BOARD OF DIRECTORS MEETING...Mar 23, 2016 · Date: Wednesday 23 March 2016 . Time: 10.00am –...

BOARD OF DIRECTORS MEETING MEETING IN PUBLIC

DATE: Wednesday 23 March 2016

TIME: 10.00am – 12.45pm VENUE: Dolman 1, Shaw House, Church Road, Newbury, West Berkshire, RG14 2DR ***

VOTING BOARD MEMBERS:

Trevor Jones Chairman

Alastair Mitchell-Baker Non Executive Director/Deputy Chairman/SID 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 Will Hancock Chief Executive Philip Astle Chief Operating Officer John Black Medical Director Charles Porter Director of Finance Deirdre Thompson Director of Patient Care James Underhay Director of Strategy & Business Development IN ATTENDANCE: Melanie Saunders Interim Director of Human Resources Steve Garside Company Secretary APOLOGIES: None

AGENDA Board of Directors Meeting – Meeting in Public Date: Wednesday 23 March 2016 Time: 10.00am – 12.45pm Venue: Dolman 1, Shaw House, Church Road, West Berkshire, RG14 2DR ______________________________________________________________

Item Outcome

OPENING BUSINESS 1 Chairman’s Welcome and Apologies for Absence

Trevor Jones – Chairman

Note Verbal

2 Declaration of Directors’ Interests Trevor Jones – Chairman

Note Verbal

3 Minutes from the 27 January 2016 Meeting Trevor Jones – Chairman

Approve

Paper

4 Matters arising from the 27 January 2016 Meeting Steve Garside – Company Secretary

Note Paper

CHAIRMAN AND CHIEF EXECUTIVE REPORTS 5 Chairman’s Report

Trevor Jones – Chairman

Note Paper

6 Chief Executive’s Report Will Hancock - Chief Executive

Note Paper

DIRECTORS REPORTS 7 Medical Director’s Report

John Black – Medical Director

Note Paper

8

Quality and Patient Safety Report including CQC Update Deirdre Thompson – Director of Patient Care; John Black – Medical Director

Note

Paper

9a Operational Performance Report – 999 and 111 Will Hancock – Chief Executive Officer; Philip Astle – Chief Operating Officer

Note Paper

9b Operational Performance Report – PTS James Underhay – Director of Strategy and Business Development

Note Paper

Item Outcome

9c Finance and Estates Report including Update on 2016/17 Budget Charles Porter – Director of Finance

Note Paper

10 Operational Plan 2016/17 James Underhay – Director of Strategy

Approve Paper

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

Note Paper

12 Workforce Report Melanie Saunders – Interim Director of Human Resources

Note Paper

13 Staff Attitude Survey 2015 Melanie Saunders – Interim Director of Human Resources

Note Paper

REGULATORY, COMPLIANCE AND CORPORATE GOVERNANCE

14 Board Assurance Framework Deirdre Thompson – Director of Patient Care

Note Paper

BOARD SUB-COMMITTEE CHAIR REPORTS

15 Report from the Audit and Charitable Funds Committees Mike Hawker – Audit Committee Chair; Keith Nuttall – Charitable Funds Committee Chair

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 2016, Shaw House, Newbury, Berkshire

Note Verbal

19 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 2016 Page 1 of 7 Author: SG

ITEM 3 - UNAPPROVED MINUTES FROM THE 27 JANUARY 2016 MEETING 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 2016 at Shaw House, Newbury, Berkshire Present Trevor Jones (Chairman); Alastair Mitchell-Baker (NED); Ilona Blue (NED); Mike Hawker (NED); Keith Nuttall (NED); Professor David Williams (NED); Will Hancock (Chief Executive); John Black (Medical Director); Charles Porter (Director of Finance); Deirdre Thompson (Director of Patient Care); James Underhay (Director of Strategy, Business Development, Communications and Engagement) In attendance Steve Garside (Company Secretary); Melanie Saunders (Interim Director of Human Resources); Steve West (Director of Performance, Planning and Scheduling) Apologies None _________________________________________________________________________ OPENING BUSINESS

15/086 - Chairman’s Welcome and Apologies for Absence The Chairman welcomed all to the meeting, including five of the Trust’s governors and Nigel Chapman (NED Designate). There were no apologies for the meeting. 15/087 - Declaration of Directors’ Interests Alastair Mitchell-Baker declared two additional interests associated with external projects he was working on; one relating to a healthcare review in Milton Keynes and Bedfordshire, and another in connection with intermediate care in the Windsor and Maidenhead area involving the local authority and clinical commissioning groups. No other new interests or issues impacting on the fit and proper person requirements for Directors were declared. 15/088 - Minutes of the Board meeting held in public on 25 November 2015 The minutes of the previous meeting were approved without amendment. 15/089 - Matters arising from the Board meeting held in public on 25 November 2015 An update on a number of matters arising from the last meeting was considered: • 15/076 (Healthcare Professionals project) – the Chief Executive explained that the HCP

service was currently being reviewed as part of the turnaround programme, including an assessment of performance against key metrics. Steve West noted that there had been some challenges around IT. It was agreed that the action point should be reiterated, with an update being presented at the March Board meeting

Action 15/089 (reiteration of 15/076 from November 2015) The Chief Executive to provide an update on the Healthcare Professionals service at the March Board meeting, including a realistic view on what could be achieved in terms of its contribution to the cost improvement programme.

• 15/078 (workforce attrition) – Melanie Saunders explained that SCAS’ front-line attrition

rates were generally higher than comparable organisations, but on a downward


trajectory. She added that the reasons for attrition were broadly similar across Ambulance Trusts, and that detailed consideration was being given to the assumptions that should be made around attrition in the 2016/17 workforce plan.

• 15/073 (medication related clinical incidents) – Keith Nuttall highlighted that, although the

specific action had been completed, the Trust needed to keep this issue on its radar. CHAIRMAN AND CHIEF EXECUTIVE REPORTS

15/090 - Chairman’s Report The Chairman reflected on the challenging period the Trust was going through, but reiterated that its first duty continued to be patients and the provision of safe and high quality services. The Chairman updated the Board on the current position in respect of Non Executive Director recruitment, advising that offers had been made to three candidates, with one accepted (Nigel Chapman) and two being finalised. He added that a Chief Executive to manage the SCAS NHS Charity had also been appointed, and that the Board was currently reviewing the aims of the charity, and its governance and operating model. The Chairman advised that the latest round of NED appraisals was due to commence shortly, and would incorporate feedback from governors. Finally, he provided an overview of his recent stakeholder engagement, which had included meetings with Chief Executives and Chairs from a number of providers and commissioners. 15/091 – Chief Executive’s Report The Chief Executive updated on a range of key issues: • service delivery – the Board noted that resilience had improved since the end of quarter

2, with performance in December 2015 better than that for the corresponding month in 2014. Demand had remained relatively flat, but with greater acuity and ongoing problems in terms of hospital handover delays. The Chief Executive advised that the increased level of front-line resources would be preserved until the end of the year.

• fire and police – in the wake of the government publishing its response to the

consultation over increased emergency services collaboration, the Chief Executive highlighted how SCAS was working closely with both local fire and police services. He noted the development of the fire co-responder schemes, and how these in conjunction with the community first responder schemes provided SCAS with additional, vital resources

• Care Quality Commission NHS111 inspection (post Daily Telegraph investigation) – the

Chief Executive advised that this represented a very good outcome, with just a single recommendation made, and a good basis for the next full inspection of 999, 111, PTS and emergency planning in May.

• NHS111 – the recent media coverage of diagnosing and treating young children with

SEPSIS was discussed. John Black explained that SEPSIS was particularly difficult to diagnose, and especially over the telephone, but that systems and processes were being developed to help with this. He noted that more subtle early warning systems, like the one described in his paper, would also make a positive contribution. The Board discussed the 111 service in general, including the design of the NHS Pathways system, and the need to make sure that the general public understand how the service works.

The Chief Executive highlighted the latest report on equality and diversity, and the work plan that was currently being developed for the next four years. Mike Hawker commented that BME representation amongst the workforce was clearly an issue. The Chief Executive responded that representation was good in certain areas, but


challenging in terms of the front-line. He added that working with the Universities to help influence the UCAS intake was a key priority. Melanie Saunders commented that, in terms of recruitment, there appeared to a marked drop-off of BME applicants at the shortlisting stage, and that this was being looked into. The Board confirmed that they looked forward to seeing the new equality and diversity action plan, and the Chairman asked the executive to consider whether there could be a role for the governors in supporting this important area of work. Action 15/091 The Trust’s new equality and diversity action plan to be presented at an appropriate future Board meeting.

Finally, Ilona Blue stated that the visit by the Medical Director (Acute Episodes of Care) of NHS England in February represented an excellent opportunity for SCAS to showcase its work and outline the vision that had been articulated in both the corporate and clinical strategies. DIRECTORS REPORTS

15/092 - Medical Director’s Report John Black provided an overview of the key elements of his report, including the paramedic 2 trial, night time air ambulance operations, and a national early warning scoring system. Keith Nuttall noted the plans to extend night time air ambulance operations in the next few weeks, and asked how safety was being assured. John Black responded that this would involve upgraded aircraft with the technological capability to operate at night. He added that extensive safety requirements, including those of the Civil Aviation Authority, had been signed off, and that the learning from similar models in the East of England and Kent/Sussex had been taken and applied. James Underhay asked about safety for ground crews, and John Black explained how this would work, including the role of the senior decision-maker. Alastair Mitchell-Baker stressed the importance of carrying out a comprehensive evaluation of night time flying, in terms of the clinical, operational and financial costs and benefits. The Board signalled their support for the proposed initiatives around national early warning and paediatric observation priority scoring systems. 15/093 – Quality and Patient Safety Report including CQC Update Deirdre Thompson highlighted the launch of the Demand Management Practitioner, and explained how this worked. She confirmed that the scope of this initiative included falls. The Board noted that the next Care Quality Commission inspection in May would, after some deliberation, include NHS111 and lead to an official rating. Deirdre Thompson reported that planning for the inspection was progressing well. Deirdre Thompson updated the Board on the position in respect of complaints, advising that this area had been added to the Board Assurance Framework. She confirmed, however, that the backlog of complaints had reduced considerably, and that a new Head of Patient Experience had been appointed and was due to start next week. Keith Nuttall, in preparation for the next CQC inspection, asked whether there were still issues in terms of inconsistencies in practice between the North and South. Deirdre Thompson responded that effective leadership was crucial in this respect, and that it was a key area of focus for the Director of Operations (Clinical Coordination Centres).


Professor Williams expressed concern at the ongoing hospital handover delay problems. Deirdre Thompson replied that, as an illustration, thirty-five hours of crew time was lost at Queen Alexandra Hospital in Portsmouth yesterday alone. She explained that this issue had been discussed at a recent NHS England led risk summit on the Portsmouth health economy. The Board discussed hospital handover delays in some detail, including noting the impact of patients waiting for out of hours services, and the approach being taken by commissioners. Finally, Ilona Blue stated that she had some views on how the data on incidents could be presented, and agreed to discuss these with Deirdre Thompson after the meeting. 15/094 – Patient Story Deirdre Thompson introduced Sue Putman, the Trust’s Mental Health Lead, and Sheila Laws. Sheila Laws discussed with the Board her experiences of suffering from mental health related issues, and accessing the various services available to her. She also outlined how she had tried to use this positively in terms of contributing to the work of the regional Suicide Prevention and Intervention Network (SPIN). Sheila Laws explained that on a number of occasions she had needlessly been conveyed to A&E due to other, more appropriate services and support networks not being available. Sue Putman discussed some of the challenges from the Trust’s perspective, noting that the service could be improved significantly if up-to-date care plans were in place and SCAS had access to a mental health services professional on a 24/7 basis. Professor Williams asked how the Board could provide further support. Sheila Laws responded that having the full-time mental health services professional in place would be a very positive step, and that the Board could provide further help by supporting paramedics to be more mental health aware (e.g. endorsing the roll-out of a new training video). Keith Nuttall acknowledged the importance of highlighting the various challenges and concerns to commissioners, and Ilona Blue noted the link with the Trust’s vision of having a ‘helicopter view’ of patients and their various conditions. Alastair Mitchell-Baker stated that there was a need for a fundamental redesign of services and more effective integration across the health and social care system. The Board noted how the Trust’s accelerated clinical transformation work could be used to explore further initiatives associated with supporting people with mental health related issues. The Chairman thanked both Sheila Laws and Sue Putman for contributing to an excellent and powerful patient story, and confirmed that SCAS would follow-up on the points raised. 15/095 – Operational Performance Report – 999 and 111 The Chief Executive highlighted a number of positive developments in relation to performance, and also gave an update on fleet issues. Mike Hawker asked whether there were income issues for the Trust associated with relatively stable demand but increased acuity. The Chief Executive responded that there were, and that these were being discussed with commissioners. He added that there were a range of other issues to factor in, including the Trust’s increased hear and treat rates. Professor Williams stated that he was encouraged by the recent upturn in performance. In response to an overview of the key factors behind increased levels of hear and treat, he noted that it would be important to understand the impact of this on the overall health and social care system, and the costs that were being reduced as a consequence of SCAS’ hear and treat work.


Alastair Mitchell-Baker asked about the restructuring of the scheduling department. Steve West responded that good progress was being made post-consultation, and gave an update on a number of new initiatives that were being introduced to strengthen planning and scheduling arrangements. On this point, the Chairman highlighted the importance of the imminent external review into operational efficiency and effectiveness. 15/096 – Operational Performance Report – Patient Transport Services (PTS) Mike Hawker noted that the Trust was not delivering on a number of measures in relation to PTS contracts. James Underhay explained that there was a range of contributing factors, including workforce availability, levels of activity, and problems with the road network in certain geographies. Alastair Mitchell-Baker asked whether the executive were confident about the various forthcoming PTS contract mobilisations. James Underhay responded that the Executive Team had recently carried out a deep-dive review of the ongoing planning and preparation, and were assured that the Trust was well-placed at this stage. 15/097 – Finance and Estates Report Charles Porter reported that December had been a very challenging month, resulting in a £300k overspend against budget, largely due to resourcing for greater levels of 999 activity than those that materialised. He added that SCAS remained on track in terms of its revised year-end forecast (£3.7m operating deficit), but that potential performance penalties were currently being discussed with commissioners. Charles Porter highlighted a range of other issues: • delivering the cost improvement programme (CIP) target for 2015/16 of £6.8m was

proving to be challenging and at significant risk • the cash balance (£24m) remained strong despite the income and expenditure deficit

position

• Monitor/NHS Improvement had asked providers to look at a number of areas in relation to their financial positions, including release of provisions and potential capital to revenue transfers

The Board discussed the cost improvement programme, noting that a number of the schemes not necessarily being achieved in 2015/16 could be successful in future years (e.g. cycle times, sickness management etc). Ilona Blue highlighted the ‘fleet efficiencies’ CIP, which was now reporting a forecast of zero against a plan of £200k at the start of the year. Charles Porter was asked to clarify what had happened, and what the impact might be for future operational planning. Action 15/097 Charles Porter to clarify the position in terms of the ‘fleet efficiencies’ CIP, and the potential future implications.

The Board debated the best way of presenting the information on CIPs, with some differing views. However, it was agreed that the planning for the 2016/17 cost improvement programme was vitally important and needed to benefit from the imminent review of operational efficiency and effectiveness. Charles Porter updated on the position in terms of the various accommodation business cases, including reporting that Hutwood Close was no longer a viable option for SCAS. He added that the overall position was being reviewed, and Keith Nuttall asked the executive not to lose sight of the benefit of having a centralised PTS facility.


Finally, Charles Porter set out the timetable for producing and approving the 2016/17 budget. He advised that Monitor were issuing ‘control totals’ to Foundation Trusts, and that the total for SCAS was a £1.9m deficit. It was acknowledged that this would need separate consideration by the Board. 15/098 – Integrated Performance Report Charles Porter explained that all of the red rated areas of performance, with the exception of workforce (see 15/100 below), had already been considered. The Board discussed the indicator for 111 to 999 referrals. It was agreed that, although SCAS’ position remained favourable against the national target of 10%, performance was worsening (due to a variety of factors) and needed to be kept on the radar. Two actions were agreed. Action 15/098a Charles Porter to confirm the December position in terms of vehicle off-road scheduled and unscheduled maintenance (no data provided).

Action 15/098b Board members to contact Charles Porter with their views on the format of the Integrated Performance Report in 2016/17 (e.g. content, presentation etc).

15/099 – Annual Planning 2016/17 The Board noted the paper, including the timetable for the development, approval and submission of the 2016/17 Operational Plan. 15/100 – Workforce Report Melanie Saunders informed the Board that two highly successful SCAS recruitment days had recently been held, with over 900 people in attendance. The Board noted that the results of the 2015 staff survey would be released imminently, and presented at the March meeting for consideration. Ilona Blue asked about PTS recruitment, and the ambitious plans for quarter 4. Both James Underhay and Melanie Saunders made positive representations that the projections would be achieved. Professor Williams raised the issue of attrition, and Melanie Saunders explained some of the factors behind the Trust’s attrition rates and the assumptions that were made when planning future staffing levels. REGULATORY, COMPLIANCE AND CORPORATE GOVERNANCE

15/101 – Monitor 2015/16 Quarter 3 Return The Board considered the nature of the proposed quarter 3 return to Monitor and agreed with the recommendations made in respect of the various declarations. These included flagging up potential risks associated with the delivery of the three national response time standards in quarter 4. 15/102 – Board Assurance Framework (BAF) The Board noted the latest BAF, and Alastair Mitchell-Baker asked the executive to consider the risks relating to IT resilience given the findings of the review into the iCAD upgrade. BOARD SUB-COMMITTEE CHAIR REPORTS

15/103 - Report from the Quality and Safety Committee The Board noted the latest upward report from the Quality and Safety Committee.


Mike Hawker reported that, in terms of the Audit Committee meeting on 14 January, the committee had noted the issuing of two internal audit reports with a “moderate assurance” opinion, and also agreed to carry out a deep-dive review of a specific risk on the Board Assurance Framework at each future meeting. CLOSING BUSINESS

15/104 - Any Other Business Steve Garside asked the Board to approve a minor amendment to the Trust’s Constitution in relation to the quoracy arrangements for Council of Governors meetings. He reported that the governors, at their meeting on 25 January 2016, had agreed to amend the requirement for a meeting to be quorate from “at least one third of the governors, of which the majority must be public governors” to “at least one third of the total governors in post and at least 50% of the total elected public governors in post”. The Board APPROVED the proposed amendment to the Trust Constitution in respect of quorum arrangements for Council of Governor meetings. Action 15/104 Steve Garside to amend section 4.12.1 of the Trust Constitution (standing orders for the practice and procedure of the Council of Governors) to state that a meeting of the Council of Governors will be quorate if a) at least one third of the total governors in post and b) at least 50% of the total elected public governors in post are present.

15/105 - Questions from Governors, Trust members, and members of the public Steve Garside advised that there were no outstanding questions from governors, Trust members, and members of the public to bring to the attention of the Board. 15/106 - Date and time of next meeting It was noted that the next Board meeting in public would take place on Wednesday 23 March 2016, commencing at 10.00am at Shaw House, Newbury. 15/107 - 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 23 MARCH 2016

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

Public Board 23 March 2016 Page 1 of 2 Author: SG

No. Minute ref.

Agenda Item Action Resp Target Due Date

Comments/Outcome

1. 15/089 (was 15/076 from Nov 15)

Opening Business The Chief Executive to provide an update on the Healthcare Professionals service at the March Board meeting, including a realistic view on what could be achieved in terms of its contribution to the cost improvement programme.

WH 23/03/16 Action completed Update included in the Operational Performance Report on today’s agenda.

2. 15/091 Chairman and Chief Executive Reports

The Trust’s new equality and diversity action plan to be presented at an appropriate future Board meeting

WH/MS TBC Action in hand This will be presented at the May 2016 Board meeting.

3. 15/097 Finance and Estates Report

Charles Porter to clarify the position in terms of the ‘fleet efficiencies’ CIP, and the potential future implications

CP ASAP Action completed Update circulated on 26 February. This confirmed a neutral position in terms of the fleet efficiencies CIP (i.e. some savings but offset by increased costs).

4. 15/098a Finance and Estates Report

Charles Porter to confirm the December position in terms of vehicle off-road scheduled and unscheduled maintenance (no data provided)

CP ASAP Action completed Update circulated on 26 February. The position for vehicle off-road was as follows: scheduled maintenance = 4%; unscheduled maintenance = 18.4%.

5. 15/098b Finance and Estates Report

Board members to contact Charles Porter with their views on the format of the Integrated Performance Report in 2016/17 (e.g. content, presentation etc).

ALL ASAP Action ongoing Board member comments are still invited ahead of presentation of the first 2016/17 IPR in May 2016.

SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST

Agenda Item 4 TRUST BOARD MEETING IN PUBLIC 23 MARCH 2016

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

Public Board 23 March 2016 Page 2 of 2 Author: SG

6. 15/104 Closing Business Steve Garside to amend section 4.12.1 of the Trust

Constitution (standing orders for the practice and procedure of the Council of Governors) to state that a meeting of the Council of Governors will be quorate if a) at least one third of the total governors in post and b) at least 50% of the total elected public governors in post are present

SG 23/03/16 Action completed The constitution has been amended to reflect the change to Council of Governor meeting quoracy rules.

CP Charles Porter SG Steve Garside WH Will Hancock MS Melanie Saunders

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ITEM 6

BOARD OF DIRECTORS PUBLIC MEETING 23 MARCH 2016

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 Operational, clinical and financial performance 2015/16 to date 2 The current year continues to be challenging both for SCAS and the wider

NHS. Although the Trust has a strong track record of achieving the three national response time standards (and delivered all three in quarter 1 of this year), we continue to face significant challenges both in terms of performance and finance.

3 Following an upturn in performance in quarter 3 (which saw us achieve the

red 19 target and deliver substantially improved performance on red 1 and red 2), quarter 4 performance has dropped across the board.

4 The quarter 4 issues have been significantly increased demand, increasing

levels of acuity, and hospital handover delays. Red demand has increased during the course of the year and, as this requires more resource, it is challenging to accurately plan and allocate resources to match the full range of activity we face. As an example, in February red demand was 28% higher than the previous February.

5 Financially, SCAS has been impacted by lower levels of demand in the earlier

part of 2015/16 (and therefore less income) and higher workforce costs as it strives to resource and deliver an improved level of performance against the national response time standards.

6 Board members will note that our current level of operational performance

remains relatively strong in comparison to most of the ambulance sector. Our performance on the red 2 and red 19 targets in Q3, for example, were 3-4% higher than the FT sector average.

7 We remain fully committed, as our main priority, to continuing to provide the

best possible patient care, through services that are safe and of the highest quality. Despite the drop in performance this year, our average response times remain good, and are indeed improving: 6m 55s for red 1, 6m 44s for red 2, and under 8 minutes for red 19. This means that, generally, patients continue to receive a service which is responsive, and where the response time standard is not met, in most cases this is by a matter of seconds.

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8 Clearly, there are examples of where patients are waiting longer than expected or is acceptable (particularly for incidents rated as ‘green’ under our prioritisation system). Clinical reviews of the patients who may have experienced delays are undertaken to ensure that patients have not come to harm and to ensure that changes to practice can be identified to reduce the impact to patients going forward.

9 Although patient feedback is vitally important to us, the level of complaints we

have received remains low and largely unchanged throughout the year, and there has been no adverse change in our level of serious incidents requiring investigation (SIRIs) – another key indicator of patient safety.

10 We fully anticipate that the challenges faced by both SCAS and the wider

NHS will continue into 2016/17. For most patients, and particularly for those with time critical conditions, we do not envisage that any significant changes in the responsiveness and quality of our 999 service will be experienced.

11 There are a range of reports on today’s agenda which consider performance

in greater detail. Major incident, Didcot 12 The Trust was part of an emergency services response to a major incident in

Didcot, Oxfordshire on 23 February, following the collapse of a building on the Didcot A Power Station site.

13 The resources deployed by SCAS to support the multi-agency response

included doctors and paramedics (including from the Air Ambulances), the Hazardous Area Response Team, Enhanced Care Response Unit, and Patient Transport Services.

14 This was a very serious incident, with one confirmed fatality, five people taken

to the John Radcliffe Hospital in Oxford (two with serious injuries, and three with minor injuries), 47 people treated at the scene for dust inhalation, and three currently reported missing on site.

15 The thoughts of all SCAS staff are with the families of those affected by the

incident. CLINICAL OUTCOMES, PATIENT SAFETY AND PATIENT EXPERIENCE Care Quality Commission (CQC) inspections 16 The CQC report, following the planned, focused inspection of our NHS111

services in November 2015, has now been published. We were delighted that the CQC concluded that our NHS111 service is safe, effective, responsive and well-led. The report is available on the CQC website:

http://www.cqc.org.uk/provider/RYE

17 Our planning continues for the formal, rated inspection which is taking place

w/c 2 May 2016; the scope of which will include 999, 111, PTS and resilience.

http://www.cqc.org.uk/provider/RYE

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National Ambulance Response Programme (NARP)

18 During October 2015 SCAS joined the National Ambulance Response Programme (NARP). This is an NHS England approved and monitored programme which enables Trusts to take up to 120 seconds longer than the standard 60 seconds before making a decision to dispatch a responding resource for Red 2 calls. This does not delay dispatch to our most critical incidents (Red 1 calls), and aims to enable us to respond even more quickly by the use of specific ‘Nature of Call’ questions.

19 The programme continues to progress well, with a positive impact on

dispatch, and no reported adverse incidents. NHS England has asked us to participate in a modified trial which allows a further 60 seconds (i.e. 180 seconds longer than the standard 60 seconds) to make a dispatch decision. Subject to our agreement, this change will be applied in April.

PORTFOLIO OF COMMERCIALLY VIABLE NON EMERGENCY CONTRACTS PTS mobilisation 20 Our preparations for the two new contracts commissioned by CCGs in the

Thames Valley, and Oxford Health NHS Foundation Trust, which go-live in 2016/17, are well underway.

21 Phase 2 of the Hampshire PTS contract commenced on 1 March, extending

our service to parts of North Hampshire, including Basingstoke. We are now the provider for journeys from treatment centres managed by the Hampshire Hospitals NHS Foundation Trust. This covers the Basingstoke and North Hampshire Hospital, the Royal Hampshire County Hospital in Winchester, and the Andover War Memorial Hospital.

22 Significant preparation went into planning and managing the go-live for phase

2 between SCAS and Hampshire Hospitals project teams. A very positive mobilisation took place despite all of the current pressures on the hospital. I would like to congratulate and thank all those involved.

LEADERSHIP, STAFF ENGAGEMENT AND WORKFORCE Philip Astle, new Chief Operating Officer 23 I am delighted to welcome Philip Astle to SCAS, as the Trust’s new Chief

Operating Officer. 24 Philip has significant experience as a senior executive in both the private and

public sectors, joining SCAS from his position as Vice President of John Menzies plc where he ran their United Kingdom and Ireland aviation business. Prior to that appointment he was the Chief Operating Officer of Her Majesty's Passport Office, and enjoyed an exceptional 25 year military career during which time he served in a variety of senior operational and strategic positions.

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Rachel Coney, new SCAS Charity Chief Executive 25 I am also delighted to welcome Rachel Coney, as the first appointed Chief

Executive for the SCAS NHS Charity. 26 Rachel was formerly Chief Executive of Healthwatch Oxfordshire, and held a

number of positions in the NHS prior to this. In conjunction with the Board, Rachel will be developing the future strategy for the Charity over the coming months and further details will be presented in due course.

Staff Survey 2015 27 The latest annual national staff survey closed before Christmas and the

outcomes will be shared with the Board at today’s meeting. The staff survey is a crucial element of our staff engagement process, and I was delighted that we had the highest response rate of any Ambulance Trust (55%). There are some very positive messages for SCAS but equally some areas which require further, detailed management attention.

GOVERNANCE, VALUE FOR MONEY AND FINANCIAL STANDING Monitor ratings 28 Our 2015/16 Q3 ratings were confirmed as “green” for governance, and “2”

for financial sustainability, although Monitor noted that we failed to achieve both the red 1 and red 2 targets in the quarter.

29 The Monitor feedback letter states that “we expect the Trust to address the

issues leading to the financial sustainability risk rating and the target failures and achieve financial sustainability and sustainable compliance with the targets promptly”.

30 The Q4 return will be submitted at the end of April. NHS Improvement 31 As reported previously, NHS Improvement (NHSI) is due to be operational

from 1 April 2016, and will incorporate Monitor, the NHS Trust Development Authority, the Patient Safety function from NHS England, the Advancing Change Team from NHS Improving Quality, and the Intensive Support Teams from NHS Interim Management and Support.

32 NHSI has recently issued its Implementing the Forward View: Supporting

Providers to Deliver publication. This describes the contribution NHSI expects the provider sector to make to implementing the NHS Five Year Forward View.

33 NHSI is setting an ambitious expectation that providers will meet the national

quality standards and access targets, and deliver an improved financial position (through a combination of efficiency savings, adopting new models of care, and developing capability).

34 Specifically in terms of finance, NHSI are requiring that providers return to

financial balance as quickly as possible, adhere to the current Monitor controls on consultancy and very senior manager pay, and deliver the

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efficiencies identified in the Carter Review through improved workforce productivity and procurement.

Annual operational plan 2016/17 35 Our final annual operational plan for 2016/17 needs to be submitted to NHS

Improvement by 11 April, and is included on today’s Board meeting agenda. 36 SCAS is also participating in the development of system-wide sustainability

and transformation plans, which will set out how the local health economy will respond to the key challenges and solutions described in the Five Year Forward View. These need to be submitted by the end of June, and I will report details with progress at the next meeting.

37 Contract negotiations with commissioners for 2016/17 are ongoing, with an

expectation that contract terms will be agreed by the end of March. Board meetings in public 38 Following this last Board meeting in public of 2015/16, the dates of next

year’s meetings are: 25 May, 13 July, 28 September, 30 November, 27 January 2017, and 29 March 2017.

PARTNERSHIPS, STAKEHOLDER RELATIONSHIPS AND MEDIA Stakeholder engagement 39 The Trust continues to actively engage with key stakeholders. The Chairman

has met with a number of local MPs and chairs, and I continue to actively engage both nationally and regionally. My recent engagement activity has included the following meetings and events:

• Thames Valley Leadership Academy • NHS Providers meeting with the NHS England Chief Executive • Chief Executive Advisory Group to NHS Improvement • various health economy / local authority system meetings

40 We hosted a highly successful visit for senior officials from NHS England,

Public Health England and the Department of Health on 25 February, including the National Medical Director (Acute Episodes of Care). This represented an excellent opportunity for us to showcase our work and demonstrate how we integrate with partners in the local healthcare system. Our visitors also spent some time with the Board.

Public engagement 41 We have been continuing with our work to engage with members of the public

across our four counties. Recently we visited Portsmouth and Reading Football Clubs on matchdays to talk to the fans about the services that we provide, and the ways in which people can get involved in our work.

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Media coverage 42 We have recently embarked on our monthly campaigns. Last month our very

successful ‘Healthy Heart’ campaign focused on how to have a healthy heart. The campaign is designed to increase the chances of people across the South Central region surviving a heart attack or cardiac arrest. It was a proactive, integrated campaign linked to the Trust’s vision – “Towards excellence; saving lives and enabling you to get the care you need”. .

43 The aim of the Healthy Heart campaign was to help people across Berkshire,

Buckinghamshire, Hampshire and Oxfordshire:

• recognise symptoms of a potential heart attack • know what to do if you or someone you know thinks they might be

suffering a heart attack • know what to do if you come across someone in cardiac arrest • encourage more people to learn how to do life-saving CPR • encourage more people to download SCAS’ App that identifies where the

nearest AED (automatic external defibrillator) is. 44 In addition, over the last couple of months we have received over 400

reactive press enquiries covering a range of topics. SCAS received a significant number of press enquiries relating to the major incident at Didcot Power Station.

45 We use Twitter to communicate information about our services and our

proactive education campaigns, as well as job vacancies. We now have 9181 Twitter followers on the SCAS999 account alone.

Lead Director: Will Hancock, Chief Executive Author: Steve Garside, Company Secretary Date: March 2016

Agenda Item: 7

BOARD MEETING IN PUBLIC 23 MARCH 2016

Details of the paper

Title Medical Director’s Report

Responsible Director John Black, Medical Director

Recommendation (eg. note, approve, endorse) To note this clinical update report from the Medical Director.

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)

N/A

Implications Regulatory and legal implications / impact (e.g. Monitor provider licence and continuity of services risk ratings, CQC essential standards, competition law etc)

N/A

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

N/A

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

The Council of Governors receive regular progress reports on clinical matters.

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

This paper is particularly concerned with opportunities relating to improving patient outcomes and experience.

Other

Previous considerations by the Board

A separate integrated report from both Medical Director and Director of Patient Care reviews current Ambulance Clinical Performance, Outcomes and Experience.

Background papers / supporting information N/A

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ITEM 7


MEDICAL DIRECTOR’S REPORT

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

month’s report focuses on four particular areas:

• Funding for Air Ambulance Research and Audit Post • Tranexamic Acid (TXA) for Isolated Severe Head Injury • Hypertonic Saline for severe head injury with clinical evidence of raised

intra-cranial pressure. • Monitoring of potentially preventable mortality

EXECUTIVE SUMMARY, KEY ISSUES AND UPDATES

A) Funding for Air Ambulance Research and Audit Post 1. The Air Ambulance Trustees have agreed to fund a part time Audit and

Research Clinical Post up to £24,000/per annum for each air base. This activity will help inform our evolving clinical strategy and provide data that will help secure additional funding for new projects and provide evidence for the improved clinical outcomes for patients who require complex care before arrival in hospital.

B) Tranexamic Acid (TXA) for Isolated Severe Head Injury

2. There is a large Multicentre International Randomised Control Trial (Crash

3) underway recruiting patients within 3 hours of significant head injury to establish whether or not early TXA administration improves survival and neurological outcomes. In-hospital recruitment of patients who have been injured within 1 hour of injury has proven challenging internationally as the ‘golden – hour’ is usually a pre-hospital (i.e. ambulance service) event.

3. SCAS has been approached by Professor Ian Roberts (London School of

Hygiene and Tropical Medicine) to explore whether we can recruit patients using the pre-hospital emergency medicine support based on both Air Ambulance Operations within 1 hour of injury.

4. Both Oxford University Hospitals NHS Foundation Trust (OUH) and

University Hospitals Southampton NHS Foundation Trust (UHS) are recruiting patients and already have the research infrastructure to follow these patients up after arrival in hospital. Both Air Ambulance Operations, as well as all front line vehicles, already carry TXA for severely injured poly-trauma patients.

5. More background information is available at: http://crash3.lshtm.ac.uk/

http://crash3.lshtm.ac.uk/

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C) Hypertonic Saline for severe Head Injury with clinical evidence of raised

intra-cranial pressure. 6. Hypertonic saline (HTS) is increasingly being used in hospital to manage

patients with severe head injury (for brain swelling/bleeding) to help reduce the pressure (ICP) inside the skull which can be life threatening. This is usually in the intensive care unit when intracranial pressure can be directly monitored, but also in the emergency department following a CT Brain scan and prior to definitive surgical intervention. The scientific level of evidence for improved outcome benefit currently is lacking for in-hospital use despite its known efficacy in reducing ICP.

7. Pre-hospital Emergency Physicians within SCAS have been keen to

explore using this early in patients with severe injury after optimising the airway, breathing and circulation care of patients. A protocol has been approved by the Air Ambulance Clinical Governance and SCAS Clinical Review Group, and after agreement with both neuro-intensive care units at UHS and OUH they are willing to monitor the pre-hospital administration HTS and outcomes of these patients. This approach has been adopted by other Air Ambulance Operations (e.g. London and Kent Surrey Sussex). After feedback from both Major Trauma Centres we plan to use a 5% concentration of HTS.

D) Monitoring of potentially preventable mortality

8. All acute hospitals, community health trusts and other NHS provider organisations have been asked by NHS England to review their processes for monitoring/reporting mortality and to ensure that Hospital Boards maintain visibility of this. High level national benchmarking is currently underway and SCAS is currently reviewing our processes for collecting/capturing data on this.

9. Current systems in place include SIRI Investigations/Datix reporting both internally and by partner NHS provider organisations, feedback from primary/secondary clinicians and local coroners, local case note reviews by Team Leaders/Clinical Mentors/111/999, Clinical Governance leads and Clinical Co-Ordination Centre managers, random Patient Report Form reviews monitored by Clinical Review Group. The roll out of ePR when complete potentially enables this process to be more streamlined and improved for patients undergoing face to face assessment and treatment by SCAS clinicians. Capturing and interpreting this raw mortality data and review activity for reporting purposes is potentially challenging.

RECOMMENDATION

A) The Trust Board is asked to receive and note the report.

John Black Medical Director, March 2016


Agenda item: 8


Title

Quality and Patient Safety Integrated 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

Links to SCAS Business & Risks Strategic theme to which the paper relates (please mark in bold)






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, 4.3, & 5.1

Implications Regulatory and legal implications / impact (e.g. Monitor terms of authorisation and risk ratings, CQC essential standards, competition law etc) All quality related work streams aid and enhance compliance with the CQC regulations. Information provided in this paper provides evidence of compliance.


Cost of undertaking preparations or actions relating to the CQC inspections

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

Quality and Patient Safety work streams are shared with commissioners through the Quality Schedule within the contract and stakeholders through regular updates and meetings and performance shared through the Integrated Performance Report.


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

Other


Quality and Safety report is presented at every board meeting

Background papers / supporting information

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.

Monitor (2015) The NHS Foundation Trust Annual Reporting Manual 2014/15

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

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QUALITY AND PATIENT SAFETY INTEGRATED 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 be found in the Integrated

Performance Report. 3. Following an initial executive summary highlighting the key issues and updates, the report follows

with updates for two dimensions of quality: • Patient Safety • Patient Experience

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

incidents and work streams and in the corporate risk register and board assurance framework (BAF).

EXECUTIVE SUMMARY, KEY SAFETY METRICS AND UPDATES

A) Turnaround and the Ambulance Quality Indicators metrics BAF risk 1.1, 1.2 & 1.3

5. The charts below show the distribution curve for January 2016 Red and Green long waits compared to the December 2015 data set outlined below each chart.

• There is an improvement in the Red 1 performance since October 2015 of 08mins:39secs average 75% target versus 08mins:23secs in January 2016.

• The Red 2 performance has deteriorated from 08mins:22secs in October to 08mins:38secs in January 2016.

• Red 19 performance has deteriorated from 20mins:50secs in October to 22mins:24secs in January 2016

• The Green 60 has deteriorated from 2hrs:33mins in October to 2hrs:51mins in January 2016. There has also been an increase in the demand and a week on week incremental increase in the percentage of Red volume compared to the same period last year.

6. Snap shot long wait audits continue and the themes for delay were demand outstripping

available resource compounded by hospital handover delays. There have been no Serious Incidents raised with a root cause of a delay in 2015/2016. The impact on patients is a poor experience. It is not possible to fully understand the impact of long delays in terms of patients decompensating clinically over time whilst awaiting a resource and we continue to encourage Healthcare Professionals to feedback and review cases. Complaints remain on plan since December and are below the levels received in the same period last year.

7. The Clinical Support Desk continue to focus on communicating with patients to ensure that they get the right outcome resulting in an increase in Hear and Treat rates to 12.9% for the week commencing 22th February 2016. Complaints or incidents have not been impacted by this change in focus and indeed an audit of 382 patient contacts in Portsmouth demonstrated that a

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number of these patients did not require an ambulance and were managed safely.

Dec – 15 – 75% @ 00:08:05 – Missed by 8 Red 1-8min Incidents | Long Waits Over 30 Mins: 2| Total Incidents: 1137 Dec audit key findings - There was one case over 30 minutes it could have resulted in patient harm but was not considered poor experience. The incident was originally a green 2 but patient’s condition worsened so the incident was upgraded with the response arriving at 3.5 minutes.

Dec – 15 75% @ 00:08:01 – Missed by 16 Red2-8min Incidents | Long Waits Over 30 Mins: 105 | Total Incidents :16497 Dec audit key findings – 16 Red 2 incidents were reviewed. One case was a 44 year old female 57 minute response with swelling all over body after leaving hospital three days earlier. Patient was taken to North Hampshire Hospital and no harm to patient from the delay was found. Another case reviewed was for a 46 year old female with a 50 minute response time who was complaining of alcohol withdrawal and was conveyed to University Hospital Southampton and no harm was noted from this delay.

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Dec ‐ 95% @ 00:20:31 ‐ Missed by 253 Red 19 Incidents ‐ Long Waits over 30 minutes: 241 ‐ Total Incidents: 17623. Dec audit key findings – no harm identified in this group

Dec ‐ 90% @ 02:10:43 ‐ Missed by 532 Green 60 Incidents ‐ Long Waits over 2Hours: 290 ‐ Total Incidents: 2467. Dec audit key findings – 94yr old male fell in care home waited 3 hrs 53 minutes with a laceration to back of head patient was treated and discharged at scene. 97yr old male waiting 2hrs 30 minutes patient had a UTI and GP visit arranged and the patient discharged on scene. Further work to be undertaken with nursing homes and managing demand using the new Demand Management Practitioners in each area.

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0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

0

100

200

300

400

500

600

Apr-

15

May

-15

Jun-

15

Jul-1

5

Aug-

15

Sep-

15

Oct

-15

Nov

-15

Dec-

15

Jan-

16

Feb-

16

Mar

-16

Qlikview ePR Dashboard

Stroke - HASU 60 - Qlikview Num Stroke - HASU 60 - Qlikview DenomStroke - HASU 60 - Qlikview PassRate Stroke - HASU 60 Plan

8. This chart shows the call to Hyper Acute Stroke unit as reported in the new Clinical Electronic

Patient Record dashboard. This shows a greater case inclusion and slight improvement in compliance and in December the trajectory was met with a decrease to 52.7% for January. There is a further piece of work being undertaken to do a manual review of patient records to ensure complete case inclusion.

9. STEMI Care Bundle has also seen improvement at 76.1% for November and work continues to reinforce the importance of pain management more generally with our staff using a variety of methods through a campaign approach.

10. NHS England in January updated the Ambulance Quality Indicators (AQI’s) which provide

guidance to ambulance trusts on how to record and report performance. The new definitions have impacted on our performance and also result in us requiring additional frontline resource to deliver performance.

Change in AQIs v1.4 Impact after mitigation Red 1 Red 2 Red 19 (Paras 2.5 & 4.6) Clock starts for calls transferred from 111 when the call presents to the Emergency Operations Centre Computer Aided Dispatch

n/a -0.5% <-0.1%

(2.10 & 4.12) No re- triage or enhanced clinical triage of Red calls passed from 111

0% -0.5-1.0% <-0.1%

(2.10) No re-triage or enhanced clinical triage of Red 1 calls originating from 999

-1% n/a <-0.1%

(2.8 & 4.9) Automatic External Defibrillators need to be “by the patient’s side” to stop the clock at Public Access Defibrillator (PAD) and Community PAD sites

-1% -1% n/a

(12.3) Assumption that subsequent call made by SCAS is covered by same rule as subsequent call made by patient

0% 0% 0%

Total mitigated impact

-2% -2.25% -0.1%

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B) National Ambulance Response Programme (NARP) update 11. Since the introduction of the National Ambulance Response Programme pilot in October 2015

there have been no adverse incidents reported by the Trust. SCAS continue to refine the Nature of Call groupings to ensure that we recognize very early into a call those patients that require the most urgent Red 1 response to a life threatening emergency.

12. Bi-weekly reviews linking with National Programme Leads at NHS England (NHSE) are ongoing. Regular weekly update reports are presented internally to the Executive Team and any further proposed changes are presented along with risks and challenges considered and decisions documented formally.

13. We are continuing with 180 seconds Red 2 dispatch pilot and recently NHS England has requested for SCAS to consider moving to 240 seconds for Red 2 Dispatch on Disposition which is being reviewed internally with a ‘Go Live’ date tentatively planned for the week commencing 11th April 2016.

14. The expert clinical reference group has signed off new clinical codes/categories (matching against AMPDS and NHS Pathways triage systems) in readiness for the next phase. It has been agreed that South Western & Yorkshire Ambulance Trusts will operationally trial new codes initially from 5th April 2016 (over 2-3 month period). There will be a formal clinical code review of SWAS & YAS trial, before a new code set is considered for rollout to other NHS Ambulance Trusts.

15. The recently completed NARP online staff survey has been collated and will be shared during

March on staff feedback of the programme from trial sites.

C) CQC Update BAF risk 4.3

2014/15 Pilot inspection - Trust wide action plan

16. Actions on the trust wide action plan have progressed well; the compliance team continue with the assurance checking of the submitted evidence.

17. The Head of Compliance continues to meet with leads regularly and update the live spread

sheet, progress of updates at the time of writing the report can be seen in the table and run chart below:

Week commencing

02-Feb

02-Mar

30-Mar

06-Apr

27-Apr

25-May

01-Jun 27-Jul 28-

Aug 30- Sep

28- Oct

25-Nov

04- Jan

29- Feb

Work in progress 77 69 34 32 26 21 20 13 11 9 8 7 2 2

Completed 41 49 84 86 92 97 98 105 107 109 110 111 116 116

18. There is one item that remains incomplete (amber) - the latest update of evidence for resolution

is as follows:

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Item Objective Update / comment Forecast status /update

S 22

Leadership in the Northern EOC and PTS supports staff and action is taken to improve staff morale where this is low.

Item 1. Use the behavioural framework review to understand cultural / behaviour differences between geographical locations and legacy and new ways of working, implementing recommendations required. (PS/LS)

Although we have missed the deadline initially set, a number of streams of work that have been planned will come to fruition over the coming months, these include;

• Behavioural Based interviewing training • Integrating the behaviours into Team

Leader Development Centres • Use of behaviours as part for the Person

Specs for new roles. Update 29/02: Dates for engagement events planned for individual staff groups through end Q4 and May 2016

19. The current position for the remaining open action due for completion by end of March 2016 is

outlined below:

Item Objective Update / comment Forecast status /update

M1

To ensure that staff have undertaken Statutory and Mandatory training commensurate to role by service in line with Trust targets.

TNA and compliance against all element completed in February 2016

This is also being monitored and supported through the Turnaround board. A further training needs analysis has been completed which demonstrates a considerable improvement over the year (see appendix 1 for detail). The ELearning Campaign is running again for a second month to ensure that staff are supported to undertake their training relevant to their job role.

2016/17 Rated CQC Inspection

20. Our preparatory work for the planned inspection is on track and at the time of writing the report

we have completed stage two of the plan. The salient activities undertaken to date in preparation include:

• We have submitted in excess of 1655 entries / pieces of evidence; this was a mixture of files (873) and data entry onto the spreadsheets (782)

• The data entry included a number of free text 250 word summaries e.g. describing the strengths and weaknesses of individual services

• Data had to be submitted in two distinct ways, as this is a parallel inspection • We are scheduled to have a first pre-inspection meeting with the both Lead Inspectors on

Monday 14th March 2016. The CEO will be attending this meeting to ensure early engagement and to gain a further understanding of the process

• We are in the process of updating the fourth edition of our ‘What SCAS Does Well’ publication for the forthcoming meeting with the CQC inspection team

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• We continue to gather evidence in anticipation of possible further data requests by the CQC

• We will commence phase three week commencing 14th March with our CQC service leads, preparing individual sites and teams with support from the senior management team, communications team and through site visits.

21. The CQC are currently out to consultation with their Strategy 2016 - 2021, Shaping the Future; Consultation document. SCAS continues to take part in the co-production forums. As previously reported to Trust Board the CQC strategy is focusing on:

• Frequency and intensity of inspections • Assessing quality for populations and across local areas • Level at which to rate and report • Delivering cost-effective health services: assessing NHS Trusts’ use of resources

D) Portsmouth Health System – Patient Safety BAF risk 1.3 & 1.6

22. The CEO, Director of Quality and Patient Care and the Medical Director have escalated an increase in quality and safety risks and concerns arising from overcrowding and ambulances queues directly to the CEO of Portsmouth Hospital Trust (PHT) on 2nd March 2016, as actions agreed at previous risk summits did not appear to have mitigated the risks sufficiently.

23. The Medical Director and the Director of Quality and Patient Care undertook a safety walkabout on the 23rd February 2016 and engaged with staff and patients being held in ambulances averaging 10 for the entire visit. We also engaged with the PHT Trust Executive and Senior Management team and the CCG to offer some insight into how other Acute Trusts within our geography manage flow and capacity issues. We discussed the issues with CQC Inspectors who were undertaking an unannounced CQC inspection of PHT Emergency Department (ED) at that time. The following day SCAS submitted the information on performance and impact to the CQC on their request.

24. There is a direct correlation between handover delays and non-compliance with performance standards. It is clear that the green performance suffers as part of mitigation actions as we seek to protect the safety of the patients. Below is a snap shot of this correlation on the 22nd February 2016.

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25. We have audited 382 incidents from 10:00 on 22/02/16 to 10:00 on 23/02/16 for patients in the Portsmouth (PO postcode) area. The findings from the audit have been reviewed at the Patient Safety Group, the Executive Management Committee and will be presented to the Quality and Safety Committee and the Southampton, Hampshire, Isle of Wight and Portsmouth Clinical Quality Review Meeting.

26. The SCAS Pre-hospital Consultant Practitioner triaged each of the patients outside the PHT

Emergency Department on Monday evening 22nd February, and did not consider that there were any inappropriate cases conveyed: they all needed either diagnostics, such as x-ray or blood tests or admitting for treatment and none of this was available to us in the pre-hospital setting.

27. PHT have instigated 10 full ambulance diverts since Wednesday 28 October 2015. University Hospitals Southampton (UHS) have accepted 8 diverts which has involved a total of 60 patients being diverted out of area.

28. The system as a whole is receiving scrutiny at the highest level and SCAS continues to demonstrate complete commitment to patient safety across the entire system; undertaking long wait reviews, prioritising workload, undertaking independent and system wide escalation actions. In addition SCAS continue to support the non-conveyance agenda using Hear and Treat, Specialist Paramedics and GP triage with good affect. Also through the demand management work, auditing conveyed patients, and proactive engagement of high activity sites to reduce further when appropriate conveyance from known high activity people or premises.

29. The Area Manager and the Director of Quality and Patient Care have attended two additional PHT Patient Safety Risk Summits chaired by NHSE in January and March 2016.

PATIENT SAFETY A) Safeguarding Update

30. We have seen an increase in 2015/16 of 131% of safeguarding adult referrals and 92% in child referrals compared to the same period April to February 2014/2015.

31. SCAS has attended 62% of safeguarding Boards April 15 to February 16. A letter has been sent

to the Independent Chairs of all of the Adult and Children Boards to ask if we need to attend or if we can be a co-optive member and attend when appropriate or if we should attend a health sub-group only. We have received four responses to date and have requested that we attend the health sub-groups only.

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32. The action plan agreed with the SHiP commissioners is on target and is being monitored via the Southampton, Hampshire, Isle of Wight and Portsmouth Clinical Quality Review meetings. A meeting has been arranged to sign the action plan off on 17th March 2016.

B) Safeguarding Activity (children and adults) BAF Risk 4.3 & 5.1

33. SCAS are still seeing an increase in the number of Serious Case Reviews (SCR)/Safeguarding Adult Reviews (SAR)/Internal Management Reviews (IMR);

Category of Review Child/Adult Area

Month SCR

/ SAR

Consideration of SCR PR DHR Child Adult Hants Berks Ox Bucks Other

Total

April 1 1 1 1 May 2 4 4 2 5 1 6 June 8 5 3 2 4 2 8 July 3 3 2 6 2 3 1 3 1 8

August 1 2 2 1 3 3 September 2 1 3 1 1 1 3

October 2 2 2 2 November 5 3 2 5 5 December 3 3 1 2 3 3 January 2 2 2 2 February 3 3 2 1 3

34. Level one training is currently 83% as at 08/01/2016 and level two at 69%. Level one is annual e-

learning and level two is face to face training which is three yearly. This is a dynamic report so these figures change weekly as the system refreshes so those that are out of date in that week will come off or get added if they have re-qualified.

35. For details of the number of safeguarding referrals raised please see appendix 2 below.

C) Serious Incidents Requiring Investigation (SIRI)

36. In January 2016 the Trust declared three serious incidents requiring investigation (SIRI), the

details of these are in the table below.

Since the last report, one SIRI has been investigated and subsequently closed by the Trust’s SIRI Review Group. This SIRI is shaded in the table below.

Incident Date

SIRI Number

Status Clinical Commissioning Group (CCG)

12/11/2015 2015/36057

Deteriorating Patient - 999 North Hampshire CCG

3/1/2016 2016/257

Unexpected / potentially avoidable injury requiring treatment to prevent death or serious harm - NHS 111

Oxfordshire CCG

17/1/2016 2016/2165

Treatment Delay NHS 111 Oxfordshire CCG

21/1/2016 2016/2126

Assault - 999 Aylesbury Vale CCG

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Total number of SIRIs declared by SCAS between January 2015 and January 2016

37. The total number of SIRIs reported by SCAS between January 2015 and January 2016 was 15. All but three of these SIRIs have been investigated and closed by the SCAS SIRI Review Group.

Incidents reported in January 2016

38. The total number of incidents (clinical and non-clinical) reported in January 2016 was 429. For further details and the categories of incidents reported see the table below.

Total number of Incidents (clinical and non-clinical) by category reported in January 2016

Categories January 2016

111 Call Centre Issues 27 111 External (non-SCAS) 6 Bullying and Harassment 3 Care Line/Organisation 1 Clinical 0 Clinical Equipment 19 Contact with/struck by object/vehicle (including hot liquids)

13

Control of Infection 7 Delayed Treatment/Transport 23 District Nurses/Midwives 5 EOC Issues 14 Estates 7 Feature Request 13 Fire 0 Fire Service 1 GPs 15 Hospitals 15 Ill Health 0 Ill Health - Patient 1 Ill Health - Staff/Contractor 1 Information Governance 5 Inter Agency: Clinical 0 Inter Agency: Non Clinical 0 Make Ready 15 Manual Handling 33 Medication 42

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Mental Health Incidents 2 Mental Health Organisations 1 Needlestick/Sharps 10 Nursing/Care Homes 9 Office Information Technology & Equipment 3 Operational 0 Operational Radio & ICT 5 Other Ambulance Services 1 Out of Hours Services 13 Patient Abuse/Aggression (by staff/third party) 1 Patient revisited within 24 hours 6 Patient Self Harm 0 Patient Treatment 2 Personal Accident 0 Pharmacy 1 Physical Assault 10 Police Service 5 PTS Contact Centre Issues 2 Security 9 Site Security 2 Slip, Trip, Fall 20 Staff Abuse/Aggression (by patient/third party) 13 Vehicle 17 Welfare 0 Welfare - Patient 5 Welfare - Staff 7 Other: Clinical 8 Other: Non-Clinical 11 Total 429

Total number of reported incidents in relation to calls and activity in January 2016

Number of reported incidents in relation to the number of calls in January 2016 Detail Number of calls and incidents reported

Total number of calls received by SCAS (111 and 999)

173563

Total number of reported incidents (111 and 999)

429

Number of reported incidents per 1,000 calls

2.47

Total number of incidents reported between January 2016

39. The total number of incidents reported between January 2015 and January 2016 was 4,850. For a breakdown of this by month, please see the graph below.

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385326 339 312 314 309

363 391 376419 436 451 429

0

100

200

300

400

500

Total number of incidents reported between January 2015 and January 2016

Clinical incidents reported by each Service Area in January 2016

40. For details of the clinical incidents reported by each service area in January 2016, please see the chart below.

Clinical incidents reported by each Working Area in January 2016

41. For details of the clinical incidents reported by each working area in January 2016, please see the chart below.

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Working Area Location Key Working Area Stations/Areas North - East Area: Wexham and Aylesbury. North Hants Area: Andover, Alton, Whitchurch, Basingstoke, Winchester and

Eastleigh. North – North Area: Milton Keynes, Bletchley, Stoke Mandeville North – South Area: Bracknell, Reading and Newbury North – West Area: Adderbury, Kidlington, Didcot and Oxford City South: Hampshire Corporate Area North: Buckinghamshire, Berkshire and Oxfordshire Corporate Area South East Hants: North Harbour and Petersfield South West Hants: Lymington, Hythe, Ringwood, Hightown and Nursling. Severity of Clinical and non-clinical incidents reported in January 2016 and graded by Managers

42. For details of the severity of clinical and non-clinical incidents as reported by each Service Area in January 2016 and as graded by Managers, please see the table below.

Severity of clinical and non-clinical incidents graded by managers in January 2016

Service Area Low Risk

Minor Risk

Moderate Risk

Significant Risk

High Risk Total

Health Care Professional 1 3 3 0 0 7 111 Call Centre 2 8 3 3 0 16 111 Clinical Desk 0 0 0 0 0 0 999 Operations 35 60 45 5 0 145 Clinical 0 0 0 1 0 1 Logistics 0 0 0 0 0 0 Patient Transport Service (PTS) Control 1 0 1 0 0 2 Emergency Operations Centre (EOC) 1 1 1 1 0 4 Patient Transport Service (PTS) Operations 6 8 12 0 0 26

Education 0 0 1 0 0 1 Emergency Operational Centre (EOC) Clinical Support Desk (CSD) 1 1 0 2 0 4 Operational Support Desk (OSD) 0 0 0 0 0 0

Human Resources (HR) 0 0 0 0 0 0 Hazard Area Response Team (HART) 0 1 0 0 0 1

Total 47 82 66 12 0 207

Severity of the Clinical incidents reported in January 2016

43. For details of the severity of clinical incidents reported in January 2016 and graded by managers, please see the chart below.

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44. With regards to the severity of the 248 clinical incidents reported in January 2016, 100 of these incidents have been examined and re-graded by managers investigating the incidents and 22 were deemed as low risk, 44 were minor risk, 24 were moderate risk, 10 were significant and none were graded as high risk.

The severity of Non-Clinical incidents reported in January 2016

45. For details of the severity of non-clinical incidents reported in January 2016 and graded by managers, please see the chart below.

24

4239

205

1015202530354045

Low Risk Minor Risk Moderate Risk Significant Risk

Severity of Non clinical incidents in January 2016 as graded by Managers

46. With regards to the severity of the 181 non-clinical incidents reported in January 2016, 107 of these incidents have been examined and re-graded by managers investigating the incidents and 24 were deemed as low risk, 42 were minor risk, 39 were moderate risk and two were significant and none were high risk.

Top three categories and sub-categories of clinical incidents reported in January 2016

47. The top three clinical categories were:

• Medication (42) • 111 Call Centre Issues (24) • Delayed Treatment/Transport (22)

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48. The top three sub-categories for medication incidents were: ‘medication missing’, ‘morphine missing’ and ‘stocktaking error’.

49. The main themes for incidents involving ‘medication missing’ were errors with returns for Paramedic2 trial drugs.

50. The main themes for incidents involving ‘morphine missing’ were ampoules of morphine that had

been administered by paramedics had not been recorded properly in the morphine log book on the vehicle.

51. The incidents involving ‘stocktaking error’ consisted of various drugs such as salbutamol,

ibuprofen, amiodarone and codeine being found to be missing from drugs bags.

52. The top three sub-categories for 111 call centre issues incidents were: ‘inappropriate disposition’; ‘communication problems’ and ‘front-ending’.

53. The main theme of the incidents involving ‘111 - inappropriate disposition’ were 111 requesting

an emergency response for patients who did not require this level of response and conversely patients who were not sent an ambulance who did require that level of response.

54. The main theme for incidents involving ‘communication problems’ were miscellaneous with no

discernible themes.

55. The incidents involving ‘front-ending’ were clinicians from the Clinical Support Desk (CSD) being asked to take 111 calls rather than their usual duties when there was a large volume of patients waiting to speak to a clinician.

56. The top three sub-categories for delayed treatment incidents were: ‘delayed back-up’; ‘delayed

conveyance’ and ‘delayed arrival at scene’.

57. The main theme for incidents involving ‘delayed back-up’ was rapid response vehicles (RRVs) experiencing long waits for Ambulance back-up.

58. The incidents involving ‘delayed conveyance’ and ‘delayed arrival at scene’ were miscellaneous

with no discernible themes other than they could be attributed to staffing levels in 999 operations.

Actions/Service Developments

Medication

59. Incidents involving missing medications and administration sheets are investigated at a local level and staff are reminded of the importance of documenting medication administration accurately.

60. Individual staff are dealt with at local level with regards to logging morphine use correctly. 111 Call Centre Issues

61. Individual call handlers are supported with extra training, as required and reflective practice undertaken in the form of a written reflective journal.

62. The practice of requesting Clinical Support Desk (CSD) clinicians to front-end have been referred to the Head of 111 to manage.

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Delayed Treatment/Transport

63. The Trust is carrying out a recruitment drive in other countries to try and recruit more paramedics.

64. The Director of Quality and Patient Care is leading ‘Demand Management’ projects to try and

reduce pressure on existing resources and to ensure patients receive the most appropriate care and support first time.

65. Within the Trust there are increased career development opportunities for Emergency Care

Assistants and Technicians to become Paramedics and increase staff retention. Incidents reported by Private Providers in January 2016

66. In January 2016, there was one incident reported by a Private Provider organisation. A Private Provider employee reported that he had been pushed out of an ambulance and had things thrown at him by an intoxicated patient. No injuries were sustained by the Private Provider employee. There is an alert/feature on this patient’s address.

RIDDOR incidents reported in the four quarters of 2014/15 and 2015/16

67. There were 11 incidents reported to the Health and Safety Executive (HSE) in January 2016. There were seven incidents reported to the HSE in January 2015.

Total number of incidents reported to the HSE in the four quarters of 2014/15 and 2015/16. Month and Quarter Number of incidents

reported to HSE 2014/15

Number of incidents reported to HSE 2015/16

Quarter 1 April 11 7 May 7 1 June 5 10 Quarter 1 Total 23 18 Quarter 2 July 10 4 August 6 5 September 9 4 Quarter 2 Total 25 13 Quarter 4 October 8 3 November 7 0 December 6 7 Quarter 4 Total 21 10 Quarter 4 January 7 11 February 5 0 March 9 0 Quarter 4 Total 21 11 Overall Total 90 52

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RIDDOR Incidents reported between January 2015 and January 2016

68. The total number of RIDDOR incidents reported to the HSE between January 2015 and January 2016 was 73.

7

5

9

7

1

10

45

43

0

7

11

0

2

4

6

8

10

12

RIDDOR Incidents reported to the HSE between January 2015 and January 2016

PATIENT EXPERIENCE

A) Parliamentary and Health Service Ombudsman (PHSO)

69. Currently two outstanding cases with the PHSO.

SCAS PE Ref Service Area Current Position PE2928 SE OPS Investigation confirmed PE3630 EOC N Investigation confirmed

70. Patient experience figures, trends and severity are outlined in Appendix 3 below.

Patient Experience Case Studies Operations

71. Complaint regarding the route taken to hospital by the crew. Journey took 45 minutes, would

normally take 15-20 minutes. Delay resulted in patient being admitted to High Dependency Unit due to time taken to stop seizures.

72. An investigation found that we should transport patient to hospital via the most direct route. Driver admitted that he made wrong decision and apologised for this and any distress caused. The Investigating Officer explained to patient it is not always possible to send an ambulance and a Rapid Response Vehicle may be sent instead if closest resource.

73. What we did: • We apologised to the patient • System note added regarding double crewed ambulance being sent ASAP if requested by

Rapid Response Vehicle • System note added to take patient the most direct route due to medical needs • We can learn by listening to patient’s local knowledge of topography

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EOC

74. Complaint received regarding the delayed ambulance response after patient suddenly became

unwell following bump to head a few days prior.

75. Investigation found the 999 call was below standard due to Emergency Call Taker and Dispatcher errors.

76. What we did:

• We apologised to the patient and to everyone who was present at the time • The Emergency Call Taker and Dispatcher will undertake a reflective practice exercise along

with any other training that this identifies 111

77. Complaint received that when a caller contacted the 111 service for their baby, they were

advised to await an Out of Hours GP phone call for purple blotchy rash. The patient’s mother later took the baby to a GP who immediately called ambulance.

78. Investigation found that the NHS Pathways protocol was not followed correctly. The 1st call was non-compliant as the call handler took a long time to probe one area and full worsening advice was not given to the mother of the patient.

79. What we did:

• We apologised to the patient’s mother for the error • The call hander to receive feedback and further training

PTS

80. Complaint received regarding the attitude of a PTS crew member. The patient was collected from hospital to be taken home. The patient's wife asked the crew member to collect on a slide but he refused and a disagreement ensued. The patient has used a slide for the past 4 years and the patient’s wife said she felt bullied/intimidated by the crew member.

81. An investigation found that the crew member’s attitude was below standard.

82. What we did: • We apologised to the patient and her husband • The crew member no longer works for SCAS for unrelated reasons

Patient Experience Team BAF risk 1.5

83. The new Head of Patient Experience joined the Trust w/c 1st February 2016. A new Senior Patient Experience Officer joined the team w/c 4th March 2016. A review of outstanding complaints has been undertaken along with a comprehensive data cleanse to ensure Datix reflects the current position of each case as accurately as possible, in turn leading to increased accuracy of reporting. The PE Team are grateful for the support provided by all areas of the Trust to this complaint review and data cleanse. Plans include much more extensive use of the Datix system in the management of complaints to ensure the tracking and responses are completed in a more efficient manner. Plans to ‘go digital’ week commencing the 1st April 2016, to record all complaint and compliment data on Datix with few paper files being held in the PE Team. All updates and correspondence will be noted on Datix.

84. The Patient Experience Team completed a process mapping exercise in Q3 2015 which aimed

to define the PE team function, analyse the operating model and improve the way of working.

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From this session the processes will be reviewed by the new Head of PE, with plans formed to communicate and implement new working practices to increase efficiency.

RECOMMENDATIONS TO THE BOARD

A) The Trust Board is asked to receive and note the report.

Appendix 1 Statutory and Mandatory Training

Staff Group Target ActualConflict Resolution Organisational Wide 3 3323 95% 76.08% 2528Dementia Awareness Organisational Wide 3 3316 95% 56.76% 1882Equality and Diversity Organisational Wide 3 3331 95% 84.75% 2823F2F Safeguarding Level 2 Organisational Wide 3 3021 95% 68.52% 2070Fire Safety Organisational Wide 1 3341 95% 73.63% 2460Health and Safety Organisational Wide 3 3340 95% 80.84% 2700Infection Control Organisational Wide 1 3330 95% 68.38% 2277Information Governance Organisational Wide 1 3322 95% 63.94% 2124Manual Handling Organisational Wide 1 3338 95% 70.31% 2347

Safeguarding Adults Level 1Organisational Wide 3 3333 95% 82.90% 2763

Safeguarding Children Level 1

Organisational Wide 3 3333 95% 82.99% 2766

Mental Capacity Organisational Wide 3 3021 95% 69.02% 2085

Module Compliant Staff

WTE staff numbers

Level

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Appendix 2 Safeguarding referrals April 2015 to February 2016

Adults North Total 5755 South Total 5353 Note the figures in the table below will not equate to the totals above as more than one element may be recognised in a case referred. Physical Abuse 891 Sexual Abuse 158 Emotional / Psychological Abuse 1108 Financial / Material Abuse 348 Neglect & Acts of Omission 6921 Discriminatory Abuse 159

Children’s North Total 1172 South Total 1551 Note the figures in the table below will not equate to the totals above as more than one element may be recognised in a case referred. Physical Abuse 591 Sexual Abuse 117 Emotional / Psychological Abuse 406 Financial / Material Abuse 48 Neglect & Acts of Omission 2201 Discriminatory Abuse 31

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Appendix 3 Patient Experience Jan & Feb 2016 Complaints by Category Jan/Feb 2016 v Jan/Feb 2015 The total number of complaints reported in Jan/Feb 2015/16 (93) versus those reported in the same period of 2014/15 (109). For a breakdown of this please see the graph below.

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Concerns by category Jan/Feb 2015/2016 v Jan/Feb 2014/2015 For details of the concerns reported in Jan/Feb 2015/2016 (100) versus the same period in 2014/2015 (144) please see the graph below.

Severity of Harm For details of the severity of clinical and non-clinical complaints and concerns as graded by Managers please see the table below. None were graded as high risk.

Agenda Item: 9a



Title Operational Performance Report – 999 and 111

Responsible Director Will Hancock, Chief Executive Officer

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









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

Maintenance of essential standards of care for patients Failure to deliver financial plans and strategic aims SCAS contractual arrangements with commissioners of its services

Implications Regulatory and legal implications / impact (e.g. Monitor provider licence and continuity of services risk ratings, CQC essential standards, competition law etc) Operational performance has particular regulatory implications; for example, quarterly reporting to Monitor covers performance on the national response time standards


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. The ongoing recruitment challenge and high attrition levels mean that we are substantially below headcount and we now are starting to see demand start to increase in towards the level of demand that was in our budget. Increased costs of private providers represent a substantial risk to finances due to their higher cost and lower productivity. 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 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


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OPERATIONAL PERFORMANCE REPORT – 999 AND 111

PURPOSE 1. The purpose of the paper is to give the Board an overview of activity and

performance in the Operations Directorate, covering the 999 and 111 services, while supplementing some of the detail in the Integrated Performance Report.

EXECUTIVE SUMMARY 2. Activity levels are rising and will continue to keep us under pressure during

Q4. 2.1.1 The Turnaround process is giving the Executive team a detailed insight into

performance, challenges, and visibility of actions and ownership. This work has been shared with commissioners and they have a plan relating specifically to their areas.

2.1.2 SCAS was selected to participate in the National Ambulance Response

Programme (NARP) and results to date are positive. 2.1.3 The national changes from 5 January 2016 to date with the revised

Ambulance Quality Indicators (AQIs) have seen changes in our operational performance achievement. The Trust is in full compliance with these revised AQIs.

OPERATIONAL PERFORMANCE 3. The report highlights specific operational departmental updates on activities in

support of improving operational delivery, performance, and business changes for this period. Note actions are aligned with work already being undertaken at weekly Turnaround meetings.

3.1 This report updates on:

a) Contract Performanace quarter / year to date (up to 28 February) b) Demand and Resourcing c) Urgent & Emergency Operational Activities d) 111 / EOC 999 e) Fleet Replacements and Equipment f) National Ambulance Response Programme (NARP) g) Ambulance Review and Modelling

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3.2 The Trust continues at REAP 3 and is likely to remain as such for the

foreseeable future due to the challenges upon the Trust during the remainder of Q4.

4. Demand 4.1 Demand levels have remained high during February with last week 7% higher

than last year in Thames Valley and 5% higher in SHIP.

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5. Resources 5.1 Resource levels were planned above to reflect this higher demand level but

were not sufficient to achieve the actual requirement in the North. Resource levels in the South have been in line with requirement apart from half term week, significant process pressure in the South are however indicating a revised Unit Hour Utilisation (UHU) level will be required to maintain performance. Leave levels are now at maximum levels which is increasing abstraction levels above plan.

5.2 Private provider hours have been increased to try to offset reducing rota

hours, averaging 6500 in January rising to 7500 by the end of February. This will be maintained through March but is the current maximum level achieveable.

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5.3 The Planning team are finalising Easter planning across both 999 and 111 services.

6. U&E Operational Activities

• The Operations team are focussing on how we can improve the call cycle time and reduce the time per incident through smarter working. This will in turn provide additional resource hours to improve the performance.

• We are continuing our focus on urban drive zone performance working with the Planning team and EOC teams to improve our urban coverage and delivery.

• We have experienced an increase in Hospital Handover times across the trust which has impacted heavily on our resource availability. The total lost hours from our acute trusts for February was 1670 hours and we have estimated the impact on our red performance being 2.5%.

• We have appointed the 4th Specialist Paramedic Manager who will cover North Hampshire and lead on developments within the role of Specialist paramedics. The new appointment has come from Oxford Health so will being additional experience to the team.

• Following the Care Quality Commission review of London Ambulance Service and the identified areas of weakness around their Emergency Preparedness, Resilience and Response (EPRR) we have been focussing on ensuring that our EPRR processes are robust and compliant. As part of this process we are advertising for a Business Continuity Manager to bring to the team.

• We are working with staff side leads to commence a review of our current rotas and following receipt of Lightfoot report we will commence the analysis stage to assess the current rotas against the demand profile. We are looking at how the rota review will be part of the wider improvements we envisage for staff welfare and well-being around reducing sickness and attrition, improved meal break compliance, and reduced over runs from shift.

7. Indirect Resources

• Indirect contribution continues to deliver above 7% unique contribution even with the AQI impact causing drop in Automated External Defibrillator (AED) contribution of 0.8%

• We are still negotiating the agreement with the Thames Valley Fire services for Co Responding with the aim of reducing our costs while not impact on the performance being delivered from these schemes. The 3 new schemes are responding to an average of 6 incidents per day.

• Working with EOC, we are reviewing how we can improve the dispatch of the indirect resources and are looking at the option of one dispatch desk covering the SCAS area with 2 dispatchers on 24/7. We are also developing a new training package for the indirect resource desk staff.

• We are working with RAF Brize Norton to provide Paramedics to work for SCAS on ambulances

• We are developing a new APP with 02 on locating AED’s in the community.

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• The new training for community first responders (CFR’s) accredited through FUTUREQUAL will go live by end of April.

• The IR team are working closely with the CEO for the SCAS charity to review how we raise additional funds for the schemes.

8. Clinical Coordination Centres (CCC) 8.1 NHS111 call levels remain higher than planned however; there are vacancies

in the service which cause churn to build.

8.2 Up to February 28th, SCAS has answered 101,356 NHS 111 calls, 70.1% of

which were answered within 60 seconds. The abandonment rate was 4.2% and 999 referrals were at 10.3%. 111 – 999 referrals (not able to be shown at a monthly rate at this stage) were 10.4% and remained higher than in January 2016

8.3 EOC 999 call answer 95th percentile performance has been stable; however

this has deteriorated during the month of February to 43 seconds at the 95th percentile. The abandonment rate for 999 calls has remained below the 1% national standard thus indicating service safety but with delays to answer. This has occurred primarily due to staff movements internally within the 999 service. It must also be noted that although the 95th percentile has risen the 50th percentile remains stable at 3 seconds.

8.4 Allocation times for Red 1 calls in February was - 83 seconds and Red 2 -

185 seconds 9. Fleet / Equipment 9.1 The 22 new Mercedes Modular ambulances will be going live starting 2nd

week of March. This is due to the changes made within South Central Fleet Services Ltd and change to the invoicing requirements for these vehicles against the SCFS and not SCAS directly. These vehicles have had a few new innovations added to previous designs:

• Rear saloon independent heater – to keep the rear of the vehicle at a

constant temperature. • On some of the rear storage cupboards we have fitted an indication

system that shows if the cupboard has been opened. This will give an

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immediate visual indication to crews and Make Ready Services that equipment or consumables may have been used. It will enhance the Make Ready service as the operative will not have to check the cupboard if the indicator hasn’t been activated and therefore speed up the checking process, which could lead to cost savings in the future on the contract.

9.1.1 One area on the current ambulances that has and does cause issues is when

it runs short of “Adblue” the vehicle goes into limp home mode reduced performance. The new ambulances have had the system altered to allow the vehicle to be driven without the limp home being activated which will result in less vehicle Lost Unit Hours. Unfortunately this cannot be altered on any other vehicle.

9.2 .Health Care Professional (HCP) Referral Vehicles 9.2.1 After evaluating various vehicle designs and the introduction of the Euro 6

engine compliance that has now become law (increases vehicle weights by up to 60-100kg base weights) a different view has become apparent. There are only two vans that will now give us the options for a conversion as these are Mercedes and Fiat. The Fiat is the preferred option as it is considerably cheaper than the Mercedes and offers a wider platform inside, thereby giving more space. After evaluating several other Trusts van conversion A&E ambulance built upon the Fiat it is believed that now there is a suitable option to have the HCP vehicles built to this type of specification. This will allow for greater flexibility and these vehicles then can also be used for main front line work and cover events when not undertaking HCP work mainly at weekends.

9.3 Single Response Vehicles (SRVs) 9.3.1 Work is still being undertaken to find a suitable replacement for our current

SRV’s of the Ford Mondeo.

9.3.2 Equipment

9.3.3 The ZOLL defibrillator project has now hopefully found the solution of data transfer problems by the introduction of “dongles” which under trial have proved successful.

9.3.4 Asset Data Base – The data that is currently held within SCAS which was hopefully being able to transfer across has not been successful. Therefore all equipment will be re-tagged and the whole process started afresh. This will start beginning of April with completion target of end of June 2016.

9.3.5 Clinical Equipment Servicing Contract – The new contract has now been

awarded and the company has now started to undertake servicing on Front Line vehicles. Various faults have already been identified and actions taken appropriately.

9.3.6 The introduced of the Clinical Equipment Directory which is being placed on

the Trust Intranet and will also be based on each resource centre will now encompass a section redirect for risk assessments and operational requires section.

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9.3.7 The Clinical Equipment Manager has identified some potential equipment that we could change resulting in financial savings and these are being brought in for evaluation through the Equipment review group. Any changes will be included into the vehicle builds for the 2016/17 financial year, and where possible exchange if original equipment needs replacement.

9.4 Make Ready Services 9.4.1 All areas of the Make Ready Service are performing against the contract

KPI’s, however as to date the actual contract has still not been signed and sitting with Churchill for further clarification on areas such as the PTS segment.

9.5 Medical Consumables 9.5.1 The introduction of a part central coordination point of consumable ordering

and min/max stock levels in the North has now started to see a fall in costs. Although minimal at present this will start to see a positive effect going forwards into the new financial year.

10. Operations Directorate Restructure 10.1 As a result of changing organisational and operational priorities within quarter

three of 2015/16, it was agreed that the next phase of the restructure should be paused and revisited in the later part of quarter four. This allowed the Trust to focus on Turnaround actions in September 2015 over the coming months. During the pause, the senior operations team were asked to relook at issues to address before final implementation could be taken forward. This covered defining benefits, resolving lines of accountabilities and firming up costs / financial implications.

10..2 The Executive Team did however agree to proceed with the proposed

Planning and Scheduling Department, restructure which was approved in early February 2016. This supported this department’s important function to forecast and resource the plan effectively, for which stability was required.

10..3 At the Trust’s Executive Committee meeting on 1 March 2016, an update on

completing the Operational Directorate restructure proposal was presented to provide an opportunity to enable the Executive Team to raise any issues and concerns that need to be addressed before seeking final approval for this change to proceed. In addition, a copy of the presentation was circulated with an offer of further discussions and/or clarification if required. At the meeting, further on clarification was requested on certain points. After these discussions, the proposal was approved in principle and agreement given for the final paper to come to the Executive Team on 8 March. It was also confirmed that once final approval has been given, endorsement from the Trust Board will be sought at the end of March.

11. National Ambulance Response Programme (NARP) 11.1 During October 2015 SCAS joined the National Ambulance Response

Programme. This is an NHS England approved and monitored programme which enables Trusts to take up to 120 seconds longer than the standard 60 seconds before making a decision to dispatch a responding resource for

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Red2 calls. This does not delay dispatch to our most critical incidents, Red1 calls, which aims to enable us to respond even more quickly by the use of ‘Nature of Call’ questions right at the beginning of the call which are designed to identify the most critical incidents very fast and for a responding resource to be dispatched and where appropriate to reach a more appropriate disposition for the patients need.

11.2 During January and February 2016 the programme continues to progress well

and in line with the national work programme and the main updates for the Trust are:

• We have had no adverse incidents reported by the Trust since the

pilot started relating to NARP • We are continuing with 180 seconds Red2 dispatch pilot and we have

made slight amendments to the Nature of Call Red1 list to help improve our ability to identify and confirm the response requirement at the earliest point during the call

• In February NHS England have requested for SCAS to move to 240 seconds for Red2 Dispatch on Disposition, which is currently being reviewed internally on this likely change and timeline for this implementation will plan to take place during early April.

• The national expert clinical reference group have now signed off new clinical codes/categories (matching against AMPDS/NHS Pathways triage systems) in readiness for the next phase of the programme, with South Western & Yorkshire Ambulance Trusts operationally trialling the new code set from 5 April (over 3 month period).

• There will be a further clinical code review, post South West Ambulance Service & Yorkshire Ambulance Service trial, before the new code set is considered for rollout to other NHS Ambulance Trusts.

• AQIs are expected to be amended as programme changes. • The recently completed NARP online staff survey has been collated

and will be shared during March on staff feedback of the programme from trial sites.

12. Ambulance Review and Modelling 12.1 The Trust has recently commissioned Lightfoot Solutions, following a

competitive review bidding process to undertake an internal ambulance review modelling between February and April 2016 to support the organisation.

13. Progress against plan to date:

• SCAS have delivered data samples and produced a 3 year historic data

• Lightfoot are currently building the system • Lightfoot have completed Workshop B - there are a number of follow

on actions from the workshop highlighted: • EOC Visit completed for Bicester- 10th March Otterbourne site visit

arranged • Lightfoot are currently progressing with the system and ETL

infrastructure build – data delays not regular (daily) ETL being resolved

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• Lightfoot are currently working on the Baseline Analysis for Workshop A (first baseline playback and validation)

14. Next Steps:

• Lightfoot to produce Agenda for Workshop A for playback on 24 March

• SCAS to replace data for clear time for validation purposes 15. Key Risk:

• If data received from SCAS is not of sufficient quality to perform subsequent activities for playback – 3 year historical data being reviewed in readiness for presentations

CONCLUSIONS 16. Over the last month, demand levels have remained high during

February, which was higher than last year in Thames Valley and higher in SHIP and there were not sufficient resources to achieve the actual requirement in certain areas of Trust. In addition, we did also experience difficulties in achieving performance in some operational areas, with a noted increase in Hospital handover times which has in turn impacted heavily on our resource availability over recent weeks.

16.1 Work is continuing by a series of initiatives on how to best use and

plan our resources to better serve our patients, but there is a great deal to be done to return performance levels to national standards at this time.

RECOMMENDATIONS TO THE BOARD 17. To acknowledge the report and continue to support with actions which will

enable the Team to reduce frontline demand, increase resources, reduce hospital delays.

Mark Ainsworth/ Luci Stephens/ Steve West/ Rob Ellery/Phil Pimlott Senior Operations Team, On behalf of Will Hancock 23 March 2016

Agenda Item: 9b



Title Operational Performance Report – Patient Transport Services (PTS)

Responsible Director James Underhay, Director of Strategy, Business Development, Communications & Engagement.

Recommendation (eg. note, approve, endorse)

To note the content









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 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 Governors receive an update on operational performance at every meeting, and also receive the monthly Integrated Performance Report


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

Operational performance is discussed at every meeting


N/A

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OPERATIONAL PERFORMANCE REPORT (PTS)

PURPOSE 1 The purpose of the paper is to give the Board an overview of activity and

performance across the Trust’s Patient Transport Service (PTS) contracts. EXECUTIVE SUMMARY 2 Throughout the months of December and January the Directorate continued

to face sustained pressure with the continued over activity and significant demand to support discharges and high volumes of on the day requests. These pressures, coupled with the current staffing challenges, require specific focus on performance versus spend to ensure continued high patient experience.

3 Recruitment drives have continued but remain challenging. The proposal to

drop the requirement for a C1 driving licence has been formally agreed and rewording of advert completed, this change will mean that the volume of recruiting will increase significantly and our reputation as a modern employer of choice will be maintained. Other initiatives such as retainers, friend and family referrals and incentive schemes are being reviewed.

4 Mobilisation continues for Southampton, Isle of Wight and Portsmouth (SHIP)

phase 2, Oxford Health Foundation Trust (OHFT) PTS, OHFT Logistics and Thames Valley PTS contracts, project teams with work streams from all departments within SCAS are supporting and all go lives are as to plan.

5 A complete restructure of the Commercial Management team has

commenced and will go live from 1 April, the restructure will be fully interim and after 1st quarter post go live will be reviewed to then go through the full consultation process to become substantive.

Contracts Summary 6 Contact Centres

Lot 1 for SHIP continues to progress against the improvement plan using the Define, Measure, Analyse, Improve and Control (DMAIC) methodology. A meeting will be held on 31 March with SHIP CCG, which will be the first formal reporting on the Remedial Action Plan. Several actions have commenced: • Call Handler rota consultation commenced 26th January to ensure

staffing levels better meet demand. • GP Urgent telephony scripting removed from HCP telephone number,

PTS receiving GP urgent calls and transferring to front line.

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• On line training video and guide cascaded to Healthcare Professionals (HCPs) for our on line system.

• Additional on line trainer due to start in early February to support the promotion of our on line system and the roll out of ‘book ready’, Instant Message and expected time of arrival (ETA) functionality across all areas.

For the month of January the contact centre received 22872 calls and there was a 2.3% improvement in calls answered within Target from November, the call abandonment target improved by 4% between November and January.

7 SHIP Contract

Overall activity for January is 0.02% over indicative contracted activity including escorts and aborts and activity is 9.03% over indicative contracted activity excluding escorts and aborts in the month of January. 18237 patients were conveyed and 7595 were renal patients. SCAS has introduced a dedicated discharge dispatcher as part of the CQUIN and are in discussions with hospitals to introduce daily transport list to pharmacy to ensure that TTO’s (dispensed prescriptions) are ready in good time. This is due to being proven effective from a pilot with the Oxford University Hospitals Trust (OUH). A trial has begun of the 30 minute plan early initiative along with a dedicated lead for the roll out of auto plan to increase the efficiency and aim to increase performance. SCAS has in addition agreed with the Commissioners a 1500 cut of for pre-planned bookings to support management of activity. Work is being done with clinical commissioning groups (CCG’s) on enforcement of eligibility criteria with those placing bookings targeting inappropriate usage of the service.

8 Oxfordshire/Buckinghamshire CCG consortium

Activity has remained constant for Oxfordshire CCG (OCCG) and key performance indicators (KPI’s) remain amber and green, patients arrival time has increased by 2% against KPI but patient collection dropped by 1%, one of the factors of this drop is the increased portering times for patients across the hospital due to the new parking arrangements. SCAS are actively working with the OUH to address these parking and access issues. Pilots are being run with OCCG which will form part of the new contract mobilisations, these include the 30 minute early planning initiative, implementation of new rotas and the continuation of the daily list given to pharmacy at the OUH of patients due to be discharged on transport to ensure that TTO’s are ready in good time. SCAS has also implemented a working in partnership with Oxfordshire County Council (OCC) Integrated Transport utilising shared resources when OCC vehicles are not operational

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9 Oxford Health Foundation Trust (OHFT)

Performance for December/January has generally plateaued and maintained within amber and green, there has been a 0.5% drop on the KPI ‘Clients Journey Time’ and a 4% drop on clients arrival time. There are still ongoing issues and challenges around Oxford due to the traffic and major roadworks.

10 Milton Keynes (MK)

The MK contract which commenced in April 2015 is averaging 20% above indicative activity which is impacting on improvements in performance. Collection KPI has decreased by 4.5% against target since November and there has been a noticeable change of activity going to different treatment sites, with a requirement to travel greater distances. Due to the month on month activity increases, discussions about contractual management have continued. Focus has been on the management of ‘queue jumping’ which is where service users book ready a patient too early in the hope they get priority but then when crews arrive the patient is still not ready, the result is wasted resources and significant rescheduling activity.

Key Issues

11 Quality

SCAS Commercial Division (CD) has made significant leaps forward with its quality agenda during the 2015/16 financial year and 2016/17 brings with it further plans and opportunities to further improve patient safety, patient experience and our clinical effectiveness. Following the successful bid for the Thames Valley, this contract is being mobilised and has a ‘Go Live’ date of 1st April 2016. This new contract has streamlined a number of pre-existing contracts and is underpinned by the NHS Standard Contract which includes clear KPIs and a detailed information schedule, containing quality, safeguarding and Patient Experience (PE) elements. This contract is similar in structure and content to the ones already in use for the SHIP and Milton Keynes PTS areas. Frequent discussions with the quality leads for all three contracts have served to build close relationships and shared understandings of the quality agenda, which are reinforced at monthly Contract Review Meetings (CRMs). We were keen to implement this approach prior to the Thames Valley Contract going live, so in the latter half of 2015 single CRM meetings for Oxfordshire, Buckinghamshire and Berkshire have been introduced in order to establish expectations and reporting formats going forward with the Thames Valley launch. We are further improving quality reporting formats, quality schedule contents and processes. Negotiations for the Thames Valley information and quality schedules are nearing completion as are those for the SHIP area. Monthly and quarterly reporting against these contracts uses standardised templates which are very similar to those used elsewhere in SCAS, which ensures consistency of approach across SCAS services. Multiple action plans have guided the quality improvements within the CD during 2015/16, including those arising from the Trust Wide CQC action plan, the Internal PTS Review, quarterly inward delays audits, a medicines audit, an aborts review overseen by the Patient Experience Review Group, and a

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DoC case action plan. Works are ongoing and most outstanding actions have now been collated in to the PTS CQC Readiness action plan which is currently in progress. Positive improvements which have already been made in the last 12 months include:- • Delivery of a bespoke PTS 2 day face to face training course for all

staff incorporating safeguarding, the mental capacity act and incident reporting procedures as well as other statutory and mandatory training aspects.

• Design and implementation of a fully accredited course which will give

new Ambulance Care Assistants a recognised qualification through “Future Quals”.

• Engagement in a trust wide campaign approach which educates staff

in areas of strategic importance such as infection prevention, month on month.

• All staff have been offered a place on a modern apprenticeship

program to contribute to their continued professional development. • Implementation of central upload of training records. • Creation of a highlight report format to share patient survey results

with staff. • Training for all Team Leaders in infection control audits to ensure care

can be delivered in a safe environment. • New guidance on leaving patients unattended and oxygen

administration has been released so risk is minimised for all. • We have provided access to and training in the use of Pedimate child

restraint harnesses. • Creation of the post of Voluntary Car Driver (VCD) Co-Ordinator to

look after all aspects of VCD governance and welfare. • Introduction of the use of Qlikview for management to monitor KPI’s. • Information available to our patients on how to complain or make a

compliment has been revised & reprinted in postcard format available on all vehicles and the PTS area of the website has also been updated.

• A Clinical Governance Lead has been appointed to provide a link to

the Clinical Team and facilitate best practice sharing across services. • A vehicle handbook which gives staff access to all the vital information

they need in the field has been created and is now at the print stage. DATIX reporting has increased within the CD by 240% from calendar years 2014 to 2015, and safeguarding reporting has increased in the order of 600%.

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These numbers are enormously encouraging and directly reflect the impact of the face to face training that all PTS staff have benefitted from since April 2015. However we are not complacent and despite these improvements further work is required to bring PTS reporting levels in line with those of other SCAS services, and further staff communications around these processes will be under taken in 16/17.

12 Patient Experience

The Commercial Directorate has introduced a new role of Patient Experience manager, since going live with this role work is being undertaken to ensure the Directorate builds on its established processes regarding Compliments, Concerns and Complaints. We are moving to have service feedback collected in real time via Kiosks in the main Acute Trusts and tablets for the patient and customer facing SCAS staff. It has been recognised that we are experiencing survey fatigue with the free post surveys which have been live since quarter two in 2013, from the beginning the response rate was sitting at 82% and to date for quarter three 15-16 the response return rate is 5.4%. PTS have set a response rate of 15%. Whilst the implementation of the real time collection tools is in place there has been a new design of the paper freepost survey and this is now on all PTS resources and responses are being collected and collated for the end of quarter four.

13 New Contracts

Mobilisations have commenced for; • SHIP Phase 2 involving Hampshire Hospitals Transport element which

went live on 1 March 2016 for stage 1 and 1 August 2016 for stage 2. • OHFT PTS & Logistics with go live 1 April 2016. • Thames Valley PTS with go live 1 April 2016. A full project mobilisation team has been initiated with bi-weekly workstream reporting ramping up to weekly reporting from 01 February 2016. Mobilisation project managers and SCAS project SRO liaise and report progress to all relevant contracting authorities. All mobilisations have specific plans in place to ensure that the service provision is developed to meet the following requirements: • Changes in CCG priorities and patient demographics. • Health provision – both location and provision of services, increased

clinic hours and different locations closer to the patient that can interface with the hours of contracted PTS service.

• Local priorities. • Contractual requirements.

A communication and marketing plan individual to all mobilisations is in place to ensure that all stakeholders, users and staff are informed of changes and progress of the project at specific points. These plans take into consideration the need for varying go-live dates mobilising at different acute settings. All mobilisations are to plan but contracts have yet to be signed due to final detail agreements between SCAS and the Contracting authorities.

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This project has an Executive Sponsor appointed who chairs the Programme Board, which the project team reports into.

CONCLUSIONS 14 The Commercial Business Managers continue to work closely with all relevant

contracting authorities regarding current and future contract requirements with specific focus on activity management and quality of service.

15 Contract mobilisations continue as planned with new initiatives being piloted

and Community partnerships developed focusing on improving services for patients.

16 The Commercial Directorate continues its vision for modernised services

driven by a quality led service enhancing overall patient experience. RECOMMENDATIONS TO THE BOARD 17 To acknowledge the report and continue to support with actions which enable

the team to improve performance across all contract areas. James Underhay Director of Strategy, Business Development, Communications Engagement 8 March 2016 Author Paul Stevens Title Assistant Director Commercial Services Date 8 March 2016

Agenda item: 9c



Title Finance and Estates Report for the month ended 29 February 2016

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. Monitor provider licence and Continuity of Services risk ratings, CQC essential standards, competition law etc.)

The paper covers our Monitor financial risk rating – our current financial risk rating is a 2, which is below the plan.


The paper covers all aspects of our financial position (e.g. CIPs, FSRR 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


February 2016 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: Monitor Risk Assessment Framework http://www.monitor.gov.uk/raf

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

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FINANCE AND ESTATES REPORT FOR THE MONTH TO 29 FEBRUARY 2016

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; Monitor 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 £168k for the month

which was £73k above the forecast deficit for the month and the year to date

position is now £166k favourable to forecast. The main area of underspend

was corporate offset by emergency services including 111, commercial

division was slightly ahead of forecast.

3 Cash and capital - The Trust’s cash balance at the end of February was £21.4m which was £0.4m higher than the January forecast. Receipts were higher than the January forecast (£0.7m better) offset by higher payments which were £0.3m worse than forecast due principally to higher than planned payments on capital. The capital expenditure forecast has been reduced further and is now expected to be £6.3m at the year-end, which is a reduction of £0.4m on the level forecast in January. Year– end cash forecast has also been adjusted and re-set at £19.9m which is £0.3m higher than the level previous forecast. The 90 day debtor figure has increased in month and now stands at £157k, up £78k from the figure reported in January. This represents 6.79% of total sales debt.

4 Monitor financial risk rating – the Monitor Financial Sustainability Risk Rating

overall is 2. This comprises a capital service cover (debt interest cover) rating which is a 2, a liquidity rating is a 4, I&E Margin rating is a 1 and I&E Margin variance from plan rating, which is a 1 for February 2016.

5 Cost savings – overall the savings were £0.7m in the month against a plan of

£0.6m. The full year forecast has been revised to £6.4m, £0.4m below the original plan.

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INCOME AND EXPENDITURE

6 As can be seen from the table below, the Trust made a deficit of £168k in the

month which was £73k above forecast.

Income was £558k lower than forecast with £669k related to emergency services offset by £110k relating to commercial services. Overall costs were £631k below forecast. Non-emergency profitability was £22k above forecast for the month. The year to date position is a deficit of £3.3m with emergency services including 111 being £339k overspent offset by lower corporate spend £287k and commercial services at £219k above forecast year to date. The main reason behind the emergency services position was poor performance resulting in penalties in the 111 Service.

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

7 The Trust’s cash balance at the end of February was £21.4m, which was £0.4m above the January forecast. Receipts from sales income were £0.7m higher than anticipated due to delayed receipt of cash from the United Care Contract (£0.2m) which ceased recently and credit notes relating to penalties re A and E activity (£0.4m) which were expected to be deducted from SLA receipts in February but were not taken until March.

Actual Forecast Forecast

Variance

Budget Budget

Variance

Actual Forecast Forecast

Variance

Budget Budget

Variance

Forecast Budget

Profitability

SCAS Income £k 14,435 14,994 (558) 15,126 (691) 158,889 160,231 (1,342) 164,004 (5,115) 173,634 179,267

SCAS Contribution £k 2,684 2,871 (187) 3,058 (374) 27,734 27,855 (121) 33,130 (5,396) 30,575 36,338

% Contribution % 19% 19% (1%) 20% (2%) 17% 17% 0% 20% (3%) 18% 20%

Corporate overheads £k 2,853 3,112 259 3,051 198 31,029 31,315 286 33,047 2,018 34,274 36,238

EBITDA £k 709 562 147 789 (80) 5,107 4,913 194 8,663 (3,556) 5,575 9,457

EBITDA % % 4.9% 3.2% 2% 5% 3% 2.4% 1% 5% 3% 5%

Overall Surplus/(Deficit) £k (168) (241) 73 8 (176) (3,294) (3,460) 165 83 (3,377) (3,700) 100

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

Month Year to date Full Year

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8 The 90 day debtor figure has increased and now stands at £157k (up from £78k in January). This represents 6.79% of debt which is higher than the proportion of debt (3.73%) reported in January. A principal attributing factor for the increase in 90 day debtors was worsening of PTS ECR debts (£96k) and £61k A&E delays and Q1 CQUIN. There is a residual risk of debt moving to the 90 day category in March of £108k with £101k of this either received or committed to be received.

9 Cash amounts paid out were £0.3m lower than forecast due principally to

payments for the new ambulances. Capital expenditure to date of £4.9m (accruals basis) was lower than the previous months forecast expectations with some IT projects slipping to March. The year - end capital forecast has now been revised downwards to £6.3m which is £0.4m lower than the January forecast. This is as a result of slippage in some estate schemes and a reduction in forecast expenditure on some IT schemes.

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 2015/16

Appendix G – balance sheet and forecast to 31 May 2016

MONITOR FINANCIAL RISK RATING

11 The Monitor risk rating remains at a 2 this month following the changes to the

measure in August.

Actual Budget Variance Actual Budget Variance Forecast Budget Prior Year Variance

to

budget

Variance

to Prior

Year

Cash and capital position

EBITDA £k 680 788 (108) 4,397 7,874 (3,476) 5,519 9,457 10,680 (3,938) (5,161)

Working capital mov't £k (1,690) (565) (1,125) (2,776) (4,679) 1,903 (2,267) (4,411) 12,547 2,144 (14,814)

Capital Expenditure £k (211) (1,797) 1,586 (3,655) (6,747) 3,092 (7,470) (10,342) (10,483) 2,872 3,013

Disposals £k 0 300 (300) 12 300 (288) 12 300 954 (288) (942)

PDC paid £k 0 0 0 (754) (804) 50 (1,507) (1,607) (1,421) 100 (86)

Interest £k 6 3 3 (49) (88) 39 (67) (103) (18) 36 (49)

Repayments of loans £k 0 0 0 (1,569) (1,569) 0 (1,738) (1,738) (488) 0 (1,250)

Other £k (1) (2) 1 (1) (4) 3 0 0 0 0 0

PDC & DOH Loans £k 0 0 0 0 0 0 0 0 7,000 0 (7,000)

Cashflow £k (1,216) (1,273) 57 (4,395) (5,717) 1,323 (7,518) (8,444) 18,771 926 (26,289)

Cash balance £k 22,705 21,383 1,322 22,705 21,383 1,322 19,582 18,656 27,100 926 (7,518)



to

budget

Variance

to Prior

Year

Financial Risk Rating

Overall Score 2.0 4.0 -2.0 2.0 4.0 -2.0 2.0 4.0 4.0 -2.0 -2.0


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COST SAVINGS

12 As can be seen from the table below, overall the savings were £0.7m which

was £0.1m above plan in the month. The year-end position has now been revised to £6.4m as a result of some scheme underperformance and a shortfall in new schemes being identified.

0

Actual Budget Var Actual Budget Var Forecast Budget Var

Call Handler efficiency 6 6 0 45 45 0 51 51 0

Auto allocation 0 12 (12) 0 110 (110) 0 122 (122)

Fuel efficient vehicles 14 14 0 116 117 (1) 130 131 (1)

Medic Now Staff 12 14 (2) 96 135 (39) 104 149 (44)

Increase use of Volunteer Car Drivers 0 8 (8) 0 32 (32) 0 40 (40)

Replace short term hire vehicles 7 11 (5) 31 80 (49) 38 91 (53)

Replace Band 3 with Band 2 6 6 (1) 47 36 11 53 42 10

Fleet Spine Point 8 3 4 86 27 59 94 30 64

Rationalisation of private providers 33 14 19 266 112 154 292 126 166

ECR process review 1 1 0 9 9 0 10 10 0

CIPS relating to new MK contract. 0 6 (6) 5 63 (58) 5 69 (64)

Reduce private provider usage Oxford. 17 8 9 173 52 121 183 60 123

Reduction in Bucks private provider usage. 0 5 (5) 0 45 (45) 0 50 (50)

Wokingham Estate termination 1 0 1 2 0 2 3 0 3

PTS Meal Breaks 0 0 0 10 0 10 10 0 10

Increased Margin per journey 48 0 48 212 0 212 252 0 252

Subtotal Commercial Division 153 108 45 1,096 862 234 1,223 970 253

HCP Project 123 88 35 576 772 (197) 676 861 (185)

Specialist Para 0 17 (17) 20 95 (75) 43 116 (74)

Rota Review 60 60 0 580 580 0 640 640 0

Skill Stream 0 13 (13) 13 63 (50) 13 75 (63)

Sickness Management 0 21 (21) 0 229 (229) 0 250 (250)

Consumables Management 69 14 55 185 136 49 205 150 55

EPRF Benefits 20 20 1 180 180 (1) 200 200 0

Private Provider Rates 0 52 (52) 173 448 (275) 173 500 (327)

Fleet efficiencies 38 17 21 38 188 (150) 38 206 (167)

Private Providers Efficiency 10 8 2 90 92 (2) 100 100 0

Lost Unit Hours reduction 0 0 0 46 150 (104) 46 150 (104)

Reduction of time on scene 0 27 (27) 73 224 (151) 73 250 (177)

Indirect Unique contribution 89 57 32 764 441 323 844 498 346

Agency staff to Perm 4 4 (1) 41 46 (5) 45 50 (5)

Staff Retention attrition reduction 0 23 (23) 0 196 (196) 5 219 (214)

Private Provider Meal Breaks 53 29 24 558 370 187 608 400 208

Air Ambulance 0 2 (2) 0 18 (18) 0 19 (19)

Subtotal Frontline Ops 466 452 14 3,336 4,228 (892) 3,708 4,683 (975)

EOC Reduce Attrition 3 3 0 82 30 52 85 33 52

EOC Sickness Reduction 2 5 (2) 2 54 (51) 7 58 (52)

EOC Floorwalking 3 2 1 23 25 (1) 27 27 (0)

111 Virtualisation 0 0 0 416 359 57 416 359 57

111 Sickness reduction 4 5 (0) 22 49 (27) 28 55 (28)

111 Introduction of Health Advisors 5 5 0 59 59 0 65 65 0

111 Reduce Attrition 2 2 0 101 23 78 103 25 78

Senior Management Reduction 0 0 0 66 66 0 66 66 0

Subtotal EOC & 111 20 22 (2) 772 665 107 796 688 107

Ad Hoc Savings 2 0 2 32 19 13 36 19 16

Technology Scheme 2 2 0 12 13 (2) 14 16 (2)

Estates 7 9 (2) 61 83 (22) 75 92 (17)

PIT Cost Reductions 19 14 6 110 133 (22) 116 147 (30)

PIT Agency Fee Reductions 38 19 19 99 160 (61) 126 179 (53)

Increase Private Contributions 3 3 (0) 32 32 0 35 35 (0)

Communications 0 0 0 11 8 4 11 8 4

ICT Contract Cancellations 11 8 3 165 88 77 175 96 79

Subtotal Corporate 82 55 26 522 536 (14) 588 592 (4)

Target/(contingency) 0 (10 ) 0 0 (58 ) 0 100 (116 ) 216

Total 721 628 93 5,726 6,233 (508) 6,415 6,818 (403)

10.6% 9.2% 84.0% 91.4%

Month YTDProject Full Year

Co

mm

erc

ial

Div

isio

nC

orp

ora

teA

&E

EO

C &

111

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BUDGET SETTING AND APPROVAL

13 The Board will be considering and approving the detailed 2016-17 budget at

the private meeting, this will then be published at the May Board meeting.

The budget is based on meeting the Monitor control total of £1.9m deficit.

This is consistent with the approach agreed by the Board to return the Trust

to breakeven over a two year period.

Whilst the expenditure budget being proposed is confirmed, the income

budget remains the subject of negotiation with commissioner. The contract

income being sort from commissioners reflects the required service level,

acuity level and implementation of the revised Ambulance Quality Indicators.

CONCLUSIONS

14 Work will continue to carry out the actions to deliver our forecasted financial

plan as well as the cost improvement programme. Further work is on-going to

clarify the risks, particularly relating the cost of delivering operational

performance, and the action plan to improve the financial position.

RECOMMENDATIONS TO THE BOARD

15 The Board is asked to note the current financial position of the Trust, and the

risk that now exists in delivering the full year position.

Charles Porter Director of Finance

Actual Budget Variance Actual Budget Variance Forecast Budget Prior Year Variance to

budget

Variance to

Prior Year

Forecast

Sept 2015

Variance

to out-

turn

£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 14,435 15,126 (691) 158,889 164,004 (5,115) 173,632 179,267 172,324 (5,635) 1,309 179,267 (5,635)

Emergency Services (inc. 111)

Income 12,204 12,980 (776) 133,787 139,972 (6,185) 146,254 153,077 146,946 (6,823) (691) 148,533 (2,278)

Direct costs 9,742 10,113 371 108,616 109,194 578 118,472 119,295 117,413 823 (1,058) 120,277 1,805

Gross contribution 2,461 2,866 (405) 25,171 30,778 (5,607) 27,783 33,782 29,532 (6,000) (1,750) 28,256 (474)

20% 22% -2% 19% 22% -3% 19% 22% 20% 19%

Non-Emergency Services

Income 2,231 2,146 85 25,102 24,032 1,070 27,378 26,190 24,879 1,188 2,499 26,595 783

Direct costs 2,009 1,954 (55) 22,539 21,681 (859) 24,587 23,634 22,799 (953) (1,789) 24,039 (548)

Gross contribution 223 192 31 2,563 2,352 212 2,791 2,556 2,081 235 710 2,556 235

10% 9% 1% 10% 10% 0% 10% 10% 8% 10%

Contribution Operational Activities 2,684 3,058 (374) 27,734 33,130 (5,396) 30,573 36,338 31,613 (5,765) (1,040) 30,812 (239)

Central CostsClinical Services 254 292 38 2,975 3,187 212 3,244 3,479 2,696 234 (549) 3,321 77

Finance 276 256 (20) 2,823 2,864 40 3,112 3,120 3,067 8 (45) 3,040 (72)

Estates 349 401 52 4,203 4,321 118 4,601 4,722 4,145 121 (457) 4,573 (28)

IM&T 427 482 55 4,842 5,256 415 5,369 5,738 4,743 369 (626) 5,436 67

Human Resources 210 204 (6) 2,301 2,207 (94) 2,530 2,411 2,157 (119) (373) 2,579 49

Education Services 270 310 40 3,361 3,329 (32) 3,817 3,639 2,529 (178) (1,288) 3,658 (159)

Service Development 89 120 31 1,010 1,294 284 1,110 1,413 945 304 (164) 1,365 255

Communications & Public Engag't 38 41 3 453 460 7 492 500 458 8 (35) 505 13

Corporate 63 55 (8) 611 604 (7) 666 659 793 (7) 126 664 (2)

Other (contingency) (0) 110 110 53 949 896 58 1,199 1,623 1,141 424 196 138

Loss/(Profit) on disposal (2) 0 2 (14) 0 14 (14) 0 (178) 14 (178) (11) 4

Depreciation 746 637 (109) 6,974 7,010 36 7,720 7,647 7,298 (73) (349) 7,615 (105)

Financing Costs 132 143 11 1,439 1,568 129 1,569 1,710 1,289 141 (281) 1,571 2

Total overhead costs 2,853 3,051 198 31,029 33,047 2,018 34,274 36,238 31,562 1,962 (3,794) 34,511 237

Net surplus/(deficit) (168) 8 (176) (3,294) 83 (3,377) (3,702) 100 51 (3,802) (3,753) (3,700) (2)

Discontinued Operations 0 0 0 0 0 0 2,500 0 2,496 0 0 1,500 1,000

Surplus/(deficit) for the year (168) 8 (176) (3,294) 83 (3,377) (1,202) 100 2,547 (3,802) (3,753) (2,200) 998

Memo:

Depreciation 746 637 (109) 6,974 7,010 36 7,720 7,647 7,298 (73) (422)

Public dividend capital 125 134 8 1,382 1,473 92 1,507 1,607 1,243 100 (264)

Net interest payable 8 10 2 60 97 37 62 103 49 41 (14)

Profit on disposal 2 0 (2) 14 0 (14) 14 0 178 (14) (164)

EBITDA 709 789 (80) 5,107 8,663 (3,556) 8,073 9,457 10,958 (1,384) (2,885)

% 4.9% 5.2% 3.2% 5.3% 4.6% 5.3% 6.4%

South Central Ambulance Service NHS Foundation Trust (Appendix A1)

Financial results for Month 11 ended 29 February 2016


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 43,214 44,201 (988) 42,999 44,428 (1,428) 43,749 45,177 (1,428) 43,670 45,462 (1,791) 173,632 179,267 (5,635)

Emergency ServicesIncome 36,317 37,549 (1,232) 36,156 37,781 (1,625) 36,826 38,732 (1,906) 36,955 39,015 (2,060) 146,254 153,077 (6,822)

Direct costs 29,603 29,520 (83) 29,833 29,685 (148) 29,671 29,828 156 29,364 30,262 898 118,472 119,295 823

Gross contribution 6,713 8,029 (1,316) 6,323 8,095 (1,773) 7,155 8,904 (1,749) 7,592 8,753 (1,162) 27,783 33,782 (5,999)

18.5% 21.4% 17.5% 21.4% 19.4% 23.0% 20.5% 22.4% 19.0% 22.1%


Income 6,897 6,652 245 6,843 6,647 196 6,923 6,445 478 6,715 6,446 269 27,378 26,190 1,187

Direct costs 6,371 5,956 (414) 6,060 5,955 (105) 6,153 5,862 (291) 6,004 5,862 (142) 24,587 23,634 (953)

Gross contribution 526 696 (170) 783 692 91 770 583 187 711 585 126 2,791 2,556 2357.6% 10.5% 11.4% 10.4% 11.1% 9.0% 10.6% 9.1% 10.2% 9.8%

Contribution Operational Activities 7,239 8,725 (1,486) 7,106 8,788 (1,682) 7,925 9,487 (1,562) 8,303 9,338 (1,035) 30,573 36,338 (5,765)

Central Costs (inc op overheads)0

Clinical Services 820 851 31 809 876 67 833 876 43 782 876 94 3,244 3,479 234Finance 786 809 23 748 714 (34) 636 678 42 741 718 (24) 2,912 2,920 8

Estates 1,076 1,174 98 1,128 1,174 46 1,276 1,171 (105) 1,121 1,203 83 4,601 4,722 121

IM&T 1,249 1,424 175 1,335 1,430 95 1,323 1,439 116 1,462 1,446 (16) 5,369 5,738 370

Transformation & OD 1,745 1,786 41 1,832 1,889 57 1,892 1,885 (7) 1,988 1,903 (85) 7,456 7,463 7

Communications & Public Engag't 129 122 (7) 124 122 (2) 122 135 13 117 122 4 492 500 8

Corporate 148 161 13 166 166 0 171 166 (5) 181 166 (15) 666 659 (7)

Contingency 41 (0) (41) 6 (0) (6) 6 719 713 5 480 475 58 1,199 1,141

Loss/(Profit) on disposal (7) 0 7 (4) 0 4 (2) 0 2 (2) 0 2 (14) 0 14Depreciation 1,746 1,912 165 1,844 1,912 68 1,924 1,912 (12) 2,206 1,912 (295) 7,720 7,647 (73)

PDC 402 402 0 352 402 49 377 402 25 377 402 25 1,507 1,607 100

Interest 13 26 13 11 26 15 20 26 6 18 26 8 62 103 41

Injury benefit 50 50 0 50 50 0 50 50 0 50 50 0 200 200 0

Total overhead costs 8,199 8,716 518 8,400 8,760 360 8,629 9,459 830 9,046 9,303 257 34,274 36,238 1,964

Net surplus (959) 9 (968) (1,294) 28 (1,322) (704) 28 (732) (743) 36 (779) (3,700) 100 3,800

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 Services

E&U Contract 2013/2014 10,834 11,093 (259) 113,262 118,184 (4,922) 124,281 129,232 119,821 (4,952) 4,460

HART income 262 258 4 2,881 2,842 39 3,143 3,100 3,114 43 29

111 Service 830 1,490 (660) 14,392 16,467 (2,075) 15,192 18,038 16,132 (2,846) (940)

Public Events 36 18 17 322 202 120 351 220 302 131 49

CBRN/Flu funding 0 26 (26) 314 288 26 314 314 352 0 (38)

RTA Recoveries 32 42 (9) 429 458 (29) 500 500 556 0 (56)

Training funding from Health Education England 155 38 117 1,575 1,373 202 1,819 1,500 2,079 319 (260)

Workshop Income 4 1 4 22 7 15 24 7 21 16 3

Other Income 79 42 37 897 458 438 967 500 5,402 467 (4,436)

AfC Transfer (28) (28) 0 (308) (308) 0 (336) (336) (336) 0 0

Total Emergency Services 12,204 12,980 (776) 133,787 139,972 (6,185) 146,254 153,077 147,444 (6,823) (1,190)


PTS Hampshire 817 788 29 9,063 8,671 392 9,863 9,459 6,836 404 3,027

PTS Berkshire 375 381 (6) 4,499 4,188 310 4,863 4,569 4,572 294 292

PTS Ox 412 404 8 4,660 4,448 212 5,096 4,852 5,231 244 (135)

PTS Bucks 293 269 24 3,053 2,962 91 3,333 3,231 4,493 102 (1,160)

PTS MK 71 57 13 706 630 76 765 687 0 78 765

Logistic Services - Berkshire 80 61 19 1,159 1,098 61 1,321 1,159 1,535 162 (215)

Logistic Services - Ox & Bucks 91 88 3 1,054 997 57 1,145 1,085 1,125 60 21

Commercial Training 39 44 (5) 334 450 (117) 365 506 397 (141) (32)

TVEA 24 25 (1) 267 280 (13) 292 306 356 (14) (64)AfC Transfer 28 28 0 308 308 0 336 336 336 0 0

Total Non-Emergency Services 2,231 2,146 85 25,102 24,032 1,070 27,378 26,190 24,880 1,188 2,498

Total income 14,435 15,126 (691) 158,889 164,004 (5,115) 173,632 179,267 172,324 (5,635) 1,308

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-16 Feb-16 Feb-16 YTD YTD YTD Full Yr Full Yr Full Yr

+/(-) +/(-)

Activity

- % inc above prior year 16.1% 6.0% 10.1% 3.1% 6.0% (2.9%) 3.8% 6.0% 5.4%

- income from growth (£k) 675 231 445 (312) 3,305 (3,617) 258 3,588 2,268

Delays at hospitals

- income from delays (£k) 157 68 89 599 663 (63) 700 700 1,285

CQUINN (Clincal Quality Incentive)

- Potential income (54) 224 (278) 1,799 2,461 (662) 1,800 2,685 2,766

- Contingency/Other 0 0 (548)

Subtotal CQUINN (54) 224 (278) 1,799 2,461 (662) 1,800 2,685 2,218

Total income from activity related measures 778 523 256 2,086 6,429 (4,343) 2,758 6,973 5,771

Actual Budget Variance Actual Budget Variance Forecast Budget Prior year

Key Operational Spend (£k) Feb-16 Feb-16 Feb-16 YTD YTD YTD Full Yr Full Yr Full Yr

+/(-) +/(-)

Overtime

- A&E - North 166 102 (63) 2,274 1,122 (1,152) 2,472 1,224 2,466

- A&E - South 143 83 (60) 1,864 918 (945) 2,024 1,002 2,022

- A&E - Control 48 24 (24) 683 264 (419) 745 288 603

- A&E - Comm Resp/Emer Plan/Fleet 30 24 (5) 373 267 (106) 399 291 503

- Commercial Division - PTS 28 33 5 330 367 37 360 400 470

- Commercial Division - non-PTS 3 3 (1) 38 30 (8) 42 33 74 - Other 59 69 (2) 834 788 (46) 910 857 1,224

Total Overtime 478 339 (151) 6,395 3,756 (2,639) 6,952 4,095 7,362

Private Providers

- A&E - North 772 513 (259) 8,842 6,120 (2,722) 9,747 6,633 7,831

- A&E - South 281 108 (173) 2,477 1,283 (1,194) 2,972 1,390 4,461

- PTS 490 323 (167) 5,804 3,550 (2,254) 6,335 3,873 5,644Total private providers 1,542 944 (598) 17,123 10,952 (6,170) 19,054 11,896 17,936

Fuel

- A&E 220 295 75 2,782 3,244 462 3,055 3,539 3,495

- Commercial Services 68 101 33 888 1,109 221 966 1,209 902

- Fleet central 0 0 0 40 1 (39) 40 1 -2

- Other 22 36 15 350 401 50 382 437 368

Total fuel 309 432 123 4,060 4,754 694 4,444 5,186 4,764

South Central Ambulance Service NHS Foundation Trust

Monitor Financial Risk Rating Actual Budget Variance Actual Budget Variance Forecast Budget Variance

Capital Service Cover 2 4 -2 2 4 -2 2 4 -2

Liquidity 4 4 0 4 4 0 4 4 0

I&E Margin 1 3 -2 1 3 -2 1 3 -2

I&E Margin Variance From Plan 1 3 -2 1 3 -2 1 3 -2

2 4 -2 2 4 -2 2 4 -2

Feb-16 Jan-16 Dec-15 Last Year

YTD YTD YTD Full year

Better payment practice target

- Non-NHS by number 83% 81% 82% 88%

- Non-NHS by £ value 91% 91% 94% 93%

- NHS by number 89% 84% 84% 87%

- NHS by £ value 93% 98% 95% 93%

Debtors > 90 days (£k) 157 78 128 173

As % of total debts 6.8% 3.7% 6.5% 3.3%

% cost improvements secured (actual) 84.0% 73.4% 63.9% 102%

% cost improvements secured (plan) 91.4% 82.1% 72.7% 100%

Overall (Financial Sustainability Risk Rating)

Appendix D

Comments

Feb-16 YTD Full Year

Nil of note

The debtor figure is mostly comprise of PTS ECR debt and is being chased by business manager

£591k behind plan and full year position is liklely to be £400k behind plan

South Central Ambulance Service NHS Foundation TrustAppendix E

11/03/2016 20:58

CASHFLOW Q1 Q1 Q1 Q2 Q2 Q2 Oct-15 Nov-15 Dec-15 Q3 Q3 Q3 Jan-16 Feb-16 Mar-16 Q4 Q4 Q4

2015-16 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Actl Budget Variance Actl Budget Variance Actl Actl Actl Actl Budget Variance Actl Actl Fcst Fcst Budget Variance

Income

SL Receipts 43,701 42,243 1,458 85,962 86,660 (698) 13,996 15,199 15,555 130,712 131,949 (1,237) 13,495 14,912 14,500 173,619 178,552 (4,933)

Fixed Asset Receipts 7 0 7 11 0 11 0 0 0 11 0 11 0 2 1 14 300 (286)

Interest 13 9 4 31 18 13 6 6 6 49 27 22 6 5 6 66 36 30

Capital Loan From HA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Other Income/PDC/VAT/RTA 763 1,125 (362) 1,754 2,250 (496) 638 464 387 3,243 3,375 (132) 272 384 500 4,399 4,500 (101)

Other - NHSD 46 0 46 198 0 198 1 1 3 203 0 203 1 0 1 205 0 205

Total Cash In 44,530 43,377 1,153 87,956 88,928 (972) 14,641 15,670 15,951 134,218 135,351 (1,133) 13,774 15,303 15,008 178,303 183,388 (5,085)

Expenditure

Pay expenditure 25,950 27,279 1,329 51,868 56,108 4,240 8,595 8,678 8,867 78,008 85,538 7,530 8,775 8,717 8,750 104,250 115,317 (11,067)

Non Pay expenditure 16,834 14,841 (1,993) 34,463 29,681 (4,782) 7,614 5,783 5,245 53,105 44,322 (8,783) 6,004 5,335 5,543 69,987 59,363 10,624

Capital expenditure 1,730 1,152 (578) 1,886 2,544 658 1,090 140 325 3,441 4,950 1,509 211 2,582 1,236 7,470 10,342 (2,872)

Dividends on PDC 0 0 0 754 804 50 0 0 0 754 804 50 0 0 753 1,507 1,607 (100)

Loan Repayment 700 700 0 869 869 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

Interest on DH Loans 44 44 0 68 71 3 0 47 0 115 118 3 0 0 21 136 139 (3)

Other expenditure NHSD 172 832 660 347 1,663 1,316 0 0 58 405 2,495 2,090 0 0 0 405 3,326 (2,921)

Total Cash Out 45,430 44,848 (582) 90,255 91,740 1,485 17,299 15,348 14,495 137,397 139,795 2,398 14,990 16,634 16,472 185,493 191,832 (6,339)

Net Cash In/(Out) (900) (1,471) 571 (2,299) (2,813) 514 (2,658) 322 1,456 (3,179) (4,444) 1,265 (1,216) (1,331) (1,464) (7,190) (8,444) 1,254

Balance B/fwd 27,100 27,100 0 27,100 27,100 0 24,801 22,143 22,465 27,100 27,100 0 23,921 22,705 21,374 27,100 27,100 0

Balance C/fwd 26,200 25,629 571 24,801 24,287 514 22,143 22,465 23,921 23,921 22,656 1,265 22,705 21,374 19,910 19,910 18,656 1,254

CASHFLOW Q1 Q1 Q1 Q2 Q2 Q2 Oct-15 Nov-15 Dec-15 Q3 Q3 Q3 Jan-16 Feb-16 Mar-16 Q4 Budget Q4

RECONCILIATION Actl Budget Variance Actl Budget Variance £000 £000 £000 Actl Budget Variance £000 £000 £000 Actl £000 Variance

EBIT (551) 437 (988) (1,487) 893 (2,380) (1,555) (1,624) (1,796) (1,796) 1,348 (3,144) (1,832) (1,870) (2,145) (2,145) 1,810 (3,955)

Depreciation & Amortisation 1,746 1,912 (166) 3,590 3,824 (234) 4,213 4,843 5,514 5,514 5,735 (221) 6,228 6,974 7,720 7,720 7,647 73

Other Gain/(Loss) 0 0 0

EBITDA 1,195 2,349 (1,154) 2,103 4,717 (2,614) 2,658 3,219 3,718 3,718 7,083 (3,365) 4,396 5,104 5,575 5,575 9,457 (3,882)

Stock (Inc)/dec 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Debtors (Inc)/dec (1,732) (1,214) (518) (1,276) (1,408) 132 (2,818) (2,680) (744) (744) (1,508) 764 (2,559) (1,825) (1,367) (1,367) 573 (1,940)

Creditors Inc/(dec) 2,474 25 2,449 938 (364) 1,302 370 909 375 375 (384) 759 569 509 413 413 1,250 (837)

Provisions Inc/(dec) (394) (744) 350 (543) (1,488) 945 (557) (591) (717) (717) (2,222) 1,505 (786) (921) (1,043) (1,043) (6,234) 5,191

Capital expenditure (1,729) (1,152) (577) (1,885) (2,544) 659 (2,975) (3,115) (3,444) (3,444) (4,950) 1,506 (3,655) (6,237) (7,470) (7,470) (10,342) 2,872

Capital disposals 7 0 7 11 0 11 12 12 12 12 0 12 12 14 15 15 300 (285)

Free Cashflow pre finance (179) (736) 557 (652) (1,087) 435 (3,310) (2,246) (800) (800) (1,981) 1,181 (2,023) (3,356) (3,877) (3,877) (4,996) 1,118

Interest (21) (35) 14 (24) (53) 29 (24) (66) (56) (56) (91) 35 (49) (47) (68) (68) (103) 35

Dividends on PDC 0 0 0 (754) (804) 50 (754) (754) (754) (754) (804) 50 (754) (754) (1,507) (1,507) (1,607) 100

Free Cashflow (200) (771) 571 (1,430) (1,944) 514 (4,088) (3,066) (1,610) (1,610) (2,875) 1,265 (2,826) (4,157) (5,452) (5,452) (6,706) 1,253

PDC Payment/(Repayment) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Loan repayments (700) (700) 0 (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

Capital Loan from DH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Net Cash In/(Out) (900) (1,471) 571 (2,299) (2,813) 514 (4,957) (4,635) (3,179) (3,179) (4,444) 1,265 (4,395) (5,726) (7,190) (7,190) (8,444) 1,253

CASHFLOW Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Q4

2016-17 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget

Income

SL Receipts 14,265 14,948 14,525 15,152 14,499 14,651 15,093 15,253 15,265 14,443 14,387 14,454 176,936

Fixed Asset Receipts 0 0 0 0 0 0 0 0 0 0 0 0 0

Interest 6 6 6 6 6 6 6 6 6 6 6 6 72

Capital Loan From HA 0 0 0 0 0 0 0 0 0 0 0 0 0

Other Income/PDC/VAT/RTA 375 375 375 375 375 375 375 375 375 375 375 375 4,500

Other - NHSD 0 0 0 0 0 0 0 0 0 0 0 0 0

Total Cash In 14,646 15,329 14,906 15,533 14,880 15,032 15,474 15,634 15,646 14,824 14,768 14,835 181,508

Expenditure

Pay expenditure 9,451 9,501 9,507 9,538 9,630 9,708 9,818 9,905 9,898 9,912 10,001 9,988 116,858

Non Pay expenditure 4,690 4,540 5,142 4,587 4,342 4,771 4,559 5,004 5,125 4,262 4,279 4,188 55,489

Capital expenditure 1,190 1,028 1,098 762 794 307 127 1,122 1,167 1,087 257 72 9,011

Dividends on PDC 0 0 0 0 0 754 0 0 0 0 0 753 1,507

Loan Repayment 0 700 0 0 0 169 0 700 0 0 0 169 1,738

Working Capital Loan 0 0 0 0 0 0 0 0 0 0 0 0 0

Interest on DH Loans 0 44 0 0 0 22 0 47 0 0 0 19 132

Other expenditure NHSD 0 0 0 0 0 0 0 0 0 0 0 0 0

Total Cash Out 15,331 15,812 15,747 14,887 14,766 15,732 14,503 16,778 16,190 15,261 14,537 15,190 184,735

Net Cash In/(Out) (685) (483) (841) 646 114 (699) 971 (1,144) (544) (437) 231 (354) (3,226)

Balance B/fwd 19,910 19,225 18,742 17,901 18,547 18,661 17,961 18,932 17,788 17,244 16,807 17,038 19,910

Balance C/fwd 19,225 18,742 17,901 18,547 18,661 17,961 18,932 17,788 17,244 16,807 17,038 16,684 16,684

CASHFLOW Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Q4

RECONCILIATION £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 Budget

EBIT (27) (54) (81) (108) (135) (162) (189) (216) (243) (270) (297) (325) (325)

Depreciation & Amortisation 666 1,332 1,998 2,665 3,332 3,999 4,665 5,331 5,997 6,664 7,340 8,000 8,000

Other Gain/(Loss) 0

EBITDA 639 1,278 1,917 2,557 3,197 3,837 4,476 5,115 5,754 6,394 7,043 7,675 7,675

0

Stock (Inc)/dec 0 0 0 0 0 0 0

Debtors (Inc)/dec (177) 198 198 798 948 948 1,288 1,523 1,613 1,653 1,673 1,503 1,503

Creditors Inc/(dec) 76 384 35 236 387 333 484 369 296 298 151 380 380

Provisions Inc/(dec) (39) (78) (117) (156) (195) (234) (273) (312) (351) (390) (429) (468) (468)

Capital expenditure (1,190) (2,218) (3,316) (4,078) (4,872) (5,179) (5,306) (6,428) (7,595) (8,682) (8,939) (9,011) (9,011)

Capital disposals 0 0 0 0 0 0 0 0 0 0 0 0 0

Free Cashflow pre finance (691) (436) (1,283) (643) (535) (295) 669 267 (283) (727) (501) 79 79

Interest 6 (32) (26) (20) (14) (30) (24) (65) (59) (53) (47) (60) (60)

Dividends on PDC 0 0 0 0 0 (754) (754) (754) (754) (754) (754) (1,507) (1,507)

Free Cashflow (685) (468) (1,309) (663) (549) (1,079) (109) (552) (1,096) (1,534) (1,302) (1,488) (1,488)

PDC Payment/(Repayment) 0 0 0 0 0 0 0 0 0 0 0 0 0

Loan repayments 0 (700) (700) (700) (700) (869) (869) (1,569) (1,569) (1,569) (1,569) (1,738) (1,738)

Lease Borrowings 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

Net Cash In/(Out) (685) (1,168) (2,009) (1,363) (1,249) (1,948) (978) (2,121) (2,665) (3,103) (2,871) (3,226) (3,226)

SOUTH CENTRAL AMBULANCE NHS

FOUNDATION TRUST Appendix F

Capital resources available F1 Budget Exp summary F1 Budget

CAPITAL EXPENDITURE 2015/16 Core Depreciation 6,279 7,647 Clinical

Disposal Receipts 300 Estates 631 2,045

For the period to Available Surplus Operations 1,041 1,082

31 March 2016 Capital loan 2,395 Fleet 2,788 5,240

Total capital resources available 6,279 10,342 IT 1,749 2,775

Contingency 70 -800

Shortfall to be financed 0 0 Total 6,279 10,342

Actual/Forecast Spend Profile

Scheme Description Budget April May June July August September October November December January February March Total

Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Fcst Fcst

£000

ESTATES

Adderbury Drain Upgrade 7 0

Andover Drain Works 8 8 8

Basingstoke Additional Parking 30 0

Basingstoke Ambirad 20 20 20

Bletchley PTS Office 10 0

Bracknell Heating Upgrade 30 0

Commercial Training New Roof 18 18 18

Gosport ASAP Fit Out 9 3 2 1 4 10

High Wycombe Kitchen 8 0

High Wycombe Garage Roof Repairs 9 15 15

Newbury RC - Conversion of Locker Room 20 0

Northern House Roof Upgrade 50 18 1 3 22

Northern House Air Con Replacement Phase 1 120 25 30 55

Northern House Condensers 31 31

Northern House New Chairs 111 7 1 27 28

Nursling Station Upgrade 20 6 14 20

Nursling New Store Room 7 7 7

Oxford City RC - Replace Ambirad Workshop 20 6 6

Oxford City RC - Workshop Office Upgrade 8 23 29 52

Portsmouth - Roof Upgrade/pigeon prevention 14 0

Ringwood - external upgrade 10 0

SEHRC - Roof Improvements 40 0

Southern House Air Con Upgrade 70 0

Southern House - Disabled Kitchen Upgrade 7 3 3 6

Southern House - Reinforced Door 30 0

Stoke Mandeville - Replace Drain and Barrier Installation 40 0

Whitchurch - Drain Upgrade in Car Park 6 6 6

HART Additional Car Parking 25 0

HART - fit ambirads 15 15 15

Hants All stations 40 Chairs 11 11 11

New Education Facility - Bone Lane 150 1 31 32

SHIP PTS Phase 2 - New building 150 1 1 21 82 105

MK PTS -New offices 6 0

New ASAPs Milton Keynes 70 4 19 13 2 -23 15

Slough ASAP 72 72

SH Accomodation 1,000 3 50 24 77

OPERATIONS

Zoll defibs x64 950 950 950

Fuel Monitoring 50 0

Vehicle Lifts 66 33 33

Bespoke Safes 16 0

HART Generator 8 8

EOC Upgrade chairs/Wallboard 16 24 40

NH Restroom 10 10

FLEET 0

Front Line Ambulances 4,386 20 35 16 41 24 1,369 1,066 184 2,755

Mid Term Refurb 250 0

Vehicle Attrition 265 0

Recovery Vehicles 167 0

Workshop Vans 67 0

Support Services Van 55 0

Training Vehicles 50 0

Corsas x 6 18 18

Ex Lease Volvo 15 15

INFORMATION TECHNOLOGY

DS2000 275 6 1 36 41 1 9 74 85 253

Vehicle WIFI 98 0

Mast Strengthening 45 3 19 4 26

Cybertech Active 70 0

Back up Server system 300 1 84 198 283

Network Infrastructure - Virtualisation 350 64 119 2 2 202 389

Blade Server Replacement 200 141 141

Power Supply 10 20 30

Fat Pipe upgrade 9 13 22

Station Infrastructure 38 36 6 5 1 86

Otterbourne re-cabling 21 4 1 26

ICT Licensing 200 0

CAD Modifications - Pathways 225 9 4 50 63

CAD - Intergraph Developments 2 19 10 4 38 73

Remote Desktops - Tablet Trial 80 8 2 2 1 13

Resilient Vehicle Comms 50 0

Digital Voice Recording 94 94 94

Business Intelligence Proposal 238 180 1 1 27 85 -101 20 213

Network Security - Server Backup 250 0

Media Information System 2 2

Orkos Medicine Management System 33 33

GRS 2 2

Email 300 0

Contingency 0

General (800) 70 70

TOTAL PROGRAMME 10,342 47 250 65 10 112 994 126 94 463 1,332 1,401 1,385 6,279

Appendix G

BALANCE SHEET Actual Actual Forecast

As at Feb 16 As at Feb 16 As at 31 Mch 15 As at 31 Mch 16

(£k) (£k) (£k)

FIXED ASSETS

Property, Plan & Equipment 66,192 68,424 66,268

Intangible assets 3,476 3,324 4,031

69,668 71,748 70,299

CURRENT ASSETS

Stocks & Work In Progress 947 946 947

Assets held for resale 2,950 2,950 2,950

Sales Ledger Debtors 2,004 2,380 2,025Prepayments & Accrued Income 7,070 5,829 6,820

Other Debtors 1,334 359 1,090

Trade & Other Receivables 10,408 8,568 9,935

Cash and cash equivalents 21,374 27,100 19,910

TOTAL CURRENT ASSETS 35,679 39,564 33,742

CREDITORSPurchase Ledger Creditors (1,772) (1,115) (1,226)

Accruals & deferred income (9,380) (9,361) (9,565)Other Creditors Incl Pensions, PAYE & NI (4,158) (3,695) (3,793)

Capital Accruals (495) (1,803) (612)

Borrowings < 1 year (1,569) (1,738) (1,738)

Provisions < 1 year (5,363) (6,234) (3,691)

CURRENT LIABILITIES (22,737) (23,946) (20,625)

NET CURRENT ASSETS/(LIABILITIES) 12,942 15,618 13,117

TOTAL ASSETS LESS CURRENT LIABILITIES 82,610 87,366 83,416

Borrowings (5,216) (6,616) (4,878)

Provisions (9,426) (9,476) (8,476)

Other Financial Liabilities (18) (30) (18)

Non-Current Liabilities (14,660) (16,122) (13,372)

TOTAL ASSETS EMPLOYED 67,950 71,244 70,044

FINANCED BY:

TAXPAYER'S EQUITY

Public Dividend Capital (57,874) (57,874) (57,874)

Revaluation Reserve (11,061) (11,061) (11,061)

Other Reserve 350 350 350

Govt Grant Reserve- bfwd

Retained Earnings (2,659) (2,659) (2,659)

I & E YTD 3,294 0 1,200

TOTAL TAXPAYERS EQUITY (67,950) (71,244) (70,044)

Adjusted net current assets/liabilities for Liquidity 9,045 11,722 9,220

South Central Ambulance Service NHS Foundation Trust

Agenda Item: 10



Title Operational Plan 2016-17

Responsible Director James Underhay, Director of Strategy, Business Development, Communications and Engagement

Recommendation (eg. note, approve, endorse) To approve the Operational Plan for 2016-17 (public version)











The annual planning process is set jointly by Monitor and NHS England. All Foundation Trusts are required to comply with this process.


There are no direct financial implications of the process. The annual planning process includes a review of the Trust’s financial performance, sustainability, resilience and plans for future years.


High level plans have been reviewed with the Council of Governors, as the initial stage in this process.


The annual planning process includes a review of the Trust’s performance, sustainability, resilience and plans for future years, both in terms of service delivery to patients and workforce.

Other


Annual planning review - process and timetable - January 2016 Discussion at Board seminar - February 2016


Technical guidance published by Monitor in December 2015 and January 2016.

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OPERATIONAL PLAN 2016/17

PURPOSE 1 The public-facing version of the Operational Plan for 2016-17 is attached. The

Board of Directors is asked to review and approve this plan. EXECUTIVE SUMMARY 2 NHS England, Monitor and the Trust Development Agency have jointly issued

guidance on the 2016 Annual Planning Review process and timetable. 3 All Foundation Trusts are required to prepare three sets of plans:

• Trust Operational Plan for 2016-17 • System Sustainability and Transformation Plan for 2016-21 • Trust Strategic Plan (5 years)

Similar is required of all non-FT provider organisations.

4 The requirements and timetable were set out in the papers for the Public

Board meeting on 27 January 2016. KEY ISSUES 5 This plan has been drafted to respond to the points identified in the guidance

issued by Monitor.

6 This plan is consistent with previous strategic and operational plans. 7 The timetable expects us to incorporate activity, finances and system-wide

plans ahead of the information being available. These sections are not covered in the attached plan.

8 Monitor have been reviewing organisational plans to check that plans are consistent in terms of internal activity, capacity, performance, finance and workforce planning, and also commissioning expectations and planning by key partners.

9 SCAS has not been offered any feedback or requests for changes following this Monitor review process.

10 The final version must be submitted to Monitor by 11 April 2016.

11 Monitor will also review any significant variances between the draft and final

submissions, as this has been identified as potential indicator of poor governance.

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RECOMMENDATIONS TO THE BOARD 12 To review and approve the plan. 13 To note that a fuller confidential version of the plan, incorporating best

estimates of financial, activity and capacity modelling, will be prepared by early April. This version needs to be submitted to Monitor by 11 April 2016.

Isobel Wroe Assistant Director – Strategy & Service Development 10 March 2016

SCAS OPERATIONAL PLAN 2016-17

1 ACTIVITY PLANNING

1.1 Overview of SCAS services

SCAS offers a range of services, with contracts across a number of care systems:

1.2 Assessment of activity in 2016-17

1.2.1 Service Growth assumption Notes

999 Incidents 2.4% in total incidents

Increased acuity experienced in 2015-16, with growth of 7-8% in red demand but reduced proportion of green calls

999 Hear and Treat Increase from 9.4% to 10.6%

999 Emergency Responses

Zero growth 2016-17

3% growth thereafter

NHS111 services

3% each year

Assume contracts renewed Most capable provider assessment during 2016-17 for the Thames Valley Services

Patient Transport Services

Zero growth in existing PTS

New contracts mobilising 16-17

Assume new contract 2018-19

We will mobilise a new contract in 2016-17 in North Hampshire. This is equivalent to about 30% increase in activity for Hampshire, with activity previously delivered by a competitor.

Commercial Training Plan does not assume growth Review of existing contract to be

undertaken during 2016-17

SCAS Operational Plan 2016-17

Item 10 - Operational Plan 2016-17 p.2/15

Healthcare Logistics About 20% reduction in activity

Berkshire has taken their logistics and pathology services in house. This will reduce our activity by about 20% and involve TUPE of some SCAS staff to the new organisation.

Clinical Hub Services

Assume OneCall will not continue No activity for OneCall after 31 March 2016

Plan assumes that the national pandemic flu service continues

1.2.2 Lessons learned from previous years

The growth for 999 incidents in 2015-16 is flat, compared to a 6% assumption in our plan. The main item of difference is the impact of 111 transfers to 999. The prior year comparative was high in the early part of the year. This year, we have carried out a more detailed modelling exercise, looking at historic trends and different types of activity, for each geographic area.

1.2.3 Changing patterns of demand

Red demand (life-threatening) continue to grow at about 7-8%. However green 999 demand (non-life threatening) appears to be flattening, with callers potentially moving to NHS111 instead. This has the effect of rising acuity for our 999 service.

1.2.4 Approach to modelling demand and capacity in 2016-17

For 999 and 111, SCAS reviews demand by hour of day and day of week, comparing with the previous week in the last year and adjusting for in-year trends. This is assessed for each local care system, as well as looking across the region. We are also adjusting our forecasts in light of the rising acuity and longer job cycle times associated with longer hospital handover times. Capacity requirements are modelled based on these demand profiles, for both the telephone-based staff in the Clinical Coordination Centres and road-based staff, providing emergency responses, care on scene and conveyance to hospital.

For PTS, we profile demand according to our contracts. Although transport resources are currently planned manually, we are looking to automate the resources allocation processes.

1.3 Capacity planning

Overall demand forecasts are based on historic trends over recent years. These forecasts are adjusted for the latest changes. For example, the new definitions for Ambulance Quality Indicators (AQIs) have changed anticipated levels of hear and treat, with this activity moving into see and treat. These demand forecasts are 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. Again this process has been revised to reflect the impact of recent changes, including the latest AQI definitions, changes to dispatch processes through the National Ambulance Resourcing Programme (NARP) and contractual boundary changes. 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.



1.4 Performance forecasts

Capacity is planned to enable delivery against performance standards, using forecasted demand and workforce levels, alongside known availability of private providers. This delivers sufficient resource capacity to enable performance delivery against both contracts. There remains little contingency in resource to respond to demand spikes or changes in process, such as AQI or NARP changes.



2 QUALITY PLANNING

2.1 Approach to quality improvement

Our quality improvement plan is directly aligned with our organisational values and strategy. The quality improvement strategy seeks to identify the best practice for each pathway, set out by patient need or condition. This new 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. The intention is to develop our Clinical Coordination Centre as a single point of entry to integrated service and seamless pathways across providers. The focus is to increase efficiency in delivering quality care and effectiveness by improving joint working between services.

2.1.1 Improvement methodology

We will support more people in their own homes, by implementing evidence-based practice and by utilising Plan, Do, Study, Act methodology. This will enable us to accelerate our pace of planned change, improve patient outcomes, increase SCAS and partner provider efficiency, generate new ideas using modern technology and enhance joint working with partners.

2.1.2 Quality improvement governance systems

The Trust has received a very positive CQC Inspection Report in January 2015, including observation that SCAS has a ‘sound governance system’. Below is our governance structure.



The Executive Director with lead responsibility for quality is Deirdre Thompson.

2.1.3 Three quality priorities for 2016-17

We continually strive to improve our services against a wide range of quality and performance indicators, including clinical outcomes and operational responsiveness. Our top priorities for improvement in the next year are:

1. To improve patient safety in the pre-hospital environment, by implementing the National Early Warning Scoring System and piloting a Paediatric Observation Priority Score.

2. To improve on the proportion of patients receiving an emergency ambulance response within 8 minutes and 19 minutes

3. To case manage very high intensity users more effectively, through support, advice and intervention by Demand Practitioners, supported by access to experienced primary or secondary care clinicians 24/7 and care plans

Our Quality priorities are being developed from the clinical risk themes emerging through the year. They are also informed by the corporate risk register, integrated performance report, committees’ upward reports, engagement of internal and external stakeholders, and other opportunities identified to improve patient care. These priorities will be confirmed and detailed in the quality Accounts. They will cover all of our services and reflect the national contract requirements.

2.1.4 Three top risks to quality Mitigation plans

1. If SCAS cannot recruit, develop and retain enough staff (for the Clinical Coordination Centre or our mobile teams in 999 or PTS), there is a risk that we cannot provide resilient and sustainable services or innovate to implement our clinical strategy.

Programme underway to become employer of choice, including development of existing staff, introduction of new roles, investment in education and training facilities, international recruitment and activities to improve staff retention.

Risk share agreement in place with commissioners to support investment in our workforce.

2. The external and internal financial deficits and constraints have the potential to impact on service delivery by the Trust.

All cost improvement schemes are assessed for the impact on quality, performance and workforce before being approved.

SCAS is focussing on supporting more people at home, with right care, first time. This approach benefits both the individual and health economy.

3. The risk of not retaining our existing NHS111 Trust-wide contracts going forward will risk our ability to deliver a fully integrated service to our patients resulting in poor patient outcomes and disabling us from integrating seamlessly with our partners.

We are planning to implement the Adastra system for our NHS111 services, in order to improve our interoperability with other providers, enable a redesigned service model with GP out of hours providers and generally to improve our 111 offer. This is a key part of the changes required to ensure compliance with national requirements and local strategic expectations.

2.1.5 Well-led elements

Our Trust Board comprises Executives and Non-Executive Directors from a wide variety of backgrounds with a wealth of knowledge and experience from healthcare, commercial and other industries. To



assure themselves that quality remains at the heart of what we do, the Board draws information from a variety of sources, including Leadership Walkabouts engaging with staff and stakeholders, upward reports from groups and committees, and the Integrated Performance report. The Trust is structured around teams to ensure visible leadership locally and the operational management teams where appropriate mirror to that of the local health economy. The teams are small and are focused on staff development with dedicated team time. Communication with the teams is through a variety of methods, including team meetings face to face, SCAScades of learning, targeted campaigns, via our ‘Hot News’, newsletters, CEO podcasts and Bright Ideas. The CQC said ‘Governance arrangements were clear and there was an integrated performance report to benchmark quality, operational and financial information. The trust has also identified its quality priorities and could demonstrate progress against these’.

2.1.6 ‘Sign up to safety’ priorities for 2016-17

We will focus on creating a continuous learning culture that addresses our current failure to consistently learn from incidents and investigations.

In 2016 -17, we will drive forward the five elements of ‘Sign up to Safety’ and ensure that all our services (999, NHS 111 and PTS) are facilitated by a designated Clinical Governance Lead, who will commit to bringing the five elements to life and to create the right conditions for safer care.

1. Put safety first Committing to reduce avoidable harm in the Trust

2. Continually learn Reviewing our incident reporting and investigation processes to make sure that we are truly learning from them and using these lessons to make the Trust more resilient to risks. Listen, learn and act on the feedback from patients and staff and by constantly measuring and monitoring how safe our services are.

3. Be honest Being open and transparent with people about our progress to tackle patient safety issues and support staff to be candid with patients and their families if something does go wrong.

4. Collaborate Stepping up and actively collaborating with other organisations and teams to ensure a sustained approach to sharing and learning across the system

5. Be supportive Be kind to your staff, help them bring joy and pride to their work. Be thoughtful when things go wrong; help staff cope and create a positive just culture that asks why things go wrong in order to put them right.

We will also revisit our safety improvement plans and refocus on sepsis and falls pathways in particular.

2.2 Seven day services

2.2.1 Progress towards seven day care

SCAS already provides a 24/7 service for 999 and 111 callers, and for urgent transport requests from healthcare professionals. We are also extending the hours of our patient transport services, in line with new contracts.

2.2.2 Improving access to out-of-hours care

A key part of our role is to enable the public to access the most appropriate service available, both during the ‘in’ and ‘out’ of hours periods. We are working hard with our partners to achieve this. There has been, and will be, considerable work with commissioners to ensure that the Directory of



Services is comprehensive and up-to-date.

We have introduced mental health and midwifery advisors to our Clinical Coordination Centres, enabling improved assessment and access for relevant 999 and 111 callers. We will continue to extend the coverage of these services in terms of hours and geography, and will also work with partners to enable access to a wider range of specialists.

We are working with local GP out of hours providers to develop a joint service model with NHS111 services, in line with the national specification for integrated urgent care.

2.2.3 Reducing excess deaths at weekends

SCAS already provides a 24/7 service and works hard to provide a consistently responsive and high-quality service. We will work collaboratively with any partner provider seeking to make changes in order to reduce excess deaths at weekends.

2.3 Quality impact assessment process

2.3.1 QIA sub-board process

The Trust has a robust process to assess and manage the impact of our cost 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.

2.3.2 QIA Board process

The Director of Quality and Patient Care and Medical Director formally approve all cost improvement programmes at the start of each financial year.

2.3.3 QIA monitoring plan

The Director of Quality and Patient Care is a member of the Cost Improvement Board and assesses each scheme, and this is reported to every public meeting of the Board of Directors. If additional schemes are added within the year, the quality impact assessment process is undertaken as above.

2.4 Triangulation of indicators

2.4.1 Approach to triangulation

Quality, workforce and financial indicators are reported via the Integrated Performance Report monthly to Trust Board. The information is presented by service in an aggregated form.

2.4.2 Key indicators

The key indicators used for each service are national and contractual performance targets, clinical indicators where applicable, complaints, sickness, appraisals, workforce, training, cost improvement and quality impact assessment.

2.4.3 Use of triangulation information

The Board uses this information to target areas of poor performance and also to understand areas of good practice, in order to share learning, to continuously improve quality of care by service area and



further enhance productivity.

3 WORKFORCE PLANNING

3.1 Workforce planning

3.1.1 Approach to workforce planning

The Trust undertakes an integrated approach to workforce planning. 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 the Trust • Provide a planned phasing of new recruits into the Trust, ensuring all new recruits are adequately

supervised • Ensure all recruitment streams offer value for money.

3.1.2 Governance process

Our workforce plans are agreed and monitored by our Workforce Development Board. Membership of this Board comprises of accountable Executive Directors, including the Director of Quality and Patient Care. 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 provided with regular progress reports and, if required, any identified improvement plans.

3.1.3 Strategic link

The majority of the clinical workforce is made up of HCPC-registered Paramedics. We continue to work with Heath Education England (Thames Valley) to plan the workforce needs for Paramedics, and future education commissioning numbers for our students. While the main strand of our workforce strategy remains the education, development and recruitment of Paramedics, we continue to increase our clinical abilities within our Clinical Coordination Centres. Clinical Advisors (nurses and paramedics) work in both NHS111 services and Emergency Operations (999) to provide clinical triage, hear and treat services, telephone advice and signposting to the most appropriate service. Our growing cadre of Specialist Paramedics/Nurses work to enhance See and Treat services, supporting the emergency service and helping to avoid conveyance to Emergency Departments where this is not appropriate to meet patient needs.

3.2 Workforce transformation

3.2.1 Local workforce transformation or productivity programmes

SCAS has recently introduced Specialist Nurse/Paramedic roles and we will continue to develop this workforce during 2016-17.

The role of Associate Ambulance Practitioner will also be launched, providing our workforce with further career progression route to Paramedic roles.

We will:



• consolidate and improve our education and training facilities, with a new purpose built facility in Newbury due to open January 2017.

• review existing arrangements for bank workers, building our capacity across all core services. • continue to review opportunities for staff who need or want flexible working patterns. • complete the restructuring of our Planning and Scheduling function, work to better align resources

with fluctuating demand • continue to transform our 999 and 111 service in line with our vision for Clinical Coordination

Centres responding to ‘2 numbers, 1 service’. 3.2.2 New initiatives with partners for Five Year Forward View

SCAS will explore further opportunities for joint working and/or rotational posts for our clinical workforce with local healthcare partners. For example, the introduction of rotational posts with partner agencies enables us to create more attractive posts incorporating advanced skills development and inter-agency working. We are working closely with the Southern Multi-speciality Care Provider Vanguard, and this may enable funding for further roles. We will also work with clinicians and specialists from partner agencies, with similar benefits for their workforce, as well as progressing towards our vision for Clinical Coordination Centres offering access to a wider range of expertise.

3.2.3 Impact on workforce by staff group

All new initiatives will provide development opportunities for our staff, improve role enrichment and aid improvements in retention.

Qualification Credit Framework (QCF) courses are being introduced by an awarding body called Future Qualifications & Awards (Future Qual). Community First Responders (CFR), Patient Transport and Front line staff will be better able to move between roles, providing career enhancement and progression at the same time. The QCF awards for the new Associate Ambulance Practitioner role should ensure that staff will be able to attend University as Student Paramedics.

The introduction of Future Qual enables the Trust to prove the Care Certificate competencies and provide academic status for Vocational Education, which will ensure external bodies can rate our learning and staff alongside other NHS department and staff grades.

3.3 Workforce supply

3.3.1 Local education and training plans

SCAS meets regularly with Health Education England (Thames Valley) to ensure adequate workforce numbers are trained and they support the University education of our staff. SCAS has a vibrant Learning Beyond Registration (LBR) programme for both Band 1-4 and post-registration education. We have high numbers of apprentices across many departments and grades. These initiatives help ensure a sustainable existing workforce, as well as development opportunities for new staff.

3.4 Quality and safety

3.4.1 Triangulation to identify areas of risk



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, 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 the 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 its sub-committees.

3.4.2 Quality impact assessment for all workforce cost improvements

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.

3.5 Flexible staffing

3.5.1 E-rostering

We have introduced systems for staff to book leave and overtime on-line. During 2016-17, we will review the IT system used by the Scheduling Department, in order to facilitate further improvements and make progress towards e-rostering.

3.5.2 Reduced reliance on agency staff

We are setting up a new system for coordinating our private providers, which is regarded as a managed service rather than agency use. We are also expanding our bank workforce and improving the system for coordinating these resources, as well as reviewing the employment terms and conditions for staff who wish to work flexibly.

3.5.3 Balancing agency rules

The new system used to co-ordinate private providers is fully compliant and supported by NHS England. It is regarded as a managed service provision and therefore outside of the new agency framework. One of the agencies currently used by SCAS will be fully reviewed for compliance, once the framework is finally published.

3.6 Workforce risks

Workforce is a key item on our corporate risk register, which is monitored on a monthly basis.

Competition to recruit and retain skilled clinical staff, both in our Clinical Coordination Centres and for our mobile workforce remains one of our key challenges. We continue to develop new and innovative solutions to the recruitment challenge, including the launch of dedicated recruitment website, rebranding of our recruitment materials.



4 FINANCIAL PLANNING

4.1 Financial forecasts and modelling

Despite several years of austerity and large cost reduction programmes, the financial outlook is one of

more of the same. 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.

In order to improve the consistency of the plan across different areas of SCAS, a workshop was held in October to identify improvements. They mainly relate to the closer working to ensure finance, resourcing, recruitment and training budgets are all using consistent assumptions. These have been tracked to ensure the actions are carried out.

4.2 Efficiency savings for 2016-17

The environment outlined above is one of increasing costs to deliver the 999 service, which have already impacted in 2015-16 and will increase in 2016-17, 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 Cost Improvement Programmes (CIPs), and maintain them to 3.8%, above the 2% assumed in the deflator

• Get agreement for a change in funding formula from CCGs reflecting the increase in red calls, and to get funding for or get an amendment to the recent AQI changes.

• Continue to invest in capital schemes, renewing the vehicle fleet and consolidating much of the estate for training in one location in Newbury.

NHS organisations including ourselves are finding it increasingly difficult to deliver yet another year of savings at 3-4% level. In order to mitigate the risk of non-delivery, we have engaged specialist ambulance consultants (Lightfoot). They will benchmark our performance, review our efficiency and make recommendations for improvement. This will provide more detail on our current CIP plan for next year, and is expected to give us new areas where efficiencies can be made.

The main areas of the cost saving programme are as follows: • Cessation of the overtime incentive scheme • Cycle time reduction – using Team Leaders to analyse and then manage the appropriate

elements of cycle time • Response ratio – reduction in the number of resources that are used for each 999 incident • 999 private provider reduction / bank improvement • Commercial private provider efficiency • Commercial crew KPI performance management

4.3 Capital planning



The capital plan supports the clinical strategy, with the main projects continuing to be investment in ambulances and a new education centre, to ensure that clinical staff can progress and develop their clinical skills. A prioritisation process occurs as part of the budget cycle. Non- essential schemes have been removed, and estates schemes have been prioritised with the low priority ones removed. The main areas of the £8m capital programme are as follows: • IT – continued investment in this area, supporting the strategic agenda, with various projects,

including the move to Adastra for 111, and the improvement of IT at our resource centres. • Fleet – procurement of 23 front line ambulances, continuing replacement of 999 fleet • Estates – the largest project is the rationalisation of the education and training centres in the

Newbury area on to one site.



5 SUSTAINABILITY AND TRANFORMATION PLANS

5.1 Hampshire and Isle of Wight

5.1.1 Vision for local health and care system

This system is currently developing its overarching vision and has identified 10 ‘wicked’ questions that need to be addressed. There has already been significant work, with a vision for ‘local, better, care’ as part of the Vanguard scheme. This is based around creating local hubs offering multi-specialty care in each community. Localities have an average of 50,000 populations. The aim is to bring together practices that naturally consider themselves to be part of the same community. Therefore, actual populations seem to range from about 25,000 to 110, 000 in size.

Southern Health FT is the lead provider, working closely with local GP practices. There is a short term focus on the setting up hubs in areas where there is an acute shortage of GPs. For the longer term, the focus will be on using this experience and learning to roll out the multi-speciality care provider (MCP) service model across Hampshire, and possibly parts of Surrey.

The Portsmouth and SE Hampshire areas are also exploring ways to address the access issues in their urgent and emergency system, which have raised clinical, operational and financial issues locally, plus a ripple effect across other parts of Hampshire in recent months. Similarly, the north-mid Hampshire area is concentrating on designing the configuration required in acute services in order to ensure clinical, operational and financial resilience in their system.

5.1.2 SCAS contribution to this vision

SCAS is involved in the Vanguard Steering Group, plus the redesign of services in Portsmouth and SE Hampshire and the design of New Models for Care for north-mid Hampshire.

SCAS is likely to be the provider of telephony and digital access to the multi-disciplinary care models and to direct patients as appropriate to the local hubs. There are tentative discussions in progress about the investment required for SCAS to contribute to the Vanguard service model.

SCAS is increasingly involved with commissioners on contingency arrangements to mitigate risks associated with access to GP out of hours services (complementing the role that Southern Health appears to be playing with regard to areas with fragile GP services in hours).

5.1.3 Key milestones in 2016-17

The milestones need to be developed once the Sustainability and Transformation Plan is available, in at least draft form. It is likely to require the following:

• SCAS to move the NHS111 service to the Adastra system for various reasons: in order to improve interoperability with other providers, to contribute to the Vanguard model of local better care, and to help to mitigate the risks around GP out of hours services, as well as ensuring compliance with the national specification for integrated urgent care.

• SCAS to increase the Paramedic workforce and to develop rotational posts, in order to support both the local hubs and multi-disciplinary home visiting services.

• Expand the Clinical Coordination Centre in Otterbourne, so that the GP out of hours service can be hosted ‘under the same roof’.



5.2 Thames Valley

5.2.1 Vision for local health and care system

The vision for Thames Valley is likely to include devolution. Another aspect of the vision may build upon the vision created for this system’s recent Vanguard bid, which in turn has built up much of the thinking in SCAS’s 5-year strategy. We expect that the focus will be on coordinating the access to care, and then working collaboratively to ensure seamless integrated pathways of care.

5.2.2 SCAS contribution to this vision

We expect that SCAS will be expected to develop a joint service model between NHS111 and GP out of hours services, and to improve the interoperability and onward referral arrangements with other partners, so that patients benefit from seamless integrated pathways of care.

5.2.3 Key milestones in 2016-17

It is likely that requirements will be similar to those in Hampshire:

• SCAS to move the NHS111 service to the Adastra system for various reasons: in order to improve interoperability with other providers, to improve integration with community services and mental health, and to develop a joint service model with GP out of hours services, as well as ensuring compliance with the national specification for integrated urgent care.

• SCAS to increase the Paramedic workforce and to develop rotational posts, in order to support community and primary care teams.

5.3 Frimley

East Berkshire and part of Surrey have formed a separate system for the purposes of the Sustainability and Transformation Plans. This is likely to build upon the Primary and Acute Care Systems (PACS) Vanguard in this area and developments for the Frimley system.

5.4 Bedfordshire and Milton Keynes

Milton Keynes and Bedfordshire have formed another system. The vision for this area is likely to include a review of the acute configuration.

5.5 Cambridgeshire and Peterborough

The service model for this area was articulated in the recent procurement of community services. Whilst the Uniting Care Partnership contract has been terminated, our understanding is that this system remains committed to the service model and it is likely to form the basis of the Sustainability and Transformation Plan.

SCAS was sub-contracted by the Uniting Care Partnership to provide OneCall, which is a telephony hub for community services. This arrangement will stop in April 2016, as part of the termination of the overall contract. At this stage, plans are unclear but SCAS will engage in conversations about how best to proceed.



6 LEADERSHIP, MEMBERSHIP AND ELECTIONS

6.1 Leadership changes in 2016-17

We have a new Chief Operating Office and some new Non-Executive Directors starting in Spring 2016. Over the next year, we will also recruit a new Chair and Senior Independent Non-Executive Director.

6.2 Governors elections in previous year and plans for next year

We did not hold any governor elections last year, but public governor elections are planned for 2016-17. The elections will begin in November, with a view to new governors commencing in March 2017.

6.3 Governor recruitment

We run an aspiring governor programme, comprising materials and events designed to explain the role of governor at SCAS and encourage members to stand to become a governor. This is supplemented with a comprehensive training, development and induction programme for new governors.

6.4 Public engagement

SCAS has an extensive programme of public engagement activities across the Trust, covering a wide variety of stakeholders and communities. We work closely also with our Council of Governors to co-produce events and opportunities to maximise public contact and awareness. Examples of activities to facilitate engagement between the public and partner governors include: • Public events such as county shows, football matches, shopping centre days • Talks at organisations such as Dementia UK, patient participation groups, etc. • Patient Forums For staff governors we provide opportunities to engage with both other staff members and the public through a range of activities, including: • Public-facing events, such as recruitment fairs and ‘Open Days’ • Drop-in sessions for all staff members • Regular updates in staff newsletter New initiatives for 2016-17 include developing a new range of communications materials to help improve engagement with the public: • New staff governors direct email • Re-launching our public web-site with enhanced governors and members areas; • Making an ambulance / educational vehicle available, specifically for public and youth engagement • Governors’ quiz for public events • Revamped videos and PowerPoint presentation for engagement activities.

6.5 Membership strategy

We have a wide range of activities to engage a diverse range of members, having met our membership quota, we are still under-represented in a number of areas, this will remain a priority for the coming year, our membership strategy will include: • Talks at secondary schools, colleges, universities, local ethnic minority and elderly groups • Working with organisations such as Healthwatch, young people, elderly and ethnic minority groups • E-communications to various stakeholders.

New initiatives for 2016/17 • Young people mini-site and videos together with bespoke factsheets and membership form • Campaign on diabetes aimed at Asian people • Partnership with Age UK being developed.

Agenda Item: 11



Title Integrated Performance Report (IPR)

Responsible Director Charles Porter, Director of Finance

Recommendation (eg. note, approve, endorse) To note performance in month 11










The IPR is one such mechanism for monitoring risks to the Trust.


A number of the KPIs relate to performance on regulatory matters; for example, the Monitor governance and financial sustainability 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.


The IPR includes a range of metrics relating to patients and staff.


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 22% 11% 67%

National Standards R 100% 0% 0%

Operational performance R 38% 23% 38%

Safety and risk management R 50% 11% 39%

111 Service A 6% 11% 83%

Corporate Areas

QIPP's (cost improvements) R 33% 20% 47%

QIPP's (quality impact) A 0% 58% 43%

Monitor - financial rating R n/a n/a n/a

Monitor - governance rating G n/a n/a n/a

Human Resources R 78% 14% 8%

Overall Commentary:

National Standards:

Safety and Risk Management

Finance

The risk rating continues to be below plan due to a reduced EBITDA.

QIPP's - Cost Improvements

Human Resources:

Recruitment & attrition continuing on improving trend, overall 999 workforce numbers above forecast for fourth consecutive month. Continued focus on 999 absence resulting below forecast for third consecutive

month. Further focus to be provided on all areas of 111 and EOC, IWP now in place for both directorates. S&M training to be reviewed and remedial action plan developed.

February's activity was 16.1% higher than the same period last year . Demand is now up 3.0% on a cumulative basis year on year. All three Red target were below this month with Red 1 being 70.4%, Red 2

was 68.3% and Red 19 at 92.8%. Financial performance continues below budget but was better than the forecast in February.

Operational performance remains challenging however the Trust is the second highest performing of the NARP participants.

The cost savings program continues to be behind on a year to date basis however the month savings were £93k above plan.

The Trust continues to encourage staff to raise incidents in order that lessons can be learned and shared more widely. There have been 2 SIRI's declared in the month and both are being investigated. SIRI's

declared YTD = 13 against a full year plan of 16.

Integrated Performance ReportReport Period: February 2016

Red -rated areas are further commented on below:

Page 1 of 34

Integrated Performance Report - 999 SCAS

Commentary:

Commentary:

Recruitment remained consistent during

January and February 2016. Overall, we

remained ahead of the re-forecast in July

Despite a small increase in January, attrition

continues to show signs of improvement,

with staff leaving the Trust totalling 27

against a forecast of 32

1,316.5 1,309.7

1,329.2 1,319.0 1,312.0

1,336.0 1,360.1

1,379.7 1,376.0 1,399.4

1,417.7

1,200.0

1,250.0

1,300.0

1,350.0

1,400.0

1,450.0

1,500.0

1,550.0

Total Frontline Workforce

2015-16 Actual

2015-16 Plan

2014-15 Actual

2015-16 Forecast 14.0 30.5

66.5 80.5 89.9

141.9

185.5

216.0 229.0

260.0

297.0

0.0

50.0

100.0

150.0

200.0

250.0

300.0

350.0

Frontline Recruitment

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

2015-16 Forecast

14.3 31.9

47.1

65.1 81.5

105.5 111.9 119.2

132.0

150.0 159.0

0.0

50.0

100.0

150.0

200.0

250.0

Frontline Attrition

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

2015-16 Forecast

13.0%

14.6% 14.4% 14.9% 14.9%

16.1%

14.6% 13.6% 13.4% 13.7% 13.2%

0.0

0.0

0.0

0.1

0.1

0.1

0.1

0.1

0.2

0.2

Frontline Attrition %

Percentage Attrition

Forecast Attrition Percentage

Page 2 of 34


Commentary:

The significant shift in activity continued into February with 12% higher demand than last year after leap year adjustment. This growth being reflected in all areas. The percentage of Red demand has also risen to 37% adding to the pressure

40,854 42,053

41,217

43,883

43,430

42,740

45,480 45,425

48,089

47,778

44,691

30,000

35,000

40,000

45,000

50,000

55,000

60,000

65,000

Activity (999 incidents) 2015-16Actual

2015-16 Plan

20,063 20,892

20,745

21,813

21,584

21,634

22,489 22,345

23,808

23,595

22,340

15,000

17,000

19,000

21,000

23,000

25,000

27,000Activity North

2015-16Actual

2015-16 Plan

20,791 21,161

20,472

22,070 21,846 21,106

22,991 23,080

24,281

24,183

22,351

15,000

17,000

19,000

21,000

23,000

25,000

27,000Activity South

2015-16Actual

2015-16 Plan

Page 3 of 34


Commentary:

Commentary:

Commentary:

Hear and treat levels continue to grow despite the AQI changes, part of this is driven by the demand pressure requiring the no send policy to be implemented on a number of days.

See and Treat levels remain consistent

The net impact is achievement of the highest level of non conveyance this year in February

6.1% 6.5% 7.1%

9.2% 10.3% 10.4%

11.3% 11.6% 12.1% 12.0% 12.5%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

Hear & Treat

2015-16Actuals2015-16 Plan

2014-15Actuals

6.2% 6.3% 6.5%

8.6%

9.9% 10.3% 10.6% 10.8% 10.7% 11.1% 10.9%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

Hear & Treat North


2014-15Actuals

5.9% 6.7%

7.6%

9.8% 10.6%

10.5%

12.0%

12.3%

13.4%

12.9%

14.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

Hear & Treat South

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

39.0%

37.9%

38.6% 37.6%

37.1% 36.8% 36.5% 35.8%

36.3%

36.4% 36.5%

34.0%

36.0%

38.0%

40.0%

42.0%

44.0%

See & Treat 2015-16Actuals

2015-16 Plan

39.7%

38.7%

39.7% 38.9%

37.6%

37.3% 36.7% 36.5%

37.2%

37.2% 37.2%

34.0%

36.0%

38.0%

40.0%

42.0%

44.0%

See & Treat North

2015-16Actuals

2015-16 Plan

38.4%

37.2%

37.5%

36.3% 36.6%

36.3% 36.4% 35.1% 35.4% 35.6%

35.7%

34.0%

36.0%

38.0%

40.0%

42.0%

44.0%

See & Treat South

2015-16Actuals

2015-16 Plan

45.1% 44.5%

45.7% 46.8%

47.3%

47.2%

47.9% 47.4% 48.4%

48.4%

48.9%

40.0%

42.0%

44.0%

46.0%

48.0%

50.0% Non Conveyance


2014-15

45.9% 45.0%

46.2%

47.6% 47.5%

47.6%

47.4% 47.4% 47.9%

48.3%

48.1%

40.0%

42.0%

44.0%

46.0%

48.0%

50.0%Non Conveyance North


2014-15Actuals

44.3% 43.9%

45.2%

46.1% 47.2%

46.8%

48.3%

47.4%

48.8%

48.5%

49.6%

40.0%

42.0%

44.0%

46.0%

48.0%

50.0%

52.0%Non Conveyance South


2014-15Actuals

Page 4 of 34


Commentary:

Commentary:

Commentary:

Red 2 performance reduced significantly reflecting the pressure the demand caused with resource levels insufficient to match it.

Red 1 performance reduced with the demand pressure but changes to EOC processes mitigated some of the impact with the drop being less than Red 2

Red 19 performance showed the same impact as Red 2

76.7% 75.5%

72.5%

67.8%

71.2% 68.7%

70.7% 71.8%

74.3% 71.9%

70.4%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

Red 1 Performance


2014-15Actuals

72.9% 72.9%

69.6%

65.7%

70.8%

67.6% 67.8%

70.8%

73.3% 72.2%

70.3%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%North Red 1 Performance


2014-15Actuals

79.9% 78.0%

75.2%

69.6%

71.6% 69.9%

73.7%

72.6%

75.3%

71.7%

70.5%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

South Red 1 Performance

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

76.6% 76.1%

74.5%

70.9%

71.6%

70.9% 72.9%

76.1%

75.0% 71.1%

68.3%

60.0%

62.0%

64.0%

66.0%

68.0%

70.0%

72.0%

74.0%

76.0%

78.0%

80.0%

Red 2 Performance

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

75.2%

73.3%

73.2%

69.7%

68.5% 68.7%

71.7%

76.1%

74.7% 71.9%

69.5%

60.0%

62.0%

64.0%

66.0%

68.0%

70.0%

72.0%

74.0%

76.0%

78.0%


2015-16 Actuals

2015-16 Plan

2014-15 Actuals

78.4% 79.0%

75.9%

72.1%

74.8%

73.2%

74.2%

76.2% 75.3%

70.3%

67.2%

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


2014-15Actuals

95.7% 95.2%

94.4%

93.7%

93.8%

93.7%

94.5%

95.3% 95.6%

93.8%

92.8%

90.0%

91.0%

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%

98.0% Red 19 Performance

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

94.3% 94.0%

94.2%

92.7% 92.3%

92.6%

93.4%

94.8%

95.4%

94.0%

92.8%

90.0%

91.0%

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%


2015-16Actuals

2015-16 Plan

97.0% 96.4%

94.7% 94.6%

95.3%

94.8%

95.6% 95.7% 95.7%

93.6%

92.7%

90.0%

91.0%

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%

98.0%South Red 19 Performance


2014-15Actuals

Page 5 of 34


Commentary:

Commentary:

Commentary:

Long waits have increased reflecting the performance pressure and insufficient resource availability to meet the very high levels of demand

0.5% 0.5%

0.6%

0.8% 0.7% 0.8%

0.7%

0.6%

0.6%

0.9%

1.1%

0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

1.2%

1.4% Long waits Red 8

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

0.4% 0.4%

0.4%

0.7%

0.7% 0.7%

0.6% 0.6%

0.5%

0.8%

1.0%

0.00%

0.20%

0.40%

0.60%

0.80%

1.00%

1.20%

1.40% Long waits Red 8 North

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

0.6% 0.6%

0.9% 0.8% 0.7%

0.9%

0.7% 0.7%

0.7%

1.1%

1.2%

0.00%

0.20%

0.40%

0.60%

0.80%

1.00%

1.20%

1.40% Long waits Red 8 South

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

1.0% 1.1%

1.3%

1.6% 1.6% 1.7%

1.5%

1.2% 1.6%

1.7%

2.1%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0% Long waits Red 19

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

1.2%

1.2% 1.2%

1.9% 2.0% 2.0%

1.8%

1.5%

1.6%

1.6%

2.1%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00% Long waits Red 19 North

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

0.8% 0.9%

1.4% 1.3% 1.3% 1.3%

1.1%

1.0%

1.6%

1.8%

2.0%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00% Long waits Red 19 South

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

7.2%

8.8% 11.9%

14.1% 14.7%

18.6%

19.3%

18.1%

15.5%

21.4%

25.1%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Long waits Greens

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

6.5%

7.8% 9.4%

13.6% 16.2%

21.2%

17.1%

17.1%

14.1%

16.9%

22.7%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

Long waits Greens North

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

7.9%

9.7% 14.3%

14.7%

13.3%

15.9%

21.5%

19.1% 17.0%

25.8%

27.6%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

Long waits Greens South

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

Page 6 of 34


Commentary:

Commentary:

Hospital delays at QA hospital remain a major pressure in the South East everely impacting on performance

706 732 554

448 552

817 872 841 769

1,304

1,547

0

500

1,000

1,500

2,000

2,500

3,000

Hospital handover delays 2015-16Actuals2015-16 Plan

2014-15Actuals

313 316

222 138

200 302 264 225 248

346 349

0

500

1,000

1,500

2,000

2,500

3,000North Hospital handover delays

2015-16Actuals

2015-16Plan

2014-15Actuals

394 416

332 309

351 515

607 616 521

957

1,198

0

500

1,000

1,500

2,000

2,500

3,000South Hospital handover delays

2015-16Actuals

2015-16Plan

2014-15Actuals

0.06% 0.06%

0.07%

0.09%

0.06%

0.09% 0.09% 0.08%

0.06%

0.04%

0.06%

-0.01%

0.01%

0.03%

0.05%

0.07%

0.09%

0.11%

0.13%

0.15%

Complaints

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

0.06%

0.03%

0.05%

0.05%

0.03%

0.12%

0.10%

0.07%

0.05%

0.03%

0.05%

-0.01%

0.01%

0.03%

0.05%

0.07%

0.09%

0.11%

0.13%

0.15% North Complaints

2015-16 Actuals

2015-16 Plan

0.06%

0.09% 0.09%

0.12%

0.08%

0.06%

0.07%

0.10%

0.08%

0.05%

0.07%

-0.01%

0.01%

0.03%

0.05%

0.07%

0.09%

0.11%

0.13%

0.15% South Complaints

2015-16 Actuals

2015-16 Plan

Page 7 of 34


Commentary:

Commentary:

We are some way behind on meeting our appraisal compliance score, in order to meet the 80% target, we will need to ensure that we have all appraisals completed Trust-Wide before the end of April 2016

The Health and Well Being cell continues to operate with sickness at the same levels as last year

6.4%

6.4% 6.2%

5.3% 5.3%

6.3% 7.0%

6.5%

5.7%

6.3%

6.0%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%North Sickness

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

7.9% 7.8%

6.3% 7.0% 7.0% 7.1% 7.3%

6.6%

6.4%

6.9%

7.7%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%South Sickness

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

7.2%

7.1%

6.3% 6.2% 6.1% 6.7%

7.1% 6.5%

6.1%

6.6%

6.8%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%Sickness

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

65.9%

66.3%

67.1%

74.0%

71.4%

70.1% 66.4%

66.7%

68.4%

68.8% 72.2%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%North Appraisals

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

68.6%

69.2%

72.9%

75.2%

76.2%

73.0% 64.5% 66.9%

72.2% 69.0% 66.6%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%South Appraisals

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

65.9%

66.3%

67.1%

74.0%

71.4%

70.1%

66.4% 66.7% 68.4%

68.8% 72.2%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%Appraisals

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

Page 8 of 34


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

999 - Safeguarding Children

999 - Fire Awareness

999 - Information Governance

Page 9 of 34


Commentary:

Commentary:

STEMI Care Bundle: Improvements in the

ePR to enable the identification of non

compliant records to improve compliance

this will be in test for April.

STEMI 150: There is very low numbers

currentley in the database but it is improving

as data is entered.

Stroke 60: Stroke 60 has had significant

focus and is approaching trajectory.

53.7% 59.4%

56.0% 55.5%

48.0%

65.4% 61.4% 60.3%

65.00%

76.7% 70.2%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Dec Jan Feb March April May June July Augt Sept Oct Nov

STEMI - Care

2015-16 Actuals

2015-16 Plan

2014-15 Actuals (Dec '13 - Nov '14)Note: National CQI's are reported with a 4 month lag 96.0%

97.2%

98.6% 98.6% 99.0%

99.4%

98.9% 99.04%

96.12%

98.0%

97.8%

94.0%

95.0%

96.0%

97.0%

98.0%

99.0%

100.0%

101.0%

102.0%


Stroke - Care 2015-16 Actuals

2015-16 Plan

2014-15 Actuals (Dec '13 to Nov'14)

Note: National CQI's are reported with a 4 month lag

72.3%

96.6%

84.4%

92.2% 92.0%

79.0% 86.5%

97.83%

83.08%

92.6% 87.5%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%


STEMI - 150min to PPCI

2015-16 Actuals

2015-16 Plan

2014-15 Actuals (Dec '13 to Nov'14)Note: National CQI's are reported with a 4 month lag

61.6% 63.9%

52.7% 51.7%

60.8%

41.3%

60.2%

54.35%

59.87%

52.7%

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

2015-16 Actuals

2015-16 Plan

2014-15 Actuals (Dec '13 to Nov'14)

Page 10 of 34


Commentary:

Survival: Is more in line with the national

average and there has been a drop in the

number of patients that have been traced for

outcome. Work will be undertaken to

contact the accute trusts to retrieve the

outcome.

25.0%

42.6%

24.4%

60.0%

69.4%

51.7%

38.89%

21.43%

18.9%

41.4%

42.8%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%


ROSC (witnessed) 2015-16 Actuals

2015-16 Plan

2014-15 Actuals (Dec'13 to Nov '14)


30.0% 28.1%

25.6%

30.8%

18.0%

48.6%

28.6%

47.06%

22.73%

13.9% 13.8%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%


Cardiac Arrest (witnessed) Survival 2015-16 Actuals

2015-16 plan

2014-15 Actuals (Dec'13 to Nov '14)


Page 11 of 34

Integrated Performance Report

Operational Performance R Overall rating (other) R

Performance Pressures

National indicators

Incident Growth - SCAS 16.1% 6.0% n/a 3.0% 6.0% n/a 3.0% 6.0% n/a

Incident Growth - Thames Valley 16.7% 6.0% n/a 1.6% 6.0% n/a 1.6% 6.0% n/a

Incident Growth - SHIP & MK 15.4% 6.0% n/a 4.4% 6.0% n/a 4.4% 6.0% n/a

999 % calls from frequent callers 3.2% 5.0% G 3.0% 5.0% G 3.0% 5.0% G

Other indicators

Actual Plan RAG Actual Plan RAG Forecast Plan RAG

Green 2 - response within 30 minutes 54.4% 88.0% R 65.6% 88.0% R 65.6% 88.0% G

Green 4 - telephone assessment within 60

minutes84.9% 90.0% A 88.9% 90.0% A 88.9% 90.0% G

Operations indicators

VOR - scheduled maintenance 4.0% 4.0% G 3.9% 3.2% G 4.0% 4.0% G

VOR - unscheduled 19.0% 18.0% A 18.5% 18.0% A 18.5% 18.0% A

A&E Performance by CCG Cluster


Green 2 - response within 30 minutes

Thames Valley Cluster 55.5% 88.0% R 66.1% 88.0% R 66.1% 88.0% R

Hampshire & MK Cluster 53.2% 88.0% R 65.1% 88.0% R 65.1% 88.0% R

Green 4 - telephone assessment within 60 minutes

Thames Valley Cluster 84.4% 90.0% A 87.1% 90.0% A 87.1% 90.0% G

Hampshire & MK Cluster 85.4% 90.0% A 90.4% 90.0% G 90.4% 90.0% A

More vehicles are being utilised for responding to meet additional shift cover which has seen an

increase in VOR rates due to less downtime of vehicles

Performance Measure Feb-16 Year to date Full year Commentary on exceptions

(Red - action to correct, Amber - action to reduce risk, Green - nil)

RAG

Feb-16 Year to date Full year Commentary on exceptions


Growth is actually 12% as this February had 29 days

Green RAP created but still awaiting detailed analysis from BI to inform the action plan, Lightfoot

due to give initial feedback on 24 March.

Commentary on exceptions


Overall rating (national - Red 8 & Red 19)

Lead Director: Will Hancock/Steve West

Feb-16Performance Measure Year to date Full year

Plan RAGForecastActual Plan RAG Actual Plan

Page 12 of 34


Clinical Performance Overall ratingA

11.00

Other clinical indicators

Hypoglycaemia care bundle 100.0% 98.2% G 98.4% 98.2% G 98.4% 98.2% G

Asthma care bundle 88.0% 82.2% G 80.2% 82.2% A 80.2% 78.0% G

Limb fractures care bundle 63.2% 45.8% G 44.0% 45.8% A 44.0% 45.0% A

Febrile convulsion care bundle 88.0% 87.5% G 86.8% 87.5% A 86.8% 87.5% A

Safeguarding

Number of adult referrals - this relates to vulnerable

adults who may be at risk from abuse or neglect1,307 460 G 10,757 5,060 G 11,735 5,520 G

Number of child referrals - this relates to children

who may be at risk of abuse or neglect322 130 G 2,540 1,430 G 2,771 1,560 G

Vehicle deep cleans - A&E 70 110 R 1,167 1,210 A 1,273 1,320 A

Vehicle routine cleans 4,799 5,364 R 59,743 62,440 A 65,174 68,429 A

Number of cleanliness compliance audits* 54 41 G 649 451 G 708 648 G

Medicines Management

Number of adverse events due to administration

errors* 0 1 G 7 11 G 8 12 G

Number of controlled drug incidents* 4 4 G 46 44 A 50 48 A

RAG Forecast

RAG Actual Plan

RAG Actual Plan

Plan RAG

Measure (care bundles are part of National Clinical

Performance Indicators data gathering) RAG Actual Plan

Feb-16

The limb Fracture indicator is improving with implementation of ePR improvements

Febrile convulsion is an improving trend

Full year

RAG

Long term staff sickness in Hightown and staffing shortages in Oxfordshire has impacted on the number of deep clean audits that

have been done this month. Staffing issues have not been addressed and this will enable us to get back on track during March.,

Actual

Year to date Commentary on exceptions




Measure



All vehicles that were available were made ready during the reporting period.

Year to date

Hygiene & infection prevention & control

Feb-16

Actual Plan

Actual Plan RAG

Plan RAG Actual Plan RAG

* These items are also reported in the quality accounts

Measure

Measure Feb-16 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-16 Full yearYear to date

Plan RAG

RAG Forecast Plan

Forecast

Forecast Plan RAG

Page 13 of 34

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.)

228 130 n/a 1,658 1,430 n/a 1,809 1,560 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.)

208 230 n/a 2,581 2,530 n/a 2,816 2,760 n/a

Number of incidents reported to the NRLS (CQC/NRLS

reportable)73 90 n/a 836 990 n/a 912 1,080 n/a

% of incidents reported to the NPSA within 30 days 1 1 G 1 1 G 1 1 G

Number of Serious Incidents Requiring Investigation (SIRI)

reported 2 1 R 13 16 G 14 17 G

The Trust is actively trying to reduce the potential for SIRIs by the sharing of learning from previous

incidents and by continuing to introduce and develop good practice.

Number of SIRI investigations outstanding after 60 days

(excluding events that are officially suspended)0 1 G 0 16 G 0 17 G

Number of Never Events (CQC/NPSA reportable) 0 0 G 0 0 G 0 0 G

Clinical negligent claims (CNST) 1 1 G 11 11 G 12 12 G

Public liability claims 2 1 R 7 11 G 8 12 G

Staff Safety Measure

Number of RIDDOR reports (HSE reportable) 11 8 R 62 88 G 68 96 G

The introduction of the Trust's electronic incident reporting system, Datix has made it easier for staff to

report incidents so consequently there has been an increase in the potential for an incident to be

reportable to the HSE under RIDDOR.

Number of Physical Assaults (NHS Protect reportable) 19 13 R 141 147 G 154 160 G

The introduction of the Trust's electronic incident reporting system, Datix has made it easier

for staff to report incidents so consequently there has been an increase in the potential for the

staff to report physical assault incidents.

Number of Non-Physical Assaults (NHS Protect reportable) 19 20 G 136 220 G 148 240 G

Number of Security Incidents (NHS Protect reportable) 5 6 G 53 66 G 58 72 G

* These items are reported in the quality accounts as well

FOI (Freedom of Information Act) 92.3% 100.0% A 93.0% 100.0% A 93.0% 100.0% A

Data protection Act (DPA) - police, solicitor/medical,

subject access96.8% 100.0% A 98.5% 100.0% A 98.5% 100.0% A

Lead director: Deirdre Thompson

Full year

Patient Safety Measure

Feb-16 Year to date Commentary on exceptions


Page 14 of 34


Clinical Quality Indicator UnitsEast

Midlands

East of

England

Isle of

WightLondon North East North West

South

Central

South East

Coast

South

Western

West

MidlandsYorkshire All Rank

SCAS

TargetRAG

RX9 RYC 5QT RRU RX6 RX7 RYE RYD RYF RYA RX8

Time to Answer - 50% mm:ss 0:02 0:01 0:01 0:00 0:01 0:01 0:03 0:03 0:03 0:01 0:01 n/a 8 0:01 R



Abandoned calls % 0.42 0.64 1.43 0.14 0.34 0.61 0.43 0.68 0.96 0.75 1.14 0.61 4 1.20 G

Cat A8 % - - - - - - - - - - - - -

Cat A8 - Red 1 % 61.7 69.6 60.4 67.4 62.9 69.3 71.9 72.0 71.9 77.8 69.0 69.9 4 75.0 R

Cat A8 - Red 2 % 49.6 58.3 75.1 60.9 61.2 63.5 71.1 62.8 60.6 74.7 71.9 63.3 3 75.0 R

Cat A8 - Red 1 - 95% mm:ss 16:57 16:23 11:27 13:42 15:50 16:04 14:13 15:41 15:00 11:56 14:23 n/a 3 19:00 G

Cat A19 % 82.0 88.8 96.1 92.2 89.4 89.8 93.8 93.5 88.8 97.4 94.7 91.1 3 95.0 R

Time to Treat - 50% mm:ss 13:10 7:54 5:11 7:12 7:43 7:25 6:21 6:24 7:42 6:01 6:22 n/a 2 6:00 A


Time to Treat - 99% mm:ss 42:45 35:45 18:46 39:18 46:50 49:07 36:56 29:44 39:42 24:04 23:48 n/a 5 29:00 R

STEMI - Care % 88.4 74.8 62.5 70.6 79.5 87.1 72.8 77.4 79.8 72.9 87.6 78.5 9 79.2 A

Stroke - Care % 98.0 98.2 97.9 98.0 98.1 98.7 99.3 97.4 95.6 96.9 98.8 97.7 1 98.0 G

Frequent caller % 0.11 0.27 1.67 0.76 0.00 0.84 3.18 0.00 0.00 0.00 2.00 0.65 10 5.00 G

Resolved by telephone % 15.2 5.7 7.4 11.8 7.3 12.8 11.1 8.0 12.5 5.5 8.2 10.2 5 8.5 G

Non A&E % 29.2 42.9 56.3 34.5 32.3 30.9 41.9 49.4 52.8 37.1 30.7 38.1 4 45.8 A

STEMI - 60 % - - - - - - - - - - - -

STEMI - 150 % 86.7 94.8 66.7 89.7 92.5 84.6 88.5 92.7 78.4 86.6 89.3 88.1 6 90.0 A

Stroke - 60 % 58.5 51.5 50.0 60.8 59.4 61.7 44.2 67.0 42.9 53.8 53.6 55.9 9 59.3 R

ROSC % 25.5 30.0 14.3 30.9 25.5 29.7 31.3 28.4 25.1 26.1 21.9 27.6 1 41.0 R

ROSC - Utstein % 41.9 63.3 100.0 54.3 50.0 50.0 51.7 54.5 53.3 44.2 45.2 51.1 5 35.0 G

Cardiac - STD % 7.7 9.4 14.3 8.9 6.7 6.8 8.3 8.0 7.1 7.7 8.9 8.0 4 25.0 R

Cardiac - STD Utstein % 36.0 47.1 100.0 40.5 50.0 16.7 13.8 22.2 23.8 18.6 26.7 27.6 10 35.0 R

Recontact 24hrs Telephone % 1.7 10.3 10.2 3.5 14.7 3.4 9.8 9.2 12.1 14.0 2.2 6.3 6 15.0 R

Recontact 24hrs On Scene % 5.2 6.1 2.7 8.9 5.1 3.0 5.1 6.0 5.4 7.0 1.4 5.5 3 5.0 G

Data in black is for the month of Jan-16

Data in purple relates to the month of Oct-15

Narrative:

Month

Page 15 of 34


Clinical Quality Indicator UnitsEast

Midlands

East of

England

Isle of

WightLondon North East North West

South

Central

South East

Coast

South

Western

West

MidlandsYorkshire All Rank

SCAS

TargetRAG

RX9 RYC 5QT RRU RX6 RX7 RYE RYD RYF RYA RX8




Abandoned calls % 0.38 0.60 1.29 0.20 0.86 0.39 0.64 0.71 0.71 0.63 0.90 0.55 6 1.20 G

Cat A8 % - - - - - - - - - - - - -

Cat A8 - Red 1 % 70.1 73.7 72.2 67.8 69.3 76.1 72.2 73.4 75.1 79.1 71.2 73.5 6 75.0 R

Cat A8 - Red 2 % 63.6 62.7 75.0 64.5 69.9 72.7 73.4 72.2 66.1 76.0 71.6 69.1 2 75.0 R

Cat A8 - Red 1 - 95% mm:ss 14:49 15:06 9:52 16:30 14:26 13:39 14:15 14:34 14:16 11:57 13:57 n/a 4 19:00 G

Cat A19 % 88.8 91.1 95.2 93.3 92.8 93.7 94.6 94.8 91.0 97.3 95.2 93.4 4 95.0 R



Time to Treat - 99% mm:ss 32:25 33:58 21:56 35:18 38:58 48:47 33:17 29:14 39:08 24:01 23:25 n/a 5 29:00 R

STEMI - Care % 76.8 79.9 72.2 70.7 88.2 86.3 63.9 68.3 84.2 77.3 85.7 78.3 10 79.2 R

Stroke - Care % 98.5 97.8 97.7 97.3 97.8 99.6 98.5 96.4 96.9 95.9 98.1 97.7 3 98.0 G

Frequent caller % 0.19 0.30 1.20 1.14 0.16 0.86 2.48 0.00 0.00 0.00 1.73 0.68 10 5.00 G

Resolved by telephone % 12.3 6.3 10.7 13.0 6.7 11.1 9.3 10.6 12.0 5.1 8.5 10.0 6 8.5 G

Non A&E % 30.0 41.3 50.8 34.2 31.5 30.8 42.0 44.2 52.7 37.3 31.4 37.2 3 45.8 A

STEMI - 60 % - - - - - - - - - - - -

STEMI - 150 % 92.1 91.1 37.5 89.6 90.9 86.9 87.8 93.4 76.1 87.7 84.0 87.0 6 90.0 A

Stroke - 60 % 55.9 51.6 61.3 62.3 63.2 70.7 51.4 65.5 45.4 57.8 55.8 59.0 9 59.3 R

ROSC % 24.4 26.9 25.0 30.5 23.3 33.4 25.3 27.3 23.6 30.8 27.1 27.8 7 41.0 R

ROSC - Utstein % 46.7 49.1 80.0 55.9 51.6 57.2 42.3 48.8 50.5 52.7 57.6 51.7 10 35.0 G

Cardiac - STD % 7.3 6.6 8.0 9.6 7.1 10.1 13.5 8.5 9.2 9.6 9.7 9.1 1 25.0 R

Cardiac - STD Utstein % 22.9 26.2 40.0 34.3 33.3 28.4 26.7 23.8 30.6 26.0 37.1 29.2 6 35.0 R

Recontact 24hrs Telephone % 3.7 10.8 6.5 2.9 14.2 4.0 9.9 8.1 13.0 13.3 1.7 6.6 6 15.0 R

Recontact 24hrs On Scene % 4.9 5.9 2.9 8.4 5.0 3.6 5.1 4.4 5.6 6.2 2.8 5.3 6 5.0 G

Data in black is YTD to the month of Jan-16

Data in purple relates to the YTD to the month of Oct-15

Narrative:

YTD

Page 16 of 34

Integrated Performance Report - Clinical Coordination Centre

Commentary:

Commentary:

inbound call volumes for 999 and NHS 111

remain higher than planned.

NHS 111 call answer performance refoects

staff vacancy factors,higher sickness and

inbound call volumes above 2015/16 plan .

999 call answer performance below trarget

for February due to internal staff movements

and high inbound call volumes. Work

effective staff numbers to increase in March

99,388

107,520

89,264 91,349

94,169

88,061

97,492

104,328

115,003

116,532

105,848

80,000

90,000

100,000

110,000

120,000

130,000

140,000Calls (111 incidents)

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

95.40% 95.00%

93.50% 94.60% 93.80% 93.90% 94.00%

94.00% 93.40%

87.00%

95.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0% 999 Call answer time (95% percentile)

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

96.7% 97.2%

98.1%

96.3%

93.5% 91.6% 89.5%

77.3% 70.0%

95.0%

96.7%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0% 111 Call answer time (95% percentile)

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

50,819

53,494

53,943 56,274

56,010

55,761

59,148 57,975

60,303

61,856 59,529

30,000

35,000

40,000

45,000

50,000

55,000

60,000

65,000Calls (999 incidents)

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

Page 17 of 34


Commentary:

Commentary:

referrals to 999 service North lower than

south however remains above 2015/16

target of 8%. South referrals above plan of

9%. Higher referrals due to staff vacancies

and clinicians front ending calls. Action plan

in place with outliers through quality

assurance coaching. Higher clinical acuity

that is seasonal also impacting

7.19% 7.30%

7.90%

8.74% 8.90%

9.62% 9.47%

9.41%

9.33%

9.87% 9.87%

6.0%

7.0%

8.0%

9.0%

10.0%

11.0%

12.0%

111 to 999 referrals (%) North 2015-16Actuals

2015-16Plan

2014-15Actuals

8.91% 9.10%

9.60%

10.49%

10.16%

10.16%

10.41%

10.54%

10.21%

10.83% 10.69%

6.0%

7.0%

8.0%

9.0%

10.0%

11.0%

12.0%

111 to 999 referrals (%) South 2015-16Actuals

2015-16Plan

2014-15Actuals

7.34% 7.26% 7.88% 8.33% 7.65% 7.49%

7.18% 7.39% 6.84%

7.18% 7.18%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

111 ED Referral (%) North

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

6.51% 7.04%

7.57% 7.64%

6.90% 6.93% 6.55% 6.32%

6.03% 6.16% 6.53%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

111 ED Referral (%) South

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

Page 18 of 34


Commentary:

Commentary:

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

17.3% 16.7% 19.2%

19.1%

18.0%

18.5%

18.2% 17.7% 16.3% 16.5% 16.6%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%111 Transfers to clinician (%)

2015-16 Actuals

2015-16 Plan

2014-15 Actuals 17.9% 23.3% 22.6%

35.8% 31.1% 29.4% 26.4%

22% 28% 25% 23%

95.0%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%111 Call back (% < 10 mins - target 95%)

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

0.36% 0.30% 0.19% 0.38% 0.51% 0.50%

0.78% 0.91%

1.88%

4.09% 4.23%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

111 Calls Abandoned (target <5%)

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

0.82% 0.76%

0.81% 0.56%

0.79%

0.37% 0.43% 0.34% 0.39% 0.43%

0.90%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

999 Calls Abandoned (target <5%)

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

Page 19 of 34


Commentary:

Commentary:

Absence in EOC is impacted by some LTS

cases. We are some way behind on

meeting our appraisal compliance score, in

order to meet the 80% target, we will need

to ensure that we have all appraisals

completed Trust-Wide before the end of

April 2016

0.01% 0.01%

0.02% 0.01%

0.00% 0.01%

0.02% 0.01% 0.01% 0.01% 0.01%

0.00%

0.02%

0.04%

0.06%

0.08%

0.10%

0.12%

0.14%

111 Complaints 2015-16Actuals2015-16 Plan

2014-15Actuals

7.5%

5.5%

6.1% 5.5%

5.2% 5.0%

4.6%

4.4%

5.9%

7.8% 8.1%

6.4%

7.0%

8.1% 8.4%

7.9% 8.2% 7.7% 8.3% 8.1%

8.6%

9.3%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0% Sickness

EOC Actual

EOC Plan

111 Actual

111 Plan*The plan is 0.5% lower than last years actual

85.8% 84.1% 83.5% 81.0% 83.1%

80.2%

76.6%

77.9%

87.2% 88.5% 85.8%

58.2% 55.7% 59.2% 56.5%

62.7%

70.6% 68.2% 72.2% 71.1%

67.3% 66.7%

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 20 of 34


Commentary:

Commentary:

The CCC workforce plan is currently being

finalised. At present, EOC is forecast to be

4% and 111 will be at 14% vacancy rates at

year-end. The 2016-17 plan has adequate

training resource to match demand to the

high number of staff employed within this

area

256.9 255.6

262.0 261.2 261.2 259.7 261.6

252.9 251.0 252.0

256.9

220.0

225.0

230.0

235.0

240.0

245.0

250.0

255.0

260.0

265.0

270.0

275.0

EOC Workforce

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

229.8

223.4

241.1 246.7

242.3

231.6

229.4

229.0

221.0 220.4 222.3

190.0

200.0

210.0

220.0

230.0

240.0

250.0

111 Workforce

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

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%

Training Course Completion (2 of 2)

Safeguarding Adults

Safeguarding Children

Fire Awareness

Information Governance

Page 21 of 34


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) 15,953 14,807 n/a 177,451 186,189 n/a 192,406 202,274 n/a

Oxford Call Answering (% within 60

seconds) 68.4% 95.0% R 90.4% 95.0% A 90.4% 95.0% A

high vacancies. Robust workforce plan in place. New staff becoming work

effective, plan to be at 80% staffing capacity by May 2016.Sickness has also

increased but is being actively managed and inbound volumes remain high

Oxford 999 referrals (%) 9.7% 10.0% G 8.4% 10.0% G 8.4% 10.0% G

Oxford Calls Abandoned (target <5%) 4.2% 5.0% G 1.3% 5.0% G 1.3% 5.0% G

Oxford Transfers to clinician (%) 16.8% 20.0% G 17.7% 20.0% G 17.7% 20.0% G

Oxford Time taken for call back (% < 10

mins - target 95%)23.1% 95.0% R 25.4% 95.0% R 25.4% 95.0% R

Hampshire :Hants Calls (no. answered, 111 and

Dental)43,939 43,174 n/a 489,685 514,922 n/a 536,073 562,025 n/a

Hants Call Answering (% within 60

seconds, 111 only) 70.2% 95.0% R 91.1% 95.0% A 91.1% 95.0% A




Hants 999 referrals (%) 10.7% 10.0% A 10.1% 10.0% A 10.1% 10.0% A

Hants Calls Abandoned (target <5%, 111

only)4.2% 5.0% G 1.3% 5.0% G 1.3% 5.0% G

Hants Transfers to clinician (%) 15.6% 20.0% G 16.7% 20.0% G 16.7% 20.0% G

Hants Time taken for call back (% < 10

mins - target 95%)25.5% 95.0% R 26.6% 95.0% R 26.6% 95.0% R Improvement plan in place

Full yearYear to date

Lead Director: Will Hancock/Luci Stephens

Measure Feb-16



Page 22 of 34



Berkshire:

Berks Calls (no.) 19,805 18,682 n/a 204,915 222,541 n/a 223,838 242,586 n/a

Berks Call Answering (% within 60

seconds) 70.1% 95.0% R 90.8% 95.0% A 90.8% 95.0% A




Berks 999 referrals (%) 10.6% 10.0% A 10.0% 10.0% G 10.0% 10.0% G

Berks Calls Abandoned (target <5%) 4.2% 5.0% G 1.3% 5.0% G 5.0% 5.0% G

Berks Transfers to clinician (%) 17.8% 20.0% G 18.6% 20.0% G 20.0% 20.0% G

Berks Time taken for call back (% < 10

mins - target 95%)21.1% 95.0% R 24.8% 95.0% R 24.8% 95.0% R

Buckinghamshire:

Bucks Calls (no.) 12,678 11,717 n/a 135,386 145,419 n/a 147,726 158,720 n/a

Bucks Call Answering (% within 60

seconds) 69.4% 95.0% R 90.6% 95.0% A 95.0% 95.0% G




Bucks 999 referrals (%) 8.9% 10.0% G 7.7% 10.0% G 10.0% 10.0% G

Bucks Calls Abandoned (target <5%) 4.2% 5.0% G 1.3% 5.0% G 1.3% 5.0% G

Bucks Transfers to clinician (%) 16.5% 20.0% G 18.6% 20.0% G 18.6% 20.8% G

Bucks Time taken for call back (% < 10

mins - target 95%)21.6% 95.0% R 24.4% 95.0% R 24.4% 95.0% R

Luton & Beds:

Luton & Beds Calls (no.) 9,323 8,632 n/a 98,601 97,791 n/a 107,267 107,148 n/a

L&B Call Answering (% within 60

seconds) 72.7% 95.0% R 93.0% 95.0% A 95.0% 95.0% G




L&B 999 referrals (%) 10.7% 10.0% A 9.4% 10.0% G 10.0% 10.0% G

L&B Calls Abandoned (target <5%) 4.3% 5.0% G 1.1% 5.0% G 1.1% 5.0% G

L&B Transfers to clinician (%) 18.5% 20.0% G 19.1% 20.0% G 19.1% 20.8% G

L&B Time taken for call back (% < 10

mins - target 95%)22.9% 95.0% R 27.7% 95.0% R 27.7% 95.0% R

Full yearYear to dateMeasure Feb-16Commentary on exceptions


Page 23 of 34


Monitor rating

Actual Actual Actual Actual Actual Actual Actual Forecast

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Financial risk rating 4 4 4 4 3 2 2 2

Actual Actual Actual Actual Actual Actual Actual Forecast

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Red 1 78.9% 76.0% 70.7% 74.3% 75.1% 69.6% 72.3% 75.0%

Red 2 74.2% 75.3% 72.4% 76.2% 75.7% 71.3% 74.0% 75.0%

Red 19 95.9% 95.8% 94.5% 95.9% 95.1% 93.8% 95.1% 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 31 March 2015 No No No No No No No No

CQC enforcement action within last 12 months up to 31 March 2015 No No No No No No No No

CQC enforcement notice currently in effect as at 31 March 2015 No No No No No No No No

Moderate CQC concerns or impacts regarding the safety of healthcare provision as at 31 March 2015 No No No No No No No No

Major CQC concerns or impacts regarding the safety of healthcare provision as at 31 March 2015 No No No No No No No No

Trust unable to declare on-going compliance with minimum standards of CQC registration No No No No No No No No

Has the Trust has been inspected by CQC No Yes No No No No Yes No

If so, did the CQC inspection find non compliance with 1 or more essential standards No No No No No No No No

Other governance factors/risks (data breaches) Yes No No No Yes No No No

Overall governance rating Green Green Green Green Green Green Green Amber

Commentary:

Forecast forward risks related to the financial position and the risk to performance and the potential impact of the overall governance rating

2014-15 - reported 2015-16 Plan

2014-15 Actual

Lead Director: Will Hancock

Governance Indicators

Financial Indicators2015-16 Plan

Page 24 of 34


Finance Finance rating R CIP rating R

Monitor Continuity of Service Risk Rating


Debt service cover rating (25%) 2 4 R 2 3 R 2 4 R Debt service is behind plan due to the YTD deficit

Liquidity Rating (25%) 4 4 G 4 4 G 4 4 G On plan. Good cash position.

I&E Margin (25%) 1 3 R 1 3 R 1 4 R Low rating due to in year deficit.

I&E Margin Variance From Plan (15%) 1 4 R 1 4 R 1 4 R Low rating as surplus is off plan

Continuity of Service Risk Rating (New) 2 4 R 2 4 R 2 4 ROverall low rating due to deficit and variance from

plan


Debtors > 90 days> 5% total balance Yes No R Yes No R No No G

Capex < 85% or >115% of ytd plan Yes No R Yes No R Yes No R Capex is currently lower than plan


(Red - action to correct, Amber - action to reduce risk, Green -

nil)

Measure Feb-16 Year to date Full year

Monitor Forward Financial Risk Ratings

Lead Director: Charles Porter

Measure: Financial sustainability risk rating Feb-16 Year to date Commentary on exceptions

(Red - action to correct, Amber - action to reduce risk, Green -

nil)

Full year

Page 25 of 34



£k £k £k £k £k £k

Commercial Division

Subtotal Commercial Division 153 90 G 1,096 862 G 1,223 970 G


£k £k £k £k £k £k

Operations

HCP Project 123 88 G 576 772 R 676 861 ARevised as YTD has not been as beneficial as budget. A single

dedicated dispatch desk and new recruitment and messaging will

contribute to success9

Specialist Para 0 17 R 20 95 R 43 116 RYTD slippage taken in to forecast. First placements

finished and benefits should now accrue6

Rota Review 60 60 G 580 580 G 640 640 G 4

bank/medic now/skillstream 0 13 R 13 63 R 13 75 R 9

Sickness Management 0 21 R 0 229 R 0 250 RReduced as not delivered in YTD. However sickness is

showing a downward trend9

Consumables Management 69 14 G 185 136 G 205 150 G 6

EPRF Benefits 20 20 G 180 180 A 200 200 G 4

Private Provider Rates 0 52 R 173 448 R 173 500 R 4

Fleet efficiencies 38 17 G 38 188 R 38 206 R 4

Private Providers Efficiency 10 8 G 90 92 A 100 100 G 6

Lost Unit Hours reduction 0 0 G 46 150 R 46 150 R Reporting visibility required 12

Reduction of time on scene 0 27 R 73 224 R 73 250 R

YTD slippage taken in to forecast. Overall TOS is on a

downward trajectory vs prior year. No improvement in

February.12

Indirect Unique contribution 89 57 G 764 441 G 844 498 G 4

Agency staff to Perm 4 4 A 41 46 A 45 50 A 1

Cost Improvement Plans (QIPP's)

Measure Feb-16 Year to date Full yearCommentary on exceptions (Red - action to correct, Amber -

action to reduce risk, Green - nil)

Quality Impact

Measure Feb-16 Year to date Full yearCommentary on exceptions (Red - action to correct, Amber -

action to reduce risk, Green - nil)

Quality Impact

Page 26 of 34


Staff Retention/attrition reduction 0 23 R 0 196 R 5 219 R Attrition is to be targeted by managers 12

Private Provider Meal Breaks 53 29 G 558 370 G 608 400 G 2

Air Ambulance 0 2 R 0 18 R 0 19 R To be reviewed 2

Reduce Attrition 3 3 G 59 30 G 85 33 G 8

EOC Sickness management 2 5 R 39 54 R 7 58 R 9

Floor walking- increase H&T, reduce red 8's 3 2 G 23 25 A 27 27 A 9

Virtualisation 0 0 G 416 359 G 416 359 G 2

Subtotal 999 Service 486 474 G 4,125 4,893 A 4,504 5,372 A

Corporate

Ad hoc savings 2 0 G 31 19 G 36 19 G 9

Tech Scheme 2 2 G 14 13 G 14 16 A 2

Estates CIPS 7 9 A 67 83 A 75 92 A 6

PIT Cost Reductions (verifiers) 19 14 G 110 133 A 116 147 A 9

PIT Agency Staff Reductions 38 19 G 125 160 A 126 179 R Due to issues with recruitment 9

Increase Private Contributions 3 3 A 25 32 A 35 35 A 4

Communications 0 0 G 11 8 G 11 8 G 1

ICT Contracts Cancellation 11 8 G 165 88 G 175 96 G 2

Subtotal Corporate 82 55 G 547 536 G 588 592 A

Contingency 0 (10) G 0 (106) G 100 (116) G

Total 721 628 G 5,767 6,185 A 6,415 6,818 A

Page 27 of 34


Quality Impact Assessment of the Cost Improvement Programmes 2015-16

HCP Project 860 Cost of less qualified staff and less equipped

vehicles for pre-triaged low and no care patients2 Q 3

This should improve quality of care - right person,

right vehicle at the right time - releasing other

crews for Red calls.9 HCP project leads and planned roll out. Audit of calls. 9

Specialist Para 116 reduction in conveyance as more specialist

paramedics deployed4 Q 3

Patients will receive care in the most appropriate

place by specialised practitioners. Patient

Experience should be good for those patients. 12

Audit of recontacts. Training of specialist paramedics.

GP triage.6

Rota Review 643

rota review to better match resource availability

against response demand in South. Will result in

higher UHU

2 Q 4Rotas aligned to demand and fluctuations will

deliver improved response and care for patients.8 Staff consultations. UHU planning. 4

bank/medic now/skillstream 75

recruit own bank staff. Use agency staff rather

than full crew with vehicle. Manage PP payment

via skillstream

3 Q 3

Recruiting SCAS bank staff will improve quality by

using regular, known staff. Use of agency

ambulance staff without vehicles enables SCAS

crews to partner those individuals reducing risks.

9 9

Sickness Management 250 reduction of 1% against 14/15 sickness levels 3 Q 3Potential to improve quality of work lives and care

provision.9

Sickness levels are still above plan and may be

impacting on resources9

Consumables Management 150

Target of 7.5% cost reduction through stock

management and rotation. Make ready will

manage Min and Max levels. Excess stocking

returned to CLU for re-allocation

3 Q 3

Impact should be to reduce out of date stock

issues. Ensuring that levels are correct across all

areas.9

\not delivering savings hence no impact on historical

stock levels6

EPRF Benefits 200 Reduction of Print costs/scanning time and

shredding services 2 Q 2

Impact on quality low if ePR systems are

continuously working efficiently.4 Monitoring. 4

Private Provider Rates 500 Negotiation to reduce PP rates due to indicative

contract levels and differential rates for skill sets 3 Q 3

Should not affect Quality if rates are reduced in

agreement but SCAS continue to have the same

level of availability of staff from PP's.9

Negotiation to ensure availability of correct skill sets

required to deliver service.4

Fleet efficiencies 205 Land rover maintenance in house. ATS new lower

rate card for tyres. Return to manufacturer for 2 Q 2 Low impact on quality. 4 No further actions required 4

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

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

Page 28 of 34


Private Providers Efficiency 100 Increase utilisation of PP's to nearer SCAS levels 4 Q 3

Potential of PP availability not being high enough.

Governance of PP would need to increase if

utilised more to meet demand.12

Clinical Governance reviews in place with PP's.

Monitoring of complaints and incidents.6

Lost Unit Hours reduction 150 remainder of 2014/15 CIP 4 Q 3Possible risks to care if resources are too low - long

waits are higher than last year12

Further work underway to understand UHU and

resource gaps12

Reduction of time on scene 270 remainder of 2014/15 CIP 4 Q 4

Performance may improve by release of staff.

Potential risk to quality of not achieving full

patient assessments. May improve stroke

performance.

16being monitored with no apparent impact on quality

of care although behind plan12

Indirect Unique contribution 448 remainder of 2014/15 CIP 3 Q 1 Quality and performance should improve. 4Training of co responders to reflect SCAS procedures

and standards to ensure care is safe and effective.4

Agency staff to Perm 50 Steve West and Mark Gaastra to become

substantive1 Q 1

No impact on Quality - better to have permanent

SCAS staff1 No further actions required 1

Staff Retention/attrition

reduction 200

reduce staff attrition from 2014/5 levels. Reduced

pp backfill costs/ lower training costs and more

efficient experienced staff (not costed)

2 Q 4

Reducing attrition and employees staying with

SCAS improves teamwork, consistency and quality

of care. 8

Attrition remains a concern and actions in place to

reduce but ahead of plan at present12

Private Provider Meal Breaks 400

Bringing private provider payment in line with

SCAS staff and only paying for effective hours and

not full shift including meal breaks.

4 Q 2

Should not affect Quality if rates are reduced in

agreement but SCAS must continue to have the

same level of availability of staff from PP's to

ensure safe patient care to meet demand.

8Negotiated fully in contract requirements and

agreements.2

Air Ambulance 19 reduction in missed meal break and staff travel

and subsistence due to longer rotation terms2 Q 2

Longer waits while staff take meal breaks during

times of unplanned high demand. Reduction in

costs relating to subsistence and travel is a benefit.4

UHU and planning in line with forecast activity to

reduce risk2

Reduce Attrition 16

Reduced staff attrition from FY14/15 levels. Thus

reducing the new starter training abstractions &

reducing WTE figure

2 Q 4



of care. 8

Exit interview analysis and ensuring staff are

appraised and developed. Robust systems in place.8

EOC Sickness management 58 Reduction of sickness- reducing abstractions 3 Q 3Potential to improve quality of work lives and care

provision.9

Sickness to be monitored weekly and resource levels

adjusted through other variable resource if sick levels

are higher than plan.9

Page 29 of 34


Floor walking- increase H&T,

reduce red 8's 27

Business case approved- adding floorwalkers in to

reduce % red 8's and increase hear & treat4 Q 3

Introducing floorwalkers should potentially

increase hear and treat and reduce response levels

freeing up crews to attend those patients most

acutely ill. Floorwalkers need to be familiar with

NHS Pathways to deliver this.

12Consideration to using own SCAS staff trained in

pathways. Behind plan YTD9

Virtualisation 359 Continuation from last 6 months of FY14-15,

virtualising NH & SH to gain economies of scale3 Q 2

Virtualisation should improve call response and

therefore the experience of callers/patients.6 2

111 Sickness management 55 Reduction of sickness- reducing abstractions 3 Q 3Potential to improve quality of work lives and care

provision.9

Sickness to be monitored weekly and resource levels

adjusted through other variable resource if sick levels

are higher than plan.9

Introduction of Health Advisors 65

For Health information calls trial in Southern

House for health info advisors dealing with call

rather than clinicians, lower banded staff

4 Q 3Potential for impact on quality of not having

clinicians taking HI calls.12

CHI computer programme and supervision to be in

place along with robust training.6

111 Reduce Attrition 25

Reduced staff attrition from FY14/15 levels. Thus

reducing the new starter training abstractions &

reducing WTE figure

2 Q 4



of care. 8

Exit interview analysis and ensuring staff are

appraised and developed. Robust systems in place.4

111 Senior Management

Reduction 66

Following the departure of the director of 111

responsible for the service has moved to the SCAS

chief operating officer.

2 Q 1Risk to quality low - workload and support for

chief operating officer to be robust.2

Assistant Directors in place for services to support

chief operating officer.1

Page 30 of 34


CQC 25 One off CQC costs not recurring 3 Q 3A further inspection due in 2015 may result in

further costs.9 No further actions required presently. 9

CEO Receptionist permanent 3 Agency staff replaced with permanent 1 Q 1No impact on Quality - better to have permanent


CD transfer to be salaried 1 Agency staff replaced with permanent 1 Q 1No impact on Quality - better to have permanent


Technology Scheme 16

Employee technology scheme. Savings from

reduction in National Insurance and pension

contributions

2 Q 1 No impact on Quality 2 No further actions required 2

Deanshanger Closure 10 Site closed 14/15 1 Q 1 No impact on quality 1 No further actions required 1

Fareham Closure 7 Site to be closed 15/16, part year effect 1 Q 1 No impact on Quality 1 No further actions required 1

John Betteridge role to

permanent 18 Agency staff replaced with permanent 1 Q 1

No impact on Quality - better to have SCAS

permanent staff1 No further actions required 1

Banbury Closure 5 Site closed 14/15 1 Q 1 No impact on quality 1 No further actions required 1

Waste Cip 56 Renegotiation of waste management by

procurement3 Q 3

Potential of costs if waste not handled/disposed of

correctly.9 Robust renegotiation of contract. 6

Increase in Private Contribution 35

Lease car increase in private contribution. Savings

from increase and also individuals returning lease

cars

2 Q 2

Low impact on Quality but may result in some staff

not travelling as much and teams managed

virtually.4

Use of computer technologies such as call and video

conferencing to increase.4

ISDN line cancellation 96 Savings from Virtual Contact Centre business case.

Ceasing ISDN telephone lines2 Q 2 ? 4 2

Sponsorship of Ambies 8 Income generation to cover cost of ambies 1 Q 2 No impact on quality 2 No further actions required 1

Performance Information Team

agency staff replacement 179 Replacement of agency staff with substantive 3 Q 3

Permanent SCAS staff will provide a better service

of receiving reports/data/quality of data.

Possibility of difficulties recruiting to specialist

posts. Impact is inability to have timely data for

contract purposes, audit, investigations, external

reviews and mandatory requirements.

9Use of agency until fully established with permanent

staff.9

Verifier Reduction 182 EPR project resulting in the reduction in verifiers

of paper forms. Continued cost base of £28k3 Q 3

Risks to quality if fall back procedures required to

verify patient records. Auditing and reviewing

records is necessary for incidents/complaints.9 Maintain a level of verifiers. 9

Corporate Areas

Page 31 of 34

Integrated Performance Report - Trust HR

Commentary:

Commentary:

We are some way behind on meeting our

appraisal compliance score, with 68% being

the lowest February total in four years. As

we have 130 becoming overdue in March

and 101 in April. In order to meet the 80%

target, we will need to ensure that we have

516 appraisals completed Trust-Wide

before the end of April 2016

6.5% 6.5% 5.8% 5.6% 5.6%

6.0% 6.4%

6.1% 6.1% 6.7% 6.8%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0% Trust Sickness

2015-16 Actual

2015-16 Plan

2014-15 Actual

66.1% 66.2% 69.4%

71.8%

72.4% 70.0% 65.9% 66.6% 68.9% 67.4% 68.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Trust Appraisals

2015-16 Actuals

2015-16 Plan

2014-15 Actuals

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%


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%


Safeguarding Adults

Safeguarding Children

Fire Awareness

Information Governance

Page 32 of 34


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

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.

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.

Page 33 of 34


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 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

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.

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 99% of patients were reached.

The time taken to answer 999 calls in an emergency control room measured by the time below which 50% of calls were answered.







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.

Page 34 of 34

Agenda Item: 12



Title Workforce Report

Responsible Director Melanie Saunders, Interim Director of HR & Education











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


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) Council of Governors receive the monthly Integrated Performance Report containing information regarding workforce 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

Other Previous considerations by the Board Board Seminars 2013, 2014, 2015


NHS Constitution http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution HEE Workforce Plan for England http://hee.nhs.uk/2015/02/15/workforceplanforengland

http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution

http://hee.nhs.uk/2015/02/15/workforceplanforengland

of 6


WORKFORCE REPORT

PURPOSE

1. The purpose of the paper is to provide an overview of progress against our recruitment and workforce plans the 999 front-line and patient transport services (PTS).

2. The workforce data and associated summaries are based upon actual activity to end of February 2016 and provide the forecast recruitment and attrition data to 31 March 2016. All data has been reconciled with Finance, all reforecast data from September has been produced and agreed in conjunction with our Finance and Operational Planning teams.

3. Forecast numbers are based upon estimated recruitment to 70% fill rate for 999

services and 65% for PTS for all programmes to the end of the financial year, this is based upon continuing difficulties in attracting candidates, in particular within the Thames Valley. The team continue to work to fill all programmes to 100%.

KEY UPDATES 999 SERVICES

RECRUITMENT

4. Recruitment remained consistent during January and February 2016. Overall, we remained ahead of the re-forecast in July, recruiting 230 full-time equivalents (FTE) against a target of 221 FTE for the full financial year; the pipeline is closely monitored on a weekly basis by our Executive and Senior Leadership team. In summary the January and February 999 results were as follows:

• Emergency Care Assistants (ECAs): total 41 joined (7 above forecast) over 2

courses • Paramedics: 13 joined (4 below forecast) over 2 courses. • Healthcare Professional (HCP) Staff: 12 joined (5 below forecast) over 1

course

5. Candidate pipelines for month 12 look positive, adverts and active recruitment for all grades continue as we begin to recruit to 2016/17 Q1 programmes.

of 6

Table 1: Total recruitment trajectory to 31 March 2016

999 STAFF ATTRITION 6. Despite a small increase in January, attrition continues to show signs of

improvement, with staff leaving the Trust totalling 27 against a forecast of 32 for the January-February period. The end of year attrition is set to see overall 999 staff turnover reduced from the forecast 15% to 13.5%.

Table 2: Total attrition trajectory to 31 March 2016

999 STAFF RETENTION

7. The 999 stability index is the rate at which existing staff are retained, where a

desirable total would be 95%. For the period April 2015 to February 2016 the overall 999 index was 85%. This means that a total of 1,436 staff were in post at the start of the period, with 1539 remaining at the end, of which 1219 (85%) were retained throughout the period. Organisationally, this is a significant improvement demonstrating signs of staff levels recovering. For comparison, in the same period during 2014/15 the stability index was 83%.

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8. Table 3 demonstrates an increase in overall contracted workforce numbers

against target. This has been as a direct result of the integrated departmental planning approach, where improved stability (retention) and reduced attrition rates have combined with recruitment meeting and exceeding forecast requirements. This is the sixth consecutive month the actual staff employed was above target.

Table 3: 999 Workforce trajectories to 31 March 2016

NB: red line denotes rota requirement, purple line denotes forecast taking into account recruitment and attrition forecasts). 9. www.scasrecruitment.co.uk continues to attract new visitors with average weekly

‘hit’ rate of 100+ plus per week.

10. Following the success of our recruitment days, candidate numbers continue to rise, in particular for roles within PTS (these have doubled) and the inclusion of the C1 attracted nearly 30 applicants in 3 days with all jobs role having had more applicants and significantly more interest.

COMMERCIAL SERVICE (PTS) WORKFORCE PLAN 11. SCAS-wide at the end of February 2016, the service (operations and contact

centres) has a total 49 WTE vacancies this represents a 13% vacancy rate, a 6% improvement since October 2015 when the Integrated Workforce Planning Team began working on the workforce and recruitment plan.

12. There has been a period of uncertainty within PTS as we await the confirmation

of the number of staff transferring to SCAS under TUPE arrangements following the tenders for SHiP and Thames Valley contracts (see trajectory in table 4). In order to mitigate any risk of over-staffing, we have increased our internal bank workforce by 29. Once we have confirmed TUPE numbers we will move to filling the remaining vacancies with substantive appointments. The 2016/17 recruitment and education plan has capacity for 120 new joiners to PTS, our target is to exceed forecast fill rates and reach near full establishment by Q2.

http://www.scasrecruitment.co.uk/

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Table 4: Total workforce trajectory to 31 March 2016

NB: Actual FTE shows figures to Feb’16, then forecasted to Mar’16. Planned FTE is the total capacity within the training programme.

13. Attrition within the PTS service is forecast at 14.6% for the year with attrition in

January and February being 9.7 FTE against a forecast of 6 FTE. Table 5: Total attrition trajectory to 31 March 2016

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14. Recruitment remained positive with a total 14 joining in November, 2 above forecast, there was no planned recruitment during December.

Table 6: Operations recruitment trajectory

Nb: Actual FTE shows actual figures to February 2016, then forecast to 31 March 2016. Planned FTE takes into account total capacity within the training programme. For January and February, BANK has been included as per paragraph 10. EOC/111 WORKFORCE PLAN 15. The workforce plan for our Contact Centre is currently being finalised, using the

same integrated approach applied successfully in 999 and PTS. The plan is scheduled to be signed-off during March.

16. At present, EOC is forecast 4% and 111 forecast at 14% vacancy rate at the end

of the financial year. The 2016/17 plan has adequate training resource to match demand to the high number of staff employed within this area.

Progress since last report 17. The Executive and Senior Leadership team continue to closely monitor a range of

factors affecting the workforce statistics on a regular basis. Through staff feedback we have developed our ‘you said we did’ plan which is focused on addressing issues affecting our staff and their working environment, thus improving workforce capacity and aid retention.

18. Rotas remain under review, work has been completed on revised demand profiles which will be the basis on which to build revised rotas. Other key drivers to the development of rotas will be delivering improved compliance with our meal-break targets and end of shift over-runs; these two elements are key to improving the working lives of our staff.

19. Our Health and Well-Being cell remains active, however during January 2016 all key areas exceeded absence forecasts. Within our 999 services the average over the last four weeks has been 6.3% and comparable for the same period 2014/15 but slightly above our forecast. 111 absence exceeded forecast in January at 9.3% with EOC also exceeding forecast at 8.1%.

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20. Following the launch of our Band 6 development opportunity a total of 173 employees have now progressed into Band 6, with a further 49 candidates in the pipeline.

RECOMMENDATIONS TO THE BOARD 21. The Board are asked to note progress with the progress with our recruitment and

attrition plans for both 999 and PTS Workforce. Melanie Saunders Interim Director of HR and Education 10 March 2016

Agenda Item: 13



Title Staff Attitude Survey 2015

Responsible Director Melanie Saunders, Interim Director of HR and Education












Links with risks on the corporate risk register/Board Assurance Framework relating to the recruitment and retention of staff


Outcomes from the annual staff survey are monitored by CQC. The survey included a basket of indicators to measure staff engagement which is key to patient care.


There are no direct financial implications


Staff Governors will have been invited to participate in the survey. Feedback from the survey provides Governors with evidence of staff engagement.


This report presents the findings of the 2015 National NHS staff survey conducted in South Central Ambulance Service NHS Foundation Trust. Section 2 of the full report, presents an overall indicator of staff engagement. Sections 3, 4, 6 and 7 of the report; the findings of the questionnaire have been summarised and presented in the form of 32 Key Findings. Section 5 of the report; the data required for the Workforce Race Equality Standard (WRES) is presented. These sections of the report have been structured around four of the seven pledges to staff in the NHS Constitution which was published in March 2013 (http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution) plus three additional themes:

• Staff Pledge 1: To provide all staff with clear roles and responsibilities and rewarding jobs for teams and individuals that make a difference to patients, their families and carers and communities.

• Staff Pledge 2: To provide all staff with personal development, access to appropriate education and training for their jobs, and line management support to enable them to fulfil their potential.

• Staff Pledge 3: To provide support and opportunities for staff to maintain their health, well-being and safety.

• Staff Pledge 4: To engage staff in decisions that affect them and the services they provide, individually, through representative organisations and through local partnership working arrangements. All staff will be empowered to put forward ways to deliver better and safer services for patients and their families.

• Additional theme: Equality and diversity • Additional theme: Errors and incidents • Additional theme: Patient experience measures

Please note, the questionnaire, key findings and benchmarking groups have all undergone substantial revision since the previous staff survey.


The results from the Staff Survey are presented annually to the Board, and actions reported through Quality and Safety reports


Further information relating to the annual staff survey and results of this and previous years surveys for all English NHS Trusts can be found at www.england.nhs.uk The full survey report can be found here: http://www.nhsstaffsurveys.com/Caches/Files/NHS_staff_survey_2015_RYE_full.pdf

http://www.england.nhs.uk/

http://www.nhsstaffsurveys.com/Caches/Files/NHS_staff_survey_2015_RYE_full.pdf

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STAFF ATTITUDE SURVEY 2015

PURPOSE 1. The purpose of the paper is to inform the Board of the outcomes of the 2015

staff attitude survey, of progress against key outcomes in the 2015 survey and of actions planned to address key indicators of concern during 2016.

EXECUTIVE SUMMARY 2. The 2015 survey response was completed by 55.5% of staff, a slightly lower

response rate to 2014 when we achieved 59%. A number of departments within the Trust achieved over 90% return.

3. Compared to the results from 2014, there has been significant change on only

6 of the 32 comparable key findings, 4 having improved, and 2 being worse. 4. The scores achieved by the Trust benchmark well against all other

ambulance trusts, being rated above average on 13 of the 32 key findings, and below average on only 7.

5. Local action plans, from the 2015 results, are now being developed by Area

Managers and Heads of Departments and progress against these will be reported to the Executive Team on a quarterly basis. This year they will be presented in a consistent format which will enable better monitoring and comparisons.

KEY ISSUES Staff Survey 2015 – Methodology and response rate 6. The staff survey was undertaken during October/November 2015, and all staff

were invited to take part. The Trust again undertook a fully electronic survey, with members of staff receiving an email with a unique log in. All staff received an electronic survey, including the Commercial Services directorate. These staff were provided with a paper version last year, however there was no significant difference in the response rates. Staff who were on maternity leave were also included in the 2015 survey.

7. Response rates were reported within the Trust on a weekly basis on a league

table basis, asking each manager to encourage staff to respond. Each department/area was given a target of 50% completion. The highest response rate was achieved by the Human Resources department at 97% and the lowest rates were experienced in the commercial services departments.

8. The overall response rate for the Trust was 55.5%, slightly lower than the

59% in 2014, but again the highest response rate for all ambulance trusts.

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Again, Corporate areas produced the highest responses. The highest non-corporate department response rate was recorded for EOC South, 85% with the lowest responses being the Commercial Logistics and Training teams, with a response rate of just 14%.

Key Findings 9. The survey consists of 92 questions, with the results reported against 29 key

findings, which are clustered against 4 of the 7 staff pledges within the NHS Constitution, and additional themes of staff satisfaction, equality and diversity and patient measures experience. A total of 86 questions have been used in the 2015, 2014 and 2013 surveys, reported against 27 key themes. Results are reported as a percentage or a scale summary score ranging from 1 to 5, with higher scores being best. In addition to the overall trust report, the trust received individual reports for each of the local areas and departments.

10. The Staff Engagement score compared as an average result when compared

against other Ambulance Trusts, but had improved considerably since 2014.

11. Of the 27 comparable key findings, 4 showed significant improvement from

2014. These were:

2014 2015 Percentage of staff believing that the organisation provides equal opportunities for career progression or promotion

66% 71%

Staff motivation at work (increase from 3.48 in 2014 to 3.59 in 2015)

3.48 3.59

Percentage of staff feeling pressure in the last 3 months to attend work when feeling unwell

66% 61%

Support from immediate managers 3.60 3.69 12. 2 had significantly deteriorated since last year, with 2 continuing that trend from

2014.

2014 2015 Percentage of staff experiencing physical violence from patients, relatives or the public in the last 12 months (increase from 28% in 2014, to 32% in 2015)

28% 32%

Staff confidence and security in reporting usage clinical practice

3.56 3.48

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All other scores were not significantly different. 13. In comparison to other ambulance trusts, SCAS scores were significantly

higher in 7 key findings. The 5 top ranking scores, compared to the average, were:

14. SCAS were only significantly lower than the average for all ambulance trusts

in 2 key findings (lowest 5 areas shown)

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Actions taken following the 2014 results 15. The 3 areas which were of concern from the 2014 survey were:

2013 2014 2015 Staff reporting work pressures 3.19 3.32 N/A Staff motivation at work. 3.72 3.57 3.59 Percentage of staff being appraised 79% 74% 75%

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16. Since the 2014 survey results there have been a number of actions which have taken place:

• Face to face Equality and Diversity training has been arranged for most

corporate departments

• Commercial Services pledges include 4 pledges based on personal development, reflecting on progress, encouraging feedback and sharing learning. The personal development pledge for example is as follows;

“We pledge that all staff will be stood down from their duties to attend two days of additional face to face training. Staff will also be given the opportunity to undertake modern apprenticeships to support personal development.”

• Commercial Services offered modern apprenticeships to all staff in March

/ April and they are being incorporated into the band 2 – 3 progression.

• Within Operations 999 some operational teams RAG rate their progress against their area action plan, others have compared results, identified common themes, shared ideas and created an overall staff survey action plan for their combined areas.

• Career development opportunities within Operations have also been

developed with the role of Specialist Paramedics and the Enhanced Paramedic.

• Team Leader’s appraisals include an objective to enhance quality of

appraisals to be measured via the staff survey” and appraisals and themes arising from appraisals to be discussed monthly at level 1s.

• Oxfordshire have implemented some good initiatives aimed at

encouraging staff engagement. In conjunction , with HR “Encourage Engagement” workshops have taken place where Team Leaders have identified practices they can implement to encourage engagement amongst their teams. The staff survey, apprasial and “encourage engagement” action plans are reviewed at the five weekly leadership meetings. These meetings also focus on the development of team-work by including Clinical Mentors and exploring issues such as how SCAS can support the Team Leader and Clinical Mentor roles.

• “Stay interviews” focusing on reducing attrition by identifying what will

make team leaders stay with SCAS are also being piloted amongst Team Leaders in Oxfordshire and North East Hampshire and action plans will be devised accordingly.

• 111 South creates Staff Survey Pledges highlighting areas of the staff

survey requiring improvement, possible misconceptions amongst staff and actions taken in response to feedback.

• A review of recruitment processes has been undertaken, which allows

new staff to start quicker than previously.

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• A “You Said, We did” action plan has been developed which highlights areas where staff have raised issues and monitors the progress against each area.

17. Focus will remain on staff appraisals in 2015. Refresher training for managers

in holding meaningful appraisal will continue to be provided. 18. Since 2012, each department has received their own detailed staff survey

report. Each Area Manager / Head of Department agrees a set of pledges with their staff based on their local findings. Pledges focused on their local areas for improvement, which included appraisals, training and development, improving local communications and support from immediate managers.

19. This approach will continue this year, each area manager has now received

their individual report for 2015 and will review it against their 2014 action plan, before agreeing their plans with their team based on the 2015 feedback.

Action plans - 2015 survey 20. Local action plans and pledges, in a consistent format are now being

developed by managers and will be monitored by the Executive team. A series of communications will provide further feedback to staff on progress against key findings and pledges, both at a trust and a local level. Consistency checking will be assured by the Human Resources team to ensure that all areas of improvement are targeted, including Trust wide concerns.

21. As a Trust, actions need to be taken to address the 2 key findings of concern,

alongside the 5 bottom ranking scores, where the Trust was lower than average across all ambulance trusts. This will be achieved by ensuring each local action plan has a specific local action to address this.

22. The training and education plan for 2015/16 is under development and

includes face to face training for all front line staff, supplemented by E- learning to address all statutory and mandatory requirements. The final plans will take due consideration of this year’s survey findings and incorporate key indicators for change. Additional development, in the form of development centres is also planned to support Team Leaders develop in their role.

CONCLUSIONS 23. The Trust has maintained a high response rate and therefore has received

meaningful feedback from staff. Some areas of the Trust have become fully engaged with the survey and the local approach to action planning and we need to maintain this. Further work will be done to improve responses in lower reporting departments next year.

24. Action plans and pledges will be developed to address local areas of concern

and delivery monitored by the Executive team. Progress will be reported through a series of staff communications. This will also be monitored via a new Wellbeing forum which is currently being designed.

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RECOMMENDATIONS TO THE BOARD 25. The Board are asked to note the findings of the staff survey and the progress made against areas of concern identified last year. 26. A further progress report will be provided at the end of Quarter 1 2016/17. Author Melanie Saunders Title Interim Director of HR and Education Date March 2016

Agenda Item: 14



Title Board Assurance Framework (BAF)

Responsible Director Deirdre Thompson, Director of Quality and Patient Care

Recommendation (eg. note, approve, endorse) To note the risk scores and assurances, controls and actions










Risks in delivering key corporate objectives and strategic aims. Ensure mitigating actions in place.

Implications Regulatory and legal implications / impact (e.g. Monitor provider licence and continuity of services risk 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 CQC outcomes 1 and 4 (Dignity, respect and welfare of patients). Risk of receiving inadequate rating following the CQC inspection as outlined in risk 4.3


Financial risks may affect compliance with the Monitor Framework. Risks associated with objective 6 (Commercial Viability) may have implications for Opportunity Pipeline and financial risks, 4.1 and 4.2 may impact on Monitor Compliance. Council of Governor implications / impact (e.g. links to governors statutory role, significant transactions etc)

Assurance from Council of Governors that risks identified have action plans 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 presented to the Board at every public meeting. Corporate risks evaluated in the risk register by Executive Committee in the Risk and Compliance Group meeting March 2016 and in the Executive Committee. Corporate Risk Register considered in Audit Committee in January 2016


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.

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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 2016. In addition a monthly

risk profile is included which gives a summary view of the mitigated scores of identified risks.

3 The Board are 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 2015 / 2016 year to

ensure Board visibility.

5 There are currently 7 red risks and 7 amber rated risks on the BAF as reviewed by the Executive Directors on a monthly basis and by the Audit Committee in January 2016

6 Risk 1.1 – Risk relating to Long Waits for patients remains red at 16.

7 Risk 1.3 - Consequences of missing red targets remains red at 15.

8 Risk 1.6 – Risk to patient safety, patient confidence and Trust reputation due

to issues with Portsmouth Hospitals NHS Trust and the upward trend in handover delays has resulted in an increased risk rating from of 12 to 16.

9 Risk 2.1 – Poor IT resilience remains red at 16

10 Risk 4.1 - The risks around the Cost Improvement Plan delivery and achieving

financial targets remains red at 16 due to the forecast deficit.

11 Risk 5.2 - Effectively managing sickness and absence remains red at 16 although there are signs of improvement using the new processes.

12 Risk 5.3 – The ability to recruit and retain staff remains red at 20 as the

benefits of all the plans currently being implemented need to be realised with an improved trajectory through the year ahead.

13 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

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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.

NEXT STEPS 14 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.

CONCLUSIONS 15 The BAF has been further reviewed and updated since the last report to the

Board in January 2016 and reflects the risks for the current year. RECOMMENDATIONS TO THE BOARD 16 The Board are asked to confirm that the principal risks have been identified

and are being adequately mitigated. Deirdre Thompson Director of Patient Care March 2016

RAG

Strategic Objective Risk

Principal Risks Date Co Lik Tot Current Control Measures Gaps in Controls Current Assurance Gaps in Assurance Action to be taken Respons. Timing /

Co

Li Tot

16

204

1. Clinical Excellence: Quality of care, patient safety and experience

Monthly review and daily analysis

Deirdre Thompson Director of Patient Care Sue Byrne COO

All 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.

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.

8 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

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.

September 2014: Improvement trajectory slightly ahead of target with continued forcus with all elements of the action plan led by operations and training and monitored via the Executive team CQRM, Q&S committee and CRG. Continued focus on practices at shift level with reviews by TL's and monitored via the CQRM, Q&S committee and CRG Nov-14 Continue to drive forward "fast means fast" project and ensuring that all incidents are included into the data set. December 2014:Face to face training now complete and early indications are that this is having a positive impact on the analgesia administration element of the care bundle against the trajectory for improvement. January 2015: Indicates that analgesia administered for Stemi patients improving slightly ahead of trajectory May 2015: continue to see slow progress with this and 'live' data continues to be challenging with monthly rebasing required to ensure valid data. Work continues with discussions ongoing with the Clinical Senates being attended by JB and RK to ensure changes to HASU and ASU are appropriate for SCAS in particular journey times and also the proposal for all Strokes to be conveyed to HASU. Trajectory for improvement on plan for the second month running following the completion of additional training and awareness June 2015:Pain audit discussed at CRG. Actions developed. Clinical Directive sent. Alternative formulaires being considered by staff group. August 2015:The target has met trajectory in month at 55.5% and work continues with access to one of our HASU's in the SCAS geography.JB working with NASMED regarding the analgesia elements of the STEMI Care bundle to ensure that the use of Entanox for this cohort of patients is better understood and is aligned to clinical evidence. Analgesia administration continues to be reinforced with our clinicians 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'

Nov-14 - long waits analysis and action plan now includes a risk rating per incident December 2014:Non-conveyance rates continue on target with recontact after 24 hours of a non-conveyance also on plan. Continue to monitor and investigate any clinical incidents for patinets who have been non-conveyed. - Longwaits have increased as a result of demand and acuity we continue to monitor at CQRM CRM April 2015 - New contract was agreed with supplier who is now working through equipment and bringing everything up to standard and providing reporting. Being reported through H&S committee and equipment group. Long Waits for red calls have improved and there is evidence from analysis that the time of the wait has reduced for green long waits but the actual number of patinets remains a challenge in the green category of calls. Monthly combined operational and clinical team audits continue to review any harm to patients and to ensure that any learning is shared. Continue to see planned levels of non-conyeance with a reduction in recontacts and fewer incidents of patients not being safety netted appropriately and a reduction in harm relating to non-conveyance. June 2015:Long Waits for red calls have improved and there is evidence from analysis that the time of the wait has reduced for green long waits but the actual number of patients remains a challenge in the green category of calls. Monthly combined operational and clinical team audits continue to review any harm to patients and to ensure that any learning is shared. Continue to see planned levels of non-conveyance with a reduction in recontacts and fewer incidents of patients not being safety netted appropriately and a reduction in harm relating to non-conveyance. June 2015 SCAS performance ytd is on target at 75%+ and 95%+ respectively however there is a material difference between service levels in the TV and SHIP/MK contract areas. Demand in both areas is below plan but TV is being adversely affected by vacancy rate and continued high levels of attrition at levels above plan whilst recruitment is behind plan. Resources are being moved between areas to support areas of high vacancy rate and service levels are improving. Deployment is being centred on the areas most impacted . w/e 14th qtd June Red 1- 72.37, red 2- 73.97 and Red 19- 94.23 August 2015: Monitoring still in place but CAD upgrade in July impacted our performance and impacted long waits for all patients. Changes made to date:• Standard approach / refined ToR to ensure long waits are reviewed consistently north and south and jointly with the Patient Safety Team• Changes made to the meal break policy• Developed a comprehensive clinical welfare check of long waiting patients with upgrades if deterioration noted• Consistent approach to invoking the ‘immediate handover policy’• ECT training tool specifically designed for falls patients and associated risks of pressure tissue damage • Continued close monitoring of performance by Q and S. 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.

3 4Monthly review

1.3 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

Board Assurance FrameworkRaw Risk

RatingMitigated

Risk

44

34 412

1,2 June 2014: Some early evidence of improvement Need to ensure that the trajectory for improvement is achieved through monthly monitoring of performance

5

Deirdre Thompson Director of Patient Care John Black, Medical Director Sue Byrne COO

3 3

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

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)

4,5

28/02/16

28/02/16

1.2 Failure to convey patients to HASU in a timely manner

and failure to provide adequate pain relief to STEMI patients

Action plan in place for STEMI and stroke (in IPR) rate SCAS performance mid table

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.

28/02/16 April 2014: Continue to monitor via IPR and reinforce dual verification at Acute Hospital Level June 2014: Minimal evidence of delays following the successful introduction of double verification and hospital handover across all Acute Trusts. Failure to achieve all targets for Q1. REAP 3 escalation instigated to mitigate resource risk. Further discussion with PP to provide additional lines of resource. Recovery action plan now being implemented - Nov 14- Ambulance turnaround times have continued to be high driven primarily by two hospitals in the SCAS region. We continue to work closely with all out hospitals to minimise turnaround. Any delays are escalated via the duty director process / REAP 3 continues to be in place. PP resource secured for winter period. Additional winter funding including HALOs to minimise hours lost at hospital. CFR programmes growing. Continue to strengthen CSD and 111 response / Trust at REAP 4 High demand and acuity impacting our ability to meet targets / VOR in line with plan vehicle availablitlity is causing minimal impact to the organisation January 2015: Continue to work very closely with partners and commissioners to ensure that Acute Trusts are making every effort to release ambulance crews. SCAS are ensuring that all available clinical staff including management are responding to incidents. May 2015 - Performance has improved in April and to date for May with key focus and emphais on waiting / handover times at hospital. The Trust is now at escalation REAP 2 and undertaking all relevant actions. The risk level remains static at 20 at present as we need to see consistent performance over a longer period of time. June 2015:Performance has improved in April and to date for May with key focus and emphais on waiting / handover times at hospital. The Trust is now at escalation REAP 2 and undertaking all relevant actions. The risk level has reduced as we now have seen ourslves on track for 2 quarters but constant scrutiny is required in TV until performance is at target level August 2015: The Trust is at REAP3 and officers and managers are being utilised to respond. The implementation of a CAD upgrade in July adversely impacted our performance and has led to SCAS performance being very poor for the whole month. August performance is improving but shortages of staff in particular at night and at weekends are making recovery challenging. Additional measures have been put in place to increase hours through private providers, recruitment and overtime incentive. Our EOC and 111 teams are also focusing on using our clinical triage teams to minimise unecessary dispatch of ambulance resources. 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.

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

9Deirdre Thompson Director of Patient Care

9

15205

Monthly review

3

RAG



Co

Li Tot


RatingMitigated

Risk

6 1.4 Private providers not consistently meeting required standards resulting in poor patient outcomes and experience

28/02/16 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.

April 2014: Continued monthly review to ensure safe, effective care provided using SCAS Clinical Standards of Care June 2014: governamce arrangements for Private Providers now extended to all Private Providers including PTS. 999 ops extended list of Private Providers from the approved list and also included in the governance reviews. September 2014: PP clinical and operational performance reviews continue demonstrating evidence of compliance with SCAS standards of care and operational efficiency Dec 2014 Robust PP governance meetings continue for the 999 contracts. This is being rolled out for the PP contractors used within the PTS service and recruitment to the PTS governance roles seen as crucial to the success of this process.June 2015: PP Governance reviews and spot check inspections have been carried out in May and June. Extending clinical governance framework to cover Conduit 111 and PTS. August 2015: All indicators show that the private providers are meeting their requirements currently and the governance meetings and unannounced visits to their premises continue 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.

COO Weekly review with formal bi-monthly monitoring

3 2 6 6

21 1.5 Non compliance with timescales for complaint acknowledgement and responses

28/02/16 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.

Deirdre Thompson Director of Quality and Patient Care

Weekly review with formal bi-monthly monitoring

3 2 6 6

22 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.

28/02/16 4 3 12 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

Poor patient experience and potential for adverse clinical outcomes. Poor reputation and risk to performance

Reviews of patient incidents demonstrating poor patient experience and minimal evidence of patient harm

Delays continuing at high levels January 2016: Formal letter of concern regarding issues with the Out of Hours provider sent to the Commissioners. SCAS working with the providers in the system 24/7 in order to reduce the risks to patients and working with Commissioners to ensure all information and intelligence is shared. 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.

DT Weekly review with formal bi-monthly monitoring

4 4 16 16

7 2.1 Poor IT Resilience 28/02/16 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.

April 2014: Major resilence work has now been undertaken to ensure that if there are failures contingencies plans are undertaken more rapidly to reduce impact on the services. July 2014: Business case approved for virtualisation. Further resilience work completed and progress against the action plan presented to the Executive Management team 15th July. Aug 14 Timetable confirmed for phased implementation of virtulisation in Sept - Nov 14 Virtualisation rolled out to PTS and 111. 999 deferred pending investigation and resolution of call drops Dec 14 Call drops have been resolved following modifications. 111/PTS virtulisation in place, 999 deferred to Jan 15 to ensure stability over Xmas period. Request from Trust Board to review IT resilience plan at Board in Jan 15 March 2015 999 virtualisation delivered, and IT resilience reviewed with Board.June 2015: Preparing for iCAD upgrade . Air conditioning upgraded to prevent failure. IM&T resilience postholder extended. August 2015: ICAD upgrade - issues being resolved with priority actions first. Report commissioned into the learning from the upgrade due Oct 15 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.


Weekly review

4 4 16 16

44144 Clear change control/quotation management with 3rd party suppliers. Strong programme budget control Clarity of technical output spec - robust FAT & SAT testing - clear change control processes Well constructed & delivered training backed up by effective mentoring & coaching processes - history (through NHS 111) of delivery of high quality, highly effective NHSP training. Training "back fill" arrangements in place. Additional staffing requirements identified & additional staff recruited & trained Detailed modelling with full operational involvment ahead of "go live". Phased transition/implementation minimising any impact & allowing time to make any futher necessary changes to operational deployment model to counter impacts. Close overview of programme activity (weekly reporting, monthly reporting up to Execs) Whole time head of programme, Whole time programme support Programme built into (integrated) overall SCAS portfolio Benefits tracker identified. Programme brief clearly identifies each benefits & programme succcess dependant upon benefits being realised

Monthly review

Chief Operating Officer

Adverse impact on financial position, reducing financial risk rating ICT technical issues - unable to implement and deliver to programme incorrect /ineffective call triage leading to incorrect patient disposition Red (1&2) performance below national standards leading to failure to achieve (monitor) quarterly performance targets Programme slip Inadequate staff training Identified benefits not achieved

1642.2 Inability to deliver all the benefits from the newly implemented 999 NHS Pathways

28/02/168

2. Emergency Performance

April 2014: Pathways is currently being rolled out to ECT & CSD in Southern EOC using the agreed methodology and monitoring programme. Review of performance daily and assessment of impact on % of red calls underway with review of trigger words and timely intervention by- CSD: AUGUST 2014 Following further Exec gateway review, introduction of Green Key words and "Auto Standown" advise functionality, roll out continued in NEOC. All metrics are within project scope, August performance at acceptable levels (above National Standards for Red incidents), H&T rates already exceeding planned out turn position, Red proportions contiue to reduce to plan. Programme remains on schedule and on budget with "Phase One" closure recommended - moving into BAU Nov-14 project now BAU. Final gateway review scheduled to review ongoing impact of higher levels of acuity experienced since implementation Dec 14: project now BAU. Final gateway review scheduled to review ongoing impact of higher levels of acuity experienced since implementation / project now BAU. Final gateway review scheduled to review ongoing impact of higher levels of acuity experienced since implementation Final gateway to be implemented in the New Year. June 2015: Gateway review - pathways audit by independent chair (post output of project and full transition to BAU) November 2015 Version 10 of pathways to be released shortly 98% of staff now fully trained for the updsated version of pathways. Version n10 includes amendments from feedback from providers. Feb 2016: No concerns raised

RAG



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RatingMitigated

Risk

9 2.3 Inability to deliver the ePR deployment programme & realise the benefits

28/02/16 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 June 2014: Medical Director and Director of Patient Care undertook a full clinical and quality review of the EPR system to ensure full compliance with clinical standards standards, patient safety elements and general user ease and functionality. Full gateway review planned for 7th July 2014 pre 'go Live' Nov 14 - Rollout to North Hampshire. Date put back due to REAP 3 and ensuring hospitals were correctly set up. Dec 14. North Hants and SW Hants rollouts successfully completed. March 2015 W Berkshire now live. Preparations for Summary Care Record and DOS.June 2015: The ePR will be changed in September to ensure the recording of all quality indicators All other Clinical indicators are showing small improvements after issues that have been identified and changes being introduced to the ePR. September 2015 Mobile DOS being piloted in W Hants, which should assist with non-conveyance benefits realisation. Latest software release includes improvements which will assist with CPI reporting. 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.

Charles Porter, Director of Finance

Monthly review

3 3 9 9

11 3.1 Risk of Information Governance Breach

28/02/16 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

Nov 14 Action plan reviewed at Audit Committee: 11 / 13 completed. One will not be closed until 2015 with new email system. One awaiting sign off by Exec Committee re web access. January 2015: Additional control recommendations made by BDO Auditors reviewed by managers and actions now in progress to further enhance IG goverenance going forward. Report presented to the Audit Committee in January 2015 March 2015: Report presented to the Audit Committee in January 2015 March 2015: IG Steering group preparation for level 2 IG toolkit submission. Robust policies for IG areas to be submitted for assessment. May 2015 - level 2 IG toolkit discussed and reviewed at the May Audit Committee and actions reviewed to ensure we embed at this level and that this is sustained going forward. June 2015:Achieved level 2 for IG toolkit 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.


Bi-monthly review

3 2 6 6

13 4.1 Risk to achieving financial targets and realise CIP’s.

28/02/16 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.

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

Forecast readjusted therefore increased risk. Demand continues at a high level. Period 7 surplus and cost savings behind budget

Further improved robust CIP development process with schemes actioned to get additional savings. - Full Quality Impact Assesment undertaken and mitgation actions and monitoring agreed - Sept 2014: Working hard with CCGs to get funding with will give additional resilience over the winter period. Nov 14 Risks and opportunities revised, financial improvement plan completed.Dec 14 Substatial assurance from BDO part 1 and 2 of the cost saving internal audit.March 2015 Continued progress to deliver savings in line with budget. May 2015 - CIPs identified and Quality Impact assessed for 2015 / 2016. 999 contract negotiations ongoing with TV and SHIP/MK Commissioners for the current year to further close the gap. June 2015: TV Heads of Terms signed. Overspends in first 2 months. Strenghtened process for signing off level of privates and resources linked to activity forecasts August 2015: Investigation is now well advanced, and nearing completion. Any issues identified are being resolved immediatley through the process. Commissioner updates are being provided to ensure proper assurance is given to key stakeholders. Independant assurer appointed who will overview the work of SCAS internal resource. Completion of investigation and report produced in draft due in Mid-September August/September 2015: Full review of Q1 operational and financial performance requested by the Board, to show issues, improvement actions and if necesary a revised forecast. This will be considered by the Board 15/9. Internal turnaround initiated with weekly meetings starting 2/9/15. New procedures relating to the control of corporate posts. 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.

Charles Porter, Director of Finance

Monthly review

4 5 20 20

14 4.2 Cost of delivering performance levels in 111 higher than assumption

28/02/16 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.

Delivery of fully networked (virtual) ACD telephony platform in plan for later this year. Further contracts via NHSD step in for Luton, Beds and Bucks have improved profitability of NHS 111 overall .Workforce planning review underway along with improved demand (and ERLANG) modelling (Process Evolution). Plans to improve staff rostering in place - introduction of GRS tool (KRONOS alternative). Further contracts via NHSD step in for Luton, Beds and Bucks and winter resilience have improved profitability of NHS 111 overall. Telephony virtualisation project. - Sept 2014: Contract negotiations underway with commissionres to balance cost and quality service Nov 14 Increased demand and the growing gap between required heads and actual are causing pressure on costs as PP's are more expensive.Dec 2014 Increased demand and the growing gap between required heads and actual are causing pressure on costs as PP's are more expensive.June 2015: New Monitor rating; Risk Share agreement; Estates 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 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.

Charles Porter, Director of Finance. Chief Operating Officer

Monthly review

4 2 8 8

3 2

3. Stakeholder preception and Trust reputation

28/02/163.2 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

4. Sound Governance

12

4 164 Deidre Thompson Director of Quality and Patient Care

Bi-weekly updates

EMG and final SIRI report to

Trust Board and

Commissioners

6 6Actions to be identified and implemented in a timely manner

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.

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.

Action plans agreed with the key leads and in progress and await completion and evidence of completion

July 2015: Gold Cell approach to the incident adopted and Chaired by Executive. SIRI declared, Investigation Manager appointed, ToR agreed, 72 hour report prodiced and sent to Commisioners and CQC, NED appointed for assurance and scrutiny. Clinical audit of all calls complete with random sample independently audited by NHSE pathways team with verification of SCAS audit scores. All patients contacted and follow up letters sent to those patients who requested them. Support also given to staff affected as individuals and as focus groups with teams. HR processes reviewed and confirmed as robust. ongoing external engagement with key external stakeholders through a variety of means. Advice being sought from Solicitors and the Information Commissioner regarding actions to take. Reported formally to the Private Trust Board. August 2015: Investigation is now well advanced, and nearing completion. Any issues identified are being resolved immediatley when possible through the process. Commissioner updates are being provided to ensure proper assurance is given to key stakeholders. Independant assurer appointed and is overviewing the work of SCAS internal investigation. Completion of investigation and report produced in draft due in mid-September with Commissioners planning a stakeholder wide formal SIRI closure meeting.Gold cell meeting continue to ensure all aspects of the risk are managed and mitigated were possible. October 2015: Final report completed and scheduled to be presented at the CCG SIRI closure meeting 21st Oct. Closure meeting to have representation from each CG lead from the CCG's to ensure robust scrutiny. Action plans and deadline dates agreed with key accountable and responsible leads for each action. Progress of the action plan to be monitored closely with evidence of completion at each SIRI Review Group and Upward reported to EMG and Trust Board as appropriate 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

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Risk

15 5.1 All staff access not met for education and training to meet mandatory, clinical and organisational requirements

28/02/16 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.

April 2014: 2014 Face to face training programme signed off by Workforce Board March 2014. Programme roll out in 3 phases. Phase 1 begun April 2014. Includes Stat & Mand Training to be completed within 4 weeks of attendance. Reporting system set up to monitor completion. Follow up with Team Leaders. Additional CPD e learning modules contiue to be added to OLM. May 2014: Face to face training begun April and continues to end June. Education Managers monitoring uptake and requesting axction from Operational Directors to ensure trajectory met. June 2014: Team Training Days introduced in the North of SCAS to improve training locally within teams. Dynamic training days designed around team requirements. positive uptake on 'Face to Face' training days. July 2014 - Leadership training days introduced.Dec 2014 No Face to Face training planned for December. Focus on ensuring staff complete e learning. Email reminders being sent in addition to management reports. First draft Training plans presented to workforce board. March 2015 Face to face training not planned during January and February.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

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

28/02/16 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.

Sickness following seasonal trend, but overall absence rate decreased 2013/14. Management action to continue, supported by HR. Nov 14 Actions remain in place to manage absence. Improvements in 111 and EOC. overall absence for September 4.6% Dec 2014 Actions remain in place to manage sickness. Referrals to Occupational Health increasing. Managers being supported to undertake return to work interviews. Improvements in attendance in 111 and EOC. March 2015 sickness absence increased in December. Actions remain in place to manage absence. 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.

Will Hancock, CEO. Melanie Saunders Acting Director of HR

Monthly review

4 4 16 16

28/02/166.1 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)

196. Commercial Viability

Monthly review

123

3 12

204

4 3

4

5

12Exec and Board review bi monthly

Pilot inspection - first wave with unclear methodolgy for the sector

Conitued recruitment programme and CPD 20

12None 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

James Underhay Executive Director

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

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.

1234

Weekly Review

Sept 2014: Good progress on project implementation, with key milestones & deliverables met. Fleet / IT / Technology streams now close to completion. Risks around staff numbers to deliver service on go-live as a number of inbound staff will now not transfer to SCAS. Also potential risk with TUPE costs for redundancy - potential mitigation through re-deployment opportunities. Contingency plans for staff recruitment being implemented. Gap analysis process with comissioners have identified 90% of service will go live by 01/10/14. Nov 14 Hampshire PTS Contract mobilizied October 2014 March 2015 Thames Valley Commissioners have advised that OX/Bucks/Berks PTS procurement is now scheduled to be released in Feb 2015. Work continuing on stakeholder engagement plus PTS Transformation Project to ensure service model is uniform and modern across alll SCAS areas. Project plan developed and ongoing. Service performance issues continue to be evident, full analysis of reported service issues to be undertaken where found. Improvement actions to be put in place to ensure we are meeting better performance and Quality Standards. April 2015: Clear action plans in place monitored by CRM/CQRM to address performance issues. Meeting with CCG to address contract over performance June 2015: ITT now released cross organisational bid team mobilised, supported by specialist external consultancy to model service requirements. Weekly Exec summary of progress in place.June 2015: Phase 2 mobilisation now underway, significantly ealier than phase 1 timeframe. PM appointed and project plan now being mobilised, with project structure to be fully in place by 30/06/15. Commissioner engagement a priority regarding lessons learnt from phase 1 implementation, and meeting set up throughout mobilisation period. Engagement with HHFT already underway. Long waits/PERG August 2015 Band 6 paramedic opportunies launched. Work on going on Band 4 development route. Meetings with OBU and Portsmouth University to confirm numbers of SCAS staff for in house development. Staff side positve about actions taken to address development needs of staff. Work on going to address work life balalnce - overruns and missed meal breaks. Further delays in all NHS 111 contracts nationally, following directive from NHS England. SCAS fully engaged in supporting central team in new specification design. 111 Performance remains strong across key contracts at SCAS. Significant work done in advance of any tendering exercises in terms of innovating SCAS offer in line with emerging national thinking 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 positive

Continued recruitment programme Increase GP use in CSD Monitor at WFDB Attrition data further analysis increase CPD opportunities Monitor at WFDB

4

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

Reduced performance Poor outcome for patients Hear and treat not improved Poor staff morale Increased use of temporary staff

28/02/16 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

28/02/16

4.3 Post the September 2014 CQC regulatory inspection, risk of not implementing all the actions required for resolving 'Must and Should' recommendations. The risk of of not being rated 'outstanding' or 'good' following the May 2016 rated comprehensive inspection

Nov 14 Awaiting report from CQC - Action Plan in place to make improvements following the inspection processDecember 2014: draft report responded with a 42 page factual accuracy supported by an 8 page CEO repsonse sent to the CQC 11th December. Compiling a draft action plan for thhose improvements within the draft report whilst awaiting final report from the CQC. Planning for the Quality summit on the 6th January. SCAS lsit of invitees sent to the CQC for their consideration. January 2015: CQC summit resulted in agreement with external stakeholders to commit to expediting stategic plans to further SCAS Services . Improvement action plan being implemented. Communication plan internally and externally being rolled out March 2015: Action plan developed and submitted to CQC, Monitor and Commissioners. Actions being implemented and monitored via the EMG and RACC. May 2015 - Completion of actions making good progress with 92 actions complete to date. Excellent continued engagement from CQC operatioanl / service Leads on delivery of the plan. June 2015: Planning for 111 inspection has begun. Ongoing executive monitoring bi monthly of action plan. New KLOE being reviewed for re:inspection later in the year. August 2015: Action plan in progress and time for completion of Stat and Mand training extended to the end of Nov with additional training days added to the 999 frontline delivery plan with agreement from OPs and Training Team. NHS 111 planning on schedule to a deadline of the end of Sept 2015 - action plan available with evidence and also prep project plan available for the NHS 111 preparedness. 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.

5. Leadership and Culture

10

17,18 5.3 Ability to recruit Ability to retain staff

Increasing competition for staff from neighbouring trusts

Inspection methodology is still new and untested. No ratings given as a pilot inspection.

4

Will Hancock, CEO. Melanie Saunders Director of HR

September 2014: Student Paramedic programme introduced to address career development reason for attrition. New ESR forms introduced to gain greater detailed reasons for leaving.Nov 14 Recruitment of paramedics remains challenging, current caimpaigns focused on EU contries with HCPC registration. Actions remain in place Student Paramedic 2nd Cohort being recruited. CPD funding and developmenet opportunities being widely advertised. Dec 2014 Detailed analysis of reasons for leaving. Listening sessions ongoing for staff to discuss new roles and new ways of working. Engaging with HETV to support Specialist Paramedic development. January 2015: Continue to work collaboratively with HEE to ensure that previously agreed actions are expediated. March 2015 overseas recruitment begun with recruitment of Polish paramedics. Contiuing to work with recruitment agency to explore other sources. Specialist Paramedic recruitment and HCP recruitment under way. Recruitment plan for 2015/16 agreed. Specialist paramedic opportunities advertised and first wave commenced training in April 2015. Work ongoing with HETV to identify additional Fast track paramedic places. All internal applicants meeting criteria for Student paramedic programme allocated places on next 2 courses. New rotas communicated to staff for voting. August 2015 Recruitment of newly qualified paramedics remaining strong. A lot of interest from graduates in Band 6 opportunity. Recruitment of ECAs improving. Workforce pland for PTS and CCCs in development. 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.

Deirdre Thompson, Director of Quality and Patient Care

882

RAG



Co

Li Tot


RatingMitigated

Risk

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)

28/02/1620 6.2 Retendering of 111 contracts for Thames Valley and risk of no retaining

Monthly review

Creation of a pipe line of opportunities monitored through the Trust Board

93SCAS 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.

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 3 982 James Underhay Executive Director

4 Sept 2014: Continued focus on NHS111 performance across all contracts has seen continued improvement against contract KPIs. Continuing engagement with both local and national groups to ensure SCAS input into new service models and procurement approaches. Internal SCAS tream continue to focus on prospective procurements.March 2015 Thames Valley contracts have been extended or agreement to extend until March 2015 (except Luton and Beds who have both asked for a 15 month extension) SCAS invested in NHS111 futures programme with NHS E and one at the vanguard of some of the Emergency features of the service. Performance remains strong across all contracts.June 2015:ITT performed for 6 months, rendering re-thinking of OOH/111 procurement. SCAS engaged in significant stakeholder and Partnership engagement to ensure best plan for prosepctive re-tender. TV performance to contract continues to be a key focus and is consistantly good. August 2015: Bid submitted on schedule for BOB PTS contract, focusing on Quality of delivery, and within financial budget. Blind submission included, executive and board scrutiny and approve. OHFT PTS and logistics bid now underway, bid team mobilised and service model focused on Quality of Service. Key stakeholder relationships/partnerships being managed throughout process. Trust board to approve final submission. Further delays in all NHS 111 contracts nationally, following directive from NHS England. SCAS fully engaged in supporting central team in new specification design. 111 Performance remains strong across key contracts at SCAS. Significant work done in advance of any tendering exercises in terms of innovating SCAS offer in line with emerging national thinking 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.

Board Assurance Framework 2015/16

PROFILE OF RISK RATINGS 2015/16 (March 2016 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 9 9 9 12 12 12 12 12 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 12 12 12 12 12 12 12 12 12 12 12 12 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

4, 5 16 20 20 20 20 15 15 15 15 15 15 15 15 15 15

1.4 Private Providers not consistently meeting required standards resulting in poor outcomes and experience for patients 6 6 6 6 6 6 9 9 9 6 6 6 6 6 6 6

1.5 Inaccurate Clinical Data 4 8 6 61.6 Ageing Patient Monitoring systems in areas of the Trust and lack of availability of Waveform Capanograpy / CO2 monitoring system across all areas

29 5 5 5

1.7 Failure to adequately prepare and plan for Ebola/VHF cases 32 12 4 4

1.5 Non compliance with timescales for complaint acknowledgement and responses 21 9 9 6 6

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 12 16 16

2.1 Poor IT Resilience 7 16 12 12 12 12 12 12 12 16 16 16 16 16 16 162.2 Inability to consistently review incidents and conduct audits in 111 services in a timely manner and meet operational performance. (Ox, Berks, Hants) from Poor operational performance in 111 service - North and South

12 3 3 3

2.2 Inability to deliver all the benefits from the newly implemented 999 NHS Pathways 8 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

2.3 Inability to deliver the ePR deployement programme and to realise the benefits 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9

3.1 Failure to engage fully with stakeholders and commissioners, to build effective external relationships and enhance organisational reputation. Particularly new CCG's

15,16 4 4 4

3.1 Risk of Information Governance Breach 11 9 9 9 9 9 9 9 9 9 9 9 9 9 6 6

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

12 16 12 12 12 12 12 6 6 6

4.1 Failure to achieve financial targets and realise CIP’s. 13 16 16 16 16 16 16 16 16 20 20 20 20 20 20 20

4.2 Cost of delivering performance levels in 111 significantly higher than assumptions 14 12 12 12 12 8 8 8 8 8 8 8 8 8 8 8

4.3 Post the September 2014 CQC regulatory inspection, risk of not implementing all the actions required for resolving 'Must and Should' recommendations. 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 8 8 8 8 8 8 8

5.1 All staff access not met for education and training to meet mandatory, clinical and organisational requirements 15 8 8 8 8 12 12 12 12 12 12 12 12 12 12 12

5.2 Effectively managing sickness absence and staff absences 16 12 12 12 12 12 12 12 12 16 16 16 16 16 16 16

5.3 Ability to recruit and retain staff 17,18 16 16 16 16 20 20 20 20 20 20 20 20 20 20 20

5.4 Consequences of strike action following Sept 2014 TU ballots vote in favour of action 31 15 9 9

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 9 12 12 12 12 12 12 12 12 6 12 12 12 12 12

6.2 Retendering of 111 contracts for Thames Valley and risk of not retaining 20 6 6 6 8 10 10 10 10 9 10 9 9 9 9 9

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

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ITEM 15 - REPORT FROM THE AUDIT AND CHARITABLE FUNDS COMMITTEES Upward report from the Audit Committee to the March 2016 Public Trust Board The Audit Committee met on 14 January 2016. The internal auditors provided a progress report which was received and discussed by the Committee. The Committee was informed that BDO would be working alongside East of England Ambulance Service next year and felt there may be an opportunity for information sharing following agreement with SCAS. The internal auditors presented two audit reports; Recruitment Services and Quality Governance 111. Their opinion was at least moderate. An additional two risks would be added to the risk register, patient experience and Portsmouth Patient Healthcare Limited. The committee expressed continuing concern about the process of reviewing and updating policies. They felt they needed to understand whether it represented a real risk or reflected an over bureaucratic approach to policies and their review. The CEO would be made aware of the issue.

Mike Hawker Chair of Audit Committee February 2016

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Upward report from the Charitable Funds Committee to the March 2016 Public Trust Board Issues identified by the Charitable Funds Committee held on 27 January 2016 Topic Issue Action Taken

1. Items with issues not achieved/ compliant

2. Areas of Concern/ Risk

SCAS DRV The Committee showed concern that they did not have full understanding of fundraising schemes for which they were expected to approve

It was suggested a full business cases would submitted following initial proposals to ensure vehicles were appropriate and fit for purpose and fundraising targets achievable.

3. Items for awareness / assurance review

Final Audited Accounts The Committee felt it necessary to ensure year end accounts were signed off promptly

A timetable would be developed and the proposed dates would be presented at the next meeting for agreement.

4. Best Practice / excellence

SCAS Strategy & Future Development

Rachel Coney agreed to review governance and responsibility issues

Future principles would be agreed which would shape the future strategy of Charitable funding

SCAS Charity Logo & strap Line

Work was underway to develop a suitable logo and strap line for the charity.

Other charities would be consulted and asked to provide input into this key development.

BOARD OF DIRECTORS MEETING...Mar 23, 2016 · Date: Wednesday 23 March 2016 . Time: 10.00am –...

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