS IMPROVEMENT USE OF RESOURCE RATING

11 As can be seen from the table below, our rating is a 2 which is on plan.

Actual Budget Variance Actual Budget Variance Forecast Budget Prior Year Variance

to budget

Variance

to Prior

Year

Cash and capital position

EBITDA £k 356 435 (79) 7,147 5,044 2,103 8,223 5,238 8,569 2,985 (346)

Working capital mov't £k 1,081 290 791 (2,863) 578 (3,441) (3,188) 1,327 (5,646) (4,515) 2,458

Capital Expenditure £k (443) (320) (123) (2,336) (8,212) 5,876 (2,753) (8,645) (6,950) 5,892 4,197

Disposals £k 4 0 4 49 0 49 647 0 14 647 633

PDC paid £k 0 0 0 (786) (785) (1) (1,613) (1,612) (1,360) (1) (253)

Interest £k (4) 6 (10) (63) (46) (17) (72) (61) (65) (11) (7)

Repayments of loans £k 0 0 0 (1,569) (1,569) 0 (1,738) (1,738) (1,738) 0 0

Other £k 0 (12) 12 0 (164) 164 (15) (1) 2 (14) (17)

PDC & DOH Loans £k 0 0 0 0 0 0 0 0 0 0 0

Cashflow £k 994 399 595 (421) (5,154) 4,733 (509) (5,492) (7,174) 4,983 6,665

Cash balance £k 19,505 14,772 4,733 19,505 14,772 4,733 19,417 14,434 19,926 4,983 (509)



to budget

Variance

to Prior

Year

Use of Resource Rating

Overall Score 2.0 3.0 1.0 2.0 3.0 1.0 2.0 2.0 2.0 0.0 0.0


of 5

COST SAVINGS

12 As can be seen from the table below, overall the savings were £461k which

was £168k behind in the month. Commercial savings remain behind plan (in particular recruitment being behind), and the cycle time project and see & treat project are not delivering as expected. The forecast now sits at £5,764k.

0

Actual Budget Var Actual Budget Var Forecast Budget Var

Com1. Auto Allocation Auto Plan 42 11 31 232 118 115 248 128 120

Com2. PP Rationalisation 0 0 0 78 42 36 78 42 36

Com3. Wokingham Rent 0 0 0 8 8 0 8 8 0

Com4. Reduce Training Time 9 8 1 77 80 (3) 85 80 5

Com5. Reduce Missed Meal Breaks 2 3 (1) 10 33 (22) 12 36 (24)

Com6. Improve SCAS Efficiency 0 17 (17) 5 183 (178) 5 200 (194)

Com7. Rearrange Driver Training 0 1 (1) 2 4 (3) 2 4 (3)

Com8. Increase Online Booking 0 6 (6) 2 54 (52) 2 60 (58)

Com9. Replace Short Term Hire Vehicles 0 0 0 40 40 0 40 40 0

Com10. Improve PP Efficiency 11 20 (9) 11 223 (212) 11 243 (232)

Com30. Cease use of Ext Examiner 1 1 0 14 14 0 16 16 0

Com31. Increase VCD usage 10 32 (22) 143 352 (208) 149 384 (235)

Com32. Increased SCAS Staffing 0 52 (52) 49 576 (527) 49 628 (579)

Com40. Reduce Sickness 0 0 0 53 0 53 55 0 55

Subtotal Commercial Division 75 151 (76) 725 1,726 (1,001) 759 1,869 (1,110)

A&E11. OT Incentive Reduction 1 1 0 1,043 1,056 (13) 1,047 1,056 (9)

A&E12. OPS Sickness Reduction 0 34 (34) 0 302 (301) 0 335 (335)

A&E13. Annual Leave Reduction 42 42 0 461 461 0 503 503 0

A&E14. Reduce Cycle Time 32 124 (92) 32 1,112 (1,081) 32 1,236 (1,204)

A&E15. Increase See and Treat 0 60 (60) 0 436 (436) 0 496 (496)

A&E16. Reduce Response Ratio 0 17 (17) 117 184 (67) 117 201 (84)

A&E17. Reduce Staff Attrition (10) 6 (16) 217 54 163 211 60 151

A&E18. Improving HCP Utilisation 0 25 (25) 95 271 (175) 95 296 (200)

A&E19. A&E Recruitment Reprofile 78 22 56 599 244 355 629 287 341

A&E33. 111 Reduce Sickness 26 10 16 59 113 (55) 79 124 (44)

A&E34. 111 Rota Redesign 21 21 0 132 132 0 153 153 0

A&E35. 111 overtime incentive 2 2 0 49 47 2 88 86 2

A&E36. 111 Reduce Attrition 6 6 (0) 37 39 (2) 43 45 (2)

A&E37. BOC Cylinder Reductions 1 4 (3) 17 46 (29) 18 50 (32)

A&E38. Fleet Cost Reductions 28 28 0 303 303 0 330 330 0

A&E39. Skillstream LUH 41 0 41 319 0 319 346 0 346

Corp 30.Clinical Agency 11 0 11 25 0 25 28 0 28

Subtotal Frontline Ops 279 402 (122) 3,504 4,799 (1,295) 3,720 5,258 (1,538)

Corp20. Estates CIPS 30 18 11 229 138 91 259 157 102

Corp21. Finance CIPS 6 13 (7) 114 145 (31) 121 163 (42)

Corp22. ICT Savings 26 27 (0) 162 186 (24) 189 213 (24)

Corp23. PIT Savings 4 2 3 60 19 41 64 20 44

Corp24. Serv Dev & Bids Savings 5 0 5 95 49 46 100 49 52

Corp25. HR CIPS 15 4 11 115 67 48 129 71 59

Corp26. Education CIPS 9 10 (1) 147 98 49 159 107 51

Corp27. CEO CIPS 9 0 9 41 55 (14) 44 55 (11)

Corp28. Corp Affairs CIPS 0 0 0 5 5 (0) 6 5 0

Corp29. Technology Scheme 1 2 (1) 15 19 (4) 15 21 (5)

Subtotal Corporate 106 76 31 983 781 202 1,085 861 224

Target/(contingency) 0 0 0 0 0 0 200 200

Total 461 629 (168) 5,212 7,307 (2,095) 5,764 7,989 (2,224)

5.8% 7.9% 65.2% 91.5%

Co

mm

erc

ial

Div

isio

nC

orp

ora

teA

&E

Month YTDProject Full Year

of 5

FUTURE PERFORMANCE

13 The revised forecast for the year is now a core deficit of £4.15m. The deficit is

now forecast at £0.7m after STF funding and NHSD, which is now in line with the control total.


14 The Board is asked to note the current financial position of the Trust, and the

actions in place to address any areas where performance is behind plan.

Charles Porter Director of Finance

Actual Budget Variance Actual Budget Variance Forecast Budget Prior Year Variance to

budget

Variance to

Prior Year

Forecast

Jan 2016

Variance

to out-

turn

NHSI

Control

Total

Variance NHSI

Control

Total

Variance

£000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's

TOTAL SCAS INCOME 14,837 14,343 494 164,021 158,369 5,652 179,450 172,566 174,986 6,884 4,464 179,037 413 14,493 344 161,389 2,632

Emergency Services (inc. 111)

Income 12,494 12,193 301 138,752 134,632 4,120 151,211 146,681 147,365 4,530 3,847 151,085 127 12,322 172 137,653 1,099

Direct costs 10,595 9,784 (811) 113,757 107,681 (6,076) 124,072 117,285 119,490 (6,787) (4,582) 123,629 (442) 9,602 (993) 108,119 (5,637)

Gross contribution 1,900 2,409 (509) 24,995 26,952 (1,956) 27,140 29,397 27,875 (2,257) (735) 27,455 (316) 2,721 (821) 29,534 (4,538)

15% 20% -5% 18% 20% -2% 18% 20% 19% 18% 22% -7% 21% -3%

Non-Emergency ServicesIncome 2,343 2,150 193 25,269 23,736 1,533 28,239 25,885 27,622 2,354 617 27,952 286 2,171 172 23,736 1,533

Direct costs 2,001 1,901 (99) 22,765 21,202 (1,564) 25,164 23,111 24,810 (2,053) (354) 24,878 (286) 1,901 (99) 21,202 (1,564)

Gross contribution 342 248 93 2,504 2,535 (31) 3,074 2,773 2,811 301 263 3,074 1 269 72 2,535 (31)

15% 12% 3% 10% 11% -1% 11% 11% 10% 11% 12% 2% 11% -1%

Contribution Operational Activities 2,241 2,657 (416) 27,499 29,486 (1,987) 30,214 32,170 30,686 (1,956) (472) 30,529 (315) 2,990 (749) 32,069 (4,569)

Central CostsCentral Costs 0 0 0

Clinical Services 313 314 1 3,502 3,441 (61) 3,819 3,755 3,234 (63) (584) 3,833 15 314 1 3,441 (61)

Finance 248 265 17 2,735 2,877 142 3,007 3,141 3,135 135 128 3,016 10 431 184 2,877 142

Estates 380 401 21 4,186 4,462 276 4,587 4,863 4,714 277 127 4,592 5 401 21 4,462 276

IM&T 252 472 221 4,834 5,197 362 5,290 5,669 5,112 379 (178) 5,453 163 472 221 5,197 362

Human Resources 245 241 (4) 2,473 2,653 180 2,766 2,893 2,555 127 (211) 2,724 (43) 241 (4) 2,653 180

Education Services 271 339 67 3,255 3,696 441 3,552 4,035 3,931 483 379 3,642 90 339 67 3,696 441

Service Development 90 108 18 1,079 1,166 87 1,170 1,274 1,126 104 (44) 1,174 4 108 18 1,166 87

Communications & Public Engag't 35 45 9 465 486 21 500 531 492 31 (8) 509 9 45 9 486 21

Corporate 51 58 7 677 644 (33) 742 702 659 (40) (83) 745 3 58 7 644 (33)

Other (contingency) (0) (21) (21) 26 (179) (205) 27 (200) (336) (227) (136) 31 5 (17) (17) 557 531

Loss/(Profit) on disposal (4) 0 4 (49) 0 49 (137) 0 (14) 137 (14) (135) 2 0 4 0 49

Depreciation 563 661 99 6,736 7,276 539 7,300 7,937 8,247 636 310 7,347 47 639 76 7,031 295

Financing Costs 145 143 (2) 1,597 1,576 (21) 1,741 1,719 1,530 (22) (212) 1,746 5 143 (2) 1,576 (21)

Total overhead costs 2,589 3,027 437 31,516 33,294 1,778 34,363 36,320 34,385 1,955 (525) 34,679 316 3,175 586 33,785 2,269

Net surplus/(deficit) (348) (369) 21 (4,017) (3,807) (210) (4,150) (4,150) (3,699) (0) (451) (4,151) 1 (185) (163) (1,717) (2,300)

NHSD 0 0 0 2,067 0 2,067 2,384 0 2,505 2,384 (121) 2,384 0 0 0 0 2,067

STF Funding 0 0 0 813 0 813 1,084 0 0 1,084 1,084 1,070 14 90 (90) 813 0

Surplus/(deficit) for the year (348) (369) 21 (1,137) (3,807) 2,670 (682) (4,150) (1,194) 3,468 512 (697) 15 (95) (254) (904) (233)8

Memo:

Depreciation 563 661 99 6,736 7,276 539 7,300 7,670 8,247 370 947 639 76 7,031 295

Public dividend capital 138 138 (0) 1,518 1,517 (1) 1,655 1,655 1,465 0 (190) 138 (0) 1,517 (1)

Net interest payable 7 5 (2) 79 59 (20) 86 63 67 (23) (19) 0 (7) 59 (20)

Profit on disposal 4 0 (4) 49 0 (49) 137 0 14 (137) 123 0 (4) 0 (49)

EBITDA 356 435 (79) 4,267 5,044 (777) 4,755 5,238 6,066 (483) (1,312) 683 (683) 7,703 (8,385)

% 2.4% 3.0% 2.6% 3.2% 2.6% 3.0% 4.9% 4.7% 4.8%

Year to date

South Central Ambulance Service NHS Foundation Trust (Appendix A1)

Financial results for Month 11 ended 28 Febuary 2017

Month Year to date Full Year Month

Actual Budget Variance Actual/

forecast

Budget Variance Forecast Budget Variance Forecast Budget Variance Forecast Budget Variance

£000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's

TOTAL SCAS INCOME 43,894 42,250 1,644 44,163 43,119 1,044 45,654 44,286 1,368 45,739 42,911 2,828 179,450 172,566 6,884

Emergency ServicesIncome 37,247 35,664 1,582 37,268 36,718 549 38,646 37,837 809 38,051 36,461 1,589 151,211 146,681 4,530

Direct costs 30,258 28,752 (1,506) 30,395 29,200 (1,195) 31,864 30,339 (1,525) 31,557 29,260 (2,297) 124,074 117,552 (6,522)

Gross contribution 6,988 6,912 76 6,872 7,518 (645) 6,783 7,498 (716) 6,494 7,201 (708) 27,137 29,129 (1,992)

18.8% 19.4% 18.4% 20.5% 17.6% 19.8% 17.1% 19.8% 17.9% 19.9%

Non-Emergency Services

Income 6,647 6,585 62 6,895 6,401 495 7,008 6,449 559 7,688 6,450 1,238 28,239 25,885 2,354

Direct costs 6,305 6,015 (291) 6,109 5,668 (440) 6,238 5,715 (523) 6,512 5,713 (799) 25,164 23,111 (2,053)

Gross contribution 342 571 (229) 786 732 54 770 734 36 1,177 737 440 3,075 2,773 3015.1% 8.7% 11.4% 11.4% 11.0% 11.4% 15.3% 11.4% 10.9% 10.7%

Contribution Operational Activities 7,330 7,483 (153) 7,659 8,250 (591) 7,553 8,232 (679) 7,670 7,938 (268) 30,212 31,903 (1,691)

Central Costs (inc op overheads)0

Clinical Services 966 925 (41) 945 943 (2) 960 943 (17) 947 943 (4) 3,819 3,755 (63)Finance 712 707 (5) 743 742 (1) 627 747 119 724 746 22 2,807 2,941 135

Estates 1,194 1,220 25 1,147 1,220 73 987 1,220 233 1,259 1,204 (55) 4,587 4,863 277

IM&T 1,387 1,417 30 1,364 1,417 53 1,366 1,417 52 1,173 1,417 244 5,290 5,669 379

Transformation & OD 1,828 1,998 170 1,912 2,072 160 1,791 2,070 280 1,958 2,062 104 7,488 8,202 714

Communications & Public Engag't 119 129 10 141 134 (7) 134 134 0 107 134 27 500 531 31

Corporate 164 174 10 182 178 (4) 188 177 (12) 207 174 (33) 742 702 (40)

Contingency 7 (38) (44) (0) (50) (50) 7 (50) (57) 12 (63) (75) 27 (200) (227)

Loss/(Profit) on disposal (5) 0 5 (24) 0 24 (15) 0 15 (93) 0 93 (137) 0 137Depreciation 1,918 1,918 0 1,821 1,918 97 1,869 1,918 48 1,693 1,918 225 7,300 7,670 370

PDC 414 414 (0) 414 414 (0) 414 414 (0) 413 414 1 1,655 1,655 (0)

Interest 19 16 (3) 22 16 (6) 24 16 (8) 22 16 (6) 86 64 (22)

Injury benefit 50 50 0 50 50 0 50 50 0 50 50 0 200 200 0

Total overhead costs 8,773 8,929 157 8,717 9,054 337 8,402 9,055 653 8,472 9,015 543 34,364 36,053 1,690

Net surplus (1,443) (1,447) 4 (1,058) (804) (255) (849) (823) (26) (801) (1,077) 275 (4,150) (4,150) (0)

NHSD 0 0 0 0 0 0 2,067 0 (2,067) 317 0 (317) 2,384 0 (2,384)

STF Funding 0 0 0 0 0 0 803 0 (803) 268 0 (268) 1,070 0 (1,070)

Surplus/(deficit) for the year (1,443) (1,447) 4 (1,058) (804) (255) 2,020 (823) 2,844 (217) (1,077) 860 (696) (4,150) (3,454)

South Central Ambulance Service NHS Foundation Trust (Appendix A2)

Q1 Q2 Q3 Q4 Full Year


Appendix B

Income analysis


to budget

Variance

to Prior

Year£000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's

Emergency ServicesE&U Contract 2016/2017 10,663 10,600 63 120,001 116,878 3,124 130,665 127,312 125,665 3,353 5,000

HART income 271 271 (0) 2,971 2,982 (11) 3,241 3,253 3,143 (12) 98

111 Service 948 1,008 (60) 11,502 11,323 179 12,602 12,353 15,249 249 (2,647)

Public Events 22 21 1 334 232 103 356 253 354 103 1

CBRN/Flu funding (33) 26 (60) 273 288 (15) 331 314 314 17 17

RTA Recoveries 19 42 (23) 408 458 (51) 445 500 439 (55) 6

Training funding from Health Education England 101 125 (24) 1,185 1,375 (190) 1,258 1,500 1,872 (242) (614)

Workshop Income 0 0 0 0 0 0 0 0 27 0 (27)

Other Income 505 102 403 2,100 1,120 980 2,339 1,222 637 1,116 1,702

AfC Transfer (2) (2) 0 (23) (23) 0 (25) (25) (336) 0 311

Total Emergency Services 12,494 12,193 301 138,752 134,632 4,120 151,211 146,681 147,365 4,530 3,847

Non-Emergency ServicesPTS Hampshire 850 900 (51) 9,867 9,739 129 10,849 10,639 9,995 210 854

PTS Thames Valley 961 980 (19) 11,154 10,776 378 12,151 11,756 4,884 395 7,267

PTS OHFT 28 42 (13) 428 460 (33) 470 502 5,104 (32) (4,634)

PTS Others 278 13 266 675 139 536 1,386 151 3,386 1,234 (2,000)

PTS MK 80 55 25 896 603 292 988 658 774 330 215

Logistic Services - Berkshire 21 21 0 688 400 289 709 420 1,322 289 (613)

Logistic Services - Ox & Bucks 106 108 (2) 1,155 1,188 (34) 1,260 1,296 1,147 (36) 113

Commercial Training 17 30 (13) 303 348 (44) 319 376 383 (57) (64)

TVEA 0 0 0 81 60 20 81 60 291 20 (211)AfC Transfer 2 2 0 23 23 0 25 25 336 0 (311)

Total Non-Emergency Services 2,343 2,150 193 25,269 23,736 1,533 28,239 25,885 27,622 2,354 617

Total income 14,837 14,343 494 164,021 158,369 5,652 179,450 172,566 174,986 6,884 4,464

South Central Ambulance Service NHS Foundation Trust (Appendix B)



South Central Ambulance Service NHS Foundation Trust Appendix C

Actual Budget Variance Actual Budget Variance Forecast Budget Prior year

Key Operational Ratios Feb-17 Feb-17 Feb-17 YTD YTD YTD Full Yr Full Yr Full Yr

+/(-) +/(-)

Activity

- % inc above prior year (6.9%) (4.9%) (2.0%) 4.2% 1.1% 3.1% 3.9% 0.4% 3.8%

- income from growth (£k) (212) (165) (47) 2,477 (153) 2,631 2,457 (59) 218

Delays at hospitals

- income from delays (£k) 55 67 (12) 835 534 301 877 589 752

CQUINN (Clincal Quality Incentive)

- Potential income 265 223 43 2,405 2,227 178 2,670 2,672 1,902

- Contingency/Other 0 0

Subtotal CQUINN 265 223 43 2,405 2,227 178 2,670 2,672 1,902

Total income from activity related measures 108 125 (17) 5,717 2,607 3,110 6,005 3,202 2,872

Actual Budget Variance Actual Budget Variance Forecast Budget Prior year

Key Operational Spend (£k) Feb-17 Feb-17 Feb-17 YTD YTD YTD Full Yr Full Yr Full Yr

+/(-) +/(-)

Overtime

- A&E - North 231 202 (28) 2,203 2,239 36 2,384 2,456 2,466

- A&E - South 199 131 (68) 1,771 1,475 (296) 1,916 1,608 2,022

- A&E - Control 63 26 (36) 495 291 (205) 536 317 603

- A&E - Comm Resp/Emer Plan/Fleet 53 36 (18) 498 391 (107) 551 427 503

- Commercial Division - PTS 27 28 1 560 307 (252) 594 335 470

- Commercial Division - non-PTS 3 4 2 29 47 18 32 51 74 - Other 56 43 (2) 486 598 111 531 651 1,224

Total Overtime 632 471 (150) 6,042 5,348 (694) 6,543 5,846 7,362

Private Providers

- A&E - North 901 192 (709) 9,561 3,405 (6,156) 10,379 3,541 7,831

- A&E - South 352 168 (184) 5,311 3,483 (1,827) 5,471 3,481 4,461

- PTS 443 176 (267) 5,081 2,251 (2,830) 5,722 2,436 5,644Total private providers 1,697 537 (1,160) 19,953 9,139 (10,814) 21,573 9,459 17,936

Fuel

- A&E 252 279 27 2,796 3,071 274 3,076 3,350 3,495

- Commercial Services 92 116 25 1,081 1,289 208 1,180 1,405 902

- Fleet central 0 0 0 0 0 0 0 0 -2

- Other 20 28 8 282 309 26 308 337 368

Total fuel 364 423 59 4,160 4,668 509 4,564 5,092 4,764

South Central Ambulance Service NHS Foundation Trust

NHS Improvement Use of Resource Rating Actual Budget Variance Actual Budget Variance Forecast Budget Variance

Capital Service Cover 2 2 0 2 2 0 2 2 0

Liquidity 1 1 0 1 1 0 1 1 0

I&E Margin 3 3 0 3 3 0 3 3 0

I&E Margin Variance From Plan 1 3 -2 1 3 -2 1 1 0

Agency 1 1 0 1 1 0 1 1 0

2 3 -1 2 3 -1 2 2 0

Feb-17 Jan-17 Dec-16 Last Year

YTD YTD YTD Full year

Better payment practice target

- Non-NHS by number 88% 85% 90% 83%

- Non-NHS by £ value 96% 96% 97% 91%

- NHS by number 87% 98% 75% 89%

- NHS by £ value 80% 98% 78% 93%

Debtors > 90 days (£k) 8 41 6 70

As % of total debts 0.3% 1.4% 1.0% 4.6%

% cost improvements secured (actual) 65.2% 59.5% 56.5% 96.5%

% cost improvements secured (plan) 91.5% 83.6% 75.0% 100.0%

Overall (Financial Sustainability Risk Rating)

Appendix D

Comments

Feb-17 YTD Full Year

Nil of note

Some key projects are behind plan and work is current being done to deliver these savings and identify new projects

South Central Ambulance Service NHS Foundation TrustAppendix E

16/03/2017 11:44

CASHFLOW Apr-16 May-16 Jun-16 Q1 Q1 Q1 Jul-16 Aug-16 Sep-16 Q2 Q2 Q2 Oct-16 Nov-16 Dec-16 Q3 Q3 Q3 Jan-17 Feb-17 Mar-17 Q4 Q4 Q4

2016-17 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Actl Actl Actl Actl Budget Variance Actl Actl Actl Actl Budget Variance Actl Actl Actl Fcst Budget Variance Actl Actl Fcst Fcst Budget Variance

Income

SL Receipts 11,284 16,275 14,390 41,949 41,949 0 14,018 17,488 15,328 88,783 85,974 2,809 15,461 15,347 15,178 134,769 130,190 4,580 14,350 16,044 15,854 181,017 174,613 6,404

Fixed Asset Receipts 0 0 0 0 0 0 17 11 0 28 0 28 0 16 44 0 44 1 4 598 647 0 647

Interest 5 4 4 13 13 0 4 4 3 24 34 (10) 3 3 2 32 54 (22) 3 3 3 41 72 (31)

Capital Loan From HA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Other Income/PDC/VAT/RTA 59 383 481 923 923 0 1,026 341 276 2,566 2,519 47 584 385 206 3,741 3,525 216 319 404 717 5,181 4,500 681

Other 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total Cash In 11,348 16,662 14,875 42,885 42,885 0 15,065 17,844 15,607 91,401 88,527 2,874 16,048 15,751 15,386 138,586 133,769 4,818 14,673 16,455 17,172 186,886 179,185 7,701

Expenditure

Pay expenditure 8,919 9,412 9,300 27,631 27,497 (134) 9,322 9,340 9,336 55,629 56,301 672 9,316 9,440 9,578 83,963 86,091 2,128 9,536 9,633 9,750 112,882 116,042 (3,160)

Non Pay expenditure 4,478 5,426 5,639 15,543 15,543 0 6,152 6,389 6,406 34,490 31,091 (3,399) 5,634 5,331 5,705 51,160 44,061 (7,099) 5,671 5,385 6,082 68,298 56,505 11,793

Capital expenditure 735 0 46 781 781 0 350 45 66 1,242 1,809 567 33 283 312 1,870 6,995 5,125 23 443 417 2,753 8,645 (5,892)

Dividends on PDC 0 0 0 0 0 0 0 0 786 786 785 (1) 0 0 0 786 785 (1) 0 0 827 1,613 1,613 0

Loan Repayment 0 700 0 700 700 0 0 0 169 869 869 0 0 700 0 1,569 1,569 0 0 0 169 1,738 1,738 0

Working Capital Loan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Interest on DH Loans 0 41 0 41 41 0 0 0 18 59 63 4 0 37 0 96 110 14 0 0 15 111 134 (23)

Other expenditure 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total Cash Out 14,132 15,579 14,985 44,696 44,562 (134) 15,824 15,774 16,781 93,075 90,918 (2,157) 14,983 15,791 15,595 139,444 139,611 167 15,230 15,461 17,260 187,395 184,677 2,718

Net Cash In/(Out) (2,784) 1,083 (110) (1,811) (1,677) (134) (759) 2,070 (1,174) (1,674) (2,391) 717 1,065 (40) (209) (858) (5,843) 4,985 (557) 994 (88) (509) (5,492) 4,983

Balance B/fwd 19,926 17,142 18,225 19,926 19,926 0 18,115 17,356 19,426 19,926 19,926 0 18,252 19,317 19,277 19,926 19,926 0 19,068 18,511 19,505 19,926 19,926 0

Balance C/fwd 17,142 18,225 18,115 18,115 18,249 (134) 17,356 19,426 18,252 18,252 17,535 717 19,317 19,277 19,068 19,068 14,083 4,985 18,511 19,505 19,417 19,417 14,434 4,983

CASHFLOW Apr-16 May-16 Jun-16 Q1 Q1 Q1 Jul-16 Aug-16 Sep-16 Q2 Q2 Q2 Oct-16 Nov-16 Dec-16 Q3 Q3 Q3 Jan-17 Feb-17 Mar-17 Q4 Budget Q4

RECONCILIATION £000 £000 £000 Actl Budget Variance £000 £000 £000 Actl Budget Variance £000 £000 £000 Actl Budget Variance £000 £000 £000 Actl £000 Variance

EBIT (753) (1,195) (1,015) (1,015) (1,019) 4 (1,195) (1,555) (1,661) (1,661) (1,394) (267) (1,745) (1,836) 782 782 (1,779) 2,561 608 401 908 908 (2,432) 3,340

Depreciation & Amortisation 639 1,278 1,917 1,917 1,917 0 2,556 3,196 3,739 3,739 3,786 (47) 4,362 4,985 5,601 5,601 5,730 (129) 6,183 6,746 7,300 7,300 7,670 (370)

0 0 0

EBITDA (114) 83 902 902 898 4 1,361 1,641 2,078 2,078 2,392 (314) 2,617 3,149 6,383 6,383 3,951 2,432 6,791 7,147 8,208 8,208 5,238 2,970

Stock (Inc)/dec 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Debtors (Inc)/dec (3,120) (821) (2,000) (2,000) (1,862) (138) (3,404) (147) (841) (841) 1,391 (2,232) (837) (404) (1,269) (1,269) (105) (1,164) (1,507) 675 222 222 2,150 (1,928)

Creditors Inc/(dec) 1,203 659 1,196 1,196 1,196 0 1,764 649 698 698 229 469 1,239 1,274 1,074 1,074 70 1,004 443 (656) (501) (501) (355) (146)

Provisions Inc/(dec) (24) (151) (402) (402) (402) 0 (450) (771) (707) (707) (234) (473) (694) (731) (2,799) (2,799) (351) (2,448) (2,880) (2,882) (2,909) (2,909) (468) (2,441)

Capital expenditure (735) (735) (781) (781) (781) 0 (1,131) (1,176) (1,242) (1,242) (4,486) 3,244 (1,275) (1,558) (1,870) (1,870) (6,995) 5,125 (1,893) (2,336) (2,753) (2,753) (8,645) 5,892

Capital disposals 0 0 5 5 0 5 17 28 29 29 0 29 30 44 44 44 0 44 45 49 647 647 0 647

Free Cashflow pre finance (2,790) (965) (1,080) (1,080) (951) (129) (1,843) 224 15 15 (708) 723 1,080 1,774 1,563 1,563 (3,430) 4,993 999 1,997 2,914 2,914 (2,080) 4,994

Interest 6 (36) (31) (31) (26) (5) (27) (24) (34) (34) (29) (5) (34) (68) (66) (66) (59) (7) (59) (63) (72) (72) (61) (11)

Dividends on PDC 0 0 0 0 0 0 0 0 (786) (786) (785) (1) (786) (786) (786) (786) (785) (1) (786) (786) (1,613) (1,613) (1,613) 0

Free Cashflow (2,784) (1,001) (1,111) (1,111) (977) (134) (1,870) 200 (805) (805) (1,522) 717 260 920 711 711 (4,274) 4,985 154 1,148 1,229 1,229 (3,754) 4,983

PDC Payment/(Repayment) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Loan repayments 0 (700) (700) (700) (700) 0 (700) (700) (869) (869) (869) 0 (869) (1,569) (1,569) (1,569) (1,569) 0 (1,569) (1,569) (1,738) (1,738) (1,738) 0

Lease Borrowings 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Capital Loan from DH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Net Cash In/(Out) (2,784) (1,701) (1,811) (1,811) (1,677) (134) (2,570) (500) (1,674) (1,674) (2,391) 717 (609) (649) (858) (858) (5,843) 4,985 (1,415) (421) (509) (509) (5,492) 4,983

Opening Bal 19,926 19,926 19,926 19,926 19,926 0 19,926 19,926 19,926 19,926 19,926 0 19,926 19,926 19,926 19,926 19,926 0 19,926 19,926 19,926 19,926 19,926 0

Closing Bal 17,142 18,225 18,115 18,115 18,249 -134 17,356 19,426 18,252 18,252 17,535 717 19,317 19,277 19,068 19,068 14,083 4,985 18,511 19,505 19,417 19,417 14,434 4,983

SOUTH CENTRAL AMBULANCE NHS FOUNDATION TRUST Appendix F

Capital resources available F1 Budget Exp summary F1 Budget

CAPITAL EXPENDITURE 2016/17 Core Depreciation 4,638 7,670 Clinical

Disposal Receipts 0 Estates 1,297 3,785

For the period to Available Surplus 0 Operations 644 90

31 March 2017 Internal Sources 825 Fleet 1,319 2,852

Total capital resources available 4,638 8,495 IT 1,328 1,768

Contingency 50 0

Shortfall to be financed 0 0 Total 4,638 8,495

Actual/Forecast Spend Profile

Scheme Description Budget April May June July August September October November December January February March Total

Actl Actl Actl Actl Actl Actl Actl Actl Actl Actl Actl Fcst Fcst

£000

ESTATES

New Education Facility - Bone Lane 2,205 133 2 201 3 124 350 813

Basingstoke Additional Parking 40 0

SHIP PTS Phase 2 - New building 3 51 3 57

Bracknell Hot Water 10 7 7

High Wycombe Kitchen 12 0

Southern House Air Con Upgrade 70 0

HART Additional Car Parking 25 0

Hythe Internal Upgrade 6 0

Transcare Upgrade 12 22 22

Newbury Conversion of Locker Room 20 0

Nursling New Store 7 0

Nursling Station Upgrade 14 0

Hants all stations 40 chirs 11 1 9 10

NH EOC Chs 2 2

Eastern Road Heating Upgrade 15 0

NH Kitchen Upgrade 12 5 5

Maidenhead ASAP 25 0

NH AC Phase 3 60 0

Bletchley RC Crew Room Upgrade 30 0

Nursling Station Upgrade Lighting 25 0

Nursling New Office Fleet 15 43 43

Bracknell Crew Room Upgrade 30 0

Didcot Crew Room Upgrade 15 0

Portsmouth - Roof Upgrade/pigeon prevention 40 0

Ringwood External Upgrade 20 0

SEHRC Roof Improvements 236 0

High Wycombe Crew Room Upgrade 25 0

High Wycombe Roof 1 1

Newbury Upgrade Lighting 15 0

Oxford City Electrical Switchgear Upgrade 50 0

Oxford City Crew Room Upgrade 20 0

Oxford City ambirad 6 6

Oxford City - Fire safety work 3 2 0 5

Oxford City wash bay upgrade 15 0

Oxford City Heating/Pipework 10 5 15

Reading Internal and External Dec 20 0

NH Roof - 2016 3 4 7

Stoke Mandeville Crew Room Upgrade 30 0 0

Wexham Park Garage Doors Replacement 50 0

New ASAP - Slough 75 23 20 4 47

Cycle Racks 30 0

Amersham Fire Exit 7 7

SH UPS 4 1 68 73

SH Accommodation 500 1 5 8 4 5 0 23

PTS Surrey 4 150 154

PTS Sussex # 0

Rev to Cap 0

OPERATIONS

Fuel Monitoring 50 0

Workshop Equipment 40 0

Zoll Defibrillators 504 504

Capitalisation of Lease Equipment and

Taelcom 140 140

FLEET

HY08 x 12 Assume Modular Build 1,496 344 52 800 1,196

HY08 x 7 Assume Conversions 791 0

RX 57 x 3 Van Conv 339 0

HX56 x 1 Van Conv 113 0

RX05 x 1 Van Conv 113 0

Driver Training Vans 49 49

Mitsubishi 19 19

Prototype into Workshop Van 55 55

Oxygen Cylinders 0

Workshops Vans 0

INFORMATION TECHNOLOGY

DS2000 78 1 1 13 21 36

Blade Server replacement 59 19 7 0 26

Skillstream Software 0

Station Infrastructure and Thin Client 433 1 0 1

Network Infrastructure - virtualisation 21 4 0 4

Replace Phones 137 0

Radio Site Strengthening 80 0 0

FAT Pipe Upgrade 20 0

Vehicle WIFI 98 0

Telemetry for vehicles 8 0 0

AW ICCs 15 0 0

Virtual Contact Centre 10 10

Email 200 0 0

CAD - Adastra 111 379 333 5 2 26 3 1 55 425

SQL Licences 33 33

GRS 50 89 7 3 12 2 1 2 116

Intergraph Development 100 21 12 5 9 200 247

Hardware/Software refresh 90 0 0

Surrey/Sussex PTS 164 202 366

Workshop vans 0 0

CFR pager replacement 64 64

Contingency 0

PTS Not Spent 0

General 50 50

TOTAL PROGRAMME 8,495 211 50 20 419 106 44 8 26 267 353 421 2,713 4,638

Appendix G

BALANCE SHEET Actual Actual Forecast

As at Feb 17 As at Feb 17 As at 31 Mch 16 As at 31 Mch 17

(£k) (£k) (£k)

FIXED ASSETS

Property, Plan & Equipment 61,342 66,005 62,901

Intangible assets 3,255 3,403 3,583

64,597 69,408 66,484

CURRENT ASSETS

Stocks & Work In Progress 1,031 1,031 1,031

Assets held for resale 2,950 2,950 2,700

Sales Ledger Debtors 2,038 1,101 1,800

Prepayments & Accrued Income 6,968 8,694 8,041

Other Debtors 1,692 1,619 1,310

Trade & Other Receivables 10,698 11,414 11,151

Cash and cash equivalents 19,505 19,926 19,417

TOTAL CURRENT ASSETS 34,184 35,321 34,299

CREDITORS

Purchase Ledger Creditors (2,080) (1,323) (1,199)

Accruals & deferred income (7,851) (9,792) (9,549)

Other Creditors Incl Pensions, PAYE & NI (4,726) (3,487) (3,357)

Capital Accruals (361) (762) (2,647)

Borrowings < 1 year (1,738) (1,738) (1,738)

Provisions < 1 year (2,691) (4,637) (2,664)

CURRENT LIABILITIES (19,447) (21,739) (21,154)

NET CURRENT ASSETS/(LIABILITIES) 14,737 13,582 13,145

TOTAL ASSETS LESS CURRENT LIABILITIES 79,334 82,990 79,629

Borrowings (3,309) (4,878) (3,140)

Provisions (7,107) (8,044) (7,107)

Other Financial Liabilities (15) (18) (15)

Non-Current Liabilities (10,431) (12,940) (10,262)

TOTAL ASSETS EMPLOYED 68,903 70,050 69,367

FINANCED BY:

TAXPAYER'S EQUITY

Public Dividend Capital (57,874) (57,874) (57,874)

Revaluation Reserve (10,973) (10,998) (10,986)

Other Reserve 350 350 350

Govt Grant Reserve- bfwd

Retained Earnings (1,553) (1,528) (1,540)

I & E YTD 1,147 0 683

TOTAL TAXPAYERS EQUITY (68,903) (70,050) (69,367)

South Central Ambulance Service NHS Foundation Trust

MM

Agenda Item: 11



Title Workforce Report including Staff Survey Update

Responsible Director Melanie Saunders, Director of HR & OD


The Trust Board is asked to receive and note the report









Please provide details of the risks associated with the subject of this paper (x-reference to the corporate risk register / Board Assurance Framework) Corporate Risks 5.1 Failure to support staff and provide access to education and training to meet mandatory, clinical and organisational requirements 5.2 Failure to effectively manage sickness absence 5.3 Failure to recruit and retain staff


CQC Regulation 22. Outcome 13 - Staffing. CQC Regulation 23, Outcome 14 - Supporting Workers

Financial implications / impact (e.g. CIPs, FRR, year-end outturn)

There are financial implications associated with delivering the workforce action plan

Council of Governor implications / impact (e.g. links to governors statutory role, significant transactions etc) The Council of Governors receive the monthly Integrated Performance Report containing information regarding workforce. Workforce was discussed as one of the key themes of the joint Council of Governors/Board of Directors strategy workshop on 1 February. Patient / staff implications (e.g. linked to NHS Constitution, equality and diversity)

The workforce action plan supports the pledges to staff in the NHS Constitution, published March 2013


All Board meeting in public, as well as more detailed considerations at Board Seminars in 2013, 2014, 2015, 2016


of 13


WORKFORCE REPORT INCLUDING STAFF SURVEY UPDATE

PURPOSE

1 The purpose of this report is to:

• Provide a summary of achievements against our workforce plan for 2016/17; • Provide an update on the development of our Health and Wellbeing Agenda

for 2016 and beyond; • Provide an update on the Trust’s performance against our agency spend

ceiling; • Outline the national agreement on new Band 6 Paramedic profile and newly

qualified Paramedic (Band 5) programme; • Publish the results of the 2016 National Staff Survey Results.

EXECUTIVE SUMMARY 2 Performance against all three workforce plans during Month 10 & 11 remained

variable, with some plans achieving forecast (PTS & 999) and others remaining below forecast (111). EOC recruitment is being carefully managed as the call taking element is close to full establishment and attrition remains low.

3 999 recruitment to Month 11 is improving, variance to year to date plan has

improved from month 9 with the gap to plan reducing from 42.4 to 23.5. Despite the challenges our Hampshire 999 teams are now close to establishment, and focus remains in filling gaps within the Thames Valley.

4 EOC recruitment and attrition remains positive, recruitment in month 10 and 11 is

being carefully managed to ensure workforce plan remains in budget. 5 Performance and progress with our health, wellbeing and engagement agenda

remains positive, with higher than forecast flu vaccination results (51.4% against 41.8%) and increasing engagement in health promotion. Quarter 3 CQUIN metrics have been submitted, approval from our commissioners is awaited.

6 Following a spike in sickness absence over the winter months, we are pleased to

report that absence continues to improve, Trust-wide the figure has reduced to 6.6%, dropping from a high of 7.5% in November 2016. Although slightly above forecast this is a slight improvement on the same period last year (refer Integrated Performance Report page 29).

7 The Trust continues to perform well against our agency spend ceiling, following a

reduction in spend over the last couple of months, our forecast spend to year-end is £3,746,000 against the ceiling of £4,476,000.

8 Following the national agreement to review the job profile of the Paramedic, the

Trust has reviewed our front-line paramedic job description, job matched our role

of 13

(via NHS job matching/evaluation procedures) against the new national profile and have confirmed that the role is now band 6.

9 The Trust will be implementing the changes during April and May which will result

in the movement of 346 eligible staff up the pay scale from c£21-28k to c£26-35k per annum.

WORKFORCE PLANS 10 Our workforce plans have been designed to deliver continuing workforce

improvements, thus supporting: • safe and effective patient care and key performance targets; • workforce sustainability and improving workforce numbers beyond 2016/17; • continued improvement on recruitment, attrition and workforce stability; • reduced reliance on agency workers and achievement of reductions in

agency spend; and • delivery of system transformation plans.

11 Our 2016/17 workforce plan aimed to deliver:

• 999 recruitment of 346 wte, with attrition forecast at 14% we anticipate a net increase in staff of c100 (allowing for internal changes/movement) and vacancies reducing to c11%.

• 111 recruitment of 201 wte, with attrition forecast at 35% we anticipate a net increase in staff of 65 and vacancies reducing to c5%.

• PTS recruitment of 138 wte, with attrition forecast at 12% we anticipate a net increase in staff of 65 and thus vacancies reducing to c5%.

MONTH 12 PERFORMANCE

999 FRONT-LINE INTEGRATED WORKFORCE PLAN

of 13

Recruitment Activity

RECRUITMENT Sep Oct Nov Dec Jan Feb

999 - Planned FTE 55.20 28.80 57.60 0.00 38.40 25.20

999 - Actual FTE 46.60 16.00 56.50 0.00 46.00 36.51

999 - Recovery FTE 0.00 0.00 0.00 0.00 0.00 0.00

Variance -8.6 -12.8 -1.1 0.0 7.6 11.3

999 - Cumulative Planned 158.40 187.20 244.80 244.80 283.20 308.40

999 - Cumulative Actual 129.91 145.91 202.41 202.41 248.41 284.92

Variance -28.5 -41.3 -42.4 -42.4 -34.8 -23.5

12 The challenge of recruiting to forecast has been evident throughout this financial

year, the last two months have seen a positive improvement and above target results in both month 10 and 11, reducing the year to date gap in recruitment from 34.8 to 23.5.

Attrition

ATTRITION Aug Sep Oct Nov Dec Jan Feb

Forecast FTE 15.0 14.0 17.0 18.0 17.0 16.0 18.0

Actual FTE 17.2 17.6 11.5 14.3 8.0 9.9 9.6

Cumulative Forecast FTE 84.0 98.0 115.0 133.0 150.0 166.0 184.0

Cumulative Actual FTE 59.6 77.2 88.6 102.9 110.9 120.8 130.4

of 13

13 Cumulative attrition in 999 continues to fall below forecast, the cumulative total of

130.4 wte remains below the forecast of 184 wte.

111 SERVICE INTEGRATED WORKFORCE PLAN


RECRUITMENT Aug Sep Oct Nov Dec Jan Feb

111 - Planned FTE 29.0 22.5 36.0 11.0 0.0 8.5 9.0

111 - Actual FTE 16.5 14.4 17.9 2.6 0.0 4.2 7.1

Variance -13 -8 -18 -8 0 -4 -2

111 - Cumulative Planned 105.0 127.5 163.5 174.5 174.5 183.0 192.0

111 - Cumulative Actual 56.0 70.4 88.2 90.8 90.8 95.1 102.2

14 The pipeline for 111 recruitment remains a challenge, in part due to the very part-

time nature of the candidates. Additional capacity within the training programme has also been released to help improve the workforce position.

15 The recruitment team continue to work with broadening the base of agency

partners. The social media campaign, targeted specifically in/around the geographical area of each call centre remains in situ. The teams continue to actively work and engage with local job and careers fairs to increase the local recruitment awareness and footprint.

of 13

Attrition


Forecast FTE 6.6 5.6 5.6 9.6 8.1 6.6 5.6

Actual FTE 7.5 9.8 10.5 3.3 5.1 10.0 7.0

% Attrition FTE 4.0% 5.1% 5.3% 1.7% 2.8% 5.6% 3.9%



% Attrition Cumulative FTE 17.0% 22.1% 27.4% 29.1% 31.9% 37.5% 41.4%

16 Attrition in month 10 and 11, although improved in M8 and 9, remains higher than

forecast. A ‘deep-dive’ into the factors driving attrition has commenced and will continue during Q4.

PATIENT TRANSPORT SERVICE INTEGRATED WORKFORCE PLAN Recruitment Activity

of 13


PTS - Planned FTE 12.0 7.2 9.6 7.2 7.2 14.4 12.0

PTS - Actual FTE 17.8 5.0 11.0 9.0 11.4 12.0 13.0

Variance 5.8 -2.2 1.4 1.8 4.2 -2.4 1

PTS - Cumulative Planned 94.8 102.0 111.6 118.8 126.0 140.4 152.4

PTS - Cumulative Actual 61.4 66.4 77.4 86.4 97.8 109.8 122.8

Variance -33.4 -35.6 -34.2 -32.4 -28.2 -30.6 -29.6

YTD Bank Recruitment 13.0 18.0 22.0 23.0 23.0 28.0 34

YTD Total HC Recruitment 74.4 84.4 99.4 109.4 120.8 137.8 157

17 Recruitment activity in PTS remains steady with pipeline candidate numbers also

remaining buoyant. The Trust is working to identify additional training capacity to help bridge the gap in workforce numbers and to keep up with the recruitment pipeline.

Attrition


Forecast FTE 6.0 4.0 3.0 5.0 7.0 3.0 5.0

Actual FTE 5.0 7.0 4.8 9.9 13.6 5.4 6.0

% Attrition FTE 1.3% 1.8% 1.2% 2.5% 3.4% 1.4% 1.5%



% Attrition Cumulative FTE 7.6% 9.6% 10.6% 13.1% 16.4% 18.1% 19.7%

18 Following positive results during Q2 attrition in PTS continues above forecast,

much of this is internal movement within SCAS. 2017/18 plans have been adjusted to better reflect the internal movement and career development of staff from PTS. Furthermore PTS and Emergency Care Assistant (ECA) training will be more closely mapped to help to reduce the impact of internal moment of staff on the workforce numbers within PTS.

of 13

PTS Workforce Vacancies

VACANCIES Aug Sep Oct Nov Dec Jan Feb

PTS ACTUAL FTE 390.7 384.0 393.9 392.3 396.6 389.0 389.0

PTS BANK UTILISATION FTE 19.5 38.2 27.9 30.0 30.7 25.2 25.2

PTS PLANNED FTE 473.6 479.2 489.8 494.4 499.4 518.0 518.0

BUDGET ESTABLISHMENT 478.5 478.3 478.3 478.3 478.3 478.3 478.3

VACANCY Vs. BUDGET EST 87.8 94.3 84.4 86.1 81.7 89.3 89.3

VACANCY Vs. BUDGET EST % 18% 20% 18% 18% 17% 19% 19%

19 Overall PTS workforce remains down on plan. However renewed focus continues

to improve attraction and applicant rates. The Trust is considering a range of new initiatives in relation to PTS recruitment, including further engagement of Job Centres and specialist agencies.

EOC INTEGRATED WORKFORCE PLAN

of 13



TOTAL - Planned FTE 11.90 16.10 26.60 10.50 0.00 9.60 14.40

TOTAL - Actual FTE 16.00 16.00 21.00 8.00 0.00 10.00 5.00

TOTAL - Variance 4.10 -0.10 -5.60 -2.50 0.00 0.40 -9.40

TOTAL - Cumulative Planned FTE 24.51 40.61 67.21 77.71 77.71 87.31 101.71

TOTAL - Cumulative Actual FTE 33.61 49.61 70.61 78.61 78.61 88.61 93.61

TOTAL - Cumulative Variance 9.10 9.00 3.40 0.90 0.90 1.30 -8.10

20 Recruitment activity for call-takers continues to be closely monitored as both call

centres are now close to above establishment.

Attrition


TOTAL - Forecast FTE 6.00 8.00 6.00 8.00 5.00 8.00 8.00

TOTAL - Actual FTE 9.00 10.26 3.00 5.60 4.61 2.00 1.00

TOTAL - Variance 3.00 2.26 -3.00 -2.40 -0.39 -6.00 -7.00

TOTAL - Cumulative Forecast FTE 26.87 34.87 40.87 48.87 53.87 61.87 69.87

TOTAL - Cumulative Actual FTE 27.87 38.13 41.13 46.73 51.34 53.34 54.34

TOTAL - Cumulative Variance 1.00 3.26 0.26 -2.14 -2.53 -8.53 -15.53

21 Attrition continues to improve, year to date cumulative 15.53wte below forecast.

of 13

Workforce Vacancies

22 In Q3, Emergency Call Takers were within 1% of full establishment in both North

and South Contact Centres, leaving the majority of vacancies within the Dispatch Team. Overall performance in month 11 has slightly reduced, the pipeline for M12 is positive and forecast to end the year on plan.

HEALTH AND WELLBEING (H&WB) 23 This year’s flu vaccination programme was hugely successful, the target for

reaching full CQUIN agreed improvement was 41.8% on frontline staff. The final figure of frontline staff was 58.8% and the final figure for all staff compliancy was 54.4%. This is the highest figure we have achieved in the last few years. Next year’s target is 70% of all staff so there is still more work to do but a lot has been learnt by this year’s campaign and we are hopeful to achieve this.

24 The health and wellbeing promotions with Occupational Health and Optum are progressing well. Visits (hits) on both wellbeing websites have again increased: Optum by 44% since April 2016 and Occupational Health by just over 46% against our forecast for the year of a 2% increase. Health promotion is key to the development of our health, wellbeing and engagement agenda, in order to gain further assurance on the benefit of these promotions.

25 Our CQUIN health and wellbeing plans were achieved in quarter 2 targets for

both Thames Valley and Southampton, Hampshire, and Portsmouth (SHiP) contracts, monies to the sum of £10,700 (equal to 10% of the CQUIN) have now been received. Q3 metrics have been submitted, approval from commissioners is awaited.

26 Whilst progress with the health, wellbeing and engagement agenda remains

positive, the target to reduce absence, in particular stress related absence remains a challenge. Stress related absence has improved over the last two months; and the target set for a 2% reduction in MSK related sickness has been successfully achieved. We are particularly encouraged by our fantastic staff

of 13

results, the Health, Wellbeing and Engagement section was particularly positive. The targets set for a 2% improvement in these areas has been met.

2016 NATIONAL STAFF SURVEY 27 Please see appendix 1 for the 2016 NHS National Staff Survey results. National Agreement: Band 6 Paramedic and Newly Qualified Paramedic Update Band 6 Paramedic 28 Following the national agreement in December 2016 to implement a new Band 6

Paramedic profile across UK Ambulance Trusts, the Trust continues to implement section 1 of the agreement and has reviewed our operational paramedic job description, job matched our role (via NHS job matching/evaluation procedures) against the new national profile and have confirmed that the role is now band 6.

29 In line with the national agreement, this outcome will be applied to qualified

paramedics currently working to the operational paramedic (formerly band 5) and HART operative paramedic job descriptions and who were employed and registered as a qualified paramedic before 1 September 2016. The new grade is applicable from 31 December 2016 but given the large numbers of staff affected and the work involved in making all the necessary changes in pay systems, we will be implementing the changes over a two month period.

30 This outcome is welcomed by the Trust and represents an enormous amount of

hard work and effort on the part of the Trade Unions and employers nationally and locally to review the paramedic roles in light of the evolving demands and requirements faced by ambulance services in the modern NHS.

31 The revised pay banding not only recognises the increased educational requirements of the role but also the greater depth of judgement and expectations required of staff to meet the needs of the urgent and emergency care agenda in terms of ‘See and Treat’ and ‘Hear and Treat’. We realise that this change not only recognises the development of the role but also provides a springboard to continue to develop our services to patients for the future.

Newly Qualified Paramedic (NQPs) 32 During February 2017 NHS Employers published agreed information and

documents relating to the Band 5 Newly Qualified Paramedic (NQP) role, which are now available for Trusts to adopt, namely:

• Agreed generic Band 5 NQP job description for Trusts to use • Principles of the NQP consolidation of learning document • Band 5 NQP FAQs • The new Band 5 NQP job profile

33 The national agreement around the Newly Qualified Paramedics (NQP) is not

intended to de-skill newly registered staff, rather Trade unions and employers recognise that new paramedics should be appropriately supported when they start to apply their knowledge and skills in their first substantive role, hence the

of 13

development of the 24-month consolidation of learning programme (CoL) for Newly Qualified Paramedics.

34 The consolidation of learning programme aims to provide a more structured

approach which properly integrates and supports NQPs into the workplace, enabling individuals time and support to consistently apply their academic knowledge, skills and placement experience into confident practice. This programme has been designed to provide a supportive transition to an effective, confident and fully autonomous clinician, furthermore, the programme will empower individuals to develop their practice and to demonstrate their transition from novice to expert.

35 The additional support given to NQPs (through the programme and additional

clinical support) in decision making at the start of their careers places the role in pay band 5 (as per the national job description and profile). Upon completion, NQPs will automatically move into a paramedic role in pay band 6 where they will be fully autonomous within the scope of their clinical practice. The national group working on the NQP programme do recognise that some NQPs may be able to ‘fast-track’ through the programme, the extent to which fast-track could take place and how this could work in practice is currently being developed.

36 SCAS will begin implementation of the job description and consolidation of

learning programming over the coming months, for those NQPs commencing since 1 September 2016.

37 The consolidation of learning portfolio and the fast track programme for newly

qualified paramedics are currently in development. These are expected to be completed and published by April 2017 and will be based on nationally agreed principles.

IR35 Changes and Agency Regulations Update

Employing Contractors – Recent Changes to IR35 38 NHSI recently published guidance on the use of NHS off payroll interims. This

follows the recent Autumn statement following which HMRC have tightened the rules regarding the treatment of what can be classed as interim employees (published in December 2016). The main change to previous guidance is that it is the responsibility of Trusts to assure themselves that the staff that they engage are complying with HMRC taxation and National Insurance (Ni) rules. These rules will apply without exception from 6 April 2017. This affects interim engagements that are arranged through an Agency or Personal Service Company (PSC).

3 9 Public sector organisations will now have the responsibility to determine

whether an interim assignment falls within, what are IR 35 rules, which will determine whether their payments are subject to tax and national insurance (and also whether contractors can take advantage of beneficial tax arrangements e.g. claiming mileage and subsistence). HMRC have developed a tool that the Trust will be able to use to determine whether the interim assignment falls within IR35 rules or not. As a “rule of thumb” if the interim assignment is undertaking project work, or does not have a fixed place of work,

http://www.nhsemployers.org/~/media/Employers/Documents/Pay%20and%20reward/Principles%20of%20NQP%20Consolidation%20of%20Learning%20Programme.pdf

http://www.nhsemployers.org/~/media/Employers/Documents/Pay%20and%20reward/Principles%20of%20NQP%20Consolidation%20of%20Learning%20Programme.pdf

of 13

they are likely to fall outside of IR35 (i.e. beneficial tax position). If the interim assignment is covering what is termed an office holder post (a substantive position within the Trust) then IR35 will probably apply.

40 The Trust is working through the regulations and using the tool-kit to review their

application to our interim assignments. Further assurance on progress and our compliance will be report via our remuneration committee.

Agency Regulations 41 The Trust continues to perform well against our agency spend ceiling, the month

11 agency spend status can be found in table 1 below, our forecast spend to year-end is £3,746,000, this is an improving picture on previous months following a reduction in spend.

Table 1:

Agency Spend February 2017 YTD £'s

Forecast £'s

Fire Responders Contracts Agency Nurses 512,873

567,000

Agency doctors - Air Ambulance 27,011

33,000 Agency - Finance IT Etc 227,103

240,000

Admin Type/Sec. Agency 804,276

845,000 Agency IT 557,425

594,000

Agency IT Sr 5,337

9,000 Agency paramedics 830,896

940,000

Agency PTS 133,820

151,000 Call Takers 359,499

367,000

Agency Staff Costs 3,458,239

3,746,000

NHSI Ceiling

4,476,000 RECOMMENDATIONS TO THE BOARD 42 The Board are asked to note the progress made in respect of the workforce plans

(including health and wellbeing and agency spend) each designed to support continued improvements in performance, quality of patient care, aid recruitment and retention and improve the working lives of our staff.

Melanie Saunders Executive Director of HR and OD 15 March 2017

of 13

Appendix 1 – Staff Survey Useful links: NHS Staff Survey Results: http://www.nhsstaffsurveys.com/Page/1047/Latest-Results/Ambulance-Trusts/ Band 6 Full agreement: http://www.nhsemployers.org/~/media/Employers/Documents/08%2012%2016%20agreement%20ambulance%20final%208%2000%20am.pdf Principles of NQP Consolidation of Learning Programme: http://www.nhsemployers.org/~/media/Employers/Documents/Pay%20and%20reward/Principles%20of%20NQP%20Consolidation%20of%20Learning%20Programme.pdf

http://www.nhsstaffsurveys.com/Page/1047/Latest-Results/Ambulance-Trusts/

http://www.nhsstaffsurveys.com/Page/1047/Latest-Results/Ambulance-Trusts/

http://www.nhsemployers.org/~/media/Employers/Documents/08%2012%2016%20agreement%20ambulance%20final%208%2000%20am.pdf

http://www.nhsemployers.org/~/media/Employers/Documents/08%2012%2016%20agreement%20ambulance%20final%208%2000%20am.pdf

of 6


APPENDIX 1 - STAFF ATTITUDE SURVEY 2016

PURPOSE 1 The purpose of the paper is to inform the Board of the outcomes of the 2016 staff

attitude survey, of progress against key outcomes in the 2015 survey and of actions planned to continue improvements and address key indicators of concern during 2017/18.

EXECUTIVE SUMMARY 2 The 2016 survey response was completed by 59.6% of staff. A number of

departments within the Trust achieved a return of over 90%. This was the highest ever result for SCAS and the highest result amongst NHS Ambulance Trusts.

3 SCAS received our highest ever overall engagement response rate (3.52); the

highest overall score compared to other ‘Picker’ Ambulance Trusts (3.41) and achieved an improvement against our own 2015 results for key finding 1 “staff recommendation of the organisation as a place to work or receive treatment” The table below highlights the staff engagement score across SCAS departments.

Table 1: Departmental comparison of SCAS Engagement score

of 6

4 Overall SCAS improved 50% of the 88 questions resulting in a more positive answer than last year. Compared to the results from 2015, the Trust has improved significantly on 39 questions, and was the best of all Ambulance Trusts on 17 questions.

5 Trust-wide, SCAS has no significant results lower than 2015 and only one result lower than the average Picker Ambulance score (Q4g: Not enough staff in my organisation to do my job properly). However, whilst this result was below the Picker Ambulance average, it was an improvement on the 2015 SCAS result for the same question.

6 Although at a departmental level variations in scoring is evident, the overall

survey can be classified as a huge success for the Trust. Combined with the high response rate, we are confident that the success is a result of the Trust’s focus on staff health & well-being, leadership development and our emphasis on corporate values.

7 The results indicate (at a Trust level) a strategic shift away from ‘recovering

below-average survey scores’, towards a philosophy of ‘Building on our Strengths’.

8 During 2017/18 our aim within the local engagement action plans will be to ‘Build

on our Success and Strengthen areas of Least Satisfaction’ with an ambition to continue our improvements and ultimately move SCAS into the upper quartile for all questions and to see every result above 50% (positive score) or heading towards achieving this target.

9 A staff communication plan has been developed and local engagement action

plans are being designed by and Heads of Departments with their teams. Progress against these plans will be reported to the Executive Team during 2017/18.

KEY ISSUES Staff Survey 2016 – Methodology and response rate 10 The staff survey was undertaken in October – November 2016 all staff were

invited to take part. The Trust undertook a fully electronic survey, with members of staff receiving an email with a unique log in. Staff on maternity leave were also encouraged to participate.

11 During the survey response rates were reported within the Trust on a weekly

league table basis, each manager actively encouraged their teams to participate. Each department/area was given a target of 50% completion. Response rates varied at a local level with the highest response rate being 100% (Human Resources Operations) and the lowest response rate being 11% (Commercial Logistic Services). The lowest rates were again experienced in the commercial services departments this year, during 2017/18 we will further explore how we can improve on this.

12 The efforts of the Workforce lead managing the survey and our team managers

actively encouraging their staff to participate resulted in an overall response rate of 59.6%, improving on the 55.5% response rate in 2015, and again the highest response rate for all Ambulance Trusts. The average response rate for the 6 'Picker' ambulance organisations was 40.5%.

of 6

Key Findings 13 A total of 88 questions were used in the 2015 and 2016 survey and the

questionnaire remained the same, enabling direct comparisons with all relevant questions.

14 The findings are presented under six themes / headings (your job, your

managers, your health, well-being and safety at work, your personal development, your organisation, background information). The results are reported as a percentage or a scale summary score ranging from 1 to 5, with higher positive scores being better and lower positive scores highlighting issues requiring further investigation. In addition to the overall Trust report the Trust received individual reports for each of our local areas and departments.

15 Compared to the 2015 Survey the Trust was significantly better on 39

questions and significantly worse on 0 questions. The top 10 improvements since the 2015 survey are listed below.

Table 2:

TOP TEN IMPROVEMENTS SINCE 2015 SURVEY

Question Asked 2015 2016 % Point Change

Would recommend SCAS as place to work (Friends & Family Test Result) 39% 49% 10%

Care of patients/service users is the SCAS top priority 49% 58% 9%

SCAS definitely takes positive action on health and well-being 18% 26% 8%

Happy with standard of care provided by SCAS (Friends & Family Test Result) 64% 72% 8%

Have adequate materials, supplies and equipment to do my work 47% 54% 7%

Staff given feedback about changes made in response to reported errors 43% 50% 7%

Would feel secure raising concerns about unsafe clinical practice 64% 71% 7%

Team members have a set of shared objectives 59% 65% 6%

SCAS takes action to ensure errors are not repeated 50% 56% 6%

Would feel confident that SCAS would address concerns about unsafe clinical practice 49% 55% 6%

16 In comparison to other Ambulance Trusts SCAS was significantly better than

average on 30 questions, achieved the average on 57 questions and significantly worse than average on 1 question. The top 10 improvements compared to other Ambulance Trusts are listed below.

of 6

Table 3:

TOP TEN IMPROVEMENTS COMPARED TO OTHER AMBULANCE TRUSTS

Question Asked SCAS Amb Ave

% Point Better

Team members often meet to discuss the team's effectiveness 43% 32% 11%

Immediate manager asks for my opinion before making decisions that affect my work 52% 42% 10%

Immediate manager encourages team working 71% 62% 9%

Immediate manager takes a positive interest in my health & well-being 71% 62% 9%

Immediate manager gives clear feedback on my work 63% 55% 8%

Immediate manager values my work 71% 63% 8%

Not felt pressure from manager to come to work when not feeling well enough 70% 63% 7%

Satisfied with support from immediate manager 69% 63% 6%

Would feel secure raising concerns about unsafe clinical practice 71% 65% 6%

Have adequate materials, supplies and equipment to do my work 54% 49% 5%

17 SCAS scored lower than the average Ambulance Trust result on the question

“there are enough staff at my organisation to do my job properly”. Only 18% of staff believed this in SCAS as opposed to the 22% average Ambulance Trust result, whilst lower than the Ambulance average this is an improvement on our 2015 score of 15%.

18 The Trust did exceptionally well on the following questions and was asked to

present nationally on how SCAS has achieved these improvements. The presentation focused on the investment that SCAS has placed in leadership development, team-working and health and well-being over the last year.

7a: Immediate manager encourages team working

71% positive score. Improved from NSS15 score by 1%, and are in NSS16 9% above Ambulance Trust average. Highest scoring Ambulance Trust by 4.4 percentage points.

7e: Immediate manager supportive in personal crisis

77% positive score. Improved from NSS15 score by 5%, and are in NSS16 10% above Ambulance Trust average. Highest scoring Ambulance Trust by 0.4 percentage points.

7f: Immediate manager takes a positive interest in my health & well-being

71% positive score. Improved NSS15 score by 2%, and are in NSS16 9% above Ambulance Trust average. Highest scoring Ambulance Trust by 0.8 percentage points.

7g: Immediate manager values my work

71% positive score Improved NSS15 score by 3%, and are in NSS16 8% above Ambulance Trust average. Highest scoring Ambulance Trust by 2.7 percentage points.

of 6

19 The overall Staff Engagement result has improved from 3.37 in 2015 to 3.51 in 2016. This also sees the Trust reach an engagement score above the national Ambulance Average for the first time in 4 years (Picker Ambulance Average = 3.41).

20 Areas where staff reported the least satisfaction include:

• Appraisals: delivery and quality of PDP’s • Senior Management: Communication and Engagement • Resources: Workforce numbers and utilisation of resources • Decision Making Process: lack of engagement at team level • Staff Health and Well-Being: Line Management engagement at local level

The table below details the top 12 areas of least satisfaction in SCAS where we need to focus our attention.

SCAS TRUST-WIDE: LEAST SATISFACTION

Question Asked 2015 2016 SCAS % change

since 2015

Ambulance Average

Not put myself under pressure to come to work when not feeling well enough 8% 9%

1% 9%

Enough staff at SCAS to do my job properly 15% 18% 3% 22%

Appraisal/review definitely helped me improve how I do my job 17% 19% 2% 16%

Senior managers act on staff feedback 20% 21% 1% 22%

Satisfied with level of pay 23% 23% 0% 23%

Senior managers try to involve staff in important decisions 22% 23% 1% 22%

Appraisal/performance review: definitely left feeling work is valued 22% 25%

3% 20%

SCAS definitely takes positive action on health and well-being 18% 26% 8% 25%

Don't work any additional paid hours per week for SCAS, over and above contracted hours 30% 28% 2% 30%

Communication between senior management and staff is effective 24% 28% 4% 27%

Appraisal/performance review: SCAS values definitely discussed 25% 29% 4% 30%

Clear work objectives definitely agreed during appraisal 25% 30%

5% 26%

21 Whilst these are the areas SCAS will continue to focus attention over the next

year, it is encouraging to see that since the 2015 survey we have improved in all these areas and remain higher than the Ambulance average in 6, the same in 2 and lower in 4.

Next steps 22 Meetings have taken place with all Heads of Department to help them to

interpret and understand their departmental results. 23 Workshops are being developed with Senior Managers to help them to

understand their results whilst highlighting how positive results in the staff

of 6

survey correlate with other HR statistics such as improved attrition, lower sickness, higher appraisal compliance.

24 The results have been shared with staff and Trade Union Representatives. 25 Managers have been asked at a local level to analyse their results, publicise

their successes and work with their teams and local managers to put in place plans to continue to improve areas of least satisfaction.

26 All managers are required to produce a local staff survey engagement plan

and 4 Pledges as a result of the staff survey by 19th May 2017. These will be review by the Executive Director of the department.

27 Local managers will also produce regular articles for Staff Matters highlighting

local actions as a result of their Staff Survey. 28 This report is presented to the Board by way of an update. The full survey

results can be found at http://www.nhsstaffsurveyresults.com/

Judith MacMillan HR Manager March 2017

http://www.nhsstaffsurveyresults.com/

Agenda Item: 12



Title Integrated Performance Report (IPR)

Responsible Director Charles Porter, Director of Finance

Recommendation (eg. note, approve, endorse) To note performance in month 11 of 2016/17










The IPR is one such mechanism for monitoring risks to the Trust.

Implications Regulatory and legal implications / impact (e.g. provider licence and segmentation ratings, CQC essential standards, competition law etc)

A number of the KPIs relate to performance on regulatory matters; for example, the NHS Improvement risk ratings.


Financial performance on CIPs, I&E, and against the financial risk ratings are all reported.


The Council of Governors receive the IPR each month, and an update on performance at each Council of Governors meeting.


The IPR includes a range of metrics relating to patients and staff. Please note that this excludes staff employed by South Central Fleet Services (SCFS) Limited; this is reported separately and monitored by the SCFS Board.


The Board receives and considers the IPR at each of its meetings.


Red > 30% Red scores, Green > 70% Green and <10% Reds (but no key indicators), Amber - rest

(Key indicators are: national standards, financial risk rating, overall FRR, SIRI's and Never Events).

RAG

Vs. last

monthR A G

999 Service

Clinical Performance A 27% 13% 60%

National Standards R 100% 0% 0%

Operational performance R 38% 15% 46%

Safety and risk management R 56% 11% 33%

111 Service A 6% 11% 83%

Corporate Areas

QIPP's (cost improvements) R 40% 16% 44%

QIPP's (quality impact) A 0% 58% 43%

Monitor - financial rating G n/a n/a n/a

Monitor - governance rating G n/a n/a n/a

Workforce R 78% 14% 8%

Overall Commentary:

Operational Performance / National Standards:

Safety and Risk Management

QIPP's - Cost Improvements

Workforce:

Integrated Performance ReportReport Period: February 2017

Red -rated areas are further commented on below:

Activity was 6.9% below the same period last year partly due to leap year effect. All three Red targets were hit in the month with Red 1 being 76.7%, Red 2 was 75.5% and Red 19 at 95.7%. Call answer performance

has improved to 94.0% in the month.

The Trust met the national constitutional standards for the 999 performance in February for the first time in over a year helped by a reduction in demand.

The main reasons for the shortfall are commercial savings being behind plan (in particular recruitment being behind), and the cycle time project and see and treat project not delivering in line with the original plan.

Febrile convulsion care bundle has seen a drop in compliance and the Clinical Governance Leads will be addressing this with the 999 Operational team to improve this compliance going forward. There has also been

a number of Public Liability Claims by members of staff relating to injuries whilst on duty. These are being investigated and the drive to ensure that staff are compliant with statutory and mandatory training e.g. manual

handling will help to drive these down and support the Trusts ability to defend these.

Page 1 of 32

Integrated Performance Report - 999 SCAS

Commentary:

Commentary:

Attrition remains better than plan and this

now more than balances the shortfall in

recruitment shown above. That said there

are geographical areas which remain

significantly under recruited whilst other

areas are now up to establishment. We are

developing plans to better target our

recruitment.

1,419.8 1,404.5

1,417.4 1,418.9 1,415.8 1,429.8 1,439.7

1,479.2

1,470.0 1,514.7 1,525.5

1,250.0

1,300.0

1,350.0

1,400.0

1,450.0

1,500.0

1,550.0

1,600.0

Total Frontline Workforce

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

33.0 39.0

51.0 68.3

83.3

129.9 145.9

202.4 202.4

248.4

284.9

0.0

50.0

100.0

150.0

200.0

250.0

300.0

350.0

400.0

Frontline Recruitment

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

7.3

20.3

31.1 42.3

59.6 77.2

88.6 102.9

110.9 121.8

130.4

0.0

50.0

100.0

150.0

200.0

250.0

Frontline Attrition

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

6.2%

8.6% 8.8%

9.0% 10.2%

11.0% 10.8% 11.0% 10.5% 10.4% 10.1%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

Frontline Attrition %

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

Page 2 of 32


Commentary:

Activity saw a sharp decline in the month in excesses of that expect due to the shorter month than prior year.

43,716

46,568 45,680

48,005

45,181

44,570

47,749

46,153

49,929

48,762

42,142

30,000

35,000

40,000

45,000

50,000

55,000

60,000

65,000

Activity (999 incidents) 2016-17Actuals2016-17 Plan

2015-16Actuals

24,606

26,416 26,134 27,319

25,369

25,349 26,562

26,119

28,340 27,414

23,998

15,000

17,000

19,000

21,000

23,000

25,000

27,000

29,000

31,000Activity North

2016-17Actuals2016-17 Plan

2015-16Actuals

19,110

20,152

19,546

20,686

19,812

19,221

21,187

20,034

21,589 21,348

18,144

15,000

16,000

17,000

18,000

19,000

20,000

21,000

22,000Activity South

2016-17Actuals

2016-17 Plan

2015-16Actuals

Page 3 of 32


Commentary:

Commentary:

As demand has dropped the acuity has increased making it more difficult to S&T and H&T. This will become an area of greater concentration in the coming year with increased focus on opening new pathways for non conveyance inspired by the integrated urgent care review

and the green code review.

Hear and Treat remains below target as clinicians remain in short supply and we concentrate their effort on reducing the demand created from 111.

11.2% 11.3% 11.6% 11.7% 11.3% 11.3% 12.4%

9.8% 9.6% 9.5% 9.1%

5.0%

7.0%

9.0%

11.0%

13.0%

15.0%

17.0%

19.0%

Hear & Treat 2016-17 Actuals

2016-17 Plan

2015-16 Actuals

9.9% 10.1% 10.6%

11.8%

10.1% 10.7% 10.7%

9.5% 9.6% 9.0%

8.6%

5.0%

7.0%

9.0%

11.0%

13.0%

15.0%

17.0%

19.0%

Hear & Treat North 2016-17 Actuals

2016-17 Plan

2015-16 Actuals

13.0% 12.8% 12.9%

11.7% 12.8%

12.1%

14.5%

10.0% 9.5% 10.1%

9.8%

5.0%

7.0%

9.0%

11.0%

13.0%

15.0%

17.0%

19.0%

Hear & Treat South 2016-17 Actuals

2016-17 Plan

2015-16 Actuals

36.9% 36.3%

36.6%

36.4% 36.2% 35.8%

34.3%

35.2%

36.6%

36.2% 36.4%

30.0%

32.0%

34.0%

36.0%

38.0%

40.0%See & Treat


2015-16Actuals

37.0%

36.8%

38.0%

35.9%

37.1%

36.3%

35.1% 35.1%

35.8%

35.7% 35.7%

30.0%

32.0%

34.0%

36.0%

38.0%

40.0%See & Treat North


2015-16Actuals

36.7%

35.7%

34.6%

37.0%

35.0%

35.1%

33.4%

35.4%

37.6%

36.9%

37.3%

30.0%

32.0%

34.0%

36.0%

38.0%

40.0%See & Treat South

2016-17Actuals

2016-17 Plan

2015-16Actuals

48.1%

47.6%

48.1% 48.1% 47.5%

47.0%

46.7%

45.0%

46.1%

45.7%

45.5%

42.0%

44.0%

46.0%

48.0%

50.0%

52.0% Non Conveyance


2015-16Actuals

46.9%

46.9%

48.6% 47.7%

47.2%

47.0% 45.8%

44.6% 45.4%

44.6%

44.3%

42.0%

44.0%

46.0%

48.0%

50.0%

52.0%Non Conveyance North


2015-16Actuals

`

49.6%

48.5% 47.5%

48.7%

47.8% 47.1%

47.8%

45.4%

47.1%

47.0%

47.1%

42.0%

44.0%

46.0%

48.0%

50.0%

52.0%Non Conveyance South


2015-16Actuals

Page 4 of 32


Commentary:

Commentary:

Commentary:

75.1% 73.7% 74.1%

68.4%

73.2%

69.8% 71.32%

73.0% 74.5% 74.7%

76.7%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

Red 1 Performance

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

RAP Trajectory

75.5%

76.1% 74.1%

67.9%

72.2%

69.6% 70.5%

72.5%

72.9% 73.9%

76.4%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%North Red 1 Performance

2016-17 Actuals

2016-17 Target

2015-16 Actuals

RAP Trajectory

74.6%

70.4%

74.1%

69.1%

74.4%

70.2%

72.3% 73.7% 76.7%

75.7% 77.2%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

South Red 1 Performance

2016-17 Actuals

2016-17 Target

2015-16 Actuals

RAP Trajectory

75.1%

72.2%

74.1%

71.5%

73.8%

73.4%

72.2% 72.4% 72.0%

71.4%

75.2%

60.0%

62.0%

64.0%

66.0%

68.0%

70.0%

72.0%

74.0%

76.0%

78.0%

Red 2 Performance

2016-17 Actuals

2016-17 Target

2015-16 Actuals

RAP Trajectory

76.5%

74.4%

75.6%

71.5%

74.5% 72.9%

72.7% 72.2% 70.7%

73.1%

75.3%

60.0%

62.0%

64.0%

66.0%

68.0%

70.0%

72.0%

74.0%

76.0%

78.0%


2016-17 Actuals

2016-17 Target

2015-16 Actuals

RAP Trajectory

73.2%

69.2%

72.0%

71.6% 72.8%

74.1% 71.6%

72.6% 73.0%

69.1%

74.9%

60.0%

62.0%

64.0%

66.0%

68.0%

70.0%

72.0%

74.0%

76.0%

78.0%

80.0% South Red 2 Performance

2015-16 Actuals

2016-17 Target

2014-15 Actuals

RAP Trajectory

96.0%

94.9% 94.6%

93.8%

95.0%

94.5% 94.1%

94.2% 94.4%

94.0%

95.2%

88.0%

89.0%

90.0%

91.0%

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%

98.0% Red 19 Performance

2016-17 Actuals

2016-17 Target

2015-16 Actuals

RAP Trajectory

96.4% 95.4%

94.6%

93.1%

95.0%

93.7% 93.9% 93.7%

92.8%

94.2%

94.9%

88.0%

89.0%

90.0%

91.0%

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%


2016-17 Actuals

2016-17 Target

2015-16 Actuals

RAP Trajectory

95.5%

94.2%

94.6%

94.7%

94.9% 95.6%

94.4%

94.9% 95.2%

93.6%

95.6%

88.0%

89.0%

90.0%

91.0%

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%

98.0%South Red 19 Performance

2016-17 Actuals

2016-17 Target

2015-16 Actuals

RAP Trajectory

Page 5 of 32


Commentary:

Commentary:

Commentary:

0.4%

0.6% 0.6%

1.2%

0.9% 0.9% 1.0% 0.8%

1.0%

1.1%

0.6%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%Long waits Red 8

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

0.2% 0.2%

0.3%

1.2%

0.6%

0.9% 0.9% 0.8%

1.2% 1.0%

0.6%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%Long waits Red 8 North

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

0.6%

1.0%

0.9%

1.3% 1.2%

1.0%

1.1%

0.9% 0.7%

1.3%

0.7%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%Long waits Red 8 South

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

0.9%

1.3% 1.3%

2.0%

1.5% 1.6%

1.7%

1.4% 1.6%

1.8%

1.0%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0% Long waits Red 19

2016-17 Actuals

2016-17 Plan

2015-16 Actuals0.7%

0.8%

1.2%

2.2%

1.3%

1.7% 1.6%

1.4%

1.6%

1.8%

1.0%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00% Long waits Red 19 North

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

1.1%

1.9%

1.4%

1.8% 1.8%

1.5%

1.9%

1.3% 1.6%

2.0%

1.0%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00% Long waits Red 19 South

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

13.46%

17.92% 19.86%

24.75%

18.35%

18.68% 21.39%

15.92%

18.41% 20.50%

13.37%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Long waits Greens

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

10.56%

15.08%

19.38%

25.73%

16.38% 20.23%

22.23%

14.99%

19.95% 18.13%

12.09%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

Long waits Greens North

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

17.35%

21.74%

20.49%

23.53%

20.83%

16.74%

20.31%

17.11% 16.46%

23.57%

15.04%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

Long waits Greens South

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

Page 6 of 32


Commentary:

Commentary:

The level of complaints in February reflects the relatively poor performance in January as the receipt of complaints has a natural lag compared to performance trends.

Performance in February was helped by a reduction, from an unacceptable high point in January. PHT still makes up 50% of the total delays and so long waits in the South remain higher than they would otherwise be.

1,059 974

698 810 830 849

1,408 1,338

1,899

2,457

1,438

0

500

1,000

1,500

2,000

2,500

3,000

Hospital handover delays


2015-16Actuals

334 300 291 372

341 335

491 470

737 803

494

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800North Hospital handover delays

2016-17Actuals

2016-17Plan

2015-16Actuals

725 675

407

438 488 514

917 868

1,163

1,654

944

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800South Hospital handover delays

2016-17Actuals

2016-17Plan

2015-16Actuals

0.05%

0.07%

0.06%

0.05% 0.06%

0.05%

0.06%

0.04% 0.03%

0.03%

0.05%

-0.01%

0.01%

0.03%

0.05%

0.07%

0.09%

0.11%

0.13%

0.15%

Complaints 2016-17 Actuals

2016-17 Plan

2015-16 Actuals

0.04%

0.06%

0.07%

0.06%

0.07%

0.05% 0.06%

0.04%

0.03% 0.02%

0.05%

-0.01%

0.01%

0.03%

0.05%

0.07%

0.09%

0.11%

0.13%

0.15% North Complaints 2016-17 Actuals

2016-17 Plan

2015-16 Actuals

0.05%

0.08%

0.05%

0.04%

0.06% 0.05%

0.07%

0.04%

0.04%

0.03%

0.04%

-0.01%

0.01%

0.03%

0.05%

0.07%

0.09%

0.11%

0.13%

0.15% South Complaints 2016-17 Actuals

2016-17 Plan

2015-16 Actuals

Page 7 of 32


Commentary:

Commentary:

4.9% 4.6%

5.2% 6.1%

4.8% 5.3% 5.6%

6.3%

9.0%

7.5% 5.5%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

11.0%

12.0%North Sickness

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

7.7%

5.9%

6.7%

6.6%

6.9% 7.5%

8.0%

7.4%

7.9%

8.1%

7.6%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

11.0%

12.0%South Sickness

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

5.6% 4.8%

5.6%

6.0%

5.5% 6.0%

6.5% 6.7%

8.8%

7.8%

6.3%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

11.0%

12.0%Sickness

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

84.6% 85.8%

82.1%

75.2%

75.8%

72.7% 74.5%

73.1%

74.2%

78.4% 77.7%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%North Appraisals

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

75.4% 75.8% 75.3%

73.4%

72.8%

74.1%

71.6% 74.5% 74.6% 75.7% 76.7%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%South Appraisals

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

84.6% 85.8% 82.1%

75.2%

75.8%

72.7%

74.5% 73.1%

74.2% 78.4% 77.7%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%Appraisals

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

Page 8 of 32


Commentary:

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%Training Course Completion (1 of 2)

999 - Manual Handling

999 - Health & Safety

999 - Equality & Diversity

999 - Conflict Management

999 - Infection Control

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%


999 - Safeguarding Adults Level 1

999 - Safeguarding Children Level1

999 - Fire Awareness

999 - Information Governance

999 - Resus

Page 9 of 32


Commentary:

Commentary:

STEMI 150 - The data is improving but

some trusts are behind with their data entry

which will affect current performance.

75.3% 73.6% 73.8% 69.6% 70.4%

67.1% 64.5%

83.2%

65.00% 76.7%

87.5%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Dec Jan Feb March April May June July Augt Sept Oct Nov

STEMI - Care

2016-17 Actuals

2016-17 Plan

2015-16 Actuals (Dec '14 - Nov '15)Note: National CQI's are reported with a 4 month lag

99.1%

97.2%

96.8%

98.2% 98.5% 98.2% 98.1%

98.89%

98.12% 99.1%

97.8%

94.0%

95.0%

96.0%

97.0%

98.0%

99.0%

100.0%

101.0%

102.0%


Stroke - Care 2016-17 Actuals

2016-17 Plan

2015-16 Actuals (Dec '14 - Nov'15)

National Average (15/16)

Note: National CQI's are reported with a 4 month lag

91.2%

86.8%

83.1%

86.4%

81.4%

92.7% 87.0% 90.24%

88.54% 83.5%

87.5%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%


STEMI - 150min to PPCI

2016-17 Actuals

2016-17 Plan

2015-16 Actuals (Dec '14 - Nov'15)

National Average (15/16)Note: National CQI's are reported with a 4 month lag

55.5% 50.7% 53.9% 53.8% 52.9%

49.3% 52.2% 52.78%

57.56%

51.3%

57.1%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

April May June July Augt Sept Oct Nov Dec Jan Feb March

Stroke - 60min to stroke centre

2016-17 Actuals

2016-17 Plan

2015-16 Actuals (Dec '14 - Nov'15)


Page 10 of 32


Commentary:

ROSC / STD - The ROSC figure has

dropped for October but the overall monthly

figure is variable. SCAS now has the

Mortality review meetings to review all cases

of witnessed arrests to gain an

understanding of any trends.

36.4%

41.7% 44.0%

40.0%

45.2%

40.8%

25.0%

47.06%

44.44%

58.1%

27.6%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%


ROSC (witnessed) 2016-17 Actuals

2016-17 Plan

2015-16 Actuals (Dec '14 - Nov '15)



34.3%

17.4%

31.8%

16.7%

16.7%

26.7%

13.6%

36.75%

20.83%

30.8% 24.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%


Cardiac Arrest (witnessed) Survival 2016-17 Actuals

2016-17 Plan

2015-16 Actuals(Dec '14 - Nov '15)


Page 11 of 32


Operational Performance R Overall rating (other) R

Performance Pressures

National indicators

Incident Growth - SCAS -6.9% -5.0% n/a 4.4% 1.1% n/a 3.9% 0.4% n/a

Incident Growth - North -6.6% -6.2% n/a 4.1% 0.7% n/a 3.7% -0.1% n/a

Incident Growth - South -7.3% -3.1% n/a 4.7% 1.6% n/a 4.2% 1.1% n/a

999 % calls from frequent callers 2.8% 5.0% G 2.9% 5.0% G 2.9% 5.0% G

Other indicators

Actual Plan RAG Actual Plan RAG Forecast Plan RAG

Green 2 - response within 30 minutes 66.5% 88.0% R 60.5% 88.0% R 60.5% 88.0% R

Green 4 - telephone assessment within 60

minutes92.7% 90.0% G 90.9% 90.0% G 90.9% 90.0% G

Operations indicators

VOR - scheduled maintenance 4.0% 4.0% G 4.0% 4.0% G 4.0% 4.0% G

VOR - unscheduled 16.3% 18.0% G 17.0% 18.0% G 16.0% 16.1% G

A&E Performance by CCG Cluster


Green 2 - response within 30 minutes

North Cluster 67.6% 88.0% R 60.5% 88.0% R 60.5% 88.0% R

South Cluster 65.1% 88.0% R 60.5% 88.0% R 60.5% 88.0% R

Green 4 - telephone assessment within 60 minutes

North Cluster 93.4% 90.0% G 90.3% 90.0% G 90.3% 90.0% G

South Cluster 91.9% 90.0% G 91.5% 90.0% G 91.5% 90.0% G

Feb-17Performance Measure Year to date Full year

Plan RAGForecastActual Plan RAG Actual Plan

Overall rating (national - Red 8 & Red 19)

Lead Director: Philip Astle

Commentary on exceptions

(Red - action to correct, Amber - action to reduce risk, Green - nil)

February saw an increase in performance as demand fell away but the high levels of acuity still

meant that Green 30 performance was behind the target.

RAG

Feb-17 Year to date Full year Commentary on exceptions


Performance Measure Feb-17 Year to date Full year Commentary on exceptions






Page 12 of 32


Clinical Performance Overall ratingA

11.00

Other clinical indicators

Hypoglycaemia care bundle 100.0% 98.2% G 99.0% 98.2% G 99.0% 98.2% G

Asthma care bundle 86.0% 82.2% G 76.0% 82.2% A 76.0% 82.2% A

Limb fractures care bundle 42.9% 45.8% A 64.6% 45.8% G 64.6% 45.8% G

Febrile convulsion care bundle 70.0% 87.5% R 88.3% 87.5% G 88.3% 87.5% G

Safeguarding

Number of adult referrals - this relates to

vulnerable adults who may be at risk from abuse or

neglect

1,012 460 n/a 13,642 5,060 n/a 14,882 5,520 n/a

Number of child referrals - this relates to children

who may be at risk of abuse or neglect194 130 n/a 2,847 1,430 n/a 3,106 1,560 n/a

Vehicle deep cleans - A&E 122 110 G 1,310 1,210 G 1,432 1,320 G

Vehicle routine cleans 3,723 5,364 R 51,083 62,440 A 54,806 68,429 A

Number of cleanliness compliance audits* 118 54 G 697 649 G 815 648 G

Number of adverse events due to administration

errors* 0 1 G 3 11 G 7 12 G

Number of controlled drug incidents* 3 4 G 59 44 R 64 48 R

Medicines Management

RAG Forecast Plan

Forecast

Forecast Plan RAG

RAG Forecast

RAG Actual Plan

RAG Actual Plan

Plan

* These items are also reported in the quality accounts

Measure

Measure Feb-17 Full year

Red > 30% Red scores, Green > 70% Green and <10% Reds (but no key indicators),

Amber - rest


(Red - action to correct, Amber - action to reduce risk, Green - nil)Full yearYear to date

Lead Director: John Black

Actual Plan

Feb-17 Full yearYear to date

Plan RAG

Actual

Year to date Commentary on exceptions




Measure



Availability of vehicles this (short) month has resulted in the low figure. Plans are in place to ensure service improvement across all

areas - pilot in Nursling workshop underway to ensure all vehicles checked and cleaned BEFORE being moved out to stations; new

working practices at some sites (Bletchley/MK) with operatives working nights and Basingstoke/ Andover , due to be implemented

mid-March.

Year to date

Hygiene & infection prevention & control

Feb-17

Actual Plan

Actual Plan RAG

Plan RAG Actual Plan RAG RAG

Measure (care bundles are part of National Clinical

Performance Indicators data gathering) RAG Actual Plan

Feb-17

The low compliance is due to the pain scoring element. The ePR compliance tool for the Single limb fracture has been

given priority over the others following the success of the STEMI Care Bundle tool. The limb fracture Change Control

Notice will be with Ortivus for pricing at the end of March 17.

The drop in compliance is due to blood glucose recording which will be shared with the Clinical Governance Leads to

share with staff.

Full year

RAG

Page 13 of 32

Integrated Performance Report - National ACQI

Safety & risk managementOverall rating R

Red > 30% Red scores, Green > 70% Green and <10% Reds (but no key indicators), Amber - rest


Number of DATIX incidents - staff (this is the internal form

to report incidents in SCAS - this covers all types of

incident - accidents, injuries, missing equipment etc.)

162 228 n/a 1,758 1,658 n/a 1,798 1,798 n/a

Number of DATIX incidents - non staff (this is the internal

form to report incidents in SCAS - this covers all types of

incident - accidents, injuries, missing equipment etc.)

280 208 n/a 3,081 2,581 n/a 2,845 2,845 n/a

Number of incidents reported to the NRLS (CQC/NRLS

reportable)18 73 n/a 177 836 n/a 193 914 n/a

% of incidents reported to the NPSA within 30 days 1 1 G 10 11 G 12 12 G

Number of Serious Incidents Requiring Investigation (SIRI)

reported 1 1 G 11 11 G 12 12 G

Number of SIRI investigations outstanding after 60 days

(excluding events that are officially suspended)0 0 G 0 0 G 0 0 G

Number of Never Events (CQC/NPSA reportable) 0 0 G 0 0 G 0 0 G

Clinical negligent claims (CNST) 1 1 G 9 11 G 12 12 G

Public liability claims 1 1 G 14 11 R 15 12 R

The majority of these claims are from members of staff who allege they have been injured at

work. It is important to note that this represents the number of claims submitted and not the

number of claims that are successful. We will continue to defend claims that are without merit.

However, the Legal Services Manager is aware that analysis for trends and themes does need to

be completed.

Staff Safety Measure

Number of RIDDOR reports (HSE reportable) 7 8 G 86 88 G 94 96 G

Number of Physical Assaults (NHS Protect reportable) 15 12 R 168 128 R 183 140 R

There has been an increase in incidents reported and an increase in the number of physical

assault incidents reported. Following an assault, the Risk Team work with the assaulted member

of staff and the Police to try and secure a sanction against the assailant. The Risk Team will also,

where possible, place a marker/alert on the address of the assailant.

Number of Non-Physical Assaults (NHS Protect

reportable)20 19 A 171 136 R 187 149 R

Number of Security Incidents (NHS Protect reportable) 9 4 R 96 44 R 105 48 RThe Risk Team are currently carrying out crime reduction surveys on Trust premises to identify any areas

of concern with regards to security.

* These items are reported in the quality accounts as well

FOI (Freedom of Information Act) 72.2% 100.0% R 79.0% 100.0% R 79.0% 100.0% R This area continues to be a challenge with a high level of requests

Data protection Act (DPA) - police, solicitor/medical,

subject access94.0% 100.0% A 86.0% 100.0% A 86.0% 100.0% A



Lead director: Deirdre Thompson

Full year

Patient Safety Measure

Feb-17 Year to date

Page 14 of 32

Integrated Performance Report - Clinical Coordination Centre

Commentary:

Commentary:

111 demand fell below 15/16 actuals

although remained close to plan. 999

demand also fell below last years actuals,

however it was a leap year last year

111 call answer improved on January

outturn due to workforce numbers and

reduced demand. 999 saw another

improvement in call answer with monthly

outturn of 94%. This was due to workforce

numbers improving.

98,165

109,785

93,870

104,771

93,722

95,169

104,878

100,828

123,359

116,864

97,942

80,000

90,000

100,000

110,000

120,000

130,000

140,000111 Calls

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

90.10%

84.60%

86.00%

81.90% 82.10% 77.70%

81.00% 86.10%

91.10%

93.20%

94.00%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0% 999 Call answer time (95% percentile)

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

89.9% 95.3%

96.9%

95.5% 97.8% 96.4%

94.0%

95.9%

82.7% 83.9%

89.3%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

110.0% 111 Call answer time (95% percentile)

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

54,976

60,301

59,817

63,905

58,958

58,726

62,624

58,903

61,546

61,928

52,361

40,000

45,000

50,000

55,000

60,000

65,000

70,000999 Calls

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

Page 15 of 32


Commentary:

Commentary:

ED referrals increased, however this still

remains below the national average

Clinical advice line demonstrating

improvement in 111 -999 referrals

9.84%

9.40%

10.21%

9.90% 9.67% 9.41%

9.80%

10.58%

8.89%

9.38% 9.08%

6.0%

7.0%

8.0%

9.0%

10.0%

11.0%

12.0%

111 to 999 referrals (%) North

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

10.63%

10.15%

11.13% 10.48%

10.03%

10.06%

10.49% 10.52%

9.75%

10.26%

9.62%

6.0%

7.0%

8.0%

9.0%

10.0%

11.0%

12.0%

111 to 999 referrals (%) South

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

7.82% 7.94% 8.22% 8.25% 8.35% 8.26% 8.80%

7.71% 7.07%

7.44% 7.76%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

111 ED Referral (%) North

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

6.58% 6.76% 7.02% 7.10% 7.28%

7.02% 7.11% 7.02%

6.27% 6.64%

7.05%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

111 ED Referral (%) South

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

Page 16 of 32


Commentary:

Commentary:

transfer to clinician saw an improvement

after introduction of clinical advice line,

however still a fair way below the 30%

national requirement for IUC 0.965

0.9571 0.9547 93.9% 0.9592 0.9578

0.9504 0.9468

0.9378

0.961

95.0%

0.9

0.91

0.92

0.93

0.94

0.95

0.96

0.97

0.98

0.99

1Red 19 Performance

2014-15 actual

2014-15 plan

2013-14 actual

Continuing improved performance in September and the Q2 targets has been

achieved

0.89 0.886

0.857

0.817

0.853

92.5%

0.7855

0.8591

0.8309

95.0%

0.7

0.75

0.8

0.85

0.9

0.95

1Call answer time (95% percentile)

2014-15 actual

2014-15 plan

2013-14 actual

Deterioration month on month due to staffing levels

- call answering still good

17.4% 18.1% 18.3%

18.3%

19.1%

19.9%

20.0% 20.1%

17.6% 16.2%

18.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%111 Transfers to clinician (%)

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

30.6% 30.2% 27.7% 28.0% 30.9% 33.0% 31.1% 29.4%

21% 24% 25%

95.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%111 Call back (% < 10 mins - target 95%)

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

1.57%

0.54% 0.39% 0.57% 0.23% 0.42% 0.63% 0.49%

2.71% 2.70%

1.32%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

111 Calls Abandoned (target <5%)

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

0.65%

1.15%

1.03%

1.42% 1.49%

1.94%

1.32% 1.24%

0.46%

0.15% 0.23%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

999 Calls Abandoned (target <5%)

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

Page 17 of 32


Commentary:

Commentary:

9

5

11

6

11

4 5

8

4 2

9

0

5

10

15

20

25

30

111 Complaints 2016-17Actuals2016-17 Plan

2015-16Actuals

5.2%

6.4%

7.5%

6.6%

5.6% 6.3%

5.8%

6.9% 6.2%

7.5%

6.5%

7.3%

5.6% 5.4% 5.1% 5.1% 5.1%

7.1%

8.3%

9.3% 9.7% 9.8%

3.0%

5.0%

7.0%

9.0%

11.0%

13.0%

15.0% Sickness EOC Actual

EOC Plan

111 Actual

111 Plan

*The plan is 0.5% lower than last years actual

91.7% 89.6% 90.7% 88.3% 90.7% 90.0% 87.4%

96.3%

97.0% 95.2% 96.4%

69.0% 72.0% 71.1% 72.0% 73.7%

67.0%

59.7%

71.8% 72.1% 68.1% 69.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

April May June July Augt Sept Oct Nov Dec Jan Feb March

Appraisals

EOC appraisals

111 Service

Appraisal Target

Page 18 of 32


Commentary:

Commentary:

111 workforce numbers remain well below

plan and are the greatest priority for

recruiting and retention planning. The

undermanning in turn leads to higher than

acceptable sickness levels. The workforce

planners are seeking a different workforce

solution including some work with Trusts in

areas of higher unemployment.

243.6 243.7 243.9 241.0

247.1 246.9

253.3

269.7

259.5

263.3

259.2

225.0

230.0

235.0

240.0

245.0

250.0

255.0

260.0

265.0

270.0

275.0

EOC Workforce

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

184.7

188.0

188.7

182.0

188.9

190.5

194.5

195.4 188.1

181.7 178.1

150.0

170.0

190.0

210.0

230.0

250.0

270.0

111 Workforce

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Training Course Completion (1 of 2)

Manual Handling

Health & Safety

Equality & Diversity

Conflict Management

Infection Control

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Training Course Completion (2 of 2)

Safeguarding Adults Level1Safeguarding ChildrenLevel 1Fire Awareness

Information Governance

Page 19 of 32


111 Service Overall rating A Red > 30% Red scores, Green > 70% Green and <10% Reds (but no key indicators), Amber - rest


Oxford :

Oxford Calls (no. answered) 15,465 13,929 n/a 177,687 181,734 n/a 194,931 197,459 n/a

Oxford Call Answering (% within 60

seconds) 88.5% 95.0% A 92.2% 95.0% A 92.2% 95.0% A

Oxford 999 referrals (%) 9.0% 10.0% G 9.4% 10.0% G 9.4% 10.0% G

Oxford Calls Abandoned (target <5%) 1.2% 5.0% G 1.1% 5.0% G 1.1% 5.0% G

Oxford Transfers to clinician (%) 18.8% 20.0% G 18.8% 20.0% G 18.8% 20.0% G

Oxford Time taken for call back (% < 10

mins - target 95%)23.9% 95.0% R 27.9% 95.0% R 27.9% 95.0% R

This performance figure covers all call priorities of call, local agreement for

RAP in place with commissioners to focus on improvement of warm

transfers of P1 calls only. P1 callbacks within 10 minutes February outturn

35%. This is still behind trajectory. The causative factor being current

service model of clinician ratio at 5:1 and a finite number of clinicians in

place

Hampshire :Hants Calls (no. answered, 111 and

Dental)42,755 42,823 n/a 503,532 515,125 n/a 550,560 561,010 n/a

Hants Call Answering (% within 60

seconds, 111 only) 89.5% 95.0% A 92.7% 95.0% A 92.7% 95.0% A

Hants 999 referrals (%) 9.6% 10.0% G 10.3% 10.0% A 10.3% 10.0% A

Hants Calls Abandoned (target <5%, 111

only)1.3% 5.0% G 1.0% 5.0% G 1.0% 5.0% G

Hants Transfers to clinician (%) 18.1% 20.0% G 17.7% 20.0% G 17.7% 20.0% G

Hants Time taken for call back (% < 10

mins - target 95%)27.2% 95.0% R 29.6% 95.0% R 29.6% 95.0% R






place


Berkshire:

Berks Calls (no.) 18,164 19,154 n/a 210,412 214,314 n/a 231,518 233,438 n/a

Measure Feb-17

Measure Feb-17



Full year

Full yearYear to date

Year to date

Lead Director: Philip Astle/Luci Stephens

Page 20 of 32


Berks Call Answering (% within 60

seconds) 89.3% 95.0% A 92.4% 95.0% A 92.4% 95.0% A

Berks 999 referrals (%) 9.5% 10.0% G 10.7% 10.0% A 10.7% 10.0% A

Berks Calls Abandoned (target <5%) 1.2% 5.0% G 1.0% 5.0% G 1.0% 5.0% G

Berks Transfers to clinician (%) 19.7% 20.0% G 19.8% 20.0% G 19.8% 20.0% G

Berks Time taken for call back (% < 10

mins - target 95%)22.7% 95.0% R 27.1% 95.0% R 27.1% 95.0% R






place

Buckinghamshire:

Bucks Calls (no.) 12,335 12,439 n/a 142,688 141,768 n/a 156,397 154,458 n/a

Bucks Call Answering (% within 60

seconds) 89.4% 95.0% A 92.2% 95.0% A 92.2% 95.0% A

Bucks 999 referrals (%) 7.6% 10.0% G 8.0% 10.0% G 8.0% 10.0% G

Bucks Calls Abandoned (target <5%) 1.9% 5.0% G 1.2% 5.0% G 1.2% 5.0% G

Bucks Transfers to clinician (%) 19.7% 20.0% G 20.9% 20.0% A 20.9% 20.8% A

Bucks Time taken for call back (% < 10

mins - target 95%)21.2% 95.0% R 25.9% 95.0% R 25.9% 95.0% R






place

Luton & Beds:

Luton & Beds Calls (no.) 9,480 8,562 n/a 103,740 102,988 n/a 111,901 112,103 n/a

L&B Call Answering (% within 60

seconds) 90.1% 95.0% A 93.0% 95.0% A 93.0% 95.0% A

L&B 999 referrals (%) 10.3% 10.0% A 10.8% 10.0% A 10.8% 10.0% A

L&B Calls Abandoned (target <5%) 1.3% 5.0% G 1.1% 5.0% G 1.1% 5.0% G

L&B Transfers to clinician (%) 19.5% 20.0% G 20.5% 20.0% A 20.5% 20.8% G

L&B Time taken for call back (% < 10

mins - target 95%)24.6% 95.0% R 28.6% 95.0% R 28.6% 95.0% R






place

Page 21 of 32


Finance Finance rating G CIP rating R


Debt service cover rating (20%) 2 2 G 2 2 G 2 2 G

Liquidity Rating (20%) 1 1 G 1 1 G 1 1 G

I&E Margin (20%) 3 4 G 3 4 G 3 4 G

I&E Margin Variance From Plan (20%) 1 3 G 1 3 G 1 3 G

Agency rating (20%) 1 1 G 1 1 G 1 1 G

Continuity of Service Risk Rating (New) 2 3 G 2 3 G 2 3 G


Debtors > 90 days> 5% total balance No No G No No G No No G

Agency Spend 284 373 G 3,223 3,730 G 3,865 4,476 G

Full year Commentary on exceptions

(Red - action to correct, Amber - action to reduce risk, Green -

nil)

Lead Director: Charles Porter

Measure: Use of Resource ratingFeb-17 Year to date


(Red - action to correct, Amber - action to reduce risk, Green -

nil)

Measure Feb-17 Year to date Full year

Page 22 of 32



£k £k £k £k £k £k

Commercial Division

Subtotal Commercial Division 75 151 R 725 1,726 R 759 1,869 RBehind plan for Commercial CIPS due to challenging

recruitment of staff and VCDs


£k £k £k £k £k £k

Operations

Eliminate overtime incentive scheme 1 1 G 1,043 1,056 A 1,047 1,056 A 9

Reduce sick absence by 0.5% to 6.2% (per mth) 0 34 R 0 302 R 0 335 RSickness in the month was at 8.35%. This eliminated

any year to date benefit that had accrued6

Annual leave reduced by 0.5% due to new recruits 42 42 G 461 461 G 503 503 G 2

Reduce cycle time by 4 mins 32 124 R 32 1,112 R 32 1,236 RIncrease in red % as well as hospital delays have

impacted on the ability to deliver this CIP.12

Increase See and Treat by 1% 0 60 R 0 436 R 0 496 RStill only one Specialist paramedic Hub, overall the

conveyance % has increased9

Reduce response ratio by 0.01 (1.12 ratio for full year) 0 17 R 117 184 R 117 201 RResponse ratio was at 1.14 for January which was due

to a reduction in hear & treat2

Staff Attrition by .6% (10) 6 R 217 54 G 211 60 G 6

Improve use of HCP tier - HCP dedicated desk 0 25 R 95 271 R 95 296 RSavings on trial HCP vehicle rental only reporting is not

yet available. Delays in CAD algorithm6

A&E Recruitment better profiling for year 78 22 G 599 244 G 629 287 GHours from own staff were affected by increase in

sickness and other abstractions12

111 reduce sickness to 14/15 level of 6.48% vs 8.8% 26 10 G 59 113 R 79 124 R Short term sickness is significant 12

111 Rota redesign to increase rota efficiency 21 21 G 132 132 G 153 153 G 2

111/EOC share clinician hours to meet peaks 2 2 G 49 47 G 88 86 G 2

Quality ImpactMeasure Feb-17 Year to date Full year

Commentary on exceptions (Red - action to correct, Amber -

action to reduce risk, Green - nil)

Full yearCommentary on exceptions (Red - action to correct, Amber -

action to reduce risk, Green - nil)

Quality Impact

Cost Improvement Plans (QIPP's)

Measure Feb-17 Year to date

Page 23 of 32


111 reduce attrition from 36% to 30% 6 6 A 37 39 A 43 45 A 2

Reduction is BOC cylinder hire 1 4 R 17 46 R 18 50 R The volume of BOC cylinders is on the increase 2

Fleet Savings 28 28 G 303 303 G 330 330 G 2

Skillstream 41 0 G 319 0 G 346 0 G 6

Clinical Agency 11 0 G 25 0 G 28 0 G 6

Subtotal 999 Service 279 402 R 3,504 4,799 R 3,720 5,258 R

Corporate

Estates CIPs 30 18 G 229 138 G 259 157 G 2

Finance CIPs 6 13 R 114 145 A 121 163 R

Forecasted to budget - year to date agency reduction

is under target but still expected to achieve CIP by

year end.2

ICT Savings 26 27 A 162 186 A 189 213 A 2

BI Savings 4 2 G 60 19 G 64 20 G 8

Service Development & Bids 5 0 G 95 49 G 100 49 G 4

HR 15 4 G 115 67 G 129 71 G 2

Education 9 10 A 147 98 G 159 107 G 1

Chief Executive 9 0 G 41 55 R 44 55 A In month adjustment 4

Corp Affairs 0 0 G 5 5 A 6 5 G 4

Technology Scheme 1 2 R 15 19 A 15 21 R Not as higher uptake as expected 4

Subtotal Corporate 106 76 G 983 781 G 1,085 861 G

Contingency 0 0 G 0 0 G 200 0 G

Total 461 629 R 5,212 7,307 R 5,764 7,989 R

Page 24 of 32


NHS Improvement rating

Actual Actual Actual Actual Actual Actual Plan Plan

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Use of Resource Rating (Formerly: Financial risk rating) 3 2 2 2 2 2 2 2

Actual Actual Actual Actual Actual Actual Actual Plan

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Red 1 75.1% 69.6% 72.3% 70.5% 74.3% 70.4% 73.0% 75.0%

Red 2 75.7% 71.3% 74.0% 69.4% 73.7% 72.9% 72.2% 73.2%

Red 19 95.1% 93.8% 95.1% 93.6% 95.2% 94.4% 94.2% 95.0%

Failure to comply with requirements regarding access to healthcare for people with a learning disability No No No No No No No No

Risk of, or actual, failure to deliver mandatory services No No No No No No No No

CQC compliance action outstanding No No No No No No No No

CQC enforcement action within last 12 months No No No No No No No No

CQC enforcement action (including notices) currently in effect No No No No No No No No

Moderate CQC concerns or impacts regarding the safety of healthcare provision No No No No No No No No

Major CQC concerns or impacts regarding the safety of healthcare provision No No No No No No No No

Trust unable to declare ongoing compliance with minimum standards of CQC registration No No No No No No No No

CQC recommendation to place trust into Special Measures No No No No No No No No

Other governance factors/risks (data breaches) Yes No No No No No No Yes

Overall governance rating Green Green Green Green Green Green Green Green

Commentary:

Lead Director: Will Hancock

Governance Indicators

Financial Indicators2016-17 Actual/Forecast

1 data breach being investigated

2015-16 - reported 2016-17 Plan

2015-16 Actual

Page 25 of 32


Quality Impact Assessment of the Cost Improvement Programmes 2016-17

Eliminate overtime incentive

scheme 1,024

Cease payment of overtime incentive for frontline

staff and EOC3 Q 3 May impact on quality if shifts uncovered 9

Need to monitor the level of resources following

implementation and any adverse incidents or

concerns relating9

Reduce sick absence by 0.5% to

6.2% (per mth) 335

Manage staff sickness absence in order to reduce

sickness abstraction by 0.5% per month3 Q 3

Potential to improve return to work and staff

availability / resource9 Needs to be monitored - improving in NHS 111 6

Annual leave reduced by 0.5%

due to new recruits 500

With a more recently recruited workforce the

overall average annual leave 2 Q 1

should not impact on quality and should improve

resourcing2 2

Reduce cycle time by 4 mins 1,236

Reduce cycle time elements which can be

specifically targeted by SCAS, e.g. overlaps and

RRV waiting times.

3 Q 4

Reducing cycle through more timely decision

making and access to a Trusted Advisor by the

crew on scene should improve the care for

patients and access to the right care first time

12

This is a challenging CIP and change and one that is

dependent on other providers and a change in culture

for some staff. Safety netting of patients is critical to

patient safety. November 2016 - not seeing a

reduction in cycle time currently although work is

underway - need to monitor closely when action to

reduce cycle time are implemented

12

Increase See and Treat by 1% 496

Trainee specialist paramedics are now nearing the

end of their training. They will be joining the team

Rotas and will be delivering more see and treat

3 Q 3 should improve quality 9Need to monitor see and treat rates and any adverse

incidents as a direct result of a see and treat9

Reduce response ratio by 0.01

(1.12 ratio for full year) 200

Post NARP we have seen the response ratio

reduce. Our YTD is 1.13 and currently we have a

ratio on 1.11. A FY average of 1.12 is the new

target

3 Q 3Should enhance resources availability and improve

quality9 Need to monitor 2

Staff Attrition by .6% 60

Reduce staff attrition via "stay interviews"

enhanced team leader skills and improved internal

education offerings.

2 Q 4Should enhance resources availability and improve

quality8 Need to monitor. Improving since April - end Sept 6

Improve use of HCP tier - HCP

dedicated desk 295

Increase the utilisation on the HCP tier by

manning the HCP desk during hours of operation,

re- deliver the Communications to GPs and own

paramedics

3 Q 5Should improve the quality if implemented

successfully15

Need to monitor impact on responsiveness and

waiting times6

A&E Recruitment better profiling

for year 350

Flow through from the recruitment profile of

15/163 Q 3

Should enhance resources availability and improve

quality9

Need to monitor delivery of the plan - behind plan

currently9

Action to Mitigate Downside

Scenario£000’s Source of Saving

Conse-

quence

Quality

/Deliver

999 Service

Likely Potential Impact to Quality/DeliveryRisk

RatingMitigating Actions

Mitigated

Risk Level

Commercial Division

Mitigated

Risk Level

Action to Mitigate Downside

Scenario

Risk

RatingMitigating ActionsPotential Impact to Quality/Delivery£000’s Source of Saving

Quality

/Deliver

Conse-

quenceLikely

Page 26 of 32


111 reduce sickness to 14/15 level

of 6.48% vs 8.8% 165

Target 111 sickness through a sickness cell and

active management plus increased staffing3 Q 3


quality9 Need to monitor through KPI's and the IPR 6

111 Rota redesign to increase rota

efficiency 100

Following Process Evolution review redesign rota's

to offer better match against call profiles2 Q 2


quality4 2

111/EOC share clinician hours to

meet peaks 30

Flex clinicians between 111 and EOC to meet

peaks in each are. E.g. 9-11 in 111, afternoons in

EOC.

2 Q 3Should improve quality but need to ensure there

are enough Clinicians available to do this safely6

Monitor effectiveness and ease of moving from each

area2

111 reduce attrition from 36% to

30% 37

Target attrition by increasing WTE, offering career

pathways and more steady Rotas'2 Q 3


quality6 Requires monitoring 2

Fleet Savings 330

Efficiencies gain through have a separate fleet

company. Being about to recruit specialist staff

more easily and negotiation prices with suppliers.

2 Q 2 no impact on quality 4 2

Reduction is BOC cylinder hire 50

Following the review of the number of cylinders

rented again the number of cylinder in the Trust

the numbers have been aligned and rental cost

reduced.

3 Q 2Need to ensure the optimum number of cylinders

in place6

The review has been completed and the optimum

number of cylinders are in place2

Skillstream 346

The use of skill stream to fill private provider shift.

This ensure billing is correct and that private

providers are booked in a more formal fashion.

3 Q 3 Enhance quality if monitored effectively 9 monthly reviews of PP via skills stream 6

Clinical Agency Q 9 6

Page 27 of 32


Estates CIPs 157

Non-renewal of lease car, exiting properties, re-

negotiated rent free periods in northern and

southern house & reduction in gas and elec prices.


Finance CIPs 188

Reductions in Agency fees, Recruitments Costs,

Consultancy, Internal Audit and A1 vehicle

parking.


ICT Savings 213

Review and consolidation of telephone lines,

photocopy re-tender and ortivus for 6 months

only,


BI Savings 20 Lower recruitment. 4 Q 3could impact on the quality of information and our

ability to analyse12 need to monitor impact on information 8

Service Development & Bids 49 Reduction in Agency fees, consultancy costs, bank

contracts & computer expenditure.4 Q 4

could impact on the quality of information and our

ability to analyse4 need to monitor impact on information 4

HR 71

Reduction in Agency spend, computer purchases

& telephone expenses. Also savings due to non-

renewal of lease car and HR Director 3 month

overlap in 15/16.

2 Q 1 should not impact on quality 2 2

Education 107

Nil ad hoc van hire and reduction of lease car

usage forecasted in 16/17. Also expecting a

reduction in refurb and consultancy costs. Further

savings expected due to cancellation of skid

course, HE team member not being replaced and

exiting Greenham Common part way through the

FY.


Chief Executive 55 Reduction in Consultancy & Recruitment Fees. 2 Q 4Need to ensure this does not impact on

recruitment numbers6 needs to be monitored 4

Corp Affairs 5 Reduction in recruitment & printing costs. 2 Q 2 should not impact on quality for patients 4 4

Technology Scheme 21

Opportunity for individuals to purchase

technology items with payments deducted

directly out of the employees salary. Savings

achieved by reducing SCAS's gross payroll liability

2 Q 4 Should not impact on quality for patients 4 4

Corporate Areas

Page 28 of 32

Integrated Performance Report - Trust HR

Commentary:

Commentary:

Absence has considerably decreased to

6.6% in January from 7.5% in November.

Focus continues on health and wellbeing

initatives which is proving successful

especially in the management of long term

absence. Focus continues on ensuring

managers are equipped with knowledge

and skills in order to carry out an effective

appraisal, along with coaching on an

individual basis. A review of the appraisal

process and associated paperwork is

currently being undertaken.

5.6% 5.2% 5.6%

6.0%

5.3%

5.8% 6.1% 6.2%

7.5% 7.2%

6.6%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

Trust Sickness

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

73.6% 75.0% 73.6%

72.0%

73.1% 69.6% 69.7% 71.6% 72.9% 74.6% 75.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Trust Appraisals

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%


Manual Handling

Health & Safety

Equality & Diversity

Conflict Management

Infection Control

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%


Safeguarding Adults Level 1

Safeguarding Children Level 1

Fire Awareness

Information Governance

Page 29 of 32


Cat Red 8

Cat Red 19

Cat Red 1

Cat Red 2

Abandoned calls

Recontact 24hrs Telephone

Recontact 24hrs On Scene

Frequent caller

Resolved by telephone

Non A&E

ROSC

ROSC - Utstein

STEMI - 60

STEMI - 150

STEMI - Care

Stroke - 60

Stroke - Care

Red 1 call are the most time critical of Red call and cover cardiac arrest patients who are not breathing and do not have a pulse and other severe

conditions such as airways obstruction.

Red 2 calls are serious but less immediately time critical and cover conditions such as stroke and fits.

The total number of patients who having had suffered a cardiac arrest and stopped breathing have then been recorded as having had a return of

spontaneous circulation (a pulse/heartbeat) at the time of their arrival at hospital.

The number of patients who have been witnessed suffering a cardiac arrest and stopped breathing, whose heart was then in a rhythm which

allowed it to be shocked with a defibrillator and have then been recorded as having had a return of spontaneous circulation (ROSC) at the time of

their arrival at hospital.

National Ambulance Clinical Quality Indicators (CQI's)

The number of patients who have been cared for and treated at the scene of the 999 call or taken to somewhere other than an A&E department

for treatment (for example, an NHS Walk-in Centre).

The percentage of Category Red (immediately life-threatening) calls reached within 8 minutes – the target is 75%.

The percentage of Category Red (immediately life-threatening) calls where a vehicle able to transport the patient has arrived within 19 minutes –

the target is 95%.

The percentage of 999 callers who have hung up before their call was answered in an emergency control room.

The number of patients who have re-contacted the ambulance trust within 24 hours of them having called 999 and been offered clinical advice

over the phone.

The number of patients who have re-contacted the ambulance trust within 24 hours of them having called 999 and then were discharged on scene

following face to face ambulance assessment.

The number of patients who have re-contacted the ambulance trust within 24 hours for whom a locally agreed frequent caller procedure is in

place. These patients are referred to as "patients at risk" in SCAS.

The proportion of 999 calls that have been resolved by providing telephone advice and no ambulance response.

The percentage of patients who have suffered an ST-elevation myocardial infarction (STEMI) – a type of heart attack – and who have received

thrombolysis (treatment with a clot-busting drug) within 60 minutes of the original 999 call to attend them.

The percentage of patients who have suffered an ST-elevation myocardial infarction (STEMI) - a type of heart attack - and who then been directly

transferred to a centre capable of delivering primary percutaneous coronary intervention (PPCI) and received angioplasty treatment within 150

minutes of the original 999 call to attend them.

The percentage of patients who have suffered a stroke, as confirmed by the face to face carrying out of a Face Arm Speech Test (FAST) and who

were potentially eligible for stroke thrombolysis (treatment with a clot-busting drug) and who arrived at a hyper acute stroke centre within 60

minutes of the original 999 call to treat them.

The percentage of suspected stroke patients who were assessed face to face and who received the correct treatment (appropriate care bundle) in

line with ambulance guidelines.

The percentage of patients who have suffered an ST-elevation myocardial infarction (STEMI) - a type of heart attack - and who have received the

correct treatment (appropriate care bundle) in line with ambulance guidelines.

Page 30 of 32


Cardiac - STD

Cardiac - STD Utstein

Time to Answer - 50%



Time to Treat - 50%

Time to Treat - 95%

Time to Treat - 99%

Handover improvement

Clear-up improvement

Turnaround improvement

CQC

HSE

NHS Protect

NPSA

REAP

RIDDOR

CCG

The percentage of patients who have been witnessed suffering a cardiac arrest and stopped breathing, whose heart was then in a rhythm which

allowed it to be shocked with a defibrillator and were successfully resuscitated and survived to be discharged from hospital.

The overall percentage of patients who having suffered a cardiac arrest and stopped breathing were successfully resuscitated and survived to be

discharged from hospital.

The time taken to answer 999 calls in an emergency control room measured by the time below which 50% of calls were answered.


The time taken for a health professional working for the ambulance trust to arrive at the scene of a Category A (immediately life-threatening) call,

measured by the time below which 50% of patients were reached.




Other terms and abbreviations

NHS Protect leads on work to identify and tackle crime across the health service.

National Patient Safety Agency

Hospital handover time is the time from hospital arrival by ambulance personnel to clinical handover to hospital clinical staff. This had a target of

15 minutes. Handover improvement is where the total handover time for all hospital arrivals has improved compared to the same period last year.



Clinical Commissioning Group

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations

Care Quality Commission

Clear-up time is the time from clinical handover above to the time that the ambulance vehicle departs hospital. This had a target of 15 minutes.

Clear-up improvement is where the total clear-up time for all hospital visits has improved compared to the same period last year.

Turnaround time is the total of handover and clear-up time. This had a target of 30 minutes. Turnaround improvement is where the total

turnaround time for all hospital visits has improved compared to the same period last year.

The Health and Safety Executive

Resource Escalation Action Plan

Page 31 of 32

Clinical Performance Patient ExperienceNational

StandardsOperational performance Safety and risk management 111 Service

Human

ResourcesSTEMI - Care Complaints - SCAS Red1 SCAS H&T - SCAS Long Waits - Red8 SCAS Oxford Calls (no. answered) Sickness - Trust

STEMI - 150Complaints - 999

TotalRed2 SCAS S&T - SCAS Long Waits - Red19 SCAS

Oxford Call Answering (%

within 60 seconds) Appraisals - Trust

Stroke - Care Complaints -PTS Red19 SCAS Non Conveyance - SCAS Long Waits - Green SCAS Oxford 999 referrals (%)Total Frontline

Workforce

Stroke - 60Complaints - 111

ServiceHospital Delays - SCAS

Number of DATIX incidents -

staff (this is the internal form to

report incidents in SCAS - this

covers all types of incident -

accidents, injuries, missing

equipment etc.)

Oxford Calls Abandoned

(target <5%)

Frontline

Recruitment

ROSC Compliments Clear up Delays - SCAS

Number of DATIX incidents - non

staff (this is the internal form to

report incidents in SCAS - this

covers all types of incident -

accidents, injuries, missing

equipment etc.)

Oxford Transfers to clinician

(%)Frontline Attrition

Cardiac Arrest

(witnessed)

999 % calls from frequent

callers

Number of incidents reported to

the NRLS (CQC/NRLS

reportable)

Oxford Time taken for call

back (% < 10 mins - target

95%)

Manual Handling

Hypoglycaemia care

bundle

Green 2 - response within 30

minutes

% of incidents reported to the

NPSA within 30 days

Hants Calls (no. answered,

111 and Dental)Health & Safety

Asthma care bundleGreen 4 - telephone

assessment within 60 minutes

Number of Serious Incidents

Requiring Investigation (SIRI)

reported

Hants Call Answering (%

within 60 seconds, 111 only)

Equality &

Diversity

Limb fractures care

bundleVOR - scheduled maintenance

Number of SIRI investigations

outstanding after 60 days

(excluding events that are

officially suspended)

Hants 999 referrals (%)Conflict

Management

Febrile convulsion care

bundleVOR - unscheduled

Number of Never Events

(CQC/NPSA reportable)

Hants Calls Abandoned

(target <5%, 111 only)Infection Control

Vehicle deep cleans -

A&E999 Call Volume Clinical negligent claims (CNST)

Hants Transfers to clinician

(%)Fire Awareness

Vehicle routine cleans 999 call answer % Public liability claims

Hants Time taken for call


95%)

Information

Governance

Number of cleanliness

compliance audits*999 Calls abandoned %

Number of RIDDOR reports

(HSE reportable)Berks Calls (no.)

Total Frontline

Workforce

Number of adverse

events due to

administration errors*

Number of Physical Assaults

(NHS Protect reportable)

Berks Call Answering (%

within 60 seconds)

Frontline

Recruitment

Number of controlled

drug incidents*

Number of Non-Physical

Assaults (NHS Protect

reportable)

Berks 999 referrals (%) Frontline Attrition

Number of Security Incidents

(NHS Protect reportable)

Berks Calls Abandoned

(target <5%)

FOI (Freedom of Information Act)Berks Transfers to clinician

(%)

Data protection Act (DPA) -

police, solicitor/medical, subject

access

Berks Time taken for call


95%)

Bucks Calls (no.)

Bucks Call Answering (%

within 60 seconds)

Bucks 999 referrals (%)

Bucks Calls Abandoned

(target <5%)

Bucks Transfers to clinician

(%)

Bucks Time taken for call


95%)

Luton & Beds Calls (no.)

L&B Call Answering (%

within 60 seconds)

L&B 999 referrals (%)

L&B Calls Abandoned (target

<5%)

L&B Transfers to clinician

(%)

L&B Time taken for call back

(% < 10 mins - target 95%)

Agenda Item: 13



Title SCAS Operational Plan 2017-19

Responsible Director James Underhay, Deputy Chief Executive

Recommendation (eg. note, approve, endorse) Note









Please provide details of the risks associated with the subject of this paper (x-reference to the corporate risk register / Board Assurance Framework) The Board Assurance Framework, presented to the Board at each Board meeting in public, will identify the risks associated with delivery of the 2017-19 Operational Plan, and set out how these are being managed/mitigated.


The Operational Plan has been developed in accordance with the requirements (e.g. content, timescales etc.) issued by the regulators, including NHS Improvement.


The financial implications of delivering the plan are set out, including details of the capital and cost improvement programmes.


A strategy workshop with the Council of Governors was held on 1 February 2017, and this provided some inputs which are reflected in the final plan.


The plan sets out implications both for patients (e.g. service delivery) and staff.


Board meetings/seminars in private, prior to publication of this final version of the plan.


of 22


SCAS OPERATIONAL PLAN 2017-19

INTRODUCTION This document sets out our plans and priorities for the next two years, both to ensure safe and effective delivery of our current services, and also to continue along our strategic path. TOWARDS EXCELLENCE – SAVING LIVES AND ENABLING YOU TO GET THE CARE YOU NEED SCAS is more than a traditional (transporting) ambulance service. Increasingly, it is also a critical player in local care systems, offering simplified access to clinical assessment and sign-posting for people who are ill, injured or concerned about their health. We continually strive to offer the ‘right care, first time’, tailored to each individual’s circumstances and needs, whether this is the immediate dispatch of an emergency team, clinical treatment in your own home, transport between health settings, referral to another service or simply telephone-based advice.

of 22

CONTENTS 1. Summary of strategy 2. Programme of change 2017-19 3. Capacity planning 4. Quality planning 5. Workforce planning 6. Financial planning 7. Link to Sustainability and Transformation Plans 8. Membership and elections

of 22

OVERVIEW OF STRATEGY

1.1 Service strategy

Right care, first time

Past Future

SCAS role Strategic objectives

Care Coordination To enable you to identify and access the care you need

> To develop our assessment, signposting and advice services

> To coordinate care across systems, sharing infrastructure with partners

Mobile Healthcare To save lives and improve outcomes

To enable you to stay safely in your home or local community

> To enhance our 24/7 mobile healthcare service

> To offer person-centred care, coordinating services with health, social care and voluntary partners

Patient Transport To enable you to travel safely between home and care settings

> To modernise and enhance our patient transport services

> To offer services to support people returning home from hospital

Helicopter view To support efficient and effective flow around systems of care

> To transform our analytical capability and capacity

> To offer a ‘helicopter view’ of flows around local care systems

of 22

1.2 Trust strategy

SCAS aims Strategic objectives

Provider of choice To secure our competitive position and to win contracts, in order to deliver our service strategy

> To improve clinical outcomes and ensure patient safety

> To provide a positive patient experience

> To achieve call answer and response time standards consistently

Partner of choice To ensure right care, first time

> To offer person-centred and locally-responsive pathways of care

> To develop and grow our services to meet a range of customer needs

> To work with partners to improve pathways across local care systems

Employer of choice To attract, recruit, develop and retain the workforce to deliver our service strategy

> To lead and engage staff in a culture of learning and improvement

> To motivate and enable our people to deliver excellence

Sustainable and dynamic organisation

To ensure sound governance, value for money and a strong financial-standing

> To transform our cost base

> To ensure future sustainability by winning viable contracts

of 22

Care Coordination

Prov

ider

of c

hoic

e

Part

ner o

f cho

ice

Empl

oyer

of c

hoic

e

Sust

aina

ble

orga

nisa

tion

Mai

nten

ance

To win and launch Thames Valley Integrated Urgent Care & NHS111

To win and mobilise Hampshire & Surrey Heath NHS111

To develop a partnership role for GP out of hours services

To trial co-location of OOH GPs in Coordination Centre South

To redesign pathways to support more 999 green calls at home

To expand Coordination Centre South

To move NHS111 service onto Adastra system to improve interface with other partners

To decommission NHS111 for Bedfordshire and Luton

To expand use of LiveLinks (video) service in order to support more people at home or at scene

To move onto the ICCS DS2000 (Integrated Command and Control System)

To re-procure 999 CAD (Computer Aided Dispatch)

To review opportunities and risks for Online NHS111

To enable direct access from the Coordination Centre into Local Hubs and Community Services

Mobile Healthcare

Prov

ider

of c

hoic

e

Part

ner o

f cho

ice

Empl

oyer

of c

hoic

e

Sust

aina

ble

orga

nisa

tion

Mai

nten

ance

To improve rosters including flexible options

To set up a Paramedic Home Visiting Service and associated charging mechanism

To consolidate Recruitment and Training into Bone Lane

To reduce job cycle time

To move into the Tri-Service Resource Centre in Milton Keynes

To review service and workforce models

To review training requirements and delivery options

To review training facilities required both short term and after wider training review

To replace training facility at Boars Hill

To expand the role of volunteers and other indirect resources, including piloting support from clinicians via LiveLinks (video)

To move onto new national radio system (NARP)

PROGRAMME OF CHANGE 2017-19

of 22

Patient Transport

Prov

ider

of c

hoic

e

Part

ner o

f cho

ice

Empl

oyer

of c

hoic

e

Sust

aina

ble

orga

nisa

tion

Mai

nten

ance

To mobilise Surrey PTS

To stabilise Sussex PTS

To review and agree PTS business strategy, including assessment of whether to bid for expanded business

To redesign processes within PTS Coordination Centre

To re-procure PTS CAD (computer aided dispatch)

To improve digital platform for volunteers

Helicopter View

Prov

ider

of c

hoic

e

Part

ner o

f cho

ice

Empl

oyer

of c

hoic

e

Sust

aina

ble

orga

nisa

tion

Mai

nten

ance

To set up scorecards for Patient Transport Services

To analyse activity, trends and outcomes by symptom group

To set up scorecards to support engagement with local delivery systems

To assess proposal to set up Business Intelligence Hub

To develop academic partnership

SCAS-wide

Prov

ider o

f cho

ice

Partn

er of

choic

e

Emplo

yer o

f cho

ice

Susta

inable

orga

nisati

on

Main

tena

nce

To transition to electronic expenses and driver / vehicle checks

To realise opportunites and benefits from using ESR more effectively

To move paper files onto eFiling for corporate services

To review medicines management

To replace Transcare workshops (used by 999 and PTS)

To deliver cost improvement programme

of 22

CAPACITY PLANNING

3.1 Demand and capacity modelling

999 Emergency Services Overall demand forecasts are based on historic trends over recent years. These

forecasts are adjusted for the latest changes, including new definitions for Ambulance Quality Indicators (AQIs) that have changed anticipated levels of ‘Hear & Treat’, with this activity moving into ‘See & Treat’. The forecast activity for 2017-19 was calculated on the basis of actual activity to month 7 of 2016-17. The case mix was then reviewed, extrapolating the increasing ‘Hear & Treat’ level forward and applying the expected changes from AQIs. These activity assumptions have been discussed and agreed with commissioner during contract negotiations. These demand forecasts are then converted into hours required, using a unit hour utilisation linked to performance delivery. Hours required is defined by geographical area (node) for each day of the year. Work-effective hours available from Trust staff are calculated for each week of the year, utilising the jointly developed Integrated Workforce Plan and Education Plan alongside budgeted abstraction planning levels. The gap between work-effective staff hours and the requirements for forecast demand is then identified, and cover planned from private providers and agency staff.

NHS111 Service In a similar manner to the 999 demand, historical trends are reviewed and

adjusted for changes in external factors such as service promotion or availability of care pathways. The forecast activity for 2017-19 has been set at 3% in conjunction with commissioners. The expected activity then gets converted into resource required to achieve the national call answer standards. Any gaps in resource availability are fed into the recruitment and training plan, to ensure there are enough staff in place to service the demand.

Patient Transport Services With our main Patient Transport Services (PTS) secured through tender, the

activity forecasts are based on activity plans put forward by the commissioners. The resources were modelled during the tender processes and have been reviewed since, to ensure they continue to provide appropriate cover following the launch of the services.

3.2 Planning assumptions

Clinical Coordination Centre (999 and 111 calls) 111 growth rates have been assumed at 3% for both 2017-18 and 2018-19. For

2016-17, our current forecast is that growth will outturn 1.3% above the prior year.

Urgent and Emergency Field Operations 999 growth rates have been assumed at 3% for both 2017-18 and 2018-19. For

2016-17, our current forecast is that growth will outturn at 3.9% above prior year, which compares to the plan of 2.1%.

Patient Transport Service (PTS) A key change for PTS is the introduction of two new contracts for 2017-18 (Surrey

and Sussex PTS).

of 22

Following previous successful mobilisations of new PTS contracts, the Trusts usual project management approach is being followed to ensure that the expansion can be delivered successfully. The activity levels in Sussex are more uncertain due to the transition arrangements.

3.3 Capacity to deliver agreed activity

Clinical Coordination Centre (999 and 111 calls) SCAS operates two Clinical Coordination Centres (CCC), which are run virtually,

with the NHS111 service backed up by a third call centre run by a private provider for resilience (Conduit). CCC capacity planning is based on the Erlang C model. Demand is modelled using a tool that gets more accurate as it learns from previous weeks and months, and that is translated into call handler and clinician requirements, which are then deployed using the GRS planning and rostering system.

There are no plans to use the independent sector for 999 services but we intend to keep a contract with Conduit, in order to provide resilience in the 111 service. They will provide between 10-20 WTEs, as the picture of demand dictates.

When performance drops, each CCC has a series of pre-planned and rehearsed escalation measures to bring performance back on line.

There is an overarching resilience plan which is tested several times a year when we practice operating from a single site. This is done when we need to change hardware, but also provides real resilience testing in the live environment.

Urgent and Emergency Field Operations Work-effective hours available from Trust staff are calculated for each week of the

year, utilising the jointly developed Integrated Workforce Plan and Education plan alongside budgeted abstraction planning levels. The gap between work-effective staff hours and the requirements for forecast demand is then identified, and cover planned from private providers and agency staff.

The amount of Agency and Private Provider cover required is calculated on a quarterly, monthly and weekly basis to get the total 999 cover as close to the short term forecast as possible. The forecast is that we will need similar numbers of private ambulances as we have used in 2016-17.

The use of the dynamic planning model means that resources can be adjusted by the week to address shortfalls in the previous weeks. That said, it takes time to mobilise additional crews from external sources, and so the Trust uses well understood and rehearsed immediate escalation plans to make immediate recovery possible.

Each year, some winter funding is made available for additional resources during the winter months. The Trust relies on that funding to increase the amount of private cover that is required during the busy winter months. It has been confirmed that this funding will still be available. As in 2015-16, during 2016-17 there has been an increase in the proportion of incidents that are in the red category (so acuity is increasing). Funding has been agreed of £1.5m relating to this increase which is a major reason for not achieving the national targets in 2016-17. This is partly to be expected as many patients with lower acuity conditions have started to call 111. A more granular pricing mechanism has been agreed as part of the contract with different prices for red and green see and treat and red and green see treat and convey. The modelling described above takes account of the proportion of red calls.

of 22

QUALITY PLANNING 4.1 Approach to quality improvement

In September 2016, the CQC rated SCAS as ‘good’ overall following an inspection of all services.

Approach to improvement The Executive Director for Quality and Patient Care leads on quality

improvement.

SCAS has a robust Trust-wide approach to ensure compliance across all key standards. Our review, report, action, monitor framework is embedded across all services and corporate functions.

Assurance is gained through reports and monitoring, using a three-tier approach:

1. internal local area 2. Executive Management Committee, Quality and Safety Committee and

Board of Directors 3. External assurance by commissioners, Health watch, Health and

Overview Scrutiny Committee and the CQC local team reviews.

The bi-monthly Quality and Safety report to the Board of Directors sets out our approach to improving clinical governance and quality.

Governance system The Board of Directors receives a range of reports on Trust performance, as well

as reports from Board sub-committees. In particular, the Integrated Performance Report reviews performance against regulatory and contractual obligations, as well as other indicators agreed with the Board.

Comprehensive Leadership and Compliance walk-arounds by Executive Directors, Non-Executives, Senior Managers and the Head of Compliance provide a vital additional level of assurance.

Independent advice is sought where appropriate, and there have been examples of this.

Capacity and capability Clinical Governance Leads are aligned to each service and, together with the

Trust’s Team Leaders, they drive compliance and improvements on an ongoing basis. In addition, the Accelerated Clinical Transformation Programme is led by the Executive Director of Quality and Patient Care.

Clinical improvement strategy One of the Trust’s core values is innovation and continuous improvement, which

was recognised by the CQC as being in evidence as a value during their inspections.

The quality improvement strategy seeks to identify the best practice for each pathway, set out by patient need or condition. This approach enables us to tailor our care and support to patients, as well as improving service integration with our partners.

A key focus of our strategy is to develop the Trusted Assessor and Trusted Advisor concept, whereby clinical assessments, undertaken either over the telephone or in person, will be accepted by experienced primary or secondary care clinicians.

of 22

Key indicators on impact and benefit to the local care systems The key measures used to evaluate the system-wide impact of SCAS

investment in quality improvement are the increase in ‘See & Treat’ and ‘Hear & Treat’ rates for 999 calls, with a corresponding impact in ‘See, Treat and Convey’ rates, resulting in conveyance rates to hospitals. Other ways to measure the system-wide impact of our clinical improvement strategy and plans are the use of alternative pathways into other providers via the Directory of service.

4.2 Summary of the quality improvement plan

Compliance with national quality priorities Benchmarking SCAS performs well against a wide range of standards and benchmarking

analysis.

Key areas requiring improvement include: Red 1 and Red 2 Emergency response times Stroke 60 Time to respond and convey to a hyper-

acute stroke unit STEMI Outcome from acute ST-elevation

myocardial infarction Asthma Compliance with care bundles Febrile convulsions in children Compliance with care bundles Single limb fractures Compliance with care bundles

National clinical audits SCAS is actively involved in the National Ambulance Service Clinical Quality

Group, which identifies trends, best practice and works nationally to ensure consistency of methodology and data collection. There is currently a national review of both Ambulance Response standards and Clinical Quality Indicators, intended to replace them with more outcome-focused indicators.

National and local priorities Seven-day services - SCAS provides 24-hour services, 7 days a week,

including Bank Holidays.

Better births - SCAS hosts a Labour Line. This is run by midwives and located in our Clinical Coordination Centre, alongside the call handlers and clinicians for 999 and NHS111 services.

Serious incidents - SCAS has a robust process for investigating serious incidents. An aggregated review of themes, trends and lessons from Serious Incidents, Complaints, Claims and Coroner Hearings is presented to the Trust’s Quality and Safety Committee, and also reported to the Board of Directors. The Trust already uses numerous ways to share learning throughout the organisation, e.g. patient stories, case studies, SCAScade to all staff, and Hot News. In 2017-18, we will continue to mature our learning and share recommendations from these incidents.

Infection Prevention and Control (IP&C) - The Trust was rated as ‘good’ for the fundamental standards relating to infection prevention and control in May 2016. The Trust has comprehensive IP&C policies and procedures, which are monitored locally by Team Leaders and audited by the Infection Prevention and Control Lead. Compliance is reported to the Patient Safety Group. In case of

of 22

any non-compliance, recovery action plans are reported upwards to ensure improvements are made in a timely manner. Senior Leadership walk-arounds also focus on IPC in all areas of the Trust, both clinical and corporate.

Falls - SCAS is committed to improving its management of fallers, and work has developed over several years. We have a falls risk assessment process, with referrals to community-based Falls teams. The aim is to ensure safety and, when appropriate, to avoid hospital admissions. SCAS is also piloting the use of Hampshire Fire & Rescue to provide a ‘pick up’ service for uninjured fallers. The pilot will be evaluated in early 2017 and, if successful, implemented across SCAS.

Sepsis - Early recognition of life-threatening sepsis is essential for Ambulance Services to initiate life-saving therapy. In 2017-18, SCAS aims to implement the first pre-hospital early warning tool to enable the early recognition in the community and thereby save more lives. SCAS staff will have the knowledge and tools to recognize sepsis and treat patients, appropriately and with speed.

End of life care - SCAS is working to increase support for people at the end of life, whether in their own home or in a Care Home. We will work in partnership with other providers, especially Palliative Care teams. Our intention is to deliver care in line with people’s wishes, through use of care plans and by offering clinical support at home to prevent avoidable admissions. We aim to be able to administer medications to keep people comfortable at home.

Patient experience - The Trust aims to respond to patient feedback in a timely manner and to ensure the service is consistently person-centred, responsive, listens and engages with feedback from all sources, in order to enable further quality improvements.

National CQUINs In conjunction with commissioners, SCAS hopes to develop plans for the three

national CQUINs: NHS Staff Health and Wellbeing – with the aim of improving the support available to NHS staff to help promote their health and wellbeing in order for them to remain healthy and well. This CQUIN enables the Trust to continue the work already started in 2016 -17. Ambulance Conveyance – with the aim to support the ambulance service to become a community based provider of mobile urgent and emergency healthcare. This CQUIN is aligned to our clinical strategy and will give further focus and impetus. NHS 111 referrals to A&E and 999 – this aims to increase the proportion of NHS 111 referrals to services other than to the ambulance service or A&E. To achieve this, we need to drive forward the roles of Trusted Assessor and Trusted Advisor, as well as pushing for further enhancements to the Directory of Services, direct referrals rights and booking systems.

Consistency with quality priorities in local STPs SCAS Clinical Strategy is extremely well aligned with the STPs. Our strategy

identifies 16 groups of conditions where we believe there is scope for improvement by looking across services and developing more integrated pathways. Many of the STPs have identified similar condition groups in their delivery plans and workstream structure.

of 22

4.3 Summary of quality impact assessment

Governance structure around creation and acceptance of new schemes Quality improvements and innovations can be suggested by any member of staff

through the Bright Ideas scheme. Initially ideas are assessed by the Portfolio Management Office, and smaller initiatives are taken forward on the agreement of the relevant departmental manager.

Bigger schemes (which may be more complex, require investment, extend beyond a single department, or carry greater risk) are assessed through a business case process. For changes to service delivery or quality, business cases are assessed by the Executive Directors, who hold a monthly Executive Transformation Board with dedicated agenda time for project-related matters.

There are also additional review groups that assess particular aspects of schemes and advise the Executive Directors before approval. These include the Quality Impact Assessment process, Clinical Review Group, Senior Operational Management Team, Fixed Assessment Management Steering Group, Cost Improvement Board, Workforce Development Board, and ICT Board.

Additionally, some schemes have to be approved by the Board of Directors, for example if higher levels of investment are required.

Quality impact assessment process The Trust has a robust process to assess and manage the impact of our

improvement programme on quality. In advance of a scheme being agreed, a Quality Impact Assessment is undertaken with a full clinical challenge testing impacts on safety, clinical effectiveness and patient experience.

The Director of Quality and Patient Care and Medical Director formally approve all improvement programmes, as well as any schemes with an impact on quality.

Monitoring arrangements SCAS runs a Portfolio Office to oversee the Trusts whole programme of change.

Monthly reports are required from the project managers of all major schemes, providing updates on progress, key issues and risks, plus matters requiring escalation to the Executive Transformation Board. This Board reviews an aggregated report on the key issues and risks across the whole portfolio of change at its monthly meetings.

There is also a separate Cost Improvement Board, as many of these schemes are much smaller and not managed as projects. This Board closely monitors the quality impact, as well as the savings realised, through cost improvement initiatives.

The Executive Director of Quality and Patient Care is a member of both the Executive Transformation Board and the Cost Improvement Board.

Progress against the overarching strategy, agreed programme of change for each year, and the cost improvement programme is reported to the Board of Directors on a regular basis.

We have incorporated progress against the Trust’s clinical strategy into the Board report on progress against the overarching strategic plan. This gives the Board of Directors a better overview of clinical and quality improvements across the Trust, to complement the existing reports on specific initiatives.

Key performance metrics Performance metrics and benefits plans are required as part of the business

of 22

case process.

Any scheme which impacts on, or has the potential to impact on, key quality indicators, national standards or contractual obligations is highlighted to the Executive Transformation Board by the Portfolio Office.

The Portfolio Office also monitors overall performance against key quality and performance indicators, in case there is an unexpected or unidentified impact of any scheme on service delivery in terms of quality or performance.

Baseline before implementation of change The Business Information Team works with operational managers and project

teams to identify and secure the data required to monitor changes. This includes a baseline assessment prior to the change, specific analysis through the transition period and ongoing monitoring to ensure that benefits are realised.

Whenever possible, SCAS seeks to avoid implementing major change during periods of peak demand or unstable performance. We also endeavour to phase-in changes and to ensure robust fallback plans, ensuring that the risks of any single change are minimised whenever possible. When pressing deadlines preclude this approach, we assess the balance of risks in managing the business and making the necessary changes. This balance is continually reviewed by the Portfolio Office, with issues or risks escalated to the Executive Transformation Board as appropriate.

Oversight of cumulative impact of change A key role for the Portfolio Office is to oversee the cumulative impact of changes

across SCAS. This is done by reviewing the phasing of changes, resource requirements, project dependencies and interfaces, knock-on implications of any delays or other issues, highlighting any double-counting of benefits, and assessing the cumulative risk across the whole programme of change.

4.4 Triangulation of quality with workforce and finance The monthly Integrated Performance Report brings together indicators on

quality, workforce, finance and operational performance. The Executive Directors meet the Senior Operational Management team on a fortnightly basis to review operational performance, finances and workforce with the senior operational teams. With the additional monthly reports from the Portfolio Office, on progress, issues and risks across the Trust’s whole programme of change, Executive Directors are able to triangulate intelligence on quality improvement schemes and also the impact that other schemes are having on quality. The Board is introducing further focus on quality and performance metrics to ensure that a whole suite of measures are reviewed together so that the impact of any deterioration in the emergency response times (in light of the contract agreement with commissioners) can be reviewed, and to triangulate quality, workforce and finance. The key indicators are: • Red performance • Red and Green long waits • Performance distribution curves – actual response time for 75% and 95% • SIRIs • Complaints • Unit hour utilization

of 22

• Workforce abstractions • Recruitment • Financial surplus v plan • Cost savings delivery The contract agreement with CCGs includes a focus on transformation with a particular focus on reducing demand and improving performance. Funding for a team focusing on the green calls has been agreed. This team together with CCGs will review and agree projects for either reducing green demand or for treating the demand using alternative pathways either inside or outside SCAS. These schemes together with improvement schemes identified as part of the Lightfoot report will contribute to an improvement in performance standards.

WORKFORCE PLANNING

5.1 Approach to workforce planning and modelling Our plans are designed to deliver continuing workforce improvements, thus

supporting: • Safe and effective patient care and key performance targets • Workforce sustainability and improving workforce numbers (3-5

years) • Continued improvement on recruitment, attrition and workforce

stability • Reduced reliance on agency workers and achievement of reductions

in agency spend • Delivery of system transformation plans.

The Trust undertakes an integrated approach to workforce planning across all core areas, i.e. 999, NHS111 and PTS. Our Integrated Workforce Planning Group (IWP) includes stakeholders from Workforce, Recruitment, Education, Operations and Finance. In developing our workforce plan, the IWP Group work together to: • Ensure recruitment and education plans are aligned with the strategic

direction of SCAS • Phase new recruits into the Trust, ensuring all new recruits are

adequately supervised • Ensure all recruitment streams offer value for money.

5.2 Governance process Our workforce plans are agreed and monitored by our Workforce

Development Board. Membership of this Board is made up of Accountable Executive Directors, including the Director of Quality and Patient Care and staff side representatives. The primary purpose of this group is to oversee and agree our workforce recruitment and development plans. The annual workforce plan is agreed during the budget setting process by the Board of Directors, who are appraised of progress regularly and, if required, improvement plans. Workforce updates (including escalation of identified risks) are provided via the Trust’s Quality & Safety Committee (which is a sub-committee of the Board). Progress, issues and risks are also reported through to Risk,

of 22

Assurance & Compliance Committee, as part of the Board Assurance Framework. Quality, workforce and financial indicators are reported monthly via the Integrated Performance Report to the Board of Directors. The key workforce indicators include recruitment, attrition, sickness, appraisals and training. The Board uses this information to identify whether workforce plans are in line with forecasts. Any resulting remedial action plans are agreed by the Workforce Development Board, with progress monitored and reported to the Board of Directors and sub-committees.

5.3 Workforce supply and efficiency through collaboration The Trust actively engages with Health Education England (HEE Thames

Valley), STPs and other local health care providers on the development of robust workforce plans for the Paramedic and clinical workforce. An inaugural Paramedic Summit will be held in March 2017, the purpose of the Summit is to develop a system-wide strategy for the urgent and emergency care workforce, across the Thames Valley. The Summit will be dedicated to exploring and understanding the workforce needs of the urgent and emergency care sector and to understanding the particular workforce demands from all provider organisations to help formulate the first system-wide workforce strategy. During 2017-18, SCAS aims to expand this venture into Hampshire. SCAS meets regularly with HEE to ensure adequate workforce numbers are trained and they support the University education of our staff. During 2017-18, the Trust will explore further opportunities for developing more vocational based programmes for Paramedic education, including the Trailblazer apprenticeship and the development of the Certificate in Higher Education programme. The Trust is exploring opportunities with our blue light partners on apprenticeships for our control centre staff. The Director of Quality and Patient Care is a member of both the Cost Improvement and Workforce Development Boards. Cost improvement programmes are reported and monitored by the Board of Directors.

5.4 Workforce transformation Whilst a core strand of our workforce strategy remains the education,

development and recruitment of Paramedics, we will continue to increase our clinical abilities within our Clinical Coordination Centres, further developing our assessment, signposting and telephone advice services to meet and exceed the national NHS111 service specification, this may include continued development of integrated service models with GPs, out of hours GPs, community teams and mental health, booking of GP appointments and planned care. As a mobile health care provider, the Trust will continue to work with local partners to find new and innovative ways to support people in their own homes or local communities. Our Specialist Paramedics/Nurses work to enhance ‘See & Treat’ services, supporting the emergency service and helping to avoid conveyance to Emergency Departments, where this is not appropriate to meet patient needs. The Trust is currently undertaking a robust strategy refresh, further exploring our ambition to be provider and partner of choice. Our clinical strategy includes development of ‘trusted advisor’. We will continue to deliver against this strategy during 2017-19.

of 22

2017-18 will also see the introduction of a national Band 6 Paramedic profile alongside new development framework for newly qualified Paramedics. This provides the Trust with further opportunity to review the skills mix within our service delivery model to ensure we are maximising the potential of our current skills mix, i.e. bands 3, 4, 5 and 6 operational grades, whilst ensuring clear pathways for development and progression.

5.5 Reducing spend on agencies All agencies used by SCAS are compliant with the framework and national

caps. The Trust has made positive progress against the agency spend ceiling and will continue to closely monitor and improve during 2017 and beyond. The Trust will be exploring the possibilities of further expanding our bank workforce and improving the system for coordinating these resources, including the potential to work with partner organisations on the development of a shared bank. During Q4 2016-17, the Trust will be trialling a new approach to flexible working within our 999 service, if successful this will continue to be developed and implemented in 2017-18.

WORKFORCE PLANNING

6.1 Financial forecasts and modelling Despite several years of austerity and large cost reduction programmes, the

financial outlook is one of more of the same and increasing challenges. Whilst there has been a relaxation in the cost savings requirement as part of the tariff inflator, there is a need for SCAS to continue to deliver significant cost savings in order to improve the financial position. We expect there to be a continuing tough stance on public sector pay, but with expectations of increases in private sector pay above the level of inflation, and increasing pay expectations for ambulance staff.

The main financial highlights from 2016-17 are:

• SCAS is expected to deliver a £0.7m deficit, in line with the control total. • Expected to win/retain the Thames Valley 111 contract • Won the Surrey PTS contract • Took over the Sussex PTS contract • Good CQC rating • Delivery of £5.7m cost improvements.

Cost improvement programme The environment outlined above is one of largely flat 999 income, increasing

inflation particularly in the form of fuel price increases, a challenging health system environment and continuing tight 999 resource market leading to further costs from development and training.

Our response is in four main areas: • Continue to press ahead with the strategy and initiatives contained within it • Continue to deliver CIPs, at the level of £6.4m or 3.2%, above the 2%

assumed in the deflator • Get agreement for a change in funding formula from CCGs reflecting the

increase in red calls to appropriately reward for changes in acuity.

of 22

• Continue to invest in capital schemes, renewing the vehicle fleet (using our subsidiary company) and investing in a new combined resource centre in Milton Keynes with the fire and police services, which allows disposal of land.

• Increased income from new commercial contracts in Surrey and Sussex

The main areas of the £6.4m cost saving programme are as follows: • Changing the agreement with staff on meal breaks away from base. • Cycle time reduction – using Team Leaders to analyse and then manage

the appropriate elements of cycle time • 999 private provider reduction / bank improvement • Commercial recruitment replacing private providers • Reduced cycle time in 111 from the introduction of Adastra • Improvements in 999 relating to non-productive time • Benefits from recruitment of 999 staff

Our whole cost improvement programme is quality risk assessed, with sign off by our Director of Quality and Patient Care and Medical Director. If the risk is too great, the project is either stopped or mitigations put in place to reduce the risk. Progress against projects and milestones is monitored at our bi-weekly performance improvement meetings, with the overall progress, new projects and the quality risk assessment reviewed at our monthly cost reduction Board. In relation to procurement, we currently publish spend over £25k. We will use the benchmarking information to analyse variances across trusts and drive down costs. Whilst accepting that the Carter report is primarily acute-focused, we are adopting, or have already adopted, several of the methodologies. We have been reviewing and changing our rotas to ensure that our 999, 111 and PTS resource is matched to demand by day of the week, and time of day. We have introduced enhanced more flexible management information (using the Qliksense software). In terms of agency, the ambulance market is different to the acute agency market. Our private ambulances only require a relatively small premium to our own costs and provide a flexible and value-for-money service. However we continue to get more value from these services, and continue to manage other agency within the caps (both absolute and price caps).

The main areas of the £7.5m capital programme in 17-18 are as follows: • IT (£1.5m) – continued investment in this area, supporting the strategic

agenda, with various projects. • Fleet (£3.5m) – continuing replacement of 999 fleet, with 20 new ambulances • Estates (£1.6m) – the largest project is the £1.0m spend on a replacement site

following the Battle sale. The main areas of the £9.0m capital programme in 18-19 are as follows: • IT (£0.6m) – continued investment in this area • Fleet (£4.7m) – continuing replacement of 999 fleet, with 25 new ambulances

and the replacement of the HART fleet. • Estates (£3.6m) – the largest project is the £2.6m spend on the Milton

Keynes resource centre.

Better use of NHS estate The main item relating to use of the NHS Estate is the disposal of our property at

of 22

the Battle site in Reading, which is a joint sale with RBH FT. It is planned that we will exchange contracts to sell this during unconditionally in 2016-17, with the cash proceeds of £5m in 2017-18, and 2018-19.

Sensitivity analysis The main risks are:

• Additional 999 resource spend: the Trust has experienced additional costs in 2016-17 from workforce issues, a higher percentage of red calls, and the changes in the Ambulance Quality indicators. There is a risk that this will continue.

• Potential CIP non delivery: the Trust has experienced a shortfall in 2016-17 on its ambitious CIP plans. We have reduced the target for the plan years but there is a risk that this may reoccur.

• STF Funding – if the control total is not delivered then no STF funding will be received.

A combination of risks and opportunities has been reviewed, including those listed above which gives net risks of £4.1m.

LINK TO SUSTAINABILITY AND TRANSFORMATION PLANS (STPS)

7.1 Local systems In 2017-19, SCAS will be delivering services in at least six STP footprints:

System footprint Ref Buckinghamshire, Oxfordshire and Berkshire West BOB 44

Frimley Health FH 34

Hampshire and the Isle of Wight HIoW 42

Milton Keynes, Bedfordshire and Luton MKBL 24

Surrey Heartlands SH 35

Sussex and East Surrey S&ES 33 7.2 How the visions in the local STPs will be taken forward in this plan The vision, leadership, challenges and priorities differ in each STP footprint. As

a consequence, the delivery plans and governance arrangements vary across STPs. Common themes include:

Promoting health and preventing illness Many STPs highlight the role that all partners need to play to achieve a step-

change in promoting health, as well as preventing accidents or a deterioration in existing health conditions. SCAS uses its oversight of care systems to identify citizens who are at risk of needing emergency, urgent or crisis services, whether it is because they already have some unmet need, they are vulnerable for non-health reasons, or they are at high risk of a deterioration or exacerbation in an existing condition. SCAS is working with partners to develop plans for these individuals.

Improving emergency responsiveness Although SCAS is in the top quartile for response times to life-threatening calls,

of 22

this is a growing national problem and all Ambulance Trusts are struggling to meet key performance standards, due to rising call demand, increasing acuity of conditions, growing workforce shortfalls, widening career opportunities for Paramedics and pressure on pay rates. The urgent need to address poor outcomes and experiences for patients, plus the workforce challenges, is identified in several STPs. SCAS is actively involved in efforts, nationally and locally, to address these issues and ensure that we (and other Ambulance Services) can respond appropriately to emergency life-threatening calls.

Integrating urgent care systems In many STPs, extended primary and community teams are being developed,

generally to work on a locality basis and in some cases co-located into a ‘hub’. The concepts are very similar but there is considerable variation in the terminology used, the range of services and disciplines involved, the opening hours and referral or access arrangements. In coming months, SCAS needs to understand the detailed aspirations of the various local ‘hubs’ and to develop appropriate links. The interface with NHS111 services is likely to be pivotal, and we need to ensure that there is visibility and access to these ‘hubs’ via the local Directory of Services. In some areas, we are also likely to develop links between our mobile clinicians and other community based teams operating from the ‘hubs’. It is proposed that this could include development of a booking arrangement for a Paramedic Visiting Service, either to undertake face-to-face assessments or to offer treatment at home.

Care coordination A Care Coordination or equivalent function also features in some STPs.

Building on the infrastructure for NHS111 services, this function needs to interface with the emerging new models for primary and community care and utilise new technologies, with the aim of supporting more people in their own homes and signposting more effectively to appropriate services. Re-procurement processes are underway in all areas where SCAS provides NHS111 services. This situation creates both opportunities and risks in the development of our Care Coordination function. However, with a backdrop of competitive procurement and such high levels of uncertainty, it is not appropriate to set out plans in a document that will be shared outside SCAS.

Local delivery systems Several areas are moving towards a local delivery system model for the

leadership and governance to deliver the STP vision and plans. The arrangements vary across our geography, with some areas moving relatively quickly to a formal Accountable Care System, whilst other areas are developing much more informal collaborative agreements.

For SCAS, this means that we need to develop effective relationships with a wide range of partners and to offer services that can be adjusted to local circumstances and priorities.

7.3 How STP programmes will impact on SCAS

SCAS contribution to STPs SCAS is committed to working collaboratively with partners in order to design

and deliver seamless integrated services to local communities, in line with the

of 22

visions set out in each local STP. However, given the extensive use of competitive procurement in our areas of business, SCAS’s contribution to STPs will be secured predominantly through the outcome of tender processes.

System-wide approach to Paramedic workforce planning and development As explained, Ambulance Trusts are already facing considerable and

deteriorating pressures with workforce shortfalls and pay rates. At present, SCAS only takes half of 999 callers to hospital, as we have developed mobile clinicians who can assess and treat at scene. Unless we can resolve our workforce challenges, SCAS will have to revert to a traditional ‘scoop and run’ service and take the majority of 999 callers to hospital, resulting in a significant adverse impact across local systems.

If our local STP plans are successful in reducing emergency admissions and supporting more people in their own homes, they will result in a further increase in the demand for skilled Paramedics. With a shift of care from hospital to community settings, there is likely to be a further increase in demand and a rise in acuity of calls to 999 and 111. The introduction of extended primary and community teams is also creating new roles and development opportunities for Paramedics, which was not factored into historical emergency service workforce plans.

SCAS is hopeful that the system-wide approach to workforce planning through STPs will help to overcome the previous silo-approach, which has been unable to prevent the current challenges.

For the Paramedic workforce, the costs/savings and benefits/risks are felt in different parts of the care system. Therefore, it is critical that we look at the Paramedic pipeline across the care system. With system-wide planning and investment, the Paramedic workforce is a potential enabler and catalyst to the successful delivery of many of the aspirations in our local STPs.

of 22

STP Area Emergency 999

HCP urgent transport

Patient Transport

NHS111 services

Healthcare logistics

Commercial training

Other care coordination

BO

B

Thames Valley ? Preferred bidder

GPOOH lead contractor if win

NHS111 IUC

HIo

W

Hampshire SCAS until March 2018

STP digital role Potential SPA for partners

MK

BL

Milton Keynes

Bedfordshire

Luton

3 ST

Ps

Surrey

S&ES

Sussex

UK

National Ad hoc contracts as contingency

NHS111 provider Pandemic flu

service

of 22

LINK TO SUSTAINABILITY AND TRANSFORMATION PLANS (STPS) 8.1 Governor elections Public governor elections were held in late 2016 to fill ten vacancies on the

Council of Governors, across all four public constituencies. This followed an extensive campaign to engage with the Trust’s membership and encourage members to stand to become a governor. In 2017-18, a further round of public and staff governor elections will be held.

8.2 Governor development and engagement The Trust has a formal duty to ensure that governors are equipped with the skills

and knowledge they require to undertake their role. SCAS has provided:

• a comprehensive and tailored induction programme for all new governors • access to relevant external training • further extended its informal ‘buddying’ scheme between individual governors

and NEDs • the opportunity for governors to tour the Coordination Centres, ride-out with

crews, and visit ambulance station, to help support their understanding of the Trust and its business

• regular briefings and bulletins.

The work of the Membership and Engagement Committee has been key to the governor’s general duty of representing the interests of the members and the public. During the course of the year, governors have attended a range of membership recruitment and engagement events, and used other opportunities to meet with Trust members and members of the public to ascertain their views on the Trust.

8.3 Membership strategy SCAS membership is broadly representative of the area we serve, with the

exception of the Asian community where members remain underrepresented in comparison with the population of the South Central region. The representation in the 14-16 age range could also be improved. This is a common denominator in several other trusts. Two particular examples of new planned activities that the Trust will undertake in 2017-18 to increase membership in the above categories are as follows:

Engagement with young people Planned activities will include working in partnership on an educational

programme with a secondary school from Bicester and Winchester respectively. The programme will then be rolled out across all colleges and secondary schools in our coverage area.

Engagement with Asian communities Planned activities for increasing the Asian membership will include delivering a

programme of diabetes prevention and control roadshows in Asian communities following a successful pilot event in Aylesbury in 2016.

Author Isobel Wroe Title Director of Service Development Date 13 March 2017


Agenda Item: 14


Title

Board Assurance Framework (BAF)

Responsible Director

Deirdre Thompson, Director of Quality and Patient Care


To note the risk scores and assurances, controls and actions









Please provide details of the risks associated with the subject of this paper Risks in delivering key corporate objectives and strategic aims. Ensure mitigating actions are in place and monitored.

Implications

Regulatory and legal implications / impact (e.g. provider licence and segmentation ratings, CQC essential standards, competition law etc.) Risks associated with response times or delays to patients to a HASU as outlined in risk 1.2 can impact on compliance with the CQC fundamental standards (Effectiveness and Safety) Risks associated with 4.4 meeting the improvement requirements from the CQC report impact on compliance and moving to good/outstanding on actions required. Risks associated with 4.4 meeting the improvement requirements from the CQC report impact on compliance and moving to good/outstanding on actions required.

Financial implications / impact (e.g. CIPs, revenue/capital, year-end forecast) Financial risks may affect compliance with the NHSI Framework. Risks associated with objective 6 (Commercial Viability) may have implications for new business and financial risks 4.1 may impact on NHSI (Monitor) Compliance.


Assurance for Council of Governors that risks identified have action plans and mitigations in place.


Links to the NHS Constitution – principle 7 – NHS is accountable to the public and should therefore transparently take responsibilities for services. The NHS also commits to ensure continuous improvement of services.

Other


BAF is presented to the Board at every public meeting. Corporate risks evaluated in the corporate risk register by the responsible Executive Directors in the Risk and Compliance Group meeting March 2017 and in the Executive Committee. Corporate Risk Register considered in Audit Committee in January 2017.


SCAS NHS FT Corporate Risk Register Department of Health (2003) gate ref: 1054 Building the assurance framework. A practical guide for NHS Boards.

Good Governance Institute (2009) version 2.1 Board Assurance Frameworks: a simple rules guide for the NHS.

of 3


BOARD ASSURANCE FRAMEWORK (BAF)

PURPOSE 1 To highlight to the Board the principal risks to the successful delivery of

the Trust’s strategic objectives and the controls and assurances in place to mitigate these.

2 The report sets out an updated BAF for March 2017. In addition a

monthly risk profile is included which gives a summary view of the mitigated scores of identified risks.

3 The Board is asked to note the risk scores, assurances, controls and

actions in place.

EXECUTIVE SUMMARY 4 The BAF is presented to include monthly risk profiles for 2016 / 2017

year to ensure Board visibility.

5 There are currently 8 red risks and 11 amber rated risks on the BAF as reviewed by the Executive Directors on a monthly basis. The previous number of red risks (January 2017) were 7 and amber 10.

6 One risk was closed this month. 6.5 (risk of Project South potentially

diverting attention and resources away from SCAS business delivery). 7 Risk 5.4 – agency caps, was reframed to include a risk around

government changes to tax, IR35, and the potential impact on resourcing. 8 Risk 1.1 – risk relating to long waits for patients remains red at 16. Daily

reviews continue with more extensive monthly audits to ensure actions are identified and implemented where required.

9 Risk 1.3 - consequences of missing red targets remains red at 15

however, the Trust achieved all performance targets in February 2017, focus needs to remain.

10 Risk 1.5 – timeliness of closing complaints, was increased to a score of 8

(previously 4) to recognise there still can be challenges and reputational

of 3

risk. 11 Risk 1.6 – the ambulance handovers and turnaround delays has been

increased from a score red 16 to red 20 in relation to Portsmouth. Regular meetings continue to ensure traction on reducing queues at this hospital.

12 Risk 3.1 – IG breach potential has been increased from yellow 6 to amber

9 as training % is down and processes are under review. 13 Risk 4.4 – CQC moving from Good to Outstanding reduced from 12 to 9

as the previous risk articulated a move from Requires Improvement to Good.

14 Risk 5.2 - effectively managing sickness absence remains red at 16

although there are signs of improvement using the new processes. It was felt too early to downgrade the risk at present as a need for ongoing improvement should be realised.

15 Risk 5.3 – the ability to recruit and retain staff remains red at 20 as this is

an aggregated score of all the services across all SCAS areas. Hampshire 999 recruitment is positive however there are areas in Thames Valley 999 and NHS 111 that still remain a challenge. The local risk registers managed by the Integrated Workforce Planning groups for each service reporting to the Workforce Development Board, are identifying further mitigating actions.

16 Risk 6.7 - has been increased from amber 12 to red 16 in relation to

SCAS mobilising the new Surrey PTS contract which include issues around premises and workforce. To remain at red until mobilisation of the contract in April 2017.

17 Risk 6.8 - remains red relating to risks associated with mobilising the

“step in” Sussex PTS contract. Work has commenced to review the governance arrangements and build key partnership relationships. A SCAS Sussex project team and project board is in place and a partial launch has gone well.

18 Risks on the BAF have been reviewed in full to ensure that

appropriate controls and assurances have been identified, and that any action plans have agreed timescales allocated and necessary updates are provided. They have also been reviewed in terms of their alignment with the Trust’s Corporate Risk Register. The BAF is a key mechanism used to reinforce strategic focus and improved management of risk.

of 3

NEXT STEPS 19 The BAF will continue to be reviewed by the Executive Directors at their

meetings with an updated report being presented to the Board of Directors meeting.

CONCLUSION

20 The BAF has been further reviewed and updated since the last report to

the Board in January 2017 and reflects the risks for the current year.

RECOMMENDATIONS TO THE BOARD 21 The Board is asked to confirm and note that the principal risks have

been identified and are being adequately mitigated. Deirdre Thompson Director of Patient Care March 2017

RAG

Strategic Objective Risk

Principal Risks Date Identified Co Lik Tot Current Control Measures Gaps in Controls Current Assurance Gaps in Assurance Action to be taken Respons. Timing /

Co

Li Tot

6 1.4 Private providers (all services) not consistently meeting the required standards resulting in poor patient outcomes and experience

14/03/17 5 4 20 Bi monthly quality assurance monitoring and checks of all PP's used by SCAS. Liaison with CQC when PP's are inspected. Revise list of approved PP's and policy to ensure assurance. SIRI investigations where required and learning applied.Using a limited number of companies Tender process to reduce number of providers

Learning from SIRI's ongoing. Monitoring of all PP's used if a company outside of agreement used National tender to be agreed Local contract to be agreed Vehicle communication infrastructure (not standardised)

Bimonthly quality assurance monitoring. Weekly reviews of PP's used. Strengtened template of assurance process. Heightened awareness for SLT of approved PP's. SCAS liaison with CQC inspections of PP's. Redefining service specification.Clinical Governance framework developed - awaiting ratification Clinical governance framework for PP’s approved by Q&S committee Sept 13 Agreed a zero tolerance approach when staff have not administered the “basic” level of care & assessment

Use of non approved PP's when demand is high Contract in negotiation Clinical Governance framework to be developed.

November 2015 situation remains unchanged with PPs still regularly checked and no SIRI's. Additional PP's are being brought on stream so continue with current processes. Conduit has been reviewed by NHS Pathways and SCAS Head of NHS 111 governance followed up with further review and agreed actions on the number of compliance audits by call handlers Feb 2016: Monthly governance reviewes continue with no significant concerns raised. APRIL 2016: No concerns raised JUNE 2016: Continue with monthly reviews and unannounced inspections of provider sites. AUGUST 2016: No change to the risk profile October 2016: NEPTS reviews of PP's in line with approach in 999 to ensure standards and governance requirements are met. New PTS services require a thorough review of providers. Walkrounds and review meetings to take place. December 2016 - As per October update work in progress to identify locations of PPs in contract areas and create a plan of visits in Q4. MARCH 2017:Private provider governance framework reviewed to encompass all services. Private providers in Sussex and Surrey PTS all visited in January. CQC reports for private providers being reviewed and actions created as a result.

Philip Astle COO

Weekly review with formal bi-monthly monitoring

3 3 6 9

November 2015 The trust has moved into turnaround mode with significant focus on performance and additional reporting of kpi's and accompanying actions Feb 2016: This continues to be a rising challenge since Jan and is being managed by areas and up to the Board level. Immediate Handover policy is being implemented when possible albeit a challemge due to space and trolley issues at the ED's. PHCP is also supporting crews in the ambulance crews to further support patinet safety alongside the Team Leaders. APRIL 2016: Handover delays have continued to impact on our ability to respond to patients. The main impact has been in SE Hampshire, although other acute trusts have seen an increase in attendances affecting their turnaorund times. The ops teams have been focusing on the clear up times to improve our vehicle availability. June 2016. The fundamental of this risk remain the same although performance has picked up in April. The trust's funding position may increase this risk. September 2016: Although QA performance has improved significantly from the end of March the level of delays is still over 100% up on the previous year. Management escalation is the only tool in our armoury. CCG must be encouraged to manage the hosptials more stringently as the lack of fines for this year is likely to make the situation worsde rather than better. September 2016: The Executive Management Team continue to drive performance and monitor via the Turnaround meetings. There is a revised remedial action plan that is awaiting formal sign off by the CCG's TV and SHIP. Actions are in progress. October 2016 - Continue to monitor daily - focus for ops. NHSI have held 2 Ambulance Hanodver workshops, one for Thames Valley and one for QA Hospital. Following these events SCAS and the acute trust sign up to a concordat for improvement in handover process. There is an event for Wessex planned for mid November. Continue to implement all actions in the remedial action plan. Closer working relationships with recruitment team to maximise the internal capacity of staff and we are also working through actions to reduce attrition including new rotas, and policy reviews for meal breaks and end of shift. December 2016 - Daily monitoring continues especially over the Christmas period / As per October update work in progress to identify locations of PPs in contract areas and create a plan of visits in Q4.MARCH 2017:PHT continues to be an outlier as described above. Heads of operations continue to work along side acute trusts handover delays have improved in February. Exec turnaround reviews bimonthly REAP3 actions implemented. PHT has been excluded from this risk

51.3 Availability of resources (fleet and staff) and turnaround times at hospitals, resulting in delays to patients and inability to meet targets - red and green calls consistently

15204 15 Stroke data for CTD times being audited.Stroke data for CTD times being audited Negative media stories Increase in complaints and incidents in 2012- drill down to reasons staff attitude, delay and not sending an ambulance remain the main reasons Risk identified with non conveyance current theme for experience - learning identified with CSD surveys Numbers of incidents reported as a delay. CSD peer reviews to be routine. Fleet improvement plan not yet implemented fully.

4,5

14/03/17

1. Clinical Excellence: Quality of care, patient safety and experience

14/03/17

1.2 Failure to convey patients to HASU in a timely manner and failure to provide adequate pain relief to STEMI patients

14/03/17 Improved CQC QRP Patient satisfaction surveys Staff satisfaction surveys/ staff safety culture audit increase in reported compliments CQC compliance with Outcomes 1,4 and 7 Quality Accounts and national ambulance benchmarking Audits of patient care records and delays to care Information on complaints and incidents shared with staff Production of ‘you said we did ‘ news letters Trust lead human factors work stream across south central –conference March 2012 with LD Patient Champion New Appraisal system implemented Random reviews / audits of delays provided assurance of quality of care, but also identified learning or improvement areas – (key priorities for quality accounts) CSD governance framework reviewed Jan 13. Compassion element applied to appraisals May 2013. Team leader training in patient experience in June 2013. Time critical transfer policy reviewed. Penalties in new acute trust contracts for A&E delays. Double verification now live across SCAS focusing A&E departments on timely handover Weekly deep clean performance data in line with vehicle availability being monitored KPI performance management meeting with MAKE READY Directors monthly Pilot of 9 week deep clean schedule commenced 4th Nov September 2014: Add in Indirect Resources actions and also North Hampsire CQUIN pilot and also the winter resilence plans

DH quality indicators and measures Patient Experience Group scrutinising data and developing actions Executive Team monitors all quality and clinical processes and policies and performance Complaints, concerns, comments and compliments monitored through the PERG. Delay to backup audit commenced. Fleet review 2013. Increased workshop hours for fleet. Contracts in hospitals to apply penalities for delays. UHU project to meet supply and demand needs. Daily monitoring, Resources adjusted as per demand, Roster management, UHU project and modelling, REAP escalation plans and CSD reviews

DH quality indicators and measures for 111 and 999 services JRCALC guidelines/Pathways for 111 audit process 1% of calls Trust Board and Quality and Safety Committee assures clinical and quality governance processes Audit committee reviews and cross references quality domain Executive Team monitors all quality and clinical processes and policies and performance Performance, complaints and incidents reviewed by the PERG and Quality and Safety Committee Clinical Review Group reviews Processes and education for all staff to raise awareness Monitoring of clinical work streams through clinical committee and governance structure Quality and clinical metrics embedded in Integrated Performance Report CQC Quality Risk Profiles New evidence supporting new care pathways (STEMI, stroke and trauma) . Planned programme of equipment maintenance in place monitored through H&S committee. Internal audititors report Feb 13 of equipment.

16

Board Assurance FrameworkRaw Risk

RatingMitigated

Risk Rating

44

34 16

CRG monitor network developments - stroke, ppci and trauma. IPR data set reported to board Clinical audit programme Clinical memos and directives to staff SIRI review group minutes and lessons learned incident reporting April 2014: Stroke and STEMI interogation and campaign with senior OPs and Clinical Team members driving changes - Sept-14 Stroke interogation and campaign with senior OPs and Clinical Team members driving changes. Robust action plan and trajectory in place and being monitored. Robust action plan and trajectory in place

9Action plan in place for STEMI and stroke (in IPR) rate SCAS performance mid table

3 12

1,2 November 2015 ACQI report guideline re-issued to staff on how to gain compliance. ePR configuration change control notice has been sent for evaluation and pricing with a view to it being in the November update. When ePR dataset included in the dataset this shows an improvement in complianceJanuary 2016: No further update - monitoring performance .On improvement trajectory for the April reported percentage Feb 2016: STEMI Performance on trajectory 76.7% - Medical Director continues to engage with Acute providers and the Stroke Networks regarding location of HASU's. Stroke 60 performance improved from same period last year folowing Campaign 'Fast Means Fast' APRIL 2016: The peformance for March 2016 is 59%. The Medical Director continues working with Wycombe HASU and the Stroke Network to ensure that SCAS are engaged with any future decisions on the location of this centre; The performance for the March is 76.1% hence the improvement has been maintained following the campaign and ensuring the inclusion in the EPR datasets. JUNE 2016: Recent review demonstrates that patients are receiving analgesia however there are incidents when patients do not record the patients pain score. This is being reinforced with clinical staff to ensure that this is recorded going forward. Recent improvements continue with the April performance at 60%. September 2016: The Trusts ePR compliance tool is due for release in September so improvements should be seen in Octobers data. September 2016: Performance as per August IPR is 56% work continues with the MD and the HASU's and networks October 2016: Awaiting October data. Review drive times in Wycombe area .Dec 2016: September (latest figures) care bundle compliance at 72%, showing slight improvement. Compliance tool on ePR implemented in December and impact of change will not be realised till December data is inputted Risks of conveying stroke patients when Wexham closes in January until Wycombe opens in June. Which will included increased drive times and impact on resource availability. All operational teams engaged in ensuring best possible safety outcomes for patients - MARCH 2017:A check of Decembers figures have shown an improvement to 79.3% but that is not yet the final figure which is not due to be submitted until April 2017. 79.3% would put SCAS just above the national average of 78% and mid table when benchmarked against all other NHS English ambulance Trusts. Interim model gone live - patients postcodes decided - monthly meetings with stroke network lead to 'iron out' challenges

November 2015 Monitoring continues. Long wait continues to be higher than target Implementation of NARP should improve resource utilisation, early indications look positive. Implemented revised CSD protocols to enable clinicians to intervene in incidents to assist with alternative pathwyas suitable for patients. January 2016: Some improvement seen through the latter part of December with NATP and CSD interventions / chnage of focus February 2016:Long Waits remains a concern and is being impacted by increases to hospital handovers and demand, long waits impacted aso by the focus to ensure that all Red (life threatening calls) are responded to. Welfare checks continue by CSD clinicuans for Long Wait patients. APRIL 2016: The performance for the March is 56% hence the improvement has been maintained following the campaign and ensuring the inclusion in the EPR datasets. June 2016. The fundamental of this risk remain the same although performance has picked up in April. The trust's funding position may increase this risk. June 2016. In April the long waits reduced significantly because demand and red acuity dropped but the fundamental issue remains. The ARP code changes are the long term solution in part and we have done a limitied trial on a Green tail vehicle to judge the effect. August 2016: Long waits is co dependent on the the red activity and performance. in August there is some improvement on July's performance. Clinical Governance Leads and Operational Leads jointly auditing impact on patinets and common themes impacting on long waiting patinets. Currently in discussion with staff-side to modify 'mealbreak' windows to elease more resource. October 2016 - Concerns and plans discussed in depth at board workshop on 20/10/16. Governance leads and ops reviews continue daily and audit regularly to review patient safety and experience impacts. Trust Board support the work to drive down long waits. December 2016 - Joint workshop with commissioners on long waits was helpful in clarifying risks and mitigating actions. A review of CSD including call back procedures commenced. (Green) Project to re-evaluate care treatment and response to this category of patients MARCH 2017: Green project on going - fraility vehicle with OT to complete falls assessments and create plans for right pathway for patients in Hampshire SW - implemented REAP 3 actions in February 2017

3 9

8All front line staff have JRCALC manuals and pocket books PCI indicators benchmarked nationally Individual scorecard for staff through the CARS system Quality Report Account KPMG audit of quality account SCAS clinical strategy/CAG meetings 111/ Quality Contract reports 111 CQC compliance with Essential Standards Green 4 action plan to increase hear and treat Research and development strategy in place with research resource developing Clinical Audit plan in place and agreed by CRG and Q&S April 2013 Internal audit provided substantial assurance against CQC standards New pathways of care in place for PCI. And Stroke with demonstrated outcome benefits. CRM monitoring of stroke improvement plan. Patient survey plan agreed at PERG June 2013 /111 satisfaction surveys Internal audit of medicines management – substantive assurance of safety of medicines storage and administration processes . Contract Performance reports and scruitiny. Performance on national quality indicators improving from previous months (Oct data) SCASCADE launched to share learning

Patient outcomes and experience due to delays through whole organisational learning from SIRI’s and complaints. Action required to address complaints pertaining to attitude of staff. Analysis of National Ambulance benchmarks (Sept 2012)Staff training requires an element of customer services as a thread running through all programmes of education. Review Francis report findings and apply robust learning programme and assurance.

4Monthly review

Safety Peer reviews Consistent data quality/thematic HCP feedback collation for 111 services further development required Organisational learning from incidents, complaints and SIRI’s and patient experience data. Learning triangulation from legal claims/complaints/incidents. Need for Qlikview to have consistency in all its reporting. need a safety culture audit planned for Q2 2013. CQUIN plans for ACP's and GP triage and Non Conveyance. Timeliness of clinical data. Consistency of clinical data.

June 2014: Some early evidence of improvement Need to ensure that the trajectory for improvement is achieved through monthly monitoring of performance

Deirdre Thompson Director of Patient Care John Black, Medical Director Philip Astle COO

Deirdre Thompson Director of Patient Care

Deirdre Thompson Director of Patient Care Philip Astle COO

Monthly review

Monthly review and daily analysis

4

3

53

1.1 Inconsistency in providing clinically excellent, evidence based and safe patient care as outlined in national quality measures / indicators .(Long Waits, Non-Conveyance and availability of equipment)

RAG



Co

Li Tot


RatingMitigated

Risk Rating

21 1.5 Non compliance with timescales for complaint acknowledgement and responses

14/03/17 3 3 9 Recruitment under way for Head of Patient experience. Process mapping exercise completed and identified changes are being planned - for implementation in January 2016. Review of complaints team structure currently being undertaken. Agency staff being employed whilst permanent recruitment is ongoing. Reports of current caseload have been reviewed and will be completed weekly so that the situation can be closely monitored. Clinical Governance leads will be involved in process.

Poor experience for complainants, potential increase in complaints relating to process issues. Non compliance with national targets/ contract quality schedules leading to increased external scrutiny. Reputational risk

Action Plan for recovery New processes yet to be embedded January 2016: New Manager appointed to start mid January. Assistant Director of Quality managing the department and focusing and responding to the backlog. Feb 2016:Actions on track, Head of Complaints and Complaints Officer now in post. Redsign of processes having a very positive impact hence reduction in risk to 6.APRIL 2016: Actions continue to improve the responsiveness for complaints June 2016: Our SCAS Acknowledgement within our target of 3 days has improved to 86%. Further work to improve the final resolution responsiveness is progressing with formal reporting by service to the Trust Board from September onwards. September 2016: Trajectory of improvement on track albeit slow. Actions for a sustained recovery on track and good progress noted at PERG on the 12th September 2016 October 2016 - Ahead of improvement trajectory. 3 days acknowledgment 100% and final responses up to 48%. Continued improvements recognised by Board December 2016 - Continue to be ahead of trajectory on response times MARCH 2017: The process for acknowledging in 3 days is well embedded. Work to improve response timeliness continues including enhanced training and guidence

Deirdre Thompson Director of Quality and Patient Care

Weekly review with formal bi-monthly monitoring

4 2 6 8

7 2.1 Inconsistent assurances around IT and telephony resilience

14/03/17 4 4 16 Programme of resilience improvements approved by the Board Nov 12 following peer review of resilience Virtual telephony business case approved for implemenation Aug 14 Back up procedures strengthened.Replacement of the UPS at Northern House Mch 14.

January 2016: ICAD report identified just minor items from a detailed audit of processes Feb 16: Review of ICT Security went to Dec 15 Board. Review of ICAD upgrade whent to Jan 16 Board.APRIL 2016:Update to telephony action plan and external penetration testing reviewed at Exec in March. Internal audit being carried out in March reviewing success in covering resilience actions. June 2016: This risk has been downgraded as there has been a consistent performancve in terms of IT over through Q4 and in the fist 2 months of Q! 2016/2017 September 2016: Action plan developed following internal audit report - update on progress to October Audit Committee, but plan monitored by management on a weekly basis . October 2016: Audit Committee discussed in depth IM&T plans for resilience on 20/10/16. Plan to report upward to EMC regularly to monitor. IM&T control Board to ensure robust documentation and evidence following BDO audit recommendations. Agree targets from November 2016. Oct 16: review of completed IT resilience actions presented to Audit Committee December 2016 - Risk score reviewed (downwards) following discussion at Execs followinga period of stability MARCH 2017:Nexthink software installed on user equipment which reports back on malware. Comprehensive update to the Board in respect of the work SCAS is going to mitigate against cyber security risk


Weekly review

4 3 12 12

9 2.3 Inability to deliver the ePR deployment programme & realise the benefits

14/09/16 3 4 12 Financial Pressures Will lead to competitive disadvantage Poor reputation

Early project phase Membership Engagement Strategy Membership and Engagement Committee Support for governors e.g. engagement toolkit Charter of Expectations inc no. of engagement events Programme of Engagement events inc. constituency meetings and patient forums Training commenced in the pilot areas

Early project phase November 2015 software updates implemented for clinical reporting. January 2016 EPR now rolled out for Portsmouth conveyance. Summary Care record now live. Mobile directory (mobile DOS) now live and being rolled out in Hampshire. Feb 16: Final area (Oxford) now completed. Mobile directory now rolled out to Berkshire. APRIL 2016: Benefits review to be presented to June 2016 Board JUNE 2016: review of benefits carried out which shows numerous benefits in excess of the business case, but financially some areas not delivering - E - learning, and with non conveyance it is difficult to establish how much is to due EPR, although total non conveyance has improved more than the target. AUGUST 2016: RECOMMENDED FOR CLOSURE BY RACC

Charles Porter, Director of Finance

Monthly review

3 3 9 9

28 2.4 Temporary closure of obstetric unit at Horton General Hospital (Banbury)

09/01/17 3 4 12 Small numbers of transfers from freestanding MLU at HGH estimated to be 3 week. Potential for delayed transfer at times of high demand. The need for time critical transfer will be rare

Reliant on third parties 1. Appropriate MLU case selection. 2. Altrnative provision for obstetric and midwifery lead care in Warwickshire/Northamptonshire. 3.Provision of DMA funded by OUH

Reliant on third parties September 2016 Joint SCAS/OUH planning to mitigate risks October 2016 - SCAS providing 24 hour ambulance cover to mitigate risk.DECEMBER 2016 RECOMMENDED FOR CLOSURE BY RACC

John Black, Medical Director

Monthly review

3 2 6 6

29 2.5 Emergency and Acute Hospital re-configuration North Hampshire Hospital

09/01/17 5 3 15 1. Increased ED handover delays in the event of service delivery failure at either Basingstoke or Winchester EDs. Increased cycle times/operational response time challenge in the event of closure of ED

Reliant on third parties 1. Close monitoring of hand over delay perfornance and sharing of best practice to prevent avoidable handover delay. 2. Managing demand.3 Supporting in pronciple provision of an 3rd Emergency Hospital Nr M3 corridor in Hants.

Reliant on third parties September 2016: Regular Joint Executive/Area Manager meetings . Input into SHIP STP. October 2016: Continue with STP.DECEMBER 2016 RECOMMENDED FOR CLOSURE BY RACC

John Black, Medical Director

Monthly review

3 2 6 6

35 2.6 SCAS fails to engage in and influence STPs in local areas, either through lack of SCAS involvement or as national templates do not include 999/111/PTS b i

14/03/17 3 4 12 SCAS is not involved in or aware of the changes planned, and opportunities associated with SCAS services are missed. The limited funds available are directed to services that are explicitly included in STPs

Reliant on third parties Senior lead and NED to be allocated to each STP footprint Reliant on third parties Senior leads identified for Hampshire & IoW plus BLMK, but leads to be identified for other footprints. NEDS allocated to each area. Analysis of key workstreams, personnel and SCAS engagement by footprint shared with Board MARCH 2017: Series of meetings ongoing involving Non-Executive and Executive Directors with STPs

James Underhay Executive Director

Monthly review

3 4 12 12

11 3.1 Risk of Information Governance Breach

14/03/17 4 5 20 June 2014: The process for loading files on to the website has been modified. The controls have been enhanced to ensure Senior manager sign off publishing rights to the Web manager alone, pending a review and retraining of all editors, Controls have been enhanced in the HR team for handling sensitive data

Outlined in the BDO Audits of the Information toolkit

Through rapid response to the incident led by FD Communicating to staff regarding the extent of the issue Full Co-operation with the ICO Improvement programme to significantly reduce the likelihood of a similar incident happening again Managers are ensuring that their staff have completed the online IG refresher training. Additional IG steering group meetings to monitor. Sept 2014: Wider review of IG commissioned with BDO

percentage of staff completing IG online refresher training uptake throughout the trust

August 2015: Continued progress on improvements. Awareness training planned in conjunction with ICO and other Ambulance Trusts Feb 16 Awareness training w/c 22 Feb.APRIL 2016: JUNE 2016:Continued improvement in IG processes and culture September 2016: Reviewing new national guidance on information security to ensure compliance. October 2016 - ongoing monitoring and assurance through IG Steering Committee December 2016 - cointinued period of stability MARCH 2017:Stability and work progressing on action from CQC audit re records audit.IG breach in February relating to the leak of GM call. Investigation ongoing. Renewed focus on getting IG training down, and review of procedures for locking down records


Bi-monthly review

3 3 9 9

12 4 Through a rapid response to the publication and allegations within, led by the Director of Strategy, Communications and communicating openly and transparently with Commissioners, Stakeholders and Regulators and through the very early involvement of staff and patients potentially affected significantly reduced the risk to reputation. The declaration of a SIRI and launching of a comprehansive investiagtion, agreeing ToR with key stakeholders, further reduces the impact. Bi-weekly progress updates to EMG and early identification and implementation of actions will further reduce the risk.

Action plans agreed with the key leads and in progress and await completion and evidence of completion

14/09/16 November 2015: CQC inspection preparations are on track, action from DT report on track January 2016: NHS 111 CQC focused inspection draft report received for factual accuracy checking. Report findings are positive and support the completion and effectiveness of the actions resulting from the DT SIRI investigation Feb 2016: CQC report published and the one 'Should' action in progress APRIL 2016: A technical solutions now sourced to ensure that going forward the Trust will be able to track that staff have viewed clinical memos or information relating to changes to standard operational procedures.. This will close the one should action from the Nov 2015 NHS 111 focused inspection.JUNE 2016:all actions completed and CQC have inspected the service as part of the Trustwide rated inspection in May 2016. Early feedback from the inspectors was in the main positive but we await the final report. September 2016: Recommended closure by RACC

22 February 2016: Performance in the SE Hampshire area continues to result in very lengthy delays at ED and also resultimg in significant delays in all categories of patinets. Senior Management Team engaged on a daily basis and all efforts being made to resource up to mitigate the risk when possible. Concersns escalated to Commissioners, CQC, NHSE and TDA. CSD continue to support patients who are waiting and the clinical team continue to audit incidents following delays. Continue to have significant media interest which is being managed through the Comms Teams.APRIL 2016: The OPs and Clinical Team are reviewing further actions to further mitigate the impact on long waits: • To have further clinical assessment at key points in their wait (Luci Stephens lead)• A protected ‘Green’ response that would focus on the longest, most vulnerable patient (Mark Ainsworth Lead)• It was also agreed that a ‘Perfect Week’ be planned internally and in collaboration with other stakeholders / providers in the area and tested the w/c 3rd May 2016 to ensure that the Trust better understand future resource requirements (Rob Kemp and Mark Ainsworth-Smith Leads)• There was some discussion on the use of indirect resources to manage the long wait patients and the operational team will be exploring this further (Mark Ainsworth Lead)• It was also agreed that our current escalation policies and procedure are reviewed and streamlined to ensure that senior decision makers have the resources and support in times of increased demand and hospital handover delays (Mark Ainsworth Lead)• Alongside the policy review it was also agreed to add in guidance for staff on how to manage / care for patients within a queue in an ED department or when waiting for periods of time in an ambulance (Jane Campbell Lead) June 2016: Extended Ambulance Handover Patient Care Standard Operating Procedure finalised to further support patient care. Improvements have been seen in handover delays over the past 4 weeks and SCAS continue to monitor this. September 2016 : The hospital handover trend by month show the cumulative hours delay by month back to April 2015 is greater then the same period last year. The backdrop is an increase in ambulance activity in the SE and even though conveyance rates remain steady, the overall results is that arrivals are higher than the same time last year. The speed of escalation in PHT is improving from a SCAS perspective October 2016 - continued scrutiny of data and delays - concern in rise in handovers noted by CQC. Daily reporting in operations. NHS i improvement workshops attended. Rota review in progress. December 2016- CEO to CEO fortnightly meetings to ensure trajection on queues at this hospital MARCH 2017: Biweekly phone call CEO to CEO - January delays worsened - February improving over 200 hours a week

Delays continuing at high levels

44 Actions to be identified and implemented in a timely manner

414/03/17

3.2 Risk to patient safety, patient confidence and Trust reputation in the NHS 111 service if recommendations and actions are not implemented in a timely manner following the investigation into the Daily Telegragh publication / incident / concerns

Through rapid response and launch of a comprehensive SIRI investigation and the responsiveness from all parties involved ensures that the investigation progresses and meets the ToR set.

16

DT

42Bi-weekly updates EMG and final SIRI report to Trust

Board and Commissioner

s

Deidre Thompson Director of Quality and Patient Care

Reviews of patient incidents demonstrating poor patient experience and minimal evidence of patient harm

2

3. Stakeholder preception and Trust

reputation

Poor patient experience and potential for adverse clinical outcomes. Poor reputation and risk to performance

Risk summit attended by stakeholders with 30 day action plan agreed. Trust will attend further risk summit in January. Local metrics identified for weekly monitoring . These include impact on emergency and 111 services. Queues being managed and permanent deployment of Jumbalance at Portsmouth hospital site. Regular calls with PHL

123

2. Emergency Performance

201245Weekly review with formal bi-monthly monitoring

1.6 Risk to patient safety, patient confidence and Trust reputation due to issues with Portsmouth Hopsitals NHS Trust and PHL. Lack of assurance for patient safety in ED and ED queue at Portsmouth Hospitals NHS Trust, associated impact on PTS due to late planning of discharges. PHT s inability to deal with demand in this locality.

RAG



Co

Li Tot


RatingMitigated

Risk Rating

26 3.3 Growth of charity may increase Trust exposure to financial and reputational

14/09/16 2 3 6 Higher than anticipated cross subsidy may be required in start up phase. Increased profile of charity may bring challenge about charity governance & compliance.

Early in start up Internal audit advising on governance issues; joined expert membership bodies to access advice; full board reviewing development strategy; CF sub committee monitoring delivery.

Early in start up Minutes of Cf Committee meetings; Audit report. James Underhay, Executive

Quarterly 2 2 4 4

13 4.1 Risk to achieving financial targets and realise CIP’s.

14/03/17 5 5 25 Cost improvement plans agreed and monitored Board approved budget & performance management of budget LTFM aligned to Monitor framework Monthly financial monitoring by Board and Executive Team. Board agreement in Sept 12 to spend additional monies at operational level. Challenge by Audit committee Internal Audit reviews or accounts Local Counter Fraud work External Audit & SIC . Cashflow reporting and analysis. Performance management of CIP'sCIPs reported monthly to the board. Strengthened CIP governance tracking process implemented. Increased performance management of late payments and debtors Review forecast risks at Board which are then mitigated. Internal audit report with substantial assurance. New risk rating (out for consultation) increases likelihood of Monitor investigation/sanctions. This would limit the ability of the organisation to deliver on its wider strategy due to the focus on financial recovery. This will lead to reputation issues. Fi i l b l t hi d Th i k i i t l t

Austerity measures to be identified and agreed. Ensuring end of year position with CIP's identified.

History of good financial management Board approved budget on 25th March 2012 CIP meetings Internal and external audits inc. year end audit reports Minutes of Board, audit committee and executive committee. 6 monthly budget reviews External Review Boards each month with commissioners Benchmarking against peers Improved SLR Performance management of CIP’s through business programme board and executive team Clean audit report and value for money conclusion. a) Contract income - Contract signed for 16/17. Pricing review to ensure sustainable footing for future years, although this may not have this desired result. b) Controlling the financial position: CIPs reported monthly to the board. Strengthened CIP governance tracking process implemented. Increased performance management of late payments and debtors Review forecast risks at Board which are then mitigated. Internal audit report with substantial assurance.

Forecast readjusted therefore increased risk. Demand continues at a high level. Period 7 surplus and cost savings behind budget

November 2015 updated financial position approved by the Board. Internal turnaround in place. Framework in place to find £1m of improvement to the position. January 2016 To date tracking slightly ahead of the agreed forecast position Feb 16: Surplus continues to be ahead of position. June 2016 Still in dispute with contracts for the 999 service. CIP target behind plan and being monitored via Turnaround SEPTEMBER 2016: a)Pricing review TOR drawn up, to be agreed with commissioners. b)financial recovery plan further developed and reviewed at Exec and Board. Progress against CIP milestones reviewed at each turnaround meeting. October 2016: a) Pricing review on track with agreed timetable - agreed with CCGs that Lightfoot and KPMG do the review with SCAS own resource. b) Analysis of H2, udpated risks and opportunities and improvement plan presented and agreed with the Board December 2016 - With signing of PTS Sussex Heads of Terms, and review of NHSD position, financial outlook for 16/17 has improved. An improved forecast was reviewed by the Board in December. MARCH 2017: February performance in line with the control total

Charles Porter, Director of Finance

Monthly review

4 4 16 16

14 4.2 Cost of delivering performance levels in 111 higher than assumption

14/09/16 5 4 20 Monthly reporting to the board.Monthly Performance Review meetings.Detailed improvement plan

111 business is new so control measures need to be adapted.

Track record of delivery of budgeted financial surplus Track record of financial recovery programmes National acceptance that the 111 service is different to originally envisaged (giving opportunity for variations)

No Track record of 111 business controlling cost or delivering the of budgeted financial surplus Service is still new so cost may vary for reasons which are not known. High sickness and attrition affects cost.

November 2015 Service is running well with focus this quarter on service delivery. Expected to deliver improved efficiency during the next quarter due to economies of scale but will continue to monitor Feb 16 Improved financial position in 15/16 due to One Call, but not at budget level. Vacancies affecting call answer and therefore penalties.APRIL 2016: Significant volume increase in March compounded by the low staff numbers and lower provision of service from Conduit lead to poor performance and high sanctions. Growth in March was 21% higher than prior year, however Easter fell in April. Overall growth in 111 was 2.7% on prior year. The year did have two Easters and an extra day being a leap year. JUNE 2016 : This risk is being contained by controlling overtime, Bank Staff and allowing the PP to under deliver and therefore under pay. However the fundamental issue remains that the cost of delivering 95% is significant. Efforts to reduce call times will help. AUGUST 2016: This risk is currently being ameliorated by taking additional calls from SWASFT at £20 per call. If we lose TV111 we will have to cut costs significantly. Risk superceded below risk 20

Charles Porter, Director of Finance. Chief Operating Officer

Monthly review

4 2 8 8

30 4.4 Risk of not achieving timescales for CQC actions to move from good to outstanding and providing comprehensive evidence

14/03/17 4 4 16 Robust action plan in place led/monitored by compliance team. Systems for recording evidence in place.

Action plan monitoring and delivery of all actions requiring constant scrutiny. Addressing any inconsistencies across the organisation.

Robust action plan in place. Good engagement with all partners. Met with key responsible and accountable persons and good governance arrangements.

Further audit and unnannounced internal spot checks/walkarounds required to ensure actions are implemented and effective in the timescales required.

OCTOBER 2016: Governance leads in place, action described in detail, evidence continues to be provided, leadership walkarounds being reviewed to address key should/must actions.December 2016: action monitored regulary by Executives and responsible action owners engaged to implement any outstanding actions. MARCH 2017: CQC action plan reviewed bimonthly by Execs, escalating and highlighting any red actions outstanding in order to influence progress. New KLOEs being considered in order to update SCAS planning and actions

Deirdre Thompson, Director of Quality and Patient Care

Monthly review

3 3 9 9

15 5.1 All staff access not met for education and training to meet mandatory, clinical and organisational requirements

14/03/17 4 4 16 Education training programme Statutory and mandatory training Training needs analysis Integrated workforce plan Appraisals and training monitored through scorecard by Exec Committee and Board

Operational pressures Northern cluster rota not yet operational undermines ability to deliver against the trajectorySustainability of provision of training CQC outcome 14 compliant but requires an outcome lead. Appraisal data not yet available for 12/13. Compliance with elearning for IG and Fire not yet achieved.

Training remains on trajectory adhering to programme Staff feel valued and have received training applicable to role – as reviewed by SHA and CQC visit Recruitment plan trajectory aligned to integrated workforce plan. Training needs analysis and review of needs for commercial sector. Staff survey results. Elearning programme to be introduced making learning more accessible. Monitoring of uptake to be done.Face to face training commenced May 13

Loss of hours due to recovery action plans. TNA to be reviewed and developed.Plans in place to deliver statutory and mandatory training Rostering system will ensure correct availability of staff Potential breach of H&S legislation not actioned in a timely manner. Review of reasons for absence with personal accident data.

May 2015 - Training plan for 2015/16 agreed by Workforce Board and due to REAP 2 plan being implemented. PTS training plan commenced with good abstraction and attendance to date. August 2015 low demand levels have led to reduced income and pressure on costs vs income. This is being mitigated by endeavouring to reduce resource in line with income wherever possible without impacting service APRIL 2016: S&M Training attendance to be monitored weekly by Executives during Q1 2016/17. October 2016 - regulation notice (regulation 18) from CQC inspection. Robust action plan developed to include: review of innovative methods of training, implementation of robust reporting tool, bi-weekly reporting against trajectory of recovery plan to EMC. Survey monkey to staff, design recovery plan post inspection. December 2016- Recovery plan commenced, monitoring in Q4.MARCH 2017: Twice monthly monitoring at Executive Performance Review. Remedial action plan in place.

Will Hancock, CEO. Melanie Saunders Acting Director of HR

Monthly review

4 3 12 12

16 5.2 Effectively managing sickness absence and staff absences

14/03/17 4 4 16 Area Managers action plans to reduce sickness absence. Monitoring at Workforce Board.

All ops managers to be trained to use Kronos absence module.

Team leaders trainined in absence management and use of policy. Joint working with Occupational Health to rehabilitate staff back to work. Slight decrease in absence showing.

Figures not showing consistent month on month reduction in all areas.

November 2015: Health, Wellbeing and Attendance project mobilised in 3 phases incorporating U&E Care, CCC. Aim of the project to reduce absence in order to add more resilience ahead of winter pressures. Will also focus on ensuring that the reduction achieved is sustainable by equipping managers with a 'tool kit' of health and welbeing tools in order to assist management of attendance in future. APRIL 2016: H&WB strategy in draft, focused work for CCCs to take place during Q1 2016/17. Absence monitor daily by line managers and weekly at Exec level. October 16: Monitoring continuing via Performance meeting, TL have KPI to reduce by 0.5%, HR support HOO with management of long term sickness cases. MARCH 2017:Figures are on an improving trajectory.

Will Hancock, CEO. Melanie Saunders Acting Director of HR

Monthly review

4 4 16 16

4.3 The risk of of not being rated 'outstanding' or 'good' following the May 2016 rated comprehensive inspection

Inspection methodology is still new and untested. No ratings given as a pilot inspection. Awaiting report

Track record of delivering projects Track record of positive judgements of compliance following previous CQC inspections Leadership drive and focus to receive outstanding rating and focus in all areas by the Exec and SLT

4 3 Weekly Review

Continued recruitment programme Increase GP use in CSD Monitor at WFDB Attrition data further analysis increase CPD opportunities Monitor at WFDB

November 2015 Health, wellbeing and attendance project implemented. In addition to plans for a "we're listening" action plan, focusing on improving day to day issues that staff indicate are an factor in retention.February 2016: Recruitment trajectories continue to achieve above forecast, activities monitored via Exec at Turnaround meetings. Integrated workforce plans for PTS and CCC now complete, PTS agreed via WFDB, CCC due at WFDB in March 2016. Attrition showing improvements, you said we did action plan in place and monitoried via staff forums and JNCC. Band 6 and APP role launched, work on rotas, mealbreaks and overruns continues to be monitored at turnaround meetings. APRIL 2016: RISK 17 (Recruit to 999) Integrated workforce plans for 2016/17 complete and scheduled for approval at April 2016 WFDB, 999 plan subject to outcome of commissioning for 2016/17. Action plan for improved retention needs further development. RISK 18 (Inability to RETAIN) : Attrition showing signs of improvement, Band 6 and AAP role providing a positive impact, high demand for Paramedic skill set within the wider health ecomony remains biggest challenge to retaining staff, along with work life balance - overruns and missed meal breaks, short notice shift change. You said we did plan to be refined during 2016/17 to include suite of workforce measures to be monitored/improved. RISK 23 CRR (Recruit to NHS111) Integrated workforce plans for 2016/17 complete and scheduled for approval at April 2016 WFDB, plan needs clarity around demand assumptions and ability to train numbers required (seating/trainer capacity). Action plan for improved retention needs further development: RISK 24 CRR (Recruit to PTS) Integrated workforce plans for 2016/17 complete approved during January 2016, Managers need to be focused on delivery of plan as approach is new to PTS management team, recruitment teams to help ensure this focus is provided and deadlines are not missed. October 16: 999 service - Recruitment continues to be challenging, twice monthly monitoring via Performance meeting, actions to support improvements underway, clinical numbers improving as a result of 2015/16 investment. (NETwice monthly monitoring via Performance meeting, actions to support improvements underway, demand profile and call length under-review may reduce wte's needed withing current IWP forecasts. (111 service) For NEPTS service - Twice monthly monitoring via performance meeting, actions to support improvements underway, including outsourcing of additional training. IWP processes now embedded and showing improvement in fill rates. H&WB strategy underway, roster reviews including mealbreak and overrun management in progress. Attrition stablised. December 2016 - Trend is positive / Rota review in progress which should improve ability to retain staff. GRS needs to be completely implemented. MARCH 2017:Fill rates continue to improve in 999/Still in progress/Further remedial action plan to be developed as challenges continue/Fill rate is improving - capacity being sought thru training providers. In April will review impact on whole trust as this is now localised to certain areas/ risk 18: still in progress but variable across directoates, will consider splitting in April. / Business growth is creating an issue that continues to work through

Increasing competition for staff from neighbouring trusts

3

0Deirdre Thompson, Director of Quality and Patient Care

5Will Hancock, CEO. Melanie Saunders Director of HR

4412

17,18, 23,24

4

12

Monthly reporting to the board. Bi- Weekly Plan to Executive meetings. 3) Detailed project and readiness / compliance plan . Comprehensive Action Plan being implemented post inspection and monitored via Executive management Group

204

Pilot inspection - first wave with unclear methodolgy for the sector

Conitued recruitment programme and CPD 20Monthly review

November 2015: CQC Action plan on track and reviewed by Execs every 2 weeks January 2016: Action plan on track. CQC rated inspection planned for the 3 - 6th May 2016. Readiness plan presented to the Executive Management Committee and being implemented through Q4. Feb 2016: Data being submitted on 3rd March. Previous action plan on track. Liaising with the CQC regarding forthcoming inspection May 2016.APRIL 2016: Plan on track and working very closely with the CQC Logistics Team and also their Analysts. Plans are now in place for the formal interviews and staff supported by the Trust Compliance team. COG and Trust Board updated on progress. JUNE 2016: CQC inspection completed along with the submission of all data requests. The Trust awaits the draft report and continues to monitor compliance and act on areas for improvement e.g. Meds management processes. Recommended for closure following a Good rating overall. Action plan in development for the areas of improvement. Action plan will be monitored via the EMC

Reduced performance Poor outcome for patients Hear and treat not improved Poor staff morale Increased use of temporary staff

5. Leadership and Culture

4

14/09/16

14/03/17

10

5.3 Ability to recruit Ability to retain staff

4. Sound Governance

RAG



Co

Li Tot


RatingMitigated

Risk Rating

25 5.4 Agency Caps/Regulations - Compliance with Agency Caps and the implications of government regulations

14/03/17 5 4 20 Being managed and monitored by NHSI weekly on the level of activity and breaches of regs - equating to possible fine and sanctions

New Project Agency task and finish group established weekly actions taken. Working with all agencies and providers to engage with the regulations and adherance to the guidance

New Project The outstanding agency is Medic now who whodul be on the correct framework by the 9th July 2106 - this is late so we will be reporting a breach. August 2016: Unlikely to breach Agency Rules October 16: All core suppliers now on framework. Deember 2016 - Based on months 6/7 data SCAS needs to conduct a forcast and improve visiblity across all services using agency staffMARCH 2017: Picture remains same as awaiting latest NHS I update /IR35 Tax changes that impacts on recruitment of agency staff

Melanie Saunders

Exec and Board review bi monthly

4 3 12 12

26 6.4 Lack of capacity/resource to progress Project South (from buddying through to potential transaction)

CLOSED DECEMBER

2016

3 2 6 Robust project management approach being applied to Project South.

SCAS is unable to satisfactorily deliver buddying support and the work required in support and potential transaction.

Resourcing plan and arrangements for back-fill/buy-in additional support (including external)

Key resource is diverted away from SCAS business

The risk is also mitigated in part by SCAS being able to 'walk away' from Project South at any point

Steve Garside, Company Secretary

Monthly review

3 2 6 6

27 6.5 Project South detracts and diverts management attention away from SCAS business and delivery

CLOSED MARCH 2017

3 3 9 Robust project management approach being applied to Project South.

SCAS Performance is adversely impacted by lack of focus and attention diverted to Project South

Resourcing plan and arrangements for back-fill/buy-in additional support (including external)

The impacts on SCAS reputation attracts regulatory/stakeholder attention, and threatens potential for any future transaction

The risk is also mitigated in part by SCAS being able to 'walk away' from Project South at any point

Steve Garside, Company Secretary

Monthly review

3 2 6 6

32 6.6 Risk of mobilising the TV NHS 111 service in line with the new commissioning standards in line with other providers

14/03/17 4 4 16 Dedicated mobilisation team, focused on delivering the service model

Reputational risk ongoing service performance issues, financial penalty

Dedicated mobilisation team, focused on delivering the service model Reputational risk ongoing service performance issues, financial penalty

Highlight and exception reporting in place to address key risks. Project teams mobilised for the NHS 111 contract. Governance structure to be agreed December 2016 - Implementation meeting has taken place with commissioners. Staff kept informed. Mobilisation planned for 1st October 2017. MARCH 2017:Coproduction workshops weekly

Philip Astle COO

Monthly review

3 3 9 9

33 6.7 Final mobilisation of the Surrey PTS contract

14/03/17 4 3 12 Dedicated mobilisation team, focused on delivering the service model


Dedicated mobilisation team, focused on delivering the ITT service model Reputational risk ongoing service performance issues, financial penalty

Highlight and exception reporting in place to address key risks. Project teams mobilised for the Surrey PTS contract. Governance structure to be agreed December 2016- Project team in place - on track MARCH 2017:Mobilisation meetings internally fortnightly, mobilisation meetings with commissioners weekly, community transport providers all visited and compliant. SCAS working closely with SECAMB on TUPE of staff/complaints/insidents. Data transfer in testing commenced. Property and workforce issues to be resolved prior to go live in April 2017


Monthly review

4 4 16 16

34 6.8 Risk of mobilising at pace the 'step in' Sussex PTS contract

14/03/17 4 4 16 Dedicated mobilisation team, focused on the transistion with full service delivery April 2017


Dedicated mobilisation team, focused on the transistion with full service delivery April 2017


Highlight and exception reporting in place to address key risks. Project teams mobilised for the Sussex PTS contract. Governance structure to be agreed December 2016- Sussex project team in place - risks identified and being mitigated/addressed. Main risks around staff/training/assurance around private providers MARCH 2017:Project board and mobilisation meetings internally and in place. All private providers for the Sussex contract visited in January. Contract and Quality schedule negotiations in progress. Patient forums in Sussex attended by SCAS. Patient leaflet for transition of service in final draft. Data transfer and accuracy being tested in readiness for go live.


Monthly review

4 4 16 16

36 6.9 Risk associated with re-tendering of 111 contracts in SHiP

14/03/17 4 4 16 SCAS strategy affected. Potential financial implications. Location of call centre for new provider resulting in TUPE/redundancy and staff losses. Risk to patient care and safety.


Strategy review by Executives - HR and COO. Service to run as normal.. Good and regular engagement with staff. Trust meetings with key stakeholders.



Monthly review

4 3 12 12

4

3 Contract performance is routinely monitored and reviewed with Commercial Management team. In addition this is reported to and discussed with commissioners, which may include actions for service or performance improvements and innovations. Performance issues identified are addressed as part of ongoing action planning with clear responsibility for rectification as apporpriate.

12

205

8

20

8



November 2015 Project teams mobilised for both SHIP 2 and TV PTS contracts. Governance structure agreed and in place. Steering group meeting regularly to oversee key workstreams Feb 2016: Implemenation on track and reviewed by the Executive Management Team in Feb. Engagement with Acute providers proactive and positiveAPRIL 2016: SHIP Phase 2 and the TV mobilisation have been implemented successfully. We continue to monitor feedback from patients and providers and also KPI's to ensure that the service is safe, effective and responsive.JUNE 2016: TV and OHFT Contracts launched successfully and now being operationalised. Excellent feedback from commissioners and service users in relation to mobilisation effort. SHIP2.2 due for launch in August 2016. Project on track with Executive scrutiny of project on bi-weekly basis SEPTEMBER 2016: Recommended for closure by RACC

None at present

SCAS performance with 111 services has continued to improve, and SCAS is now generally regarded as a strong provider. Issues still remain with key relationships at commissioning bodies, which may have an influence upon future successes at retender.

Creation of a pipe line of opportunities monitored through the Trust Board

4 2

NHS 111 continues to have a key focus within the organisation to ensure that we are delivering consistently strong performance, at optimal cost to SCAS. Service improvements are routinely being implemented, and outstanding backlogs of QA are being addressed with a formal planned approach

None at present

Both Hampshire and Ox/Bucks PTS contracts may be retendered during 2013/14. Currently it is unclear as to the exact timetable when this may occur, or the likely content of the retendered services. The outcome of these will largely depend on the content and weighting of the ITT requirements

November 2015 NHS England have published the revised commissioning standards during October 2015. Review is underway to compare current service capabilities against new service and clarify the gaps. Work is well advanced as part of the transformation programme to introduce new innovations within the current service in line with emergency thinking, SCAS working closely with NHS England and is well regarded as a leading provider of 111 services. CQC inspection will be critical to mental perception of the service following the DT undercover investigation. CG been developing a comprehensive plan to address issues identifed as a consequence of internal/external review. Performance of service remain high, meeting most current service KPIs'. Feb 2016: Market warming event attended by SCAS w/c 22nd Feb. Acclerated Clinical Transformation pilots in progress to link with Pharmacy, Mental Health Practititioners and other key practitioners in preparation for intergrated care and assessment going forward. APRIL 2016:SCAS PQQ response developed and submitted in partnership with key TV sub-contractors, (OHFT / BHT / Bucks-HT) Agreement in place to work collaboratively with partner organisations to deliver a compelling and integrated service model. Performance issues still a risk to reputation, which is now being scrutinised through the Turnaround process by Exec. Signs of performance improving as activity volume reducing. Work underway with partners to co-design innovative service model. JUNE 2016:SCAS and TV NHS111 partners working collaberatively to produce a quality submission in response to the MCP procurement process. Extensive partner involvement and Executive scrutiny of the service model and bid submission September 2016: Exit plan being developed. Ongoing discussion with the CCG TV. Risks to retention and recruitment of staff for the remainder of the contract and there is a need for these risks to be mitigated as part of the exit plan being developed currently.October 2016 post Audit Committee CLOSED and REVISED into 31

Significant engagement ongoing with key stakeholders, scenario analysis developed re potential outcomes and discussed at Trust Board Level. Mitigating actions re service and service performance are underway

Exec and Board review bi monthly

6.3 Risk associated with decommissioning of TV111 service

CLOSED 21st OCTOBER

(Audit Committee)

82

4

20 6.2 Retendering of 111 contracts for Thames Valley and risk of no retaining

4

RAG Key:Green - Risk is low and or is being adequately mitigated (<8)Amber - Risk is high and is being adequately mitigated (equal to or more than 8 but less than 15)

14/09/166.1 Final mobilisation of SHiP2 and Thames Valley PTS contracts (Potential loss of PTS & logistics contracts along with mobilisation of phase II SHiP PTS contract and ensuring contract KPI's met)

19

31 1644 16 Staff engagement and TUPE arrangements. Service running as per contract until 31st March 2017. Strategy review by executives.

Dedicated risk register to be created.

Philip Astle COO

Monthly review

Monthly review

4CLOSED NOVEMBER

2016

4 SCAS meetings with key stakeholders. Good engagement with staff. Potential financial implications. Location of call centre for new provider resulting in TUPE/redundancy and staff losses. Risk to patient care and safety in Q4.

October 2016: Decomissioning team in situ, retention scheme being explored as part of decomissioning process to aid retention and support safe, effective service through winter. HR and management teams working with staff to provide assurance on employment rights and entitlements as the contract transfers to new provider.

6. Commercial Viability

16

Board Assurance Framework 2016/17

PROFILE OF RISK RATINGS 2016/17 (March 2017 Updated BAF)

RISK REG REF

JAN FEB MAR 15/16 APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR

1.1 Inconsistency in providing clinically excellent, evidence based and safe patient care as outlined in national quality measures / indicators (long waits, non-conveyance and equipment availability)

3 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16

1.2 Failure to convey patients to HASU in a timely manner and failure to provide adequate pain relief to STEMI patients 1,2 12 9 9 9 9 9 9 9 9 9 9 9 9 9 9

1.3 Availibility of resources (fleet and staff) and turnaround times resulting in delays and inability to meet targets - red and green calls consistently (excluding PHT)

4, 5 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15

1.4 Maintaining consistent standards for all private providers - 999, 111, NEPTS and risk of compliance with CQC inspections and fundamental standards

6 6 6 6 6 6 6 6 6 6 9 9 9 9 9 9

1.5 Non compliance with timescales for complaint acknowledgement and responses 21 9 6 6 6 6 6 6 6 6 6 4 4 4 8 8

1.6 Risk to patient safety, patient confidence and Trust reputation due to issues with Portsmouth Hopsitals NHS Trust and PHL. Lack of assurance for patient safety in ED and ED queue at Portsmouth Hospitals NHS Trust, associated impact on PTS due to late planning of discharges. PHL s inability to deal with demand in this locality.

22 12 16 16 16 16 16 16 12 12 12 16 16 16 20 20

2.1 Inconsistent assurances around IT and telephony 7 16 16 16 16 16 12 12 12 12 12 12 12 12 12 12

2.2 Inability to deliver all the benefits from the newly implemented 999 NHS Pathways 8 4 4 4

2.3 Inability to deliver the ePR deployement programme and to realise the benefits 9 9 9 9 9 9 9

2.4 Temporary closure of obstetric unit at Horton General Hospital (Banbury) 28 6 6 6

2.5 Emergency and Acute Hospital re-configuration North Hampshire Hospital 29 6 6 62.6 Failure to track and monitor the impact of STP (Sustainable Transformation Plan) Changes 35 12 12 12 12

3.1 Risk of Information Governance Breach 11 9 6 6 6 6 6 6 6 6 6 6 6 6 9 93.2 Risk to patient safety, patient confidence and Trust reputation in the NHS 111 service if recommendations and actions are not implemented in a timely manner following the investigation into the Daily Telegragh publication / incident / concerns

12 6 6 6 6 6 4 4

3.3 Growth of charity may increase Trust exposure to financial and reputational risk during start up phase 26 4 4 4

4.1 Failure to achieve financial targets and realise CIP’s. 13 20 20 20 20 20 20 20 20 20 20 20 16 16 16 16

4.2 Cost of delivering performance levels in 111 significantly higher than assumptions 14 8 8 8 8 8 8 8 8

4.3 The risk of of not being rated 'outstanding' or 'good' following the May 2016 rated comprehensive inspection 10 8 8 8 8 8 8 8 8

4.4 Risk of not achieving timescales for CQC actions to move from good to outstanding and providing comprehensive evidence 30 12 12 12 12 9 9

5.1 All staff access not met for education and training to meet mandatory, clinical and organisational requirements 15 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12

5.2 Effectively managing sickness absence and staff absences 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16

5.3 Ability to recruit and retain staff 17,18,23,24 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20

5.4 Agency Caps/Regulations - Compliance with Agency Caps and the implications of government regulations 25 9 9 6 6 6 6 9 9 12 12

6.1. Final mobilisation of SHiP2 and Thames Valley PTS contracts (Potential loss of PTS & logistics contracts along with mobilisation of phase II SHiP PTS contract and ensuring contract KPI's met)

19 12 12 12 8 8 8 8 8

6.2 Retendering of 111 contracts for Thames Valley and risk of not retaining 20 9 9 9 12 12 12 12 12 20

6.3 Risk Associated with decommissioning of TV111 service 31 16

6.4. Lack of capacity/resource to progress Project South (from buddying through to potential transaction). 26 6 6 6 66.5. Project South detracts and diverts management attention away from SCAS business and delivery. 27 9 9 9 9 6 66.6. Risks of mobilising the TV NHS 111 service in line with the new commissioning stardards in partnership with other profiders 32 16 9 9 9 96.7. Final mobilisation of the Surrey PTS contract 33 12 12 12 16 166.8. Risk of mobilising at pace the 'step in' Sussex PTS contract 34 16 16 16 16 166.9 Risks associated with re-tendering of 111 contracts in SHiP 36 12 12 12 12

OBJECTIVE 5: LEADERSHIP AND CULTURE

OBJECTIVE 6: COMMERCIAL VIABILITY

OBJECTIVE 1: CLINICAL EXCELLENCE QUALITY OF CARE, PATIENT SAFETY AND EXPERIENCE

OBJECTIVE 2: EMERGENCY PERFORMANCE

OBJECTIVE 3: STAKEHOLDER PRECEPTIONS AND TRUST REPUTATION

OBJECTIVE 4: SOUND GOVERNANCE

of 4

ITEM 15 – BOARD COMMITTEE UPWARD REPORTS Upward reporting from the Quality & Safety Committee to the March 2017 Trust Board (Keith Nuttall to present) Issues identified by the Quality & Safety Committee on 2nd March 2017

Topic Issue Action Taken

Items with issues not achieved/ compliant

1. Quality of papers submitted to the Q&S Committee was rather variable in quality.

All papers require a consistent approach, with an Executive Summary setting out the purpose of the paper; the key points to be considered, and what actions were required of the committee. Authors should recognise the proper process of the Q&S committee receiving and considering papers falling within the scope of the Committee prior to discussion at the Board. This point was reinforced by the Chair-Designate

All authors to follow due process and provide clear cover papers for each item.

Areas of Concern/ Risk

2. Aggregated Learning report was recognised as still needing further development

The purpose of this report was to identify cross-cutting themes and propose action where appropriate that would result in improvements in Quality and Safety

Aggregated Learning Report to be presented in future succinctly and in a way that gave the Committee assurance that organisational learning was happening.

of 4

Items for awareness / assurance/noting

3. CQC update The committee received a presentation on the action plan progress and the changes to Key Lines of Enquiry at the CQC. The committee were assured that any overdue (red) actions were monitored and in progress.

For noting

4. Alternative Transport project. The committee reviewed information on a scheme in SCAS to provide alternative types of transport for low acuity patients who have been clinically assessed. Licensed private hire vehicles could be utilised. There would be validation processes in place in line with the current Governance framework.

For awareness

5. Quality Accounts progress 2016/17

The committee were presented with a final draft version of the Quality priorities for approval.

Approval from the committee.

6. Terms of Reference Review of the terms of reference by the Committee – the terms of reference have minor changes around accuracy of membership and language in terms of compliance standards.

Approved by the committee

7. Private providers validation and visits in Sussex PTS step in service.

All the sub-contracted ambulance and taxi firms providing transport on behalf of SCAS for the new PTS contract have been visited in Sussex to assure the committee on the provision of care available and expected.

Private provider Governance Framework is being reviewed to ensure all services were being properly assessed. Validation forms to be updated to align with new CQC Key Lines of Enquiry (KLOE’s)

Best practice

8. Green Codes project A detailed presentation on the work to date on patients reaching a Green 30 or 60 disposition was given to the committee. Current work stream that is reviewing the Green calls cohort (8 conditions) to better manage the resource available for those calls.

Further update to next Q&S committee. The committee noted the potential changes and benefits.

of 4

The project is to determine the assessment method of safe alternative pathways of care. This would use Accelerated Clinical Triage. Benefits include: most appropriate response for the patient/reduce delays/reduce ambulance responses and conveyance to acute trusts.

Upward reporting from the Charitable Funds Committee to the Board Meeting 29th March 2017 (Keith Nuttall to present)

Issues identified by the Extra Ordinary Charitable Funds Committee held on 25th January 2017

Topic Issue Action Taken

1. Items with issues not achieved/ compliant

2. Areas of Concern/ Risk

3. Items for awareness / assurance review

CFR Vehicles Since April 2016 the Charity has approved the purchase of 8 DRVs by CFR schemes using funds raised by those schemes.

Grant Application An application has been submitted to the Cabinet Office for a grant of £150k and formal confirmation of the outcome is awaited.

If successful the grant will fund early stage implementation of the Extended CFR role,

of 4

embedding use of live link in the CCC and an extensive volunteer recruitment campaign.

Charity Grants The Charity has approved £11k of grants towards enhancing 999 care by funding staff led initiatives. A further £9k is still available.

Second call for applications to be made before the end of the financial year.

2016/17 Financial Target The Charity is on track to hit its financial targets and the Committee has approved a new budget for 2017/18 with substantially more ambitious income targets than originally planned.

Risk Profile There has been a substantial improvement in the Charity’s risk profile over the course of the last financial year.

4. Best Practice / excellence

Internal Auditor Compliance The Committee has received a report showing that the charity is on track to be fully compliance with all the recommendations made by the Internal Auditor.

BOARD OF DIRECTORS MEETING · 3/29/2017 · The Company Secretary would advise NHS Improvement of...

Documents

Transcript of BOARD OF DIRECTORS MEETING · 3/29/2017 · The Company Secretary would advise NHS Improvement of...