05 Annual Report/06 - Northern Ireland Ambulance Service2)/annual_report_2005_06.pdf · Annual...

Northern Ireland Ambulance Service

Annual Report

05/06

Contents

Chairman’s Preface 01

Service Profile 02

Trust Board 03

Chief Executive’s Report 04

Ambulance Operations 06

The Year in Pictures 12

Clinical Governance 14

Human Resources 19

Finance 21

CORE VALUES

QualityWe will work to the highest possiblestandards in all our endeavours, evaluatingand monitoring to maximise effectivenessand basing decisions on the best availableresearch and benchmarking information.

RespectWe will always treat people with dignity andconsideration and expect our staff to betreated in a similar way.

IntegrityWe will be reliable and honest in the waywe deliver our service.

AccessibilityWe will provide services based on clinicalpriority, where it is needed, to those whoneed it, when they need it.

ConfidentialityWe will be open in all our dealings whileensuring that absolute confidentiality ofpatients’ clinical information is maintained.

Service ExcellenceWe will be responsive to the changingneeds of our patients through teamwork,communication and collaboration.

CollaborationWe will work closely with other providers ofhealth and social care in both statutory andvoluntary sectors and establish effective co-ordination of work with other emergencyservices.

GovernanceWe will adhere to the principles ofaccountability and probity, which underpinpublic service.

MISSION STATEMENT"To deliver effective and efficient care topeople in need and improve the health andwell-being of the community through thedelivery of high quality ambulance services."

VISION"An Ambulance Service contributing to asafer community and a better quality of life in Northern Ireland through first class "out ofhospital" emergency, non-emergency anddisaster services."

01

Annual Report 2005/06

On behalf of the Trust Board, I am pleased to present the 2005/06 Annual Report

of the Northern Ireland Ambulance Service (NIAS). The individual reports which

follow detail the year’s work, its volume and cost, the problems faced and

developments realised as well as an indication of the organisational and service

challenges that face the Service in the immediate future.

Overall, the year’s outturn was satisfactory with the

in-year increase in demand for service absorbed,

efficiency targets met and costs being retained with

budget. Additionally, significant strategic landmarks

were achieved, notably the opening of the Regional

Ambulance Training Centre and the construction of the

Regional Emergency Medical Dispatch Centre.

Regrettably, other important targets were not met.

Approval for regular, planned fleet replacement was not

secured, despite prolonged negotiation, and little

progress has been made in establishing the additional

deployment points, agreed by the Boards, as essential

to improving response times in the remoter parts of the

Province.

Looking ahead, the combined effect of meeting

continuing year-on-year efficiency and addressing

further changes in Acute Hospital configuration, whilst

simultaneously striving to make improvements in

response times and raise clinical standards will continue

to place the Service under pressure for years to come.

A commitment to both increased revenue and regular

year on year capital funding is urgently required if an

effective pre-hospital service, which not only serves the

community directly but also efficiently joins up the

changing pattern of Acute Hospital services, is to

become a reality.

Although structurally unaffected by the Review of Public

Administration, establishing understanding and building

new relationships and working protocols with the newly

created Trusts and Strategic Health Service Authority

will take time. As a Trust, NIAS is committed to

partnership working and looks forward to working

closely with the new bodies.

It is to be hoped that the restructuring of services will

not unduely affect the ongoing programme of service

development to which this Trust is committed.

Staff at all levels are to be congratulated on the manner

in which they have managed the Trust’s business

throughout the year. Thanks is also due to Board

colleagues for their commitment, wisdom and advice.

Doug Smyth (Mr)

CHAIRMAN

Chairman’s Preface

NIAS responds to the needs of a population in Northern Ireland in excess of 1.7 million people in the pre-hospital

environment. It directly employs over 958 (average wholetime equivalent) staff, across 32 ambulance

stations/substations, 2 Control Centres (Emergency and Non-Emergency), a Regional Training Centre and

Headquarters.

NIAS has an operational area of approximately 14,100 sq kilometres, serviced by a fleet of 243 ambulances

(Accident & Emergency and Patient Care Service).

The ambulance services we provide are:

- Emergency response to patients with sudden illness and injury;

- Non-Emergency Patient Care and Transportation. The journeys undertaken cover admissions, hospital outpatient

appointments, discharges and inter-hospital transfers;

- Specialised health transport services;

- Training and education of ambulance professionals;

- Planning for and co-ordination of major events, mass casualty incidents and disasters;

- Support for community based First Responder services;

- Stand-by at special events;

- Community Education;

- Out-of-hospital care research.

02


NIAS was established on 1 April 1995 under the Health and Personal Social

Services (Northern Ireland) Order 1991 and the (Establishment Order) 1995,

thereby becoming a regional service. We provide ambulance services to the

people of the Northern Ireland twenty four hours per day, seven days per week,

and three hundred and sixty five days per year.

Service Profile

03


The Trust Board is made up of 6 Non-Executive

Directors, including the Chair, and 5 Executive

Directors including the Chief Executive.

Trust Board Members

Non-Executive Directors

• Mr Douglas Smyth, OBE, Chairman

• Professor Ron Perrott, Non-Executive Director

• Mrs Margie Greer, Non-Executive Director

• Mr Frank Hughes, Non-Executive Director

• Mrs Linda Gillespie, Non-Executive Director

• Mr Seamus Mullan, Non-Executive Director

Executive Directors

• Mr Liam McIvor, Chief Executive

• Mr Brian McNeill, Director of Operations

• Doctor David McManus, Medical Director

• Mrs Sharon McCue, Director of Finance

• Ms Roisin O’Hara, Director of Human Resources

The Trust Board meets bi-monthly (usually on a

Thursday) in public venues across Northern Ireland and

an Annual General Meeting is held in September.

Arrangements for public meetings are published in the

local press to encourage public attendance and the

Agenda is widely circulated.

Non-Executive Directors are also represented on three

Committees:

- Remuneration Committee;

- Audit Committee;

- Clinical Governance Committee.

The Remuneration Committee

Makes recommendations to the Trust Board on

remuneration and terms and conditions of service of the

Chief Executive and Directors.

Non-Executive Membership:

• Mr D Smyth (Chair), Mrs L Gillespie, Mrs M Greer

The Audit Committee

Ensures effective internal financial controls.


• Professor R Perrott (Chair), Mr S Mullan,

Mrs L Gillespie

The Clinical and Social Care Governance

Committee

Oversees the Trust’s Clinical and Social Governance

arrangements and provides assurances that local

arrangements are in place to secure accountability for

the delivery, monitoring and regulation of its services

within a quality and risk management framework.


• Mrs M Greer (Chair), Mr F Hughes

Trust Board


In presenting this Annual Report of the Northern Ireland Ambulance Service

(NIAS) for the year April 2005 to March 2006, I am pleased to record that NIAS

has once again met the key financial and performance targets set:

04

Chief Executive’s Report

• Delivering the full range of ambulance services

despite increased demand for ambulance response

and transportation;

• Achieving the required financial targets and

operating within budget despite pressures of

efficiency savings and Agenda for Change;

• Providing an emergency ambulance response within

8 minutes for 50% of emergency calls to the

population of Northern Ireland in line with agreed

targets and available funds.

In addition to this, NIAS has continued to make

progress in a challenging change programme linked to

the implementation of the Strategic Review of NIAS,

while supporting service reconfiguration in the wider

heath service associated with the introduction of

Developing Better Services and managing risk. Several

key milestones have been reached this year, including

the opening of the Regional Ambulance Training Centre

in September 2005 by the Permanent Secretary of the

HPSS, Dr. Andrew McCormick, and the building of

Regional Emergency and Non-Emergency Ambulance

Control Centres.

Ambulance Control staff transferred into the newly-

established Regional Emergency Medical Dispatch

Centre (REMDC) towards the end of the year. The

commencement of centralised emergency ambulance

control from this facility is a particularly welcome

advance on which we continue to build and develop

improved ambulance response. The further

development of our control environment and operation

is a key element of our plans to deliver improved

ambulance services to Northern Ireland. Additional

proposals to improve ambulance response to arrive at

75% of life-threatening calls within 8 minutes are

described in the report. More effective use of

information, in particular activity and response data and

information/feedback on the patient experience,

operational risk and clinical outcomes will be critical to

the development of the ambulance service and

achieving these goals.

These and many other developments are more fully

described in the body of this report, which by necessity

can only provide an overview of the many events and

incidents that have shaped the year and our response

to the challenges it presented.


One major event of 2005/6 worthy of particular mention

was the announcement of the outcome of the Review of

Public Administration (RPA). We were anxious that the

unique role and individual position occupied by NIAS as

the only regional provider of direct health care were

recognised and acknowledged in the final outcome of

the consultation. The decision to retain NIAS as a

single regional ambulance service for Northern Ireland

with Trust status was a very positive outcome for the

Trust and our supporters. We look forward to working

with the five newly-established Trusts and the Strategic

Health and Social Services Authority to improve

healthcare and the patient experience throughout

Northern Ireland. This is an opportune time to thank all

those who lobbied on our behalf to ensure that

ambulance services were appropriately considered and

addressed through the RPA process.

Finally we would like to offer our thanks and

appreciation to those who have contributed, both

directly and indirectly, to the delivery and development

of ambulance services during 2005/6. As a service we

continue to rise to the challenges of increasing demand

and expectation in an often uncertain and difficult

operating environment.

Our appreciation is particularly directed at the

ambulance staff in the front-line of service delivery and

in control, who are in direct contact with our patients

and their representatives, and who have sought to

provide the highest standards of out-of-hospital care to

those patients throughout the year.

The re-establishment of the Medal Ceremony in

October 2005 formally acknowledged Long Service and

Good Conduct by ambulance staff and provided a fitting

tribute to the commitment of ambulance staff to serving

their community over many difficult years.

Staff providing direct patient care are supported in their

efforts by their colleagues in support services such as

maintenance, supplies, training, information technology,

finance and human resources who work equally hard to

ensure that front-line staff have the resources to deliver

care. The contribution and dedication of the

management team and the Trust Board should also be

acknowledged, particularly in guiding and delivering

change while maintaining existing service provision. We

also need to recognise the contribution and support of

the families of our staff, and our supporters in the wider

Northern Ireland community whose commitment while

less visible is vital.

While essentially looking back to the year just past, this

report also provides an opportunity to look forward to

further progress in the years ahead in securing a first-

class Ambulance Service for Northern Ireland. We hope

that the whole community will join us in working to this

end.

Liam McIvor (Mr)

CHIEF EXECUTIVE

05

06


Ambulance Operations


07


60.8% 42.5% 39.0% 49.8% 50.7%

95.7% 91.6% 91.4% 91.6% 93.3%

EHSSB NHSSB SHSSB WHSSB NI

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

8 mins

18/21 mins

Response within 8 mins (CAT A) and 18/21 (All 999)

% R

espo

nse

in 8

/18/

21 m

ins

Growth in Ambulance Activity During 2005/06

999 Urgent PCS Total

10%

5%

0%

-5%

-10%

6.4% 1.8% 3.2% 3.9%

Emergency Response

Demand for Emergency and Non-Emergency

Ambulance Services continues in its ever upward

climb. During the year 2005/2006, NIAS has seen a

growth in emergency calls responded-to of 6% for

Northern Ireland. The total number of calls responded

to was 92,597 compared with 87,374 the previous year.

We have also experienced growth in urgent and non-

urgent activity. It is worth noting that the rate of growth

was not uniform across Northern Ireland. The Northern

Health and Social Services Board and Southern Health

and Social Services Board in particular saw much

higher rates of growth than those recorded for Northern

Ireland as a whole.

In spite of increases in demand, NIAS maintained its

responsiveness to emergency calls within eight

minutes at the same level as the previous year (50%).

We had hoped to improve the percentage of calls

responded to within eight minutes and consider that we

would have done so had demand not increased so

significantly and had we been able to progress further

elements of the Strategic Review Implementation.

2005/06 92,997 37,687 223,190 353,8742004/05 87,374 37,021 216,328 340,723Increase 5,623 666 6,682 13,151

08


Improving our responsiveness to life threatening calls

remains the highest priority for the Ambulance Service

at this time. We have developed and introduced a

range of measures to improve our response to

emergency calls and look to extend these even further

in the years ahead. The key measures which we

propose to use are as follows:

Rapid Response

Rapid Response Vehicles (RRVs) currently contribute

about 3% of total performance at the 8 minute

response target. We will continue to develop this with

separate arrangements for mobilisation from other

accident and emergency resources and more effective

targeting of the RRVs at our disposal. We would also

hope to increase the number of RRVs in operation to

increase the effectiveness of this group of staff.

Additional Deployment Points

NIAS is committed to developing our estate and in

particular to increasing the number of points from

which we deploy ambulances to disperse our

ambulances more widely into the community and place

them closer to where we anticipate emergency calls

will originate. Priorities in this area would be those

ambulance stations which currently have multiple

resources assigned to them such as Belfast,

Downpatrick, Craigavon and Altnagelvin.

We will continue to review our internal procedures in an

effort to shave vital seconds off the time it takes to

respond. This will be achieved by seeking to reduce

activation times for Ambulances further with the use of

technology such as radio tannoys, the targeting of

Category A life threatening emergency calls and

diverting resources to these where appropriate instead

of non-life threatening calls.

Community First Response

NIAS has also developed a number of ‘First Response’

Schemes in Northern Ireland and will seek to extend

these further both in terms of the intensity with which

we use existing schemes and the development of new

schemes in key areas where it is difficult to respond

within eight minutes to life threatening emergencies.

First Response must be viewed as a compliment to the

existing ambulance service and not as a replacement

for it. NIAS will therefore continue to dispatch the

nearest local emergency ambulance while using

automatic electronic activation of First Response

pagers in an effort to direct trained personnel to the

scene of the incident to deliver potentially life saving

aid such as Cardiac Defibrillation and Cardio

Pulmonary Resuscitation (CPR).


09


Hospital ServiceReconfiguration

NIAS also had a key role to play in supporting the

service reconfiguration in the Acute Hospital Sector

during 2005/06 which will continue into 2006/07 and

beyond. In particular we played a key role in managing

the risk associated with changes in areas such as

Omagh, Lagan Valley, Mid Ulster, Belfast Hospitals,

Craigavon and Daisyhill. This has resulted in new and

additional ambulance resources in both Omagh and

Lagan Valley and bids for extra resources in other

areas.

Fleet and Estate

Unfortunately no funding was allocated by DHSSPS for

the replacement of ambulance vehicles during 2005/06.

As of 31 March 2006 a significant proportion of the

emergency ambulance fleet (34%) was out of standard

in relation to Department of Health guidelines. NIAS

continues to press for replacement vehicles and plans

to replace 20 Accident & Emergency vehicles during

2006/07 as an interim measure pending introduction of

a rolling replacement programme for our total fleet.

In the interim during 2005/06, NIAS has introduced

revised arrangements for Fleet Management and

appointed a Fleet Manager to ensure that we make

most effective use of the resources at our disposal.

We were very pleased during 2005/06 to open a new

ambulance station at the Ballymacarrett site on the

Newtownards Road as a replacement for our

Templemore Avenue Station. We were also able in the

year to progress the development of an additional

ambulance deployment point in Northland Road in

association with Northern Ireland Fire and Rescue

Service. Considerable effort was expended on our

estate to ensure compliance with the Disabilities

Discrimination Act and other statutory requirements.


10


Ambulance Control

As part of the ongoing implementation of the Strategic

Review, the major change in ambulance control this

year was the move from four Control Centres to a

Regional Emergency Medical Dispatch (REMDC)

Centre based in Belfast and a Regional Non-

Emergency Medical Dispatch Centre based at

Altnagelvin (RNEMDC). This reorganisation is now well

underway with further changes proposed for 2006/07.

As part of the planning and preparation for these major

service changes NIAS introduced an Integrated Control

and Communications System (ICCS) which provided

enhanced functionality for the use of our radio and

telephone facilities. It also introduced a single

Northern Ireland wide system available to NIAS for our

telephony and radio communications. A new Patient

Care Service Command and Control System has been

purchased which is compatible with the emergency

ambulance control system and facilitates more effective

utilisation of all resources. Training is underway and

the system will become fully operational during

2006/07.

We have begun trials of satellite navigation and

automatic vehicle location software on Rapid Response

Vehicles (RRVs) with a view to making this available to

the whole of the NIAS fleet. These developments will

assist Ambulance Control in determining where the

nearest ambulance vehicle is to an incident and

ensuring the most effective response given the clinical

severity of the incident determined by our Advanced

Medical Priority Dispatch System (AMPDS).

In addition, satellite navigation in vehicles will enable

ambulance staff to locate incidents more effectively

than at present.

During 2005/06, we were pleased to see both local and

national media coverage for the actions of NIAS Staff

based in Ambulance Control where the advice they

provided to callers by telephone saved lives and also

enabled safe and successful home births.

Emergency Planning and Preparedness

NIAS continues to develop capacity in this area and in

particular in relation to the management of major

incidents and preparation for Chemical, Biological,

Radiological and Nuclear Incidents (CBRN).

During 2005/06 we secured additional funding for 2

new posts of Assistant Emergency Planning Officer

which coincided with an extension of the role in NIAS

and the linkages with DHSSPS.

Our Emergency Planning and Operational Departments

dealt with a range of incidents and issues during the

year, including 2 potential and 2 declared major

incidents; 4 hazardous materials incidents and 13

airport alerts. The Emergency Planning Department

was actively involved in preparing for these incidents,

managing the incidents and conducting the debrief

following incidents to identify and address lessons

learnt.


11


12


The Year in Pictures

12

5

6

11

12

13

7

13


9

10

8

4

3

1. Chief Executive, Liam McIvor with Chief Fire Officer Colin Lammey and Chief Constable, Sir Hugh Orde at the launch of the new text messaging service for the deaf. Jun 05

2. Paul Meehan (Training officer) and Paul Kennedy (Station Supervisor, Coleraine) demonstrate latest training aid during opening of RATC.

3. Hugh O�Neill at the launch of the text messaging service for the deaf. Jun 05 4. Recipients and dignitaries pictured at the Trust�s Long Service Medal

presentation. Oct 05 5. Patients who received "treatment" at the launch of the Essential Services Safety

Group Jun 056. Roisin O�Hara, Director of HR and Marie Mullan, Employee Resourcing Manager

receive Opportunity Now Workplace Award on behalf of the Trust in respect of the Work Life Balance Policies. Oct 05

7. David McCrory (Whiteabbey) and Adrian McGrath (Newry) during the filming of a cross border anti drinking campaign TV ad. Oct 05

8. Human Resources Staff at Opportunity Now Workplace Awards Ceremony. Oct 05

9. Trevor Steele and Joe Finn, (Whiteabbey) and Leona Backus (North Control) meet Mandy Overton who gave birth at home thanks to advice given on the phone until the crew arrived. Jan 06

10. ICS staff, Eddie Murphy, Isobel Owens and Eugene Fox demonstrating the Paediatric Ambulance to the Lord Mayor of Belfast, Councillor Wallace Browne along with Liam McIvor, Chief Executive and Colin McMinn, DHSSPS. Nov 05

11. Chief Executive, Liam McIvor and Chairman, Douglas Smyth with Permanent Secretary for Health, Andrew McCormick at the opening of the Regional Ambulance Training Centre. Sept 05

12. Eugene Jordan, Ardoyne presents Bravery Certificate to North Belfast School boy. Nov 05

13. NIAS staff and board members pictured with Health Minister, Shaun Woodward and MP for the area, Mark Durkan, during a ministerial visit to Altnagelvin ambulance station. Jan 06

14


Clinical Governance

15


Clinical Governance

Clinical Issues

During the year a number of significant clinical issues

arose and where resolved:-

Nalbuphine (the analgesic in use by NIAS and many

other Ambulance Services) ceased to be produced for

commercial reasons necessitating the introduction of

Tramadol as an alternative. Protocols were developed

and a Patient Group Direction drawn up and issued.

Tramadol along with Metoclopromide were successfully

introduced throughout the Trust. An ongoing audit into

their use shows that they are being used frequently,

appropriately and with effect and no significant

problems have been encountered.

A significant amount of work was undertaken to

facilitate the reconfiguration of acute services in Tyrone

County Hospital. NIAS were extensively involved in

discussions with Sperrin Lakeland Trust, Western

Health and Social Services Board and DHSSPS in the

implementation of the changes. An operational and

clinical protocol was developed and implemented with

additional activity pressures and the need for additional

resources and investment identified. NIAS

acknowledges the hard work and dedication of its staff

in implementing the changes.

A Medical Devices and Equipment Alert was issued

regionally, necessitating the withdrawal of the airways

in use within the Trust. Affected airways were

successfully identified, quarantined and withdrawn with

alternative products being identified and introduced.

The Trust also successfully dealt with a number of

other medical device alerts relevant to the Ambulance

Service.

The Trust also initiated a Medical Devices alert to the

rest of the Health Service with the identification of a

significant problem affecting a new but widely

distributed oxygen mask. This product was successfully

withdrawn and replaced due to the vigilance of Trust

staff.

Glucometers were also introduced and staff trained in

their use. These allow the measurement of blood

glucose levels in patients with conditions such as

diabetes, unconsciousness, strokes and acute cardiac

conditions for example.

A ministerial statement was also made for the

introduction of paramedic administered thrombolysis to

patients with acute myocardial infarction (heart attack)

commencing with a pilot during 2006/07. This will

require significant investment in equipment and

technology as well as training.

The Trust is committed to the delivery of clinical care of the highest standard in

accordance with current best practice. To ensure this, a system of Clinical

Governance has been in place within the Trust for several years and is overseen

by the Clinical Governance Committee. During the year the Committee has

continued to regularly monitor and review many aspects of clinical practice within

NIAS.

16


Pharmacy Review

In order to expand the number of drugs used by NIAS

personnel and to minimise the risks associated with

drug management and administration, a review of

pharmacy services was undertaken at the request of

the NIAS. Following consultation with the DHSSPS this

was undertaken by a Consultant Pharmacist.

While the current arrangements for the dispensing and

use of medications were felt to be robust and

appropriate, a number of recommendations were made

the most significant of which was to move to a central

pharmacy for the supply of medications. Work has now

commenced to progress this and other

recommendations.

Infection Control

A trial was undertaken and report commissioned into

the use of a vapourised hydrogen peroxide system for

the decontamination of the interior of the vehicles. This

involved the assessment of the levels of bacterial

contamination in ambulance vehicles. The trial was

very successful and while it did not find MRSA in the

vehicles it confirmed the effectiveness of the

technology. Further assessment of the feasibility of the

introduction of the technology to the service is required.

A review of cleaning procedures was also undertaken.

The Clinical Governance Committee considered

various ways of ensuring the monitoring and

development of infection control procedures and the

formation of an infection control group has been

recommended.

Clinical Audit and Research

During the year, details from over 89,000 patient report

forms were entered into the system allowing the

analysis of clinical data from a full year’s activity for the

first time. This permitted a complete data set to be

generated using the Utstein template in compliance

with the National Out-of-Hospital Cardiac Arrest Audit.

This showed that the rate of return of spontaneous

circulation following resuscitation was equivalent to that

in the rest of the United Kingdom. This has also

enabled particular areas of clinical practice in relation

to resuscitation to be specifically examined in order to

improve performance further.

Audits were completed into the number of patients who

were not transported to hospital following emergency

calls for assistance as well as ongoing audits into the

use of extended skills. An audit was also completed

into the use of analgesia (pain relief) by ambulance

personnel and shows that the administration of pain

relief to patients is increasing.

Clinical Governance

17


A joint audit was also undertaken in association with

the Royal Victoria Hospital into the effect of medical

interventions and support at scene with doctors from

the Accident and Emergency Department attending

calls with the ambulance crews.

NIAS also participated in and facilitated a joint research

project into Public Access Defibrillation in Belfast and

Antrim, as well as a national audit of adult self-harm by

the Royal College of Psychiatrists and NCEPOD (a

national audit of severely injured adults).

Further audit programmes continue to be developed to

inform developments in clinical practice and a review

and redesign of the current Patient Report Form (PFR)

has commenced to facilitate this.

BASICS

A network of doctors who are members of the British

Association of Immediate Care experienced in the

provision of pre-hospital emergency medical care and

who provide medical assistance and support to

ambulance crews at serious incidents was formalised

and a BASICS NI scheme formally established under

the auspices of the Trust. The scheme was facilitated

and supported with Personal Protective Equipment

(PPE), training facilities, administrative support,

communication equipment and revised dispatch

arrangements.

The doctors are also trained to act as medical

commanders at major incidents and continue to provide

the emergency services with invaluable support.

Clinical Guidance

The Trust’s Medical Director was appointed to the Joint

Royal Colleges Ambulance Liaison Committee

(JRCALC) in London. This national committee is

responsible for, among other things, the development

of national clinical guidelines for pre-hospital care

throughout the United Kingdom. The JRCALC National

Clinical Guidelines are currently in use by NIAS

following their introduction during the previous year.

Clinical Governance

18


Clinical Governance

Consent

As a result of the participation of the Trust in regional

discussions regarding good practice in consent, and

following a review of a number of incidents, a policy

and procedure was developed for use when consent to

treatment or transport is withheld or withdrawn. A new

form for use in such circumstances has been

developed which incorporates instructions to staff and

advice to patients and will enhance the protection of

both patients and ambulance staff.

Paramedic Registration

Since July 2005 all paramedics are required to be

registered with the Health Professions Council in

London in order to continue to practice. Despite

significant practical difficulties being encountered by all

ambulance services in this regard all paramedics

employed by the Trust and practising as such are now

state registered.

Risk Management

The Trust’s Critical Incident and Untoward Incident

Reporting Policy and Procedures were reviewed and

revised and a new reporting procedure introduced and

disseminated to all staff. An electronic risk register has

also been established and populated and is regularly

reviewed. A review of the Trust’s risk management

structures has also been undertaken and will be

revised. The new arrangements have allowed the

production of regular risk management reports to the

Risk Management Steering Group and a number of

risks have been successfully reported, recorded and

managed.

Controls Assurance Standards

A number of audits of the Trust’s compliance with the

DHSSPS Controls Assurance Standards were

undertaken. These showed that the Trust is compliant

to the requisite level with all the standards with the

exception of one recently introduced Environmental

Standard, for which action plans are being developed.

19


Human Resources

Investing in the recruitment and development of our staff is a high priority for NIAS.

This is evidenced by the pro-active staff recruitment and training programme

delivered by the service during 2005/06. As a result of this programme, we trained

10 Paramedics, 36 Emergency Medical Technicians (EMTs) and 61 Patient Care

Service (PCS) staff.

We were very pleased on 15 September 2006, to

welcome Doctor Andrew McCormick, Permanent

Secretary, DHSSPS to Ambulance Headquarters to

formally open the Regional Ambulance Training Centre

(RATC). This marked a significant milestone in the

development of the service, reflecting our commitment

to the highest levels of quality in training and

development for our staff, particularly in the clinical

skills areas.

The clinical and non-clinical training programme was

extended further on previous years to include:

• Advanced Medical Priority Dispatch training and

accreditation for Control staff;

• Care and Responsibility training;

• Moving people (ambulance specific training).

Overall NIAS provided 5,852 training days for our staff

during the year excluding the initial training of new

recruits to NIAS.

Managing employee relations required a significant

investment in time and effort with the commencement

of a review of our Recognition Agreement with trade

unions. The input of the Labour Relations Agency was

engaged to support this process. The implementation

of Agenda for Change within NIAS was both

challenging and time consuming. A partnership

agreement was developed and signed with the

recognised trade unions and progress made on the

implementation of Agenda for Change within NIAS.

Regular staff communiqu�s have been issued jointly

through the partnership agreement to all staff and

training delivered on the knowledge and skills element

of Agenda for Change which presents a particular

challenge.

Complaints and compliments continue to receive

particular attention forming a standing item on the Trust

Board agenda. Efforts have continued during 2005/06

to improve both speed and quality of response to

complaints and compliments.

20


Human Resources

It is pleasing to note that the number of complaints

received has not increased in line with the additional

activity undertaken and continues to represent a small

proportion of the total patient contacts provided by the

service. However, we acknowledge that we continue to

have difficulty in responding to complaints within the

timeframes set. This is influenced in part by the

operational exigencies of the service, with a 24/7

operation, dispersed throughout Northern Ireland, and

more traditional 9.00 to 5.00 support and management

arrangements. This aspect of the Complaints

Management is under review and we intend to develop

procedures to address deficiencies.

During 2005/06, there were 144 complaints received

which is approximately 1 complaint for every 2300

direct patient interactions.

The management of sickness absence represents a

particular challenge in the Ambulance Service. This

reflects the nature of the work which incorporates

significant amounts of manual handling and the

environment in which it is undertaken which is often

hostile in relation to work being performed outdoors at

all times in all weather conditions. The NIAS recorded

an increase in sickness absence to 8.2% during

2005/06 which is being addressed through

management meetings to ensure policy

implementation.

We have also reviewed and revised our contract with

our provider of Occupational Health Services in an

effort to ensure that everything is being done to drive

down absence. We have tested our absence figures

with other UK ambulance services and this exercise

would suggest that NIAS performance is probably

consistent with those services.

The Trust has continued to recognise the importance of

addressing the needs of our patients in the context of

delivering our service in an increasingly diverse society.

This is reflected in the purchase and distribution of a

Community Handbook providing information on

religious and cultural matters relevant to healthcare. In

addition the Trust continues to use the multi-lingual

emergency phrasebook as well as Language Line, a

telephone interpreting service used by the REMDC.

The Trust has embarked on an external region-wide

consultation on its Draft Transportation of Wheelchair

Users Policy. This consultation was conducted in

partnership with Disability Action. Public events were

held at locations throughout Northern Ireland and NIAS

staff participated in the Disability Action Mobility

Exhibition in the Odyssey Arena in May 2006 to further

facilitate the involvement of consultees.

A programme of Equality and Good Relations Training

was incorporated into the Trust Training Plan. This

was developed and delivered by the Equality Manager

in conjunction with Trademark (an ethically based not

for profit organisation) and began with training for

managers. Plans have been developed to roll out this

training to all staff including a session for Trust Board

members.

In line with best practice in the Disability field, the Trust

has adopted a practice of ‘Guaranteed Shortlisting’ for

applicants with a disability (provided they meet the

minimum essential criteria for the post).

21


Finance

NIAS continues to remain focused on the achievement of its statutory financial

duties. This is measured by a series of financial targets set by DHSSPS. The

fundamental target is the achievement of a "breakeven" position whereby the Trust

only spends up to the level of funds which it is allocated. NIAS continued to meet

this target this year and matched income to expenditure.

NIAS also achieved its target to control cash and

commitment to capital expenditure during the year. The

performance against the capital cost absorption duty

rate was 3.9%, which falls within the Department’s

range of 3-4%. The Trust paid 96.3% (by value) and

93.2% (by volume) of invoices within the 30 day

Confederation of British Industry Prompt Payment

Code, compared to 94.6% (by value) and 90.5% (by

volume) in the previous financial year.

A number of financial risks for 2006/07 are being

closely monitored. In particular significant additional

costs are likely to be incurred in the implementation of

the Agenda for Change pay structure. Service

provision with the use of overtime places new

pressures on the budget as overtime (as part of the

Agenda for Change arrangements) is now paid at

premium rates. Similarly with overtime at new premium

rates providing cover for absenteeism, there is a

renewed focus on reducing levels of absenteeism

where appropriate. As always there remains the risk of

unbudgeted provisions crystallising in 2006/07.

The Finance Directorate is directly engaged at each

stage of NIAS’s development of new services. It plays

a key role in identifying the associated financial

implications and contributing to relevant business cases

and appraisals. Ongoing liaison takes place with the

Commissioning Group for Ambulance Services (CGAS),

Department colleagues and patient representative

groups to introduce service improvements, consider the

effect of changes in the Health Service environment

and monitor performance.

Following bids for increased funding, the Trust

managed to secure £44.6 million in the financial year

2005/06. This represents an increase of 12% from

2004/05 which enabled work to be carried out to further

progress the modernisation of the Ambulance Service.

22


Finance

Information Technology

This was a particularly busy year for the Information

Technology (IT) team as part of the Finance

Directorate. The year was marked by a series of

important projects designed to deliver improved

communications between Control Centres and

ambulance crews/stations.

The introduction of new technologies has provided

substantial additional information to enable ambulance

staff to be better informed about their patients and the

situations which they are dealing with. Increasingly,

this information is being developed to allow resources,

in terms of crews, vehicles and equipment to be at the

right place, at the right time.

The IT team concentrated on the reconfiguration of the

Control Centre environment for NIAS. Whilst this

entailed the physical movement of staff and equipment,

it also required dedicated IT staff to ensure that the

appropriate communications framework was available

when required, tailored to meet the needs of the

Control Room staff and the Service as a whole. A 24/7

support service was provided by the IT team to build a

new technology structure in the new Control Centre

rooms in Knockbracken Healthcare Park and

Altnagelvin and introduce new IT frameworks such as

an Integrated Control and Communications System

(ICCS). These systems provide a platform for NIAS to

deal with emergency and non-emergency work in a

modern, effective and efficient manner, consistent with

other best performing ambulance services across the

globe.

Review of PublicAdministration

The announcement of the Review of Public

Administration (RPA) in November 2005 set out the

proposals for the reform of the HPSS. Implementation

of the RPA proposals will see the establishment of a

new Health and Social Services Authority and seven

Local Commissioning Groups (LCG’s). An

independent Patient and Client Council will also be

established to safeguard the interests of service users.

All these changes will be implemented in April 2008.

Delivery of health and personal social services will be

in the hands of five new Trusts which will replace

eighteen of the existing Trusts. The new Trusts will

come into operation in April 2007. NIAS will continue

to provide a regional ambulance service.

The RPA will also see a significant reduction in non-

departmental bodies, with only the Blood Transfusion

Service, the Social Care Council and the Guardian and

Litem Agency unaffected. Several organisations will

also be absorbed into the new HSS Authority, and the

Fire Authority will, in due course, become the

responsibility of local government.

The Department of Health and Social Services and

Public Safety has made a central provision for the

identifiable one-off investment needed to underpin the

establishment of the new HPSS structures created

following the Review of Public Administration. The

expenditure in question relates to early leaving

payments which are not yet quantifiable at individual

HPSS level.


23

Financial Summary

The Trust performed within its key financial targets in the Year 2005/06. A comparison of these targets and actualachievements are set out below.

SUMMARY FINANCIAL STATEMENTS 2006 2005

INCOME & EXPENDITURE £,000 £,000Income 44,641 39,941Interest Receivable less Interest Payable 19 (137)Surplus/(deficit) for the year 367 965Public Dividend Capital Dividend Payable (388) (955)Provision for Liabilities/Charges (187) 127Operational Surplus/(deficit) for the year (21) 10

BALANCE SHEET £,000 £,000Fixed Assets 17,828 19,000Current Assets 6,225 4,727Creditors due within one year (7,173) (6,324)Net current Assets/(Liabilities) (948) (1,597)Total Assets less Current Liabilities 16,880 17,403Creditors due after one year (2,261) (2,428)Provisions for Liabilities/Charges (1,859) (1,504)Capital and Reserves 12,760 13,471

CASH FLOW £,000 £,000Cash Inflow 3,973 2,834Net Cash (Outflow) Inflow from returns on Investments & Servicing of Finance 12 (138)Capital Outflow (2,062) (2,066)Dividends Paid (955) (462)Financing (Outflow) (968) (167)Increase (Decrease) in Cash 0 1

TOTAL RECOGNISED GAINS AND LOSSES £,000 £,000Surplus for the year 367 965Provision for future obligations (187) 127Indexation of fixed assets 196 786Unrealised surplus on revaluation of fixed assets 158 234Total Gains/(losses) for year 534 2,112

THE TRUST PERFORMANCE AGAINST STATUTORY FINANCIAL TARGETS FOR THE YEAR IS:

TARGET ACHIEVEDBreakeven annually on income and expenditure Expenditure exceeded Income by £21,000 (this is

within the materiality limits set by the Department)Cost of Capital Absorption of 3.5% Rate achieved was 3.9% Remain within External Financing Limit Undershoot of £167,000


24

Financial Summary

Related Party TransactionsNone of the directors of the Trust hold company directorships with companies that are likely to do business with theHPSS.

During the year, none of the board members, members of the key management staff or other related parties hasundertaken any material transactions with the Northern Ireland Ambulance Service HSS Trust.

The Department of Health, Social Services and Public Safety is regarded as a related party and the ultimatecontrolling parent Department. During the year the Northern Ireland Ambulance Service HSS Trust has had asignificant number of material transactions.

TRUST MANAGEMENT COSTS 2006 2005

£,000 £,000Trust Management Costs 2,587 2,262Total Income 44,258 39,604

% of Total Income 5.85% 5.71%

The above information is based on the Audit Commission�s definition "M2" Trust management costs, as detailed in HSS (THR) 2/99.

PUBLIC SECTOR PAYMENT POLICY - MEASURES OF COMPLIANCEThe Department requires that Trusts pay their non HPSS trade creditors in accordance with the CBI PromptPayment Code and Government Accounting Rules. The Trust’s payment policy is consistent with the CBI PromptPayment Code and Government Accounting Rules and its measure of compliance its measure of compliance is asfollows:

2006 2005Number £ Number £

Total bills paid 12,776 11,579,021 11,223 9,076,219Total bills paid within 30 day target 11,902 11,154,437 10,159 8,583,344

% of bills paid within 30 day target 93.2% 96.3% 90.5% 94.6%

This Summary Financial Statement does not contain sufficient information for a full understanding of the activitiesand performance of the Trust. For further information the full Annual Accounts and Audtitor’s Report for the yearended 31 March 2006 should be consulted.

Copies of the full accounts are available from myself at the following address: Northern Ireland Ambulance Service,Knockbracken Healthcare Park, Saintfield Road, Belfast BT8 8SG.

Mrs S McCueDirector of Finance

25


Remuneration Report

Membership of the Remuneration CommitteeNon-Executive Director MembershipMr Douglas Smyth, ChairmanMrs Margie GreerMrs Linda Gillespie

Policy for the Remuneration of Directors and Senior Managers for current and future financial yearsThe Policy on the Remuneration of Directors andSenior Managers is governed and administered on thebasis of the DHSSPS Departmental Directives andCirculars on HPSS Senior Executive Salaries.

Methods used to Assess Performance Conditions NIAS applies the Senior Executive PerformanceManagement Scheme as set out within DepartmentalCircular HSS(SM) 1/2003 ‘Senior ExecutivesPerformance Management Scheme’. Under the termsof this circular, the following requirements are appliedwithin the Trust.

• BoardThe Board determines the strategic and operational corporate objectives of the Trust for the year ahead taking into account the parameters established by the Department and incorporates them within its Service or Trust Delivery Plan. The Board monitors performance against objectives and approves recommendations of the Remuneration Committee.

• Remuneration CommitteeThe Remuneration Committee oversees the performance management process and makes recommendations to the Board.

• ChairThe Chairman agrees the Chief Executive’s performance objectives and review of performance and completes final report.

• Chief ExecutiveThe Chief Executive agrees individual performance objectives of Executive Directors and review of performance and completes final report.

• Senior ExecutivesAgree performance objectives with the Chief Executive, participate in reviews and take responsibility for personal development.

Performance ObjectivesPerformance objectives are linked to the Trust DeliveryPlan and Strategic Plans. Performance objectives areclearly defined and measurable.

Evidence of PerformanceDirector’s performance is reviewed by the ChiefExecutive on an annual basis. The approach adoptedis based on the Executive Director’s contributiontowards the achievement of key targets included in theTrust’s Strategic and Trust Delivery Plan. A similarapproach is used by the Chairman for the ChiefExecutive.

Performance pay would be considered within the totalpay limit determined by the DHSSPS.

Proportion of Remuneration Subject to Performance ConditionsAll Directors within NIAS are on the ‘new contract�provisions issued by the Department and effective from1 April 2002. During 2005/06, the Medical Directormoved to a Consultant Contract and operates underseparate Terms and Conditions.Directors total remuneration package is performancerelated.

Duration of ContractPermanent Contracts of Employment with continuationsubject to satisfactory performance.

Notice PeriodsThree months.

Termination PaymentsStatutory provisions only as detailed in contract.

Mr Liam McIvorCHIEF EXECUTIVE

26


Information Regarding Board Members Remuneration

The salary, pension entitlements and value of any taxable benefits in kind of the most Senior members of the Trustwere as follows:

Real TotalIncrease accrued

in pension pension atSalary, Benefits and age 60

including in Kind related and RealPerformance (rounded lump sum related CETV at CETV at increase

Pay to nearest at age 60 lump sum 31/03/05 31/03/06 in CETVName £,000 £100) £,000 £,000 £,000 £,000 £,000

Non-Executive MembersD Smyth 16-20 0 - - - - -L Gillespie 5-10 0 - - - - -M Greer 5-10 0 - - - - -F Hughes 5-10 0 - - - - -S Mullan 5-10 0 - - - - -R Perrott 5-10 0 - - - - -

Executive MembersL McIvor 60-65 0 5 53 151 170 8S McCue * * * * * * *R O’Hara * * * * * * *D McManus * * * * * * *B McNeill * * * * * * *B Snoddy * * * * * * *

* Consent to disclose personal data in the Trust Annual Accounts and Annual Report has been withheld under theprovisions of the Data Protection Act 1998.

During the financial year, there was one change to themembership of the Board. Mr B McNeill was appointedDirector of Operations from 01 June and replaced Mr BSnoddy (Assistant Director of Operations) who wasacting in that post until 31 July. The remunerationinformation disclosed above reflects the Directors’salaries on a pro-rata basis.

As Non-Executive members do not receive pensionableremuneration, there will be no entries in respect ofpensions for Non-Executive members.

27


A Cash Equivalent Transfer Value (CETV) is theactuarially assessed capital value of the pensionscheme benefits accrued by a member at a particularpoint in time. The benefits valued are the member’saccrued benefits and any contingent spouse’s pensionpayable from the scheme. A CETV is a payment madeby a pension scheme, or arrangement to securepension benefits in another scheme or arrangementwhen the member leaves a scheme and chooses totransfer the benefits accrued in their former scheme.The pension figures shown relate to the benefits thatthe individual has accrued as a consequence of theirtotal membership of the pension scheme, not just theirservice in a senior capacity to which the disclosureapplies. The CETV figures, and from 2004-05 the otherpension details, include the value of any pensionbenefits in anothe scheme or arrangement which theindividual has transferred to the HPSS pensionscheme. They also include any additional pensionbenefit accrued to the member as a result of theirpurchasing additional years of pension service in thescheme at their own cost. CETVs are calculated withinthe guidelines prescribed by the Institute and Faculty ofActuaries.

Real Increase in CETV - This reflects the increase inCETV effectively funded by the employer. It takesaccount of the increase in accrued pension due toinflation, contributions paid by the employee (Includingthe value of any benefits transferred from anotherpension scheme or arrangement) and uses commonmarket valuation factors for the start and end of theperiod.

The above figures include an estimate of theremuneration due to certain Executives in respect ofthe annual pay uplift for cost of living and performancefor the financial year 2005/06. Negotiations arecurrently ongoing between DHSSPS and theDepartment of Finance and Personnel (DFP) inagreeing the final pay award. Based on advice fromDHSSPS the pension figures include an estimate of3.225% and the salary figures include a revisedestimate of 5.225%. An estimate of the total expectedliability has also been accrued in the annual accountsconsistent with DHSSPS guidance. The above figuresdo not include an estimate of the remuneration due tocertain executives in respect of an Industrial Tribunaldecision relating to entitlement to annual cost of livingincreases. This has not been included as theimplications for each individual has not yet been fullydetermined.

28


Audit Certificate

NORTHERN IRELAND AMBULANCE SERVICE HEALTH AND SOCIAL SERVICES TRUST

THE STATEMENT OF THE COMPTROLLER AND AUDITOR GENERAL TO THE HOUSE OF COMMONS AND THE NORTHERN IRELAND ASSEMBLY

I have examined the summary financial statement of the Northern Ireland Ambulance Service Health and SocialServices Trust.

Respective responsibilities of the Trust, Accountable Officer and Auditor

The summary financial statement is the responsibility of the Trust and Accountable Officer.

My responsibility is to report to you my opinion on the consistency of the summary financial statement within theAnnual Report with the full financial statements, and its compliance with the relevant requirements of the Healthand Personal Social Services (Northern Ireland) Order 1972, as amended, and Department of Health, SocialServices and Public Safety directions made thereunder.

I also read the other information contained in the Annual Report, and consider whether it is consistent with thesummary financial statements. This other information comprises only the Chairman�s Statement, the unaudited partof the Remuneration Report and the Management Commentary. I consider the implications for my report if Ibecome aware of any apparent misstatements or material inconsistencies with the summary financial statement. Myresponsibilities do not extend to any other information.

Basis of Opinion

I have conducted my work in accordance with Bulletin 1999/6 �The auditors� statement on the summary financialstatement� issued by the Auditing Practices Board for use in the United Kingdom.

Opinion

In my opinion the summary financial statement is consistent with the full financial statements of the Northern IrelandAmbulance Service Health and Social Services Trust for the year ended 31 March 2006 and complies with theapplicable requirements of the Health and Personal Social Services (Northern Ireland) Order 1972, as amended,and Department of Health, Social Services and Public Safety directions made thereunder.

JM Dowdall CB Northern Ireland Audit OfficeComptroller and Auditor General 106 University Street18 August 2006 BELFAST BT7 1EU


You ask us......to get there quickly

You ask us......to help you breath

You ask us......to stop the bleeding

You ask us.......to ease the pain

You ask us.......to save your life

We ask you...Let us do our job!

Help stop the attacks on Ambulance Staff.

The NIAS Trust welcomes your comments andsuggestions on the provision of ambulance services.

Contact Us:Northern Ireland Ambulance ServiceAmbulance HeadquartersSite 30, Knockbracken Healthcare ParkSaintfield RoadBelfastBT8 8SG

Telephone No: (028) 9040 0999Fax No: (028) 9040 0900Text No: (028) 9040 0871Web: www.niamb.co.uk

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