ANNUAL REPORT AND ACCOUNTS 2016/17

Full draft v6

South CentralAmbulance Service

NHS Foundation Trust

2016 /17

ANNUAL REPORT & ACCOUNTS

Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006.

SOUTH CENTRAL AmbULANCE SERviCE NHS FOUNdATiON TRUST

ANNUAL REPORTS ANd ACCOUNTS 2016/17

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CONTENTSWELCOME FROM CHIEF EXECUTIVE AND CHAIR 7

PERFORMANCE REPORT

1. OvERviEW OF PERFORmANCE 00 10

2. PERFORmANCE ANALYSiS 24

ACCOUNTABILITY REPORT

3. STAFF REPORT 30

4. GOvERNORS 0 41

5. mEmbERSHiP 48

6. REGULATORY RATiNG 0 52

7. ANNUAL GOvERNANCE STATEmENT 0 54

8. bOARd OF diRECTORS 0 62

9. REPORT OF THE AUdiT COmmiTTEE 0 70

10. OPERATiONAL ANd FiNANCiAL REviEW 72

11. REmUNERATiON REPORT 76

ANNUAL ACCOUNTS 2016/17

FOREWORd TO THE ACCOUNTS 83

NOTES TO THE ACCOUNTS 0 89

ACCOUNTiNG OFFiCER’S STATEmENT OF RESPONSibiLiTiES 138

QUALITY REPORT 142

iNdEPENdENT AUdiTORS REPORT TO THE COUNCiL OF GOvERNORS OF SOUTH CENTRAL AmbULANCE SERviCE NHS FOUNdATiON TRUST ON THE QUALiTY REPORT 224

iNdEPENdENT AUdiTORS REPORT TO THE COUNCiL OF GOvERNORS OF SOUTH CENTRAL AmbULANCE SERviCE NHS FOUNdATiON TRUST ONLY 227

GLOSSARY 231 ©2017 South Central Ambulance Service NHS Foundation Trust

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WELCOME FROM CHIEF EXECUTIVE AND CHAIRThe last 12 months have been challenging, not just for South Central Ambulance Service NHS Foundation Trust (SCAS) but for the whole National Health Service. Ambulance services, NHS 111, hospitals, mental health services, GPs, community and social care providers have been under the spotlight for significant parts of the year like never before.

it has been no different for ourselves here in SCAS, but we are exiting 2016/17 in a far stronger position, in terms of our performance right across the organisation, than we entered it. We are one of the most high performing, successful and innovative ambulance services in England. For the last three months of this year, we have hit our 999 performance targets despite another annual increase in overall demand, as well as the proportion of Red call demand, and all the pressure that entails.

Not only are we getting to our patients quickly, we are giving them the critical emergency care they need and getting them to the right hospital specialist team to continue treatment. This is most strongly evidenced by the fact that within the SCAS region, more patients survive to leave hospital after a cardiac arrest than anywhere else in England. Just under half (46.5%) of patients who we send an ambulance or rapid response vehicle to, are not taken to hospital. Our frontline teams, together with clinicians in our clinical coordination centres, are able

to ensure that these patients can be treated at the scene, or provided with more clinically appropriate alternatives to A&E. Given the volume of patients we see, this takes a huge number of patients away from already over-stretched A&E departments in hospitals.

The values of teamwork, caring, professionalism and innovation that our staff show day in, day out, are the foundations of our success. Nowhere was this better demonstrated than in our full CQC inspection Report which, when it was published in September 2016, meant that SCAS was the first ambulance service in the country to be rated as ‘Good’.

it was heartening to read that the CQC found that staff were positive about working for the Trust, that we involved patients and their relatives in their care and treatment decisions, and that we followed best practice and utilised national guidance. Special mention was deservedly given to all the staff working in our non-emergency patient transport service (NEPTS), who

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were recognised as providing outstanding care to patients and congratulating NEPTS staff for developing supportive and trusted relationships with regular users.

The whole NEPTS team has managed to deliver this at a time of rapid growth, with the department doubling in size in the last 12 months. Not only have we secured and expanded our existing NEPTS contracts in our region, but we have also expanded into Surrey and Sussex. SCAS is now the single largest NHS provider of non-emergency patient transport services in the country.

Our NHS 111 service, which has grown in terms of patient and staff numbers since we launched it over five years ago, took over 1.27m calls in 2016/17. it is now a vital part of the NHS that many of the four million people who live in the South Central region rely on it to be available 24-7-365. The overwhelming majority of feedback we get from users of our NHS 111 service is extremely positive. Consequently, we were delighted to have ultimately been successful in being awarded a new contract by the Thames valley NHS 111 commissioners to develop the service still further in 2017/18.

SCAS is the lead organisation of the Thames valley 111 Partnership, a powerful and integrated alliance of local and experienced NHS providers, who – from September 2017 – will begin to transform the existing NHS 111 service into ‘the new front door to urgent care’ and an enhanced clinical offer. These are developments which staff within the Thames valley 111 Partnership are excited about and ones which patients will value highly and demonstrate how the NHS is evolving to meet the needs and challenges of modern society.

in October we formally launched the South Central Ambulance Charity. This brought together our highly valued community first responders, car drivers, fundraisers and other volunteers into a single, focused organisation. Supported by our Patron, Simon Weston ObE, the Charity team, with the help of many others in the organisation, has – in a very short space of time – significantly raised the profile of our existing charity and volunteer

work. We now have a strong brand, ambitious plans to raise £1m and other ambulance trusts are starting to seek advice from us about how they can follow SCAS’ lead in this area.

it has been a time of change within our organisation as well. Our Foundation Trust Chair for the last five years, Trevor Jones, left as planned at the end of his second term on 31 march 2017. His contribution to the Trust’s success over that time has been considerable and he will be missed. Lena Samuels has taken over the Chair role and brings a wealth of healthcare, communications and engagement experience to SCAS.

Far from resting on our laurels, we have identified areas where improvements are needed and action plans are already being implemented. Once again, we had the highest response rate of all ambulance trusts in the annual NHS Staff Survey. The media focus on the ever-increasing demand and pressure on the NHS is felt most acutely by those working on the frontline. That’s why we focus on ensuring not only that as many staff as possible respond to the annual survey, but that we keep acting on the suggestions and making the improvements that our staff tell us need to happen.

The coming months and years will no doubt bring more challenges, but, as the last 10 years have shown, we have the people with the skills, experience, knowledge and commitment to not just meet whatever the future holds, but shape it in a better way for the patients we serve.

Will Hancock Chief Executive

Lena Samuels Chair

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1. OVERVIEW OF PERFORMANCE

1.1 ABOUT USSouth Central Ambulance Service (SCAS) became an NHS Foundation Trust on 1 march 2012 and now has a foundation trust public and staff membership of more than 16,800 people.

Our role has gone far beyond simply transporting people to the nearest hospital. Today, we provide a single point of access for people, predominantly, in berkshire, buckinghamshire, Hampshire and Oxfordshire, who are ill, injured or concerned about their health. As well as clinical assessment, signposting and advice services, SCAS also works closely with clinical networks and trauma teams to provide the best possible care for those with critical or life-threatening conditions. We also have a growing reputation as one of the best providers of non-emergency patient transport services in the country, securing NHS contracts in the last 12 months well beyond our traditional South Central borders.

despite a number of densely populated urban cities such as Southampton, Portsmouth, Reading, Oxford and milton Keynes, our operational area is classified as predominantly rural with a population of around four million. High levels of demand for our services continues to put significant pressure on us and requires us to continually review and improve the services we offer.

OUR VISION >

TOWARdS EXCELLENCE - SAviNG LivES ANd ENAbLiNG YOU TO GET THE CARE YOU NEEd

We will achieve our vision by:

è Helping people access appropriate care by assessing individual needs and directing people to the most relevant service

è dispatching emergency clinicians to treat people with life-threatening injuries or conditions and providing specialist care whilst transporting those people to the most appropriate healthcare facility

è Enabling people to stay safe and well in their own communities by providing mobile healthcare closer to home

è Supporting whole system healthcare by working with partner organisations to assess needs and plan care for local communities and individual needs.

We deliver our services from:

è Our headquarters in bicester, Oxfordshire, and a regional office in Otterbourne, Hampshire. Each of these sites also houses a clinical co-ordination centre where 999 and NHS 111 calls are received, clinical advice provided and emergency vehicles dispatched if needed. The Non-Emergency Patient Transport Service (NEPTS) is also coordinated from control rooms within these buildings.

è 104 sites including resource centres, standby points, NEPTS bases and air ambulances bases

è 325 frontline vehicles

è 2 air ambulances

We rely on the support of:

è 3,333 members of staff

è 943 active Community First Responders (CFRs) and Co-responders

è 98 volunteer drivers

è 26 governors

è 13,476 Foundation Trust public members

1.2 WHAT WE DOAs a Trust, we triage and respond to our patients in a more integrated and clinically focussed way. irrespective of the number that our patients dial, 999 or NHS 111, we can effectively assess and signpost them to the most appropriate area of the health economy to receive the care they need. We can also provide expert clinical telephone advice to enable some patients to manage their symptoms at home.

Our two clinical co-ordination centres (CCCs) are located in bicester, Oxfordshire, and Otterbourne in Hampshire. both our 999 and NHS 111 call centre staff are co-located and our ethos is two numbers, one service.

We can now provide simplified access to healthcare across the four counties within our footprint for patients who have telephoned 999 in a crisis situation, contacted NHS 111 with an urgent query, requested advice and support, or requires access to a GP both in hours and during the out of hours period.

during the past 12 months, our focus has been on maturing from an emergency point of contact to become more of an integrated and urgent care service for patients needing access into local healthcare services. As we build this capability, the Trust will also become a provider of more mobile healthcare services, providing advice and support over the phone and in-person, that allows more people to be supported in their own homes and local communities.

The record number of 999 calls received in 2015/16 has increased again over the last 12 months creating further challenges to meet demand.

There also remains a national shortage of paramedics, which provides challenges, not just for SCAS but for all emergency ambulance services to meet the growing demand from patients. As well as supporting staff from within the Trust to train to become qualified paramedics, we have also been working with Oxford brookes and other local universities to ensure that we are building the required capacity within the higher education sector to increase the volume of graduate paramedics entering the job market in future years. in addition, our recruitment teams have been working relentlessly to attract qualified paramedics from across the UK and internationally to SCAS. Our recruitment team’s success at reducing our overall vacancy rate in 2016/17 is explained in more detail later in this report.

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999

Our clinical coordination centres receive on average over 1,800 emergency 999 calls every day, which are handled by over 500 call centre staff who work 24/7.

To meet this demand we have more than 1,500 paramedics, technicians and emergency care assistants on the road delivering excellent frontline care. We have a fleet of 279 specially-equipped emergency vehicles from over 30 sites across the region.

Our specialist paramedics and nurses have additional skills such as being able to treat minor injuries, supply medication for a range of minor illnesses and chronic conditions, and provide advanced care for long term conditions with a focus on preventing unnecessary attendances at hospital. We are rapidly expanding this service by training more frontline staff to be able to be deployed with these specialist skills.

during the last 12 months we have developed a new role for paramedics who wish to develop their skills further. The enhanced paramedic role is a step between a paramedic and a clinical mentor, and has been developed to provide paramedics with the opportunity to support student paramedics, new staff and existing staff by developing their skills in a supported environment. This has been a positive development opportunity for paramedics and attracted internal and external applications as well as improving our retention of paramedics.

As an ambulance service we regularly work in close partnership with other blue light and emergency services in response to a wide range of incidents.

As well as working together routinely, we also train together regularly in order that we can be prepared for emergency situations. Such cooperation and interoperability ensures the public receives a joined up, coordinated and comprehensive service in crisis situations. The implementation of the Joint Emergency Services interoperability Principles (JESiP) provides us a framework to work closely with other emergency services and responders.

in addition, we are able to rely on a number of in-house, partner and voluntary resources in dealing with emergencies which not only helps us save time and lives, but also helps free our core resources to respond to emergencies elsewhere.

Such resources include:

HAZARDOUS AREA RESPONSE TEAM (HART)

HART is a cadre of paramedics specifically trained and equipped to deliver first class care to patients who are injured or ill in hazardous environments, such as collapsed structures or high rope rescues. Previously the ambulance service was unable to work in these areas as it would have been unsafe for ambulance staff to do so. by ensuring ongoing specialist training with partner agencies such as Police, Fire Service and maritime & Coastguard Agency, and by having the correct specialist equipment and procedures, we are able to provide the public with greater reassurance that we can respond to challenging, complex incidents where they need help.

incidents where HART has been deployed to in the last 12 months include major incidents, such as the explosion, fire and collapse of a residential block of flats in Oxford city centre in February 2017, chemical incidents, inland river incidents, patients injured while at height and complex, high speed road traffic collisions. HART also supports the Trust’s operational staff daily by sharing the team’s knowledge, experience and unique use of equipment in other incidents that thankfully are not deemed hazardous in nature but can still be challenging for the Trust.

by providing excellent clinical care in these hazardous areas, we can ensure that our patients receive the best clinical treatment and management at the earliest opportunity.

TRAUMA RESPONSE

Patients with major trauma are no longer taken to their nearest hospital for treatment: patients are transported to major trauma centres where expert trauma teams treat them for their injuries. Transporting major trauma cases further across the Trust places additional pressure on our crews, but they have been extensively trained to deliver life-saving interventions en route to hospital.

SCAS has a team of highly experienced pre-hospital doctors who respond to emergencies to support crews. We also have two specialist response cars covering the Thames valley and Hampshire, and two air ambulances to take the care, once only available in hospital, to the patient’s side. The air ambulances are staffed by experienced pre-hospital emergency medicine (PHEm) doctors and paramedics trained in critical care who have enhanced skills to deal with trauma.

There is evidence that trauma networks are having a dramatic, positive impact on death rates. Following a national audit by the Trauma Audit and Research Network released in July 2015, patients suffering major injuries are now 63% more likely to survive than they were in 2008.

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AIR AMBULANCES

Working with the Thames valley Air Ambulance (TvAA) and Hampshire and isle of Wight Air Ambulance (HiOWAA) charities, we are able to deploy two air ambulances to deliver critical care paramedics and PHEm doctors to the patient as quickly as possible. This helps ensure the most badly injured and seriously ill of our patients receive the care they need. Helicopters can also access locations that land ambulances find difficult to get to.

The air ambulances operate daily from 06.00 to 02.00 and staff on board the TvAA helicopter are trialling the use of live streaming cameras. This new innovation, the first of its kind in the UK, allows senior clinicians back in emergency departments and hospitals who are being asked for advice, to see live footage of what is happening. This not only saves valuable time but also means more accurate advice can be given which improves the already high quality pre-hospital care still further.

When bad weather prevents the helicopters from flying, the Helicopter Emergency medical Service (HEmS) teams for the Thames valley and Hampshire respond using specialist critical care vehicles that allow the team to bring their skills to the patient. We also deploy a HEmS Paramedic and doctor in a specially equipped car at peak demand periods across the Thames valley to support our operational teams and improve patient outcomes. both the air and land assets deploy additional skills such as pre-hospital ultrasound, blood transfusion and advanced surgical skills.

NHS 111

Over the last year, SCAS’ NHS 111 service has continued to deliver urgent care telephone assessment across the six contracts covering Oxfordshire, berkshire, buckinghamshire, Hampshire, bedfordshire and Luton. The NHS 111 service is provided using NHS Pathways-trained call handlers and clinicians (nurses/paramedics). SCAS’ NHS 111 service also provides health information and responds to medication enquiries via specially trained health information advisors, as well as providing a dental advisory service to callers in Hampshire.

This year, demand for our NHS 111 service increased again as we received 1.72 million inbound calls, of which over 1.27 million were answered by our dedicated, professional staff. We are proud to meet the NHS 111 key performance indicators on most occasions:

è 95% of calls are answered within in 60 seconds

è Call abandonment rate is well below the 5% target

è Transfer to 999 has been reduced and remains consistently lower than the national average for NHS 111 services

in may 2016, the CQC inspected the Trust – including the NHS 111 service – and we were delighted to be rated ‘Good’. The key finding was that we provide a safe, caring, responsive and well-led service. The team continues to work on the areas of practice where the CQC felt we should make improvements to make services more effective.

This year we commenced a project to introduce an advanced clinical patient management system, Adastra, into the NHS 111 service, which should go live in summer 2017. The technology integrates with GP systems and should enable better access to patient information which will support us in delivering higher standards of patient care.

Work is currently underway to develop the Thames valley integrated Urgent Care Service – a five year contract that SCAS was awarded this year by commissioners – that will integrate a wide range of community-based teams and hospital-based specialists with SCAS, to provide simplified access through the NHS 111 portal, improved triage, enhanced assessment and more personalised care to each patient’s individual needs.

We continue to improve the way new staff are recruited, trained and coached in the live environment. Utilising Quality Assurance Coaches to support new staff ensures we both maintain the high standards set for patient safety and reduce clinical risk in the live environment. The audit team continues to meet monthly target and within SCAS we see high audit compliance in comparison to the national figures.

Regular surveys undertaken over the past year confirm that patients are generally satisfied with the NHS 111 service that SCAS provides.

With our partners, we are developing a number of service innovations and pilot projects that will enhance our high quality service and improve the patient experience in the year ahead.

1.3 COMMERCIAL SERVICESAn additional range of services, including Non-Emergency Patient Transport Services (NEPTS), Healthcare Logistics & Courier Services and First Aid and Clinical Training (FACT), is provided by the Trust and managed within the Commercial Services directorate. The markets the directorate operates within are open to any company or organisation, both public and private sector, and are highly competitive as contracts tend to be only for 3-5 years in length. Commissioners’ quests to obtain greater value for money with increasing growing demand for services over future years mean that it is critical SCAS continues to maintain high-quality service delivery whilst also offering good value for money.

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OVERVIEW OF THE YEAR

The Commercial directorate has continued through 2016/17 to focus on the quality agenda and has in the process been awarded the iSO9001 Quality Standard and the Non-Emergency Patient Transport Service (NEPTS) was rated by the CQC as delivering ‘outstanding’ care to its patients. The CQC ratings for the SCAS NEPTS are summarised below:

NEPTS overall rating Good

Safe Good

Effective Requires improvement

Caring Outstanding

Responsive Good

Well-led? Good

The CQC identified some areas for improvement within NEPTS, notably in terms of incident reporting and response and staff appraisals, however, for caring the CQC noted that:

“Care was outstanding in patient transport services where patients reported well developed supportive and caring and trusted relationships particularly regular users, such as renal or mental health patients. Patients appreciated this personal approach and the respect shown by staff for their social and emotional needs.”

during 2016/17 SCAS NEPTS mobilised three new contracts. On 1 April 2016, SCAS went live with the new Thames valley wide contract which bought together patient journeys across 10 CCGs, a mental health trust and a hospital trust. The contract is significantly different from previously held contracts and softens the borders between each CCG boundary allowing better utilisation of resources. The contract is 24/7/365 for both the contact centre and operational delivery. Over the first few months of the contract it was shown that the Key Performance indicators (KPis) and specification did not meet service user requirements and following negotiations and service user feedback new KPis were introduced in december 2016.

SCAS was also awarded a contract with Oxford Health Foundation Trust to deliver NEPTS and secure transport for Oxfordshire, buckinghamshire and Wiltshire mental Health patients. This contract also went live on 1 April 2016. We are working closely with the commissioner to develop the contract review meeting format and information schedules based on the contract service specification. in August 2016, SCAS went live with the final part of the SHiP contract mobilising the Winchester and Andover element of the contract; this now brings into one single consortium contract all Hampshire patient journeys.

during the last year the directorate, through competitive tendering, was awarded the Surrey NEPTS Contract with a go live of 1 April 2017; this contract will be approximately 130,000 journeys a year. in addition SCAS NEPTS was requested by High Weald Lewes Havens CCG to take over as step in providers for the Sussex NEPTS Contract due to failings of the contract in that area. Anticipated journey numbers will be around 300,000. This request to step in as a provider demonstrated the high regard SCAS NEPTS is held in for the professional service it delivers regarding patients’ experience.

NON-EMERGENCY PATIENT TRANSPORT SERVICE (NEPTS)

Our Non-Emergency Patient Transport Service (NEPTS) has provided non-emergency transport across buckinghamshire, berkshire, Hampshire and Oxfordshire for more than 40 years and is one of the three core services currently provided by SCAS, alongside 999 and NHS 111. in 2016/17 we undertook 650,000 journeys and this is expected with the new contracts to increase to over one million journeys for 2017/18. Our NEPTS Contact Centres at Otterbourne and bicester host our planning, call handling and dispatch functions and are pivotal to the success of the service. in 2016/17 the team took in excess of 270,000 calls and with new contracts this number will look to double for 2017/18.

Since non-emergency patient transport provision was de-regulated in 2002, the NEPTS market share held by ambulance trusts has reduced from 100% of the market to an estimated 50%. However, SCAS has bucked this trend, and the NEPTS team has successfully retained existing business and won new business through tenders and ‘step in’ contracts such as Sussex.

Patient transport services across the UK came under enhanced scrutiny in the last 12 months due to service delivery issues regarding patient experience across several contracts external to SCAS. These issues were covered by national media organisations and raised at mP level. SCAS continually monitors these performance issues ensuring no repeat of failures across SCAS contracts. The CQC over the last year has focussed inspections on smaller private ambulance providers and SCAS has supported these inspections sharing our end to end validation processes for third party providers.

Eligibility of patients for NHS funded patient transport services was defined nationally in 2007 but over 2016/17 several commissioners developed their own (stricter) criteria for inclusion in tender processes and this trend may continue as CCG budgets become increasingly constrained.

SCAS continues to proudly work alongside a large cadre of volunteer car drivers who support walking patients and our volunteers build fantastic relationships with our regular patients. in June 2016 one of SCAS’ volunteer drivers, John Salter from Newbury, clocked up over 1 million miles driving for SCAS over a 30 year span of volunteering.

2016/17 2017/18

Vehicles 251

Vehicles 440

Workforce 900

Patient Journeys 1,235,000

Workforce 500

Patient Journeys 650,000

Oxfordshire

Berkshire

Hampshire

Bucks

Surrey

Oxfordshire

Berkshire

Hampshire

Bucks

East SussexWest Sussex

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NEPTS deploys a number of strategies for learning from complaints, incidents, near misses, and compliments; however this is a continuous learning process and one that is continually being embedded into the NEPTS learning culture. Satisfaction amongst patients with the service provided by SCAS remains high and the team continually strive to further improve quality reporting formats, quality schedules and processes.

There continues to be challenges across all the NEPTS contracts reflecting the wider NHS pressures, and often resulting from a wider NHS system change causing an increase in activity, particularly on the day ambulatory care resulting in increased on the day bookings. These journeys remain the most difficult to resource due to their unplanned nature, and this profile of activity is not reflected in current contract specifications. Negotiations were held over 2016/17 with both milton Keynes and Thames valley Commissioners to change contract KPis and specifications to align the contracts to current service user requirements.

The SCAS NEPTS restructure has commenced with rewriting of job descriptions and full cost analysis. Our aim is to move the service in to a position to meet the ever changing service requirements. The NEPTS management team continues to work closely with our 999 and NHS 111 colleagues to ensure briefings and current challenges are addressed through the urgent care boards and system meetings to ensure the organisation is aligned.

There have been numerous innovations introduced over the year to enhance patient experience and support efficiencies;

è A patient zone where patients can manage their own bookings, view online their transport and access estimated times of arrival

è introduction of smart phones with a software app for volunteer drivers

è Auto plan and auto allocation of vehicles

è introduction of a Patient Charter, which explains to the patient their rights and

responsibilities when using our NEPTS and outlines our expectations of them as service users

REPORTING AND ANALYSIS

The business intelligence team has introduced a live dashboard system for NEPTS that shows to the minute performance levels. This has enabled the teams to dynamically react to performance issues and identify trends of activity. The dashboard displays performance against individual KPis for all contracts and future developments will enable the management team to access the dashboard from smart phone devices.

WORkFORCE

Headcount for NEPTS at the end of this year had remained behind the integrated workforce plan of 500 WTE and back fill for headcount remains challenging requiring utilisation of private providers. Over the last 12 months, NEPTS lost 26 team members moving for internal career development, specifically ambulance care assistants (ACA) transferring to the 999 service to become emergency care assistants (ECA). initiatives to enhance recruitment were introduced and the requirement for a C1 licence was dropped with SCAS providing C1 courses. This opened up NEPTS to a wider candidate pool in the recruitment market. Through analysis of initial ACA course failures it was identified that the majority were down to the driving element of the course. NEPTS took the initiative to reverse the course content so the driving element was at the start of course.

FLEET

during 2015/16 and into 2016/17 we have introduced 260 new vehicles in to the fleet to deliver against the new contracts. The new vehicles and equipment are state of the art for NEPTS requirements, reduce any manual handling risks to a minimum and have a complete maintenance schedule programme aligned to their use. All vehicles are fuel efficient and meet the highest green requirements.

HEALTHCARE LOGISTICS & COURIER SERVICES

South Central Ambulance Service NHS Foundation Trust (SCAS) provides a Healthcare Logistics delivery and collection service across Oxfordshire, buckinghamshire and Wiltshire. during the year SCAS successfully mobilised the Oxford Health NHS Foundation Trust Logistics contract which bought innovations to the service.

Over 2016/17 the Healthcare Logistics team transported over ten millions items and travelled over a million miles. The team has continued to drive the methodology of the right vehicle, at the right time, in the right location. This, combined with the investment in innovative iT solutions for booking, tracking and reporting ensure SCAS continues to provide the most efficient, capable logistics service in the marketplace today.

We deliver and collect on a day to day basis items such as post, specimens, linen and parcels to acute hospitals, community hospitals, mental health sites, GP surgeries, county councils, dentists, opticians, pharmacies, and to South Central Ambulance Service NHS Foundation Trust sites across three counties and other clinics.

The Royal berkshire Hospital NHS Foundation Trust decided during this year to take its logistics service in house resulting in TUPE of some of the SCAS logistics team members; this was a sad time for the service to lose such committed members of staff.

FIRST AID AND CLINICAL TRAINING (FACT)

The First Aid and Clinical Training (FACT) department is a dedicated division of SCAS with over 16 years’ experience of training delivery. We have a dedicated, experienced and professional training team who have the skills, clinical knowledge and professional status that ensure all delegates get the most out of their training.

during 2016/17 we made the decision to expand the portfolio further by also offering training through the QualSafe framework in

addition to FutureQuals. This allows FACT to select the most appropriate course for our customer. FACT continued to support other NHS Trusts in the provision of basic Life Support including use of Automated External defibrillators (AEd).

during the latter part of the financial year FACT decided to sell AEd with comprehensive training for basic Life Support and the use of AEd as a package. The aim is to support the community in which we operate as comprehensively as possible.

First Aid is the basis of our portfolio and we are proud to provide accredited and bespoke courses on and off site. There were additional sections to be added to our first aid courses this year, including catastrophic bleeding, use of specialised dressings and tourniquets.

Over the year FACT introduced the option to clients of developing tailor made courses for company specific solutions. This involves discussions to ascertain the specific requirements and the development and deployment of a specialist course. Our training courses are highly regarded by our customers, from private companies to other NHS healthcare providers, with consistent high levels of customer satisfaction.

during the year FACT launched its own Twitter Account https://twitter.com/SCASFACT Please follow us to learn more.

For reservations and general enquiries, please call 0300 7900136 or email fact@scas.nhs.uk and someone from our team will be pleased to assist you.

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1.4 RISK MANAGEMENTThe Trust has a robust risk management strategy which provides a basis for a well-managed risk assurance process to ensure safe services and an accurate record of risks. it is reviewed on an annual basis and approved by the Trust board. it is published and made available to the public and stakeholders via the Trust’s website.

The aims of this strategy are to:

è integrate risk management into the Trust’s culture and everyday management practice

è Clearly define the Trust’s approach and commitment to risk management

è Raise staff awareness, knowledge and skills

è document responsibilities and a structure for managing risk

è Ensure a co-ordinated, standard methodology is adopted by every directorate/ department

è Encourage and support incident reporting in a ‘fair blame’ culture

è Ensure that the Trust Chief Executive and Trust board are provided with evidence that risks are being appropriately identified, assessed, addressed and monitored

è Adopt an integrated approach to risk management, whether the risk relates to clinical, organisational, health and safety or financial risk, through the processes

in accordance with governance best practice and legislative requirements the Trust formally assesses and records all significant risks in a Corporate Risk Register and in the board Assurance Framework. Risks are reviewed through the Risk, Assurance and Compliance Committee and the Audit Committee.

The Trust’s aim is that the carrying out of suitable and sufficient risk assessments should become an integral part of everyday activity, becoming a pre-emptive approach to reducing accidents and adverse incidents rather than being reactive.

The Trust’s principal risks have been identified as:

è Recruiting staff across all services to ensure a safe level of care and performance

è Achieving financial targets

è Long waits resulting in delayed care and poor patient experience

è Handover delays at hospitals resulting in delayed care

è mobilising new NEPTS contracts

è Operational response targets not being consistently met

1.5 SERVICE DEVELOPMENTS

Towards excellence – saving lives and enabling you to get the care you need

SCAS continues to be more than a traditional (transporting) ambulance service. increasingly, we are developing a pivotal role as a partner in local care systems, by offering simplified access to clinical assessment and sign-posting for people who are ill, injured or concerned about their health.

We strive continually to offer the ‘right care, first time’, tailored to each individual’s circumstances and needs, whether this is the immediate dispatch of an emergency team, clinical treatment in your own home, transport between health settings, referral to another service or simply telephone-based advice.

999

Emergency

Urgent

111

Advice byPhone

GP andPrimary

Care

Urgent Care

Centre

EmergencyCentre

MajorEmergency

Centre

Paramedicat Home

CommunityPharmacy

Emergency care netw

ork

Self-care

Service strategy SCAS role Strategic objectives

Care coordination To enable you to identify and access the care you need

è To develop our assessment, signposting and advice services

è To coordinate care across systems, sharing infrastructure with partners

Mobile healthcare è To save lives and improve outcomes

è To enable you to stay safely in your home or local community

è To enhance our 24/7 mobile healthcare service

è To offer person-centred care, coordinating services with health, social care and voluntary partners

Patient transport To enable you to travel safely between home and care settings

è To modernise and enhance our non-emergency patient transport services

è To offer services to support people returning home from hospital

Helicopter view To support efficient and effective flow around systems of care

è To transform our analytical capability and capacity

è To offer a ‘helicopter view’ of flows around local care systems

//22 //23

Right care, first time

Last year Our progress

Care coordination è Transitioned 999 service to NHS Pathways assessment tool, which enables more clinically-focussed assessment of individual needs and direction to most appropriate available pathway of care

è introduced mental health and maternity support for relevant callers

è Automated emergency dispatch to Red 1 calls, which enables a much faster response to people with time-critical life-threatening conditions

è Retained Thames valley NHS 111 business, including major engagement work with other providers and patients to design an integrated urgent care service

Mobile healthcare è Achieved significant increase in survival rates following major trauma

è Rolled out electronic devices across mobile teams, ensuring that relevant information and policies can be made available to our crews, and also improve the collection of clinical data and service improvements

è introduced clinical directive for End of Life, covering the administration of appropriate medicine which enables us to improve pain management and support people in their own homes at the end of their life

Patient transport è implemented single technical platform across patient transport and logistics

è doubled size of non-emergency patient transport service (NEPTS) over the last three years, undertaking major implementations in Surrey and Sussex in Spring 2017

Helicopter view è improved our analytical capability and capacity

Future Our plans

Care coordination è To launch Thames valley integrated Urgent Care & NHS 111

è To win and mobilise Hampshire & Surrey Heath NHS 111

è To develop partnerships with GPs, both for in-hours and out-of-hours services

è To redesign 999 green pathways to support more people at home

è To expand our clinical coordination centre capacity to support service developments

è To move NHS 111 service onto Adastra to improve interface with partners

è To develop use of Live Links service for wider group of patients

è To move to iCCS dS2000 to improve communications across emergency services

è To review opportunities for Online NHS 111

Mobile healthcare è To improve rosters including flexible options

è To assess feasibility of setting up mobile urgent care service

è To consolidate recruitment and training into bone Lane

è To move into the Tri-Service Resource Centre in milton Keynes

è To expand the role of volunteers and other indirect resources

è To move onto new national radio system

è To respond to national review of paramedic pay banding

Patient transport è To stabilise Sussex NEPTS

è To review and agree NEPTS business strategy

è To redesign processes within NEPTS Coordination Centre

è To improve the digital platform for volunteers

Helicopter view è To provide management information for NEPTS, Logistics and the Clinical Coordination Centre (CCC)

è To combine management information to give a complete picture of SCAS incident cycle and flows

è To develop a helicopter view, for internal and external understanding of systems

è increased focus required on clinical data not just activity data

Past Future

//24 //25

2.1 PERFORMANCE: A REVIEW

TARGET NATiONAL TARGET

ACTUAL 2016/17

ACTUAL 2015/16

ACTUAL 2014/15

REd 1 75% 73.3% 71.9% 75.0%

REd 2 75% 73.1% 72.7% 74.5%

19 miNUTE TRANSPORTATiON TimE

95% 94.7% 94.4% 95.5%

National targets are set by the department of Health and are amongst the most challenging standards set for ambulance services in the world. They apply to every ambulance service in England with the exception of three ambulance services who are trialling a revised target set as part of the Ambulance Response Programme (ARP).

The targets ensure the Trust is measured against the percentage of calls responded to in 8 or 19 minutes depending on the priority of call with Category A calls measured as the highest priority. This data is extracted from the Trust’s Computer Aided dispatch (CAd) systems.

Category A calls are subdivided into Red 1 calls covering response to patients in a condition which may be immediately life-threatening, such as a cardiac arrest, and Red 2 calls where patients may still be in a life-threatening condition but less time critical. The national target for both Red 1 and Red 2 calls is to receive an emergency response within eight minutes irrespective of location in 75% of cases.

The final target is designed to measure the percentage of Red 1 and Red 2 calls where a fully equipped ambulance vehicle arrives within 19 minutes that is able to transport the patient in a clinically safe manner. Known as the 19 minute transportation time, the target is to achieve this in 95% of cases.

Red call demand continues to rise and this year there was a further 20% increase; over 40% of our calls are now classified in these most urgent groups. This has been a significant factor in SCAS not achieving the national performance targets this year.

However, our response times to patients in life-threatening conditions remains good. On average we get to Red 1 and Red 2 patients in less than seven minutes and when we do miss the eight minute target, it is usually by a matter of seconds.

Of the trusts being measured against the same targets as we are, we have been the highest performing trust across the three targets.

//24

//26 //27

NHS ENGLAND: AMBULANCE TRUST PERFORMANCE 2016/17

REd 1 % REd 2 % 19 miNUTE %

South Central 73.3 South Central 73.1 South Central 94.7

London 69.2 isle of Wight 70.0 London 93.5

East midlands 69.0 London 66.3 isle of Wight 91.9

East of England 68.8 North West 62.7 East of England 90.7

North West 67.7 North East 62.2 North East 89.3

North East 67.5 East of England 61.3 South East Coast 89.2

South East Coast 65.1 East midlands 57.1 North West 89.0

isle of Wight 63.2 South East Coast 52.5 East midlands 84.3

England avg 68.7 England avg 62.5 England avg 90.4

South West, West midlands and Yorkshire are not measured on the same performance criteria as the trusts above.

With demand expected to continue to rise, as the population we serve increases and the proportion of elderly people and those with complex medical problems grows, we are working hard to improve our response and keep delivering a high quality service to all patients who require our assistance.

Action plans have been designed to take effect during the year in order to assist us in making those improvements in 2017/18.

2.2 SUSTAINABILITY REPORTThe Trust is in the process of revising its Sustainable development management Plan (SdmP) which will cover the next three years. As in previous years, the Trust continues to play an active part in the Green Environmental Ambulance Network (GREAN) and is an active member of the Oxford Sustainability Network which comprises health and other public sector bodies. These groups allow the Trust to keep up to date with latest initiatives and engage in joint projects that will allow the Trust to lower its carbon emissions.

The Trust has a dedicated Green Coordinator who is supported internally by a network of volunteers from within the Trust who are known as the green team. A regular newsletter is produced which updates all Trust staff about the latest green initiatives. The Trust has an overseeing Green Committee that meets three times a year and monitors progress against the strategy. The Committee is chaired by the director of Finance, who is also the board sponsor, and comprises all of the main functional heads. The Green Coordinator undertakes regular site visits identifying any areas of improvement from an environmental perspective.

Amongst some of the initiatives that continue to have direct impact in the reduction of our carbon footprint include:

è All new ambulance vehicles met Euro 6 standards using less fuel

è video conferencing launched within the Trust which is saving travel time and cost

è Electronic timesheet project launched saving paper

è A new e-expenses solution has been approved by the Trust and will be piloted and implemented in 2017/18

è New waste disposal contract agreed with the aim of increasing waste that is recycled

è Second tranche of cycle to work scheme launched in 2016/17

è Lease car policy that limits vehicles to 100 COkg emissions

The Trust continues to work towards the department of Health CO2 emission reduction initiative and has achieved a reduction over its 2008/09 baseline in spite of increasing activity and business.

Function 2008/09Actual CO2

2016/17Forecast CO2

Fleet 10009 1150

Estates related 68.8 325

Total 15043 1475

2.3 SCAS IN THE COMMUNITYSCAS continues to excel in providing healthcare and other services for the communities we serve. The Trust is committed to investing in our local areas to help build a better, more resilient society and we do that by continuing to invest in the local communities by recruiting, training and developing a diverse team of community based volunteers who work side by side with our frontline staff to deliver care in medical emergencies.

SCAS has 396 schemes and there are now 943 active community first responders (CFRs) and co-responders who respond either within a three mile radius of their location or deploy themselves to cover an area of SCAS where our clinical coordination centres need them.

We have very active CFRs and the Trust continues to strengthen partnerships with our Thames valley Fire & Rescue Services in buckinghamshire, Oxfordshire and berkshire and Hampshire Fire & Rescue Service. We have expanded our co-responder schemes in the Thames valley and are continuing with the national trials around cardiac arrest. We have been training berkshire, Oxfordshire and buckinghamshire Fire & Rescue Services in immediate emergency care training with Hampshire Fire & Rescue delivering the course to their staff. This means firefighters

//28 //29

from across the four counties are able to administer enhanced first aid skills utilising medical equipment where there is an immediate threat to life prior to an emergency ambulance arriving on scene.

The co-responder schemes, not just with the region’s fire and rescue services, but also with local military services and our police responders in North Hampshire, will come on board in April 2017. They will provide patients in life-threatening emergencies with a greater chance of survival and full recovery by getting appropriate, qualified and emergency first aid trained personnel to the scene as quickly as possible. The demand for SCAS ambulance services to attend life-threatening incidents (Red calls) has increased by 20% over the last 12 months alone (and over 60% in the last five years). This comes at a time when fire crews nationally are attending around half the call outs for fires that they used to ten years ago. At the end of march 2017, SCAS had trained 462 co-responders.

Towards the end of 2016/17, we saw the roll out of the accredited ‘Level 3 Certificate in Ambulance First Response’ course. This has enabled some of our volunteers to obtain a national qualification and has enhanced their knowledge and skills so that we can continue to deliver excellent patient care to our members of the local community. We are continuing this roll out throughout 2017/18 and our co-responders have received their additional training should they be first on scene to major trauma incidents, such as road traffic collisions and drownings; our CFRs are not currently sent to these. This training has been invaluable as they are able to consistently provide more specialised first aid care in those few minutes before our paramedic teams arrive at the scene.

Over the last 12 months, SCAS has increased the total number of community first and co-responders by 11% - and we see this increase year on year that is continuing to help save lives across the many communities we serve. Together, our CFRs and co-responders have been called out to and attended 61,657 incidents – an increase of 13% above the incidents they attended in 2015/16.

Sudden Cardiac Arrest (SCA) remains the UK’s single biggest killer, claiming an estimated 60,000 lives annually. Nationally, only 7% of those suffering SCA will survive. Early cardiopulmonary resuscitation (CPR) and the use of an automatic external defibrillator (AEd) can significantly improve survival rates; possibly to 60%.

To help achieve this, we have had a dedicated team supported by CFRs, working within communities and organisations to advise and support them in establishing public access defibrillators (PAds). during 2016/17, a further 281 PAds were established bringing the total to 981 across the SCAS region; a significant increase from 2013/14 when 99 PAds had been installed.

in addition to establishing PAds, the team has worked with organisations to secure defibrillators in their buildings. As well as the many companies securing defibrillators for their staff and visitors, the team has helped over thirty schools install them.

We are committed to continuing to support the installation of PAds, along with advice and guidance for local communities, to strengthen the network of life-saving devices across the region.

during 2016/17, over 7,000 people have been trained in the safe use of a defibrillator and how to perform CPR. most of these were villagers and townspeople undertaking the sessions in their local area.

during the year, the team supported by CFRs and co-responders, trained almost 3,000 school students in CPR as part of the national Re-start a Heart programme. Re-start a Heart is an initiative to give CPR training to as many school students as possible in a single day. This year (16 October 2017), we are planning to give the training to 10,000 children.

A new and improved app, Save a Life, has been launched. Save a Life not only shows all PAds in the SCAS area, it also shows those organisations and companies who have defibrillators. Additionally, it has a frequently asked questions section, along with videos showing how to perform CPR and how to use a defibrillator.

Launched in October 2016, the Save a Life app had been downloaded 10,750 times by the end of March 2017.

Links to download the free Save a Life app, available in iOS and Android, can be found here: www.scas.nhs.uk/savealife

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STAFF REPORT

3.1 OUR WORKFORCEOur key workforce priorities during 2016/17 remained recruitment and retention. We have maintained the work started in 2015/16 on re-branding and marketing of our recruitment materials. We have continued to develop our SCAS recruitment website and have run some very successful recruitment open days.

At the end of this financial year there was an overall net growth in workforce numbers of 304. This is as a result of overall increases in recruitment and overall reduced attrition as shown in the tables below.

A&E FRONTLINE

Recruitment to A&E frontline has been positive during 2016/17 with 313 new recruits. The new recruits included international paramedics from both Poland and Australia. Attrition has stabilised and reduced from its height of 14% in 2015/16 to 10.5% in 2016/17. This follows the introduction of additional progression routes for student paramedics and of the Associate Ambulance Practitioner Programme. We have also made a significant investment in the training and development of team leaders.

Overall vacancies have fallen from 19% (323FTE) to 12% (204 FTE).

EMERGENCY OPERATIONS CENTRE (EOC)

Recruitment to the emergency call taker (ECT) position in EOC has been very effective during 2016/17 with 105 new recruits. At the close of the year we have just 0.5 WTE vacancy for ECTs. Whilst we have made excellent progress with recruitment to ECT positions we continue to experience clinician shortfalls in both EOC and our NHS 111 service. Work is on-going to address these shortfalls.

Attrition remained broadly constant from 2015/16 to 2016/17 at 26%.

Attrition 15/16 16/17

999 235 148

EOC 52 57

111 59 83

PTS 59 81

TOTAL 405 369

Recruitment 15/16 16/17

999 210 313

EOC 94 106

111 151 111

PTS 126 143

TOTAL 581 673

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999 EOC

IWP Recruitment2 year comparison

111 PTS TOTAL

8007006005004003002001000

999 EOC

IWP Attrition2 year comparison

111 PTS TOTAL

450400350300250200150100500

210

235

52 59 59

405

94151 126

581

313

106 111

148

57 83 81

369

143

673

15/16 15/1616/17 16/17

//32 //33

NHS 111

Whilst we have successfully recruited 110 WTE to our NHS 111 service, we have also experienced very high attrition at 44.5%. Nevertheless we have made an increase in the number of staff employed in NHS 111 of 27. Work on reducing attrition in our NHS 111 service will be on-going during 2017/18.

NON-EMERGENCY PATIENT TRANSPORT SERVICE (NEPTS)

We opened the year with 15% vacancies in NEPTS; vacancies then peaked at 20% in September. Since then we have used targeted Facebook campaigns and steadily reduced from that high level of vacancies in June and ended the year at 15%.

Over the course of the year we recruited 143 FTEs. Attrition ran significantly higher than expected – 81 FTE leavers against an expected 56. in addition to the leavers, the NEPTS service saw 35 FTE move to other parts of SCAS. Overall the net increase in staffing was just 36.1 FTE.

3.2 STAFF SURVEYFeedback from our staff is welcomed and valued within SCAS; we encourage all staff to share their opinions through our annual staff surveys and friends and family test.

As a result of previous feedback from staff surveys a number of actions have been

implemented. These include the opportunity for all staff within our non-emergency patient transport services to undertake modern apprenticeships and investment in leadership development across SCAS. Additionally, management and our recognised unions are working hard to address some of the frustrations around flexible working; rotas; missed meal breaks and over-runs, specifically in our A&E services.

during October and November 2016 all staff (including those on maternity leave) were invited to participate in the annual NHS Staff Survey. The Trust again undertook a fully electronic survey this year, with members of staff receiving an email with a unique login, via their internal email address.

The Trust has achieved a final overall response rate of 59.6%, improving on the 55.5% response rate in 2015. For the second year running, this was the highest response rate for all ambulance trusts.

kEY FINDINGS

A total of 88 questions were used in the 2015 and 2016 survey and the questionnaire remained the same, enabling direct comparisons with all relevant questions.

Compared to the 2015 survey, the Trust was significantly better on 39 questions, with none of our results delivering a significantly worse response. The top 10 improvements since the 2015 survey are:

TOP TEN IMPROVEMENTS SINCE 2015 SURVEY

Question Asked 2015 2016 % Point Change

Would recommend SCAS as place to work (Friends & Family Test Result) 39% 49% 10%

Care of patients/service users is the SCAS top priority 49% 58% 9%

SCAS definitely takes positive action on health and well-being 18% 26% 8%

Happy with standard of care provided by SCAS (Friends & Family Test Result) 64% 72% 8%

Have adequate materials, supplies and equipment to do my work 47% 54% 7%

Staff given feedback about changes made in response to reported errors 43% 50% 7%

Would feel secure raising concerns about unsafe clinical practice 64% 71% 7%

Team members have a set of shared objectives 59% 65% 6%

SCAS takes action to ensure errors are not repeated 50% 56% 6%

Would feel confident that SCAS would address concerns about unsafe clinical practice 49% 55% 6%

The Trust did exceptionally well on the following questions and was delighted to be asked to present nationally by NHS Employers, on how SCAS has achieved these improvements. The presentation focused on the investment that SCAS has placed in leadership development, team working and health and well-being over the last year.

7a: immediate manager encourages team working 71% positive score.

improved from NSS15 score by 1%

7e: immediate manager supportive in personal crisis 77% positive score.

improved from NSS15 score by 5%.

7f: immediate manager takes a positive interest in my

health & well-being

71% positive score.

improved NSS15 score by 2%

7g: immediate manager values my work 71% positive score

improved NSS15 score by 3%

The overall staff engagement result has improved from 3.37 in 2015 to 3.51 in 2016. This again reflects the work invested into improving the working lives of our staff.

//34 //35

There continue to be areas where we need to focus attention where staff reported the least satisfaction:

SCAS TRUST-WIDE: LEAST SATISFACTION

Question Asked 2015 2016

SCAS % change since 2015

Ambulance Average

Not put myself under pressure to come to work when not feeling well enough 8% 9% 1% 9%

Enough staff at SCAS to do my job properly 15% 18% 3% 22%

Appraisal/review definitely helped me improve how i do my job 17% 19% 2% 16%

Senior managers act on staff feedback 20% 21% 1% 22%

Satisfied with level of pay 23% 23% 0% 23%

Senior managers try to involve staff in important decisions 22% 23% 1% 22%

Appraisal/performance review: definitely left feeling work is valued 22% 25% 3% 20%

SCAS definitely takes positive action on health and well-being 18% 26% 8% 25%

don’t work any additional paid hours per week for SCAS, over and above contracted hours 30% 28% 2% 30%

Communication between senior management and staff is effective 24% 28% 4% 27%

Appraisal/performance review: SCAS values definitely discussed 25% 29% 4% 30%

Clear work objectives definitely agreed during appraisal 25% 30% 5% 26%

Whilst these are the areas SCAS will continue to invest in over the next year, it is encouraging to see that since the 2015 survey we have improved in all these areas and remain higher than the ambulance average in six, the same in two and lower in four.

ACTION PLANS FOR 2016 RESULTS

All teams are actively participating in workshops, developed with senior managers, to help them to understand their results whilst highlighting how positive results in the staff survey positively correlate with other HR statistics such as improved attrition, lower

sickness and higher appraisal compliance. These in turn result in improved patient care.

Team leaders and managers have been asked at a local level to analyse their results, publicise their successes and work with their teams to put in place plans to continue to improve areas of least satisfaction, whilst also striving to continue to improve all areas of the survey.

Local action plans will be reviewed by the executive team during the year and the steps individual departments are taking will be publicised in Trust communications on a regular basis.

3.3 STAFF ENGAGEMENTOur formal routes for staff engagement remain our Joint Negotiation and Consultative Committee and directorate focused partnership forums, both meeting on a regular basis.

Additionally, staff side representatives from our recognised unions join management leaders on major committee and project boards.

Our staff side representatives have been fully engaged and committed to work in partnership with the Trust in our bids for commercial contracts and have worked in partnership with the management teams on the mobilisation of the contracts secured this year.

All operational, risk and HR policies are developed in partnership through joint working groups.

Our newly formed health, wellbeing and engagement forum includes representatives across all areas of the business, along with “champions” with a focus in ensuring that we engage all staff with health and wellbeing, resulting in increased engagement in all areas.

informal routes for staff engagement exist in a variety of ways. These include access to Chief Executive and members of the board through CEO meetings and leadership walk-rounds, feedback to the Chief Executive through a dedicated confidential email address, and staff and station meetings.

3.4 COUNTERING FRAUDThe Trust has a responsibility to ensure that public money is spent appropriately. The Trust has policies in place to counter fraud and corruption. These include Standing Financial instructions, a detection and Prevention of Fraud and Corruption Policy and an Anti- bribery Policy.

The Trust receives its anti-fraud service from TiAA Ltd. An annual work plan is developed to meet the requirements of the NHS Protect

Anti-Fraud Strategy and this is shared with the Trust’s Audit Committee along with the Annual Report on counter fraud activities.

There have been no significant fraud issues or threats in the year affecting the Trust. The Trust’s Local Counter Fraud Specialist continues to work closely with the Trust in making them aware of risk areas to the Trust so that the Trust can make arrangements to reduce that risk.

3.5 SUPPORTING STAFF HEALTH AND WELLBEINGWe continue to provide support to our staff through our Occupational Health Service provider Team Prevent. The Team Prevent ‘Wellbeing’ website is a well-supported resource that is used by our managers and staff. The site aims to help anyone:

è Understand more about the role of Occupational Health through the information provided in the manager and employee zones

è Find out how to get the best from Occupational Health

è Complete an individual, confidential health risk assessment and download a personalised health report

è discover what steps individuals can take to improve their health and wellbeing

Staff from Team Prevent are invited to Trust meetings in order to provide expert advice in their field.

Optum, our confidential Employee Assistance Programme and counselling service is available to staff and their families. Optum offers a wide range of advice and help both in person and online, and the service works with Occupational Health to promote healthy lifestyles and health choices. Optum have introduced a very useful app which can be downloaded onto smartphones giving easy access to resources at all times.

//36 //37

We continue to expand the team of trained Trauma Risk management (TRim) practitioners to support staff who may experience stress in the workplace. The team will provide advice on coping strategies and signposting to other services if required.

The team follow established protocols to support staff after dealing with distressing or traumatic incidents in the early stages, and assess whether there is a need for further intervention. All TRim practitioners are volunteers and receive training and support to fulfil this difficult but essential role.

Our TRim managers who support the TRim team are also qualified as trainers, so we can continue to train more practitioners as and when needed in house in order to maintain the numbers of practitioners needed for the optimum ratio between practitioners and number of staff.

Last year, SCAS introduced a Health, Wellbeing and Staff Engagement team who provide extra support and advice to staff on maintaining good health. This support is in addition to the access all staff have to online stress training as well as actively promoting health and wellbeing through:

è Work out at work days

è Physiotherapy at work sessions

è Fruity Fridays and fruit instead of sugar

è Cycle-to-work scheme

è Promoting dry January and other NHS and national programme initiatives, such as stopping smoking

è Weekly health and wellbeing tips in line with national schemes such as cancer awareness and mental health awareness week

è Health and wellbeing champions

è Job well done cards

è Health and wellbeing promotion days

The team also successfully rolled out a Health and Wellbeing Plan incorporating policy updates, arranging and facilitating mental health awareness training and wallet cards with support details. The Trust will continue to support national schemes throughout 2017/18 as well as managing attendance and attraction schemes.

3.6 WORKFORCE STATISTICSduring 2016/17 SCAS has recruited 673 new staff.

The ongoing development of our workforce and the recruitment of additional resources within our 999 frontline services has been a top priority for SCAS in 2016/17. Over the past 12 months, SCAS has welcomed 313 new 999 frontline recruits in clinical, non-clinical and clinical-student positions. The Trust has continued to recruit paramedics both from abroad and within the UK to meet increasing demand for our emergency services.

We have continued to invest in developing staff and 113 frontline staff completed paramedic education courses during 2016. We have also supported 55 staff through apprenticeship programmes.

Attrition amongst 999 frontline services has been substantially reduced and across 2016/17 achieved a level of 10.5%. This combined with the good level of recruitment has resulted in a reduction in vacancies from 19% to 12%.

The following tables show a breakdown of the Trust’s workforce by age, ethnicity and gender, as well as disability information, for 2015/16 and 2016/17 respectively.

31 March 2016 31 March 2017

Ethnic Group Headcount % FTE Headcount % FTE

A White - british 2,596 85.2 2359.47 2,839 85.2 2598.23

b White - irish 18 0.6 16.73 21 0.6 20.35

C White - Any other White background 102 3.3 95.48 144 4.3 136.35

C3 White Unspecified 7 0.2 6.61 8 0.2 7.61

CA White English 36 1.2 34.20 31 0.9 29.83

Cb White Scottish 1 0.0 1.00 1 0.0 1.00

CC White Welsh 3 0.1 2.80 2 0.1 1.80

Cd White Cornish 2 0.1 1.51 2 0.1 1.51

CK White italian 1 0.0 1.00 1 0.0 1.00

CP White Polish 2 0.1 2.00 6 0.2 6.00

CY White Other European 1 0.0 1.00 2 0.1 2.00

d mixed - White & black Caribbean 3 0.1 3.00 7 0.2 6.02

E mixed - White & black African 3 0.1 3.00 5 0.2 4.12

F mixed - White & Asian 8 0.3 7.53 8 0.2 8.00

G mixed - Any other mixed background 8 0.3 7.55 8 0.2 8.00

Gd mixed - Chinese & White 1 0.0 1.00 1 0.0 1.00

H Asian or Asian british - indian 9 0.3 7.91 15 0.5 12.77

J Asian or Asian british - Pakistani 5 0.2 4.33 6 0.2 5.12

K Asian or Asian british - bangladeshi 0 0.0 0.00 2 0.1 1.80

L Asian or Asian british - Any other Asian background 9 0.3 7.27 10 0.3 8.63

LH Asian british 1 0.0 1.00 1 0.0 1.00

LK Asian Unspecified 1 0.0 1.00 1 0.0 1.00

m black or black british - Caribbean 13 0.4 10.53 12 0.4 10.97

N black or black british - African 9 0.3 8.11 14 0.4 11.95

P black or black british - Any other black background 1 0.0 0.27 1 0.0 0.27

R Chinese 1 0.0 1.00 3 0.1 2.32

S Any Other Ethnic Group 2 0.1 1.80 3 0.1 2.80

SE Other Specified 1 0.0 0.92 1 0.0 0.92

Unspecified 5 0.2 5.00 7 0.2 7.00

Z Not Stated 197 6.5 165.32 171 5.1 146.66

Grand Total 3,046 100.0 2758.33 3,333 100.0 3046.02

//38 //39

31 March 2016 31 March 2017

Age band Headcount % FTE Headcount % FTE

<20 13 0.43 11.76 15 0.45 13.92

20-25 342 11.23 322.82 397 11.91 373.77

26-30 408 13.39 377.69 473 14.19 444.67

31-35 336 11.03 300.06 360 10.80 331.12

36-40 376 12.34 326.53 404 12.12 351.43

41-45 457 15.00 407.72 466 13.98 417.26

46-50 368 12.08 334.71 410 12.30 374.09

51-55 347 11.39 324.69 392 11.76 367.90

56-60 234 7.68 217.83 262 7.86 243.44

61-65 108 3.55 94.20 109 3.27 94.71

66-70 41 1.35 30.50 31 0.93 24.60

71+ 16 0.53 9.83 14 0.42 9.13

3,046 100.00 2758.33 3,333 100.00 3046.02

31 March 2016 31 March 2017

Gender Headcount % FTE Headcount % FTE

Female 1,506 49.4 1296.46 1,658 49.7 1439.96

male 1,540 50.6 1461.87 1,675 50.3 1606.06

Grand Total 3,046 100.0 2758.33 3,333 100.0 3046.02

31 March 2016 31 March 2017

disability Flag Headcount % FTE Headcount % FTE

No 2,256 74.1 2048.57 2,623 78.7 2406.54

Not declared 632 20.7 565.25 540 16.2 484.60

Unspecified 24 0.8 23.23 15 0.5 13.91

Yes 134 4.4 121.28 155 4.7 140.97

Grand Total 3,046 100.0 2758.33 3,333 100.0 3046.02

FTE = full-time equivalent

3.7 CELEBRATING DIVERSITY

EQUALITY DELIVERY SYSTEM

On 3 may 2016, SCAS was inspected by the CQC and when the findings were published in September 2016, the CQC rated SCAS overall as ‘Good’, including rating the Trust as ‘Good’ in the well-led domain. The report highlighted positives across all five Key Lines of Enquiry (KLOE) and assessed SCAS as ‘Outstanding’ for equality and diversity.

The report found that “the Trust had evaluated its equality delivery system (EdS) uniquely, using community groups to do so. The EdS aims to improve patient outcomes and

patient access to services and to have a representative and supportive workforce and inclusive leadership. The majority of indicators were achieved. The Trust was taking further action to reduce discrimination and recruitment bias (also identified in the staff survey) in the Trust and ensure patient safety.”

SCAS was able to demonstrate that it is an organisation that adheres to the broad principles of the CQC KLOEs:

è Staff are positive about working for the Trust and recognised the value of their service

è Providing safe, caring, responsive and well-led services

è diverse board that reflects a diverse workforce and therefore decision making that considers diversity

è monitors the diversity of its users and reassures itself with accurate data that the needs are all met

WORkFORCE RACE EQUALITY STANDARDS

in July 2014, the NHS Equality and diversity Council proposed a national Workforce Race Equality Standard to tackle the lack of black and minority ethnic (bmE) representation at senior levels in the NHS, and to galvanise cultural and organisational change.

The Workforce Race Equality Standard (WRES), underpinned by commissioning and regulatory action, is aimed at helping address the treatment of bmE staff including adverse outcomes throughout recruitment and promotion, access to non-mandatory training and over-representation in disciplinary procedures, bullying and harassment.

There are nine metrics: four are specifically related to workforce data and four are based on the national NHS staff survey indicators. The latter highlights any differences between the experience and treatment of white staff and black and ethnic minority staff in the NHS, with a view to closing the gaps highlighted by those metrics. The final metric requires SCAS to ensure that the board is broadly representative of its workforce.

SCAS has now published its board approved 2016-17 WRES report/action plan and its equality and diversity working group and steering group are now working to deliver on the actions as acknowledged by the CQC.

RAISING CONCERNS

in July 2014, the Public Accounts Committee published a report into whistleblowing; it emphasised that it is essential employees have trust in the system for handling whistle-blowers, and confidence that they will be taken seriously, protected and supported by their organisations if they blow the whistle.

The report which made a number of recommendations coincided with the independent policy review into whistleblowing and creating a culture of openness and honesty in the NHS lead by Sir Robert Francis QC.

in light of the above SCAS undertook a formal systemic review of its whistle blowing policy. The review was completed and signed off by the Equality and diversity steering group during February 2015 and published in may 2015.

The Trust’s approach to raising concerns provides individuals with the opportunity to speak up through the usual line management process, via the Assistant director of HR or via members of the Executive team, which ever the individual feels s/he is most comfortable with raising their concern and/or appropriate to deal with their concern. Failing this, staff wishing to raise concerns directly with nominated Non-Executive director, david Williams, may do so.

during the period 1 April 2016 and 31 march 2017 no concerns were raised.

//40 //41

THE DISABILITY SYMBOL

SCAS has for the seventh year running achieved the disability symbol awarded by Jobcentre Plus to employers who show their commitment to employing disabled people. it demonstrates to disabled people which employers will be positive about their abilities.

in achieving the disability symbol status SCAS has demonstrated that it will:

è interview all disabled applicants who meet the minimum criteria for a job vacancy and consider them on their abilities

è Ensure that there is a mechanism in place to discuss, at any time but at least once a year, with disabled employees, what both parties can do to make sure disabled employees can develop and use their abilities

è make every effort when employees become disabled to make sure they stay in employment

è Take action to ensure that all employees develop the appropriate levels of disability awareness needed to make sure these commitments work

è Review these commitments each year and assess what has been achieved, plan ways to improve on them and let employees and Jobcentre Plus know about the progress and future plans

The Trust’s Council of Governors (CoG) plays an essential role in the governance of South Central Ambulance Service NHS Foundation Trust, providing a forum through which the board of directors is accountable to the local community.

The Trust’s Constitution sets out the key requirements in respect of the functioning of the CoG. its general functions are to:

è Hold the non-executive directors individually and collectively to account for the performance of the board of directors

è Represent the interests of the members of the Trust as a whole and the interests of the public

The period 1 April 2016 to 31 march 2017 represents the fifth full year of working for the CoG and the delivery of its statutory duties.

4.1 MEMBERSHIP AND MEETINGS

MEMBERSHIP OF THE COUNCIL OF GOVERNORS (COG)

The CoG is chaired by the Trust Chair, and the full composition of governors numbers twenty six as follows:

è 15 elected public governors across four constituencies (Hampshire, berkshire, Oxfordshire and buckinghamshire)

è Five elected staff governors

è Three appointed local authority governors

è Two appointed clinical commissioning group governors

è One appointed partner governor (the air ambulance charities)

The CoG elects a lead governor and Robert duggan served in this position throughout 2016/17.

The CoG started the year with twenty two governors in place, with the four vacancies relating to the Oxfordshire, berkshire and buckinghamshire public governor constituencies, and the NEPTS staff governor constituency. it ended the year with twenty three governors in place and therefore three vacancies (two for the buckinghamshire public governor constituency, and the NEPTS and Logistics Field staff governor).

during 2016/17, a year in which public governor elections were held, there have been the following changes to the composition of the CoG.

è during the course of the year, and prior to the Autumn 2016 elections taking place, three public governors resigned: one from each of the berkshire, buckinghamshire and Oxfordshire constituencies

è As a result of the Autumn 2016 elections process, two public governors did not seek re-election, two public governors did seek re-election and were successfully re-elected, and six public governors were elected for the first time

A further round will be held in Autumn 2017.

details about each governor, including biographies and declared interests, can be seen on the Trust’s website.

//41

//42 //43

FORMAL MEETINGS OF THE COG

Three formal meetings of the CoG have been held during 2016/17: in April 2016, July 2016 and October 2016. The meeting planned for January 2017 was cancelled due to adverse weather. All three meetings were held in public, and fully in accordance with the Trust’s Constitution.

Two of the three meetings were chaired by the Trust Chair, and one by the deputy Chair/Senior independent director. All had a very good representation of board members, including non-executive directors, in attendance.

The table in Section 4.6 below, reports on the attendance of governors at formal meetings of the CoG. This is also reported in the Trust’s Annual Report, as a specific requirement of the NHS Foundation Trust Reporting manual.

OTHER MEETINGS OF THE COG

The CoG has had two formal sub-committees during 2016/17; the Nominations Committee, and the membership and Engagement Committee. details of their meetings and work programmes are explained below.

Two governor workshops were held during the year; in June 2016, to consider efficiency and quality, and in February 2017, to obtain the views of the governors on the Trust’s corporate strategy and strategic challenges.

4.2 DUTIES AND FUNCTIONS

DELIVERY OF SPECIFIC STATUTORY DUTIES

The governors have a range of specific statutory duties, and all of the statutory duties relevant to 2016/17 were satisfactorily discharged.

Duty Comments

Receive annual accounts, auditor’s report and annual report

ü Received annual accounts and reports at the July 2016 meeting. Overview from KPmG (external auditors) of their approach to the 2016/17 audit programme at the October 2016 meeting.

Appoint and, if appropriate, remove the external auditor

N/A The CoG will be required to approve a new external audit appointment in 2017/18, and work in preparation for this took place in 2016/17.

directors must have regard to governors’ views when preparing the forward plan

ü A strategic review workshop was held on 1 February 2017 to obtain the views of the governors, and these were taken into account in developing the 2017/18 annual business plan.

Appoint and, if appropriate, remove the Chair ü in 2016/17 the CoG approved the appointment of a new Chair, to take effect from 1 April 2017.

Appoint and, if appropriate, remove the other non-executive directors (NEds)

ü during 2016/17, and following CoG process and approval, two new NEds were appointed to the SCAS board.

decide remuneration and terms of conditions for Chair and other NEds

ü during 2016/17 the CoG accepted a recommendation from the Nominations Committee that remuneration levels for the Chair and NEds should remain unchanged.

Approve appointment of Chief Executive N/A No new appointment was made in 2016/17.

Approve significant transactions N/A No significant transactions required approval in 2016/17.

Approve an application by the Trust to enter into a merger, acquisition, separation or dissolution

N/A No such applications occurred in 2016/17.

decide whether the Trust’s non-NHS work would significantly interfere with its ‘principle purpose’

N/A This was not required during 2016/17.

Approve amendments to the Constitution ü A number of minor constitutional amendments were approved by the CoG during 2016/17 (including increasing the maximum number of NEds on the board from eight to nine).

DELIVERY OF OTHER DUTIES AND FUNCTIONS OF THE COG

There are general duties for the governors in relation to holding the board of directors to account for the performance of the Trust via the non-executive directors, and representing the interests of the members and the public.

A range of mechanisms have been in place to support the governors with their holding to account role, including:

è Six board meetings in public have been held, and governor attendance at these has been strongly promoted. There has been good attendance at board meetings, with an average of nine governors attending each meeting

è The Trust ensures that the governors receive the papers for board meetings one week ahead of the meeting, and the minutes on a timely basis subsequent to the meeting having taken place

è Governors have been invited to ‘buddy up’ with one of the Trust’s NEds to help develop their understanding of how the NEds seek assurance over the day-to-day running of the organisation

è All formal meetings of the CoG include an update from the Chief Executive on key strategic issues and operational performance, with an opportunity for governors to ask questions. in addition, the format of CoG meetings is such that governors can hear from the NEds how they seek assurance and hold the executive directors to account for improving the performance of the Trust.

è information is regularly circulated by the Company Secretariat office to keep governors up-to-date on key Trust issues and developments, with any questions and comments being responded to as appropriate.

during 2016/17, most of the Trust’s governors attended at least one of the board meetings in public.

The work of the membership and Engagement Committee (see below) has been key to the governors’ other general duty of representing the interests of the members and the public.

during the course of the year, governors have attended a range of membership recruitment and engagement events, and used other opportunities to meet with Trust members and members of the public to ascertain their views on the Trust.

//44 //45

4.3 COG SUB COMMITTEES

NOMINATIONS COMMITTEE

One of two formal sub-committees, and a statutory requirement, the CoG already has an established Nominations Committee, which is chaired by the Trust Chair and has four other governor members (the Lead Governor and one governor each from the categories of local authority, staff and public).

The Nominations Committee has met formally on two occasions during 2016/17, and meeting attendance levels can be seen at Appendix A. A number of additional committee teleconferences have been held to discuss emerging items of business.

during the year, and with delegated authority from the CoG, the Nominations Committee has performed a range of tasks including:

è Overseeing an extensive and competitive recruitment process for the successful appointment of a new Chair

è developing processes for the 2016/17 Chair and NEd appraisals

MEMBERSHIP AND ENGAGEMENT COMMITTEE

The CoG already has an established membership and Engagement Committee, whose main role is to recommend strategies to the CoG for the recruitment of, and engagement with, Trust members.

The membership and Engagement Committee ended the year with five members, comprising three public governors, and two appointed partner governors.

during the year, the membership and Engagement Committee has:

è Agreed a Foundation Trust membership Plan for 2016/17, and monitored progress throughout the year

è Contributed to the development of the Trust’s annual member satisfaction and patient care survey

è Overseen the arrangements for the Trust’s fifth Annual members’ meeting in September 2016

è Considered how governors can support the work of the SCA Charity

4.4 GOVERNOR SUPPORT, TRAINING AND DEVELOPMENT

SUPPORT, TRAINING AND DEVELOPMENT

The Trust has a formal duty to ensure that governors are equipped with the skills and knowledge they require to undertake their role, and during the course of the year the Trust has supported governors in this respect. in addition to the mechanisms outlined to support the general duties of governors, the Trust has:

è Provided a comprehensive and tailored induction programme for all new governors

è Provided access to relevant external training as provided by NHS improvement and NHS Providers (for instance, NEd recruitment training for governors on the Nominations Committee)

è Further extended its informal ‘buddying’ scheme between individual governors and NEds

è Held a very well attended finance training course for governors

è issued regular briefings and bulletins

4.5 CONCLUSIONS AND PRIORITIES 2017 18

CONCLUSIONS

The Council of Governors has overseen some major achievements during 2016/17 and helped contribute to the overall success of the Trust. Additionally, all of the relevant statutory duties have been effectively delivered.

it is considered that the Council of Governors has a good working relationship with the board of directors, and directors regularly attend Council of Governors meetings to answer questions, participate in discussions, and help the governors deliver their statutory duties. in turn, the Trust has benefitted from the perspectives brought by a diverse group of governors, and this has been demonstrated in recent years by the governors’ input to the annual planning and CQC inspection processes.

PRIORITIES FOR 2017/18

The CoG has identified the following priorities for 2017/18:

è With a continually growing membership that now stands at over 16,500 (public and staff), further developing arrangements for engaging with the Trust’s membership and ensuring that the interests of members are suitably represented and that their views are brought to the attention of the Trust

è Given the challenges faced by the NHS, continuing the strong focus that the governors have in terms of holding the board to account, via the non-executive directors, for the performance of the Trust

è Overseeing the appointment processes for the recruitment of new non-executive directors

è Contributing to the development of the Trust’s future strategic priorities and forward plans

è Continuing to review the effectiveness of the Council of Governors to ensure that the governors are appropriately supported to deliver their roles, that value is added where appropriate, and the functioning of the CoG is delivered in the most cost effective way.

//46 //47

4.6

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(1) This is a full record of the governors who served during 2016/17. Those highlighted in bold were in post at the end of the 2016/17 year (31 march 2017)(2) did not seek re-election when term of office expired on 28 February 2017(3) Resigned in June 2016 (term of office was until 28 February 2017)(4) Resigned in October 2016 (term of office was until 28 February 2017)(5) Resigned in April 2016 (term of office was until 28 February 2017)(6) did not seek re-election when term of office expired on 28 February 2017

//48 //49

5.1 INTRODUCTION Effective public engagement is a key element for providing excellent patient care and the Trust wants to continue working with patients, the public, local organisations, partners and other stakeholders to keep on being seen as a service which is proud to be caring for the communities it serves.

in march 2017, SCAS celebrated its fifth year as a Foundation Trust. Our membership has grown and developed and continues to be an asset to the Trust in ensuring that the voices of our communities are heard and reflected in how our organisation is run.

SCAS has a total membership of 16,877 people as of 31 march 2017. We have 13,476 public members and 3,401 staff members.

5.2 OUR MEMBERS

PUBLIC CONSTITUENCY

members of the public aged 14 and over are eligible to become public members of the Trust if they live in the area (or have a connection with) where SCAS provides services (buckinghamshire, berkshire, Oxfordshire and Hampshire).

STAFF CONSTITUENCY

Any SCAS staff member with a permanent contract or a fixed term contract of 12 months or longer is able to become a member of the Trust. Staff who join the Trust are automatically opted into the membership and advised how they can opt out if they wish.

ANALYSIS OF PUBLIC MEMBERSHIP AS AT 31 MARCH 2017

The profile of SCAS public membership is compared against the records held by the Office of National Statistics (ONS) to determine how representative the Trust’s membership is of the South Central population.

The public membership breakdown by category on 31 march 2017 is shown on the right. Public constituency

Number of members

Population in South Central

Index (%) 100 = ideal representation)

Age 13,476 4,202,106 100.00

0-16 59 n/a n/a

17-21 418 255,661 51

22+ 12,815 3,073,784 130

Not stated 184

Gender

Unspecified 31

male 5,532 2,080,679 83

Female 7,913 2,121,425 116

Ethnicity

White 10,966 3,556,479 92

mixed 191 85,182 67

Asian or Asian british 545 277,046 59

black or black british 269 86,155 93

Other ethnic group 82 24,636 92

Not stated 1,423

Acorn Socio-Economic Category

Affluent Achievers 3,952 1,365,118 90

Rising Prosperity 1,558 502,374 97

Comfortable Communities 3,541 1,041, 808 106

Financially Stretched 2,663 798,389 104

Urban Adversity 1,547 451,824 107

Not Private Households 162 42,591 119

Not available 53 Red – under-represented i Green – over-represented i Amber – within correct tolerance

Public constituency Public members Population

berkshire 2,682 901,533

buckinghamshire 2,696 795,587

Hampshire 5,199 1,824,043

Oxfordshire 2,899 680,941

SCAS membership is broadly representative of the area we serve with the exception of the Asian and young people categories where members remain underrepresented in comparison with the population of the South Central region.

The Trust continued to target and encourage participation by working with various groups and schools together with attending multicultural festivals and career fairs and encouraging more members of black and minority ethnic (bmE) communities to join our membership and become a governor.

These activities will be expanded further in 2017/18 by launching the following initiatives:

è SCAS diabetes Awareness roadshows in mosques, Hindu temples and universities

è SCAS 100 virtual Club

è Prince’s Trust Team Programme

(See 2017-19 SCAS NHS FT membership and Engagement Strategy for more details – separate document)

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//50 //51

5.3 A MEMBER’S STORYAli Beg, SCAS Hampshire public member and vice chair of SCAS Hampshire Community Engagement Forum

“i was born and bred in Southampton and currently work as Project manager for Awaaz Community Radio. Having lived, worked and studied in the city, my wish is to work for continuous improvement and excellence in local health and social care services as i have good ground knowledge of the needs of the local bmE community especially the Pakistani community including overcoming barriers (religious or customs).

i am passionate about health awareness in the community and was at the forefront of the delivery of Healthwatch England. i participated in Healthwatch England activities through my work with the CQC.

i have particular interest in SCAS to help ensure it reaches diverse communities especially those that are seldom heard. When i was approached by monica moro, the membership, Engagement and marketing Support Officer at SCAS, getting involved would give me an active role in advancing bmE public engagement.

As an FT member, i am able to use my experience of working with the ethnic community represented by Awaaz for mutual collaboration and gathering views and understanding experiences. As a SCAS Hampshire Community Engagement Forum member, i am able to put forward views and experiences of people – via the Awaaz platform - who use SCAS services from the wider community. This is a valuable asset in helping to understand the experiences of the service users.

i spend my spare time with family. my recreational interests include swimming, squash and long distance driving.”

5.4 MEMBERSHIP AND ENGAGEMENT ACTIVITIESSCAS is committed to ensure that the public, not only continues to have confidence in the service, but also understands and gets involved in helping the Trust to shape future services through its foundation trust members and the public at large.

SCAS places considerable emphasis on membership and public engagement activities to ensure that our services are accessible to all members of the community and that it meets its duty to involve and consult with patients and the public in the way it develops and designs services.

below is a summary of some of the various types of engagement activities which SCAS carried out in 2016/17.

PUBLIC EVENTS

in 2016/17 we continued to hold engagement events across our region, enabling us to hear from local people, share our updates with them and get their views on our future plans.

Engagement events included emergency service days, local community fairs, talks at various community groups, SCAS roadshows and forums, career fairs at local colleges and schools, recruitment open days and multicultural festivals.

MEMBERSHIP SATISFACTION AND PATIENT CARE SURVEY

The fourth annual membership survey was undertaken in June 2016 over a six week period. it was sent via Foundation Times, the Trust’s membership newsletter to all Foundation Trust public members who have supplied the Trust with an email address.

A postal survey was sent to 1,211 members. These are members who have expressed an interest in taking part in surveys on their application form but do not have/or have not supplied the Trust with an email address.

due to budget constraints we did not include a hardcopy of the survey with the letter. However, it directed interested parties to a link to the survey, with the option of requesting a hardcopy.

For the third year running we invited GP surgeries across our four counties to pass on our request to complete the survey to their Patient Participation Groups (PPGs) so they could tell us about their experience of care they receive from us.

in total we received 375 broken down as follows: 369 via email and 6 by post. Last year we received 485 responses broken down as follows: 401 via email and 84 by post. below are some examples of feedback from some of our responders.

Q. PLEASE TELL US ONE THING THAT WOULD MOST IMPROVE YOUR EXPERIENCE OF 999

è ‘my husband was very ill last year and had to have a number of hospital admissions. What would have improved things for me was to be told as soon as the ambulance was on its way. A couple of times the call handler kept on asking questions and i had to ask if help had been dispatched yet.’

è ‘You seem to have a lot of paperwork! Not a problem for me but it must slow you down!!’

è ‘i can’t think of anything as i have nothing but praise for the staff.’

è ‘No suggestion as the service was excellent.’

Q. PLEASE TELL US ONE THING THAT WOULD MOST IMPROVE YOUR EXPERIENCE OF OUR NON-EMERGENCY PATIENT TRANSPORT SERVICE

è ‘A call to confirm time of arrival.’

è ‘Softer springing!! Ambulance was too hard!’

è ‘No suggestions.’

Q. PLEASE TELL US ONE THING THAT WOULD MOST IMPROVE YOUR EXPERIENCE OF NHS 111

è ‘Less time going through the check list.’

è ‘Quicker call back from on call doctor.’

è ‘Service was great. Nothing to improve’

è ‘it was very good. No improvement required.’

PATIENT FORUMSThroughout the year SCAS continued to work with our four patient forums (one in each county) and its members had the opportunity to undertake the following activities:

è make recommendations on certain aspects of the Trust’s charity

è Give feedback on the SCAS Forums report and 2017-18 Plan, together with the revised Honorary Contract, Nomination Form and Terms of Reference to reflect the change of name to Community Engagement Forum (from April 2017)

è Take part in a project and advisory group which looks at how we can improve the treatment we give when a person’s heart stops (cardiac arrest)

è Give feedback on the new SCAS main website

è Tell their views about SCAS as part of the CQC inspection of the Trust in 2016

è Give feedback on SCAS dementia and Learning difficulties videos

Furthermore the Trust took action from the feedback received from milton Keynes Lions Club about deaf awareness training for frontline staff. As a result SCAS produced a podcast on communicating with individuals who are hard of hearing.

Three of the patient forums are chaired by an existing public governor for the Trust. The Hampshire Forum is chaired by a former Trust public governor.

//52 //53

NHS improvement’s Single Oversight Framework provides the framework for overseeing providers and identifying potential support needs. The framework looks at five themes:

è Quality of care

è Finance and use of resources

è Operational performance

è Strategic change

è Leadership and improvement capability (well-led)

based on information from these themes, providers are segmented from 1 to 4; where 4 reflects providers receiving the most support, and 1 reflects providers with maximum autonomy. A foundation trust will only be in segments 3 or 4 where it has been found in breach or suspected breach of its licence.

The Single Oversight Framework applied from Quarter 3 of 2016/17. Prior to this, monitor’s Risk Assessment Framework (RAF) has not been presented as the basis of accountability was different. This is line with NHS improvement’s guidance for annual reports.

SEGMENTATION

South Central Ambulance NHS Foundation Trust has been placed in segment 2 reflecting the performance and financial challenges that the Trust has faced. The Trust continues to be one of the best performing ambulance services achieving a ‘Good’ CQC rating.

This segmentation information is the Trust’s position as at 31 march 2017. Current segmentation information for NHS trusts and foundation trusts is published on the NHS improvement website.

FINANCE AND USE OF RESOURCES

The finance and use of resources theme is based on the scoring of five measures from 1 to 4 where 1 reflects the strongest performance. These scores are then weighted to give an overall score. Given that finance and use of resources is only one of five themes feeding into the Single Oversight Framework, the segmentation of the Trust disclosed above might not be the same as the overall finance score here.

Area Metric2016/17 Q3 score

2016/17 Q4 score

Financial sustainability

Capital service capacity

2 1

Liquidity 1 1

Financial efficiency

i and E margin 3 2

Financial controls

distance from financial plan

1 1

Agency spend 1 1

Overall scoring

2 1

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7.1 SCOPE OF RESPONSIBILITY

As Accounting Officer, i have responsibility for maintaining a sound system of internal control that supports the achievement of South Central Ambulance Service NHS Foundation Trust’s policies, aims and objectives, whilst safeguarding the public funds and departmental assets for which i am personally responsible, in accordance with the responsibilities assigned to me. i am also responsible for ensuring that South Central Ambulance Service NHS Foundation Trust is administered prudently and economically and that resources are applied efficiently and effectively. i also acknowledge my responsibilities as set out in the NHS Foundation Trust Accounting Officer Memorandum.

7.2 THE PURPOSE OF THE SYSTEM OF INTERNAL CONTROLThe system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control is based on an ongoing process designed to identify and prioritise the risks to the achievement of the policies, aims and objectives of South Central Ambulance

Service NHS Foundation Trust (SCAS), to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control has been in place in SCAS for the year ended 31 march 2017 and up to the date of approval of the annual report and accounts.

7.3 CAPACITY TO HANDLE RISKThe Risk management Strategy comprehensively sets out arrangements in respect of the accountability for risk management in SCAS.

LEADERSHIP

As Chief Executive and Accounting Officer i have overall accountability for ensuring that the organisation has effective risk management systems in place. i have delegated specific areas of risk management activity to each of the Executive directors; for example, as follows:

è The director of Patient Care has day-to-day responsibility for managing the strategic development and implementation of organisational risk management, clinical effectiveness and clinical governance. This includes acting as the designated lead for a range of

responsibilities such as health and safety, security management, and infection prevention and control

è The medical director has responsibility for the management and development of clinical standards

è The director of Finance has responsibility for financial risk management and, in the role of Senior information Risk Owner, for risks relating to information

è The Chief Operating Officer has responsibility for managing the strategic development and implementation of clinical and non-clinical risk management (operational risks) associated with the provision of emergency ambulance services, NHS 111 and fleet management, as well as being the lead for emergency planning and business continuity activities

è The director of Strategy, business development, Communications and Engagement has responsibility for managing the risks associated with the provision of non-emergency ambulance services, including non-emergency patient transport services

è The board, with overall responsibility for governance, considers the risks faced by the Trust on a regular basis. For example, it receives the board Assurance Framework at each public board meeting

è The Quality and Safety Committee, with delegated authority from the board, monitors and reviews the Trust’s clinical governance arrangements

è The Audit Committee, also with delegated authority from the board, receives the board Assurance Framework and strategic risk register at every meeting, with the purpose of seeking assurance that effective risk management practice is in place

è The executive team, underpinned by the work of its various sub-committees, receives and reviews updates from all directorates relating to risk management, as well as the Trust’s board Assurance Framework and strategic risk register

è The executive team has also established a Risk, Assurance and Compliance Committee. This committee, comprising the executive directors of the Trust and the Company Secretary, carries out a deep-dive review of the Trust’s biggest risks and ensures that appropriate mechanisms are in place to provide assurance over the management of those risks

TRAINING

è Officers involved in leading the Trust’s risk management processes (e.g. Head of Risk and Security management, Clinical and Non Clinical Risk managers) are suitably qualified and experienced governance and risk management professionals. A wide range of training has been delivered to staff to enable them to manage identified clinical and non-clinical risks effectively. This training has been informed by a detailed training needs analysis based on external training requirements outlined by the NHSLA and CQC, in addition to training needs identified internally by the Trust. Our corporate induction training programme for new staff covers health and safety, awareness of risk, and incident reporting.

è The Trust has a very positive culture of incident reporting. The team structure in place enables immediate raising of concerns with on duty team supervisors who are able to directly support the reporting of incidents and the actual investigation, and can apply actions to mitigate. incidents are monitored and reviewed at different levels of the organisation, including by a Serious incidents Requiring investigation Review (SiRi) Group, to ensure trends and patterns are identified and responded to where appropriate.

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7.4 THE RISK AND CONTROL FRAMEWORK

STRATEGY

The Trust has a comprehensive Risk management Strategy which is reviewed periodically (e.g. annually), and updated where required. it was last updated in January 2017, and a number of minor amendments were approved by the board.

The key elements of our strategy are to:

è integrate risk management into the Trust’s culture and everyday management practice by clearly defining the Trust’s approach and commitment to risk management, by raising staff awareness, and building knowledge and skills

è Provide clearly documented responsibilities and structure for managing risk to ensure a coordinated, standard methodology is adopted by every directorate/department

è Encourage and support incident reporting in a culture to ensure that the Chief Executive and board are provided with evidence that risks are being appropriately identified, assessed, addressed and monitored

è Adopt an integrated approach to risk management, whether the risk relates to clinical, organisational, health and safety or financial risk, through the processes and structures detailed in the Trust’s Risk management Policy

Accept that whilst the provision of health care is not risk free, the Trust will aim to minimise the adverse effects of any risks through management of risk via the Quality and Safety Committee and Audit Committee both of which are sub committees of the board.

IDENTIFICATION OF RISk

A range of tools are used to identify and control risks, including:

è The monthly integrated Performance Report, including SiRis

è Review of adverse incidents and accident reports

è Quarterly reviews of claims and complaints

è Workforce engagement and leadership walkarounds

è Annual fire safety inspections

è Health and safety risk assessments

è Review of performance against the NHSLA Risk management Standards

è Self-assessments against the Care Quality Commission essential standards of quality and safety

The risks are identified through careful triangulation of the themes across the above reporting mechanisms, recognising issues that affect patient safety, treatment and experience as the most reliable indicators. The intention is to identify risks through a balance of top-down and bottom-up processes.

The board undertook a strategy refresh process during the second half of 2016/17 and as part of this process – for example, through SWOT and PESTLE analysis tools – considered some of the biggest strategic risks facing the Trust.

The board also plans to hold a risk workshop during 2017/18 and this will cover mechanisms for identifying potential future risks (e.g. horizon scanning).

APPETITE FOR RISk

The Trust has documented its appetite for risk in a ‘Risk Appetite Statement’. in doing so, it is acknowledged that delivery of healthcare and, in particular, the provision of ambulance services, will always involve a degree of risk (potentially heightened during periods of demand and change management). However, the Trust is fully committed to taking all necessary actions to ensure that risk is both minimised and mitigated. We adopt a positive approach to risk management and are particularly cautious on matters affecting our reputation.

Equally, it is considered that risk is a component of change and improvement, and therefore the Trust does not expect or consider the absence of risk as a necessarily positive position, as all change involves risk in order to adapt and improve.

The Trust has the greatest risk appetite in pursuit of innovation and challenging current working practices to improve patient care, access to services and reputational risk in terms of its willingness to take opportunities where positive gains can be realised, within the constraints of the regulatory environment.

QUALITY GOVERNANCE ARRANGEMENTS

The key elements of our quality governance arrangements are set out in the periodic self-assessments we undertake against the monitor Quality Governance Framework, and report to the board. We are either compliant (mostly) or partly compliant for all elements. Performance information is key to ensuring delivery of quality, and we have rigorous processes in place to ensure the quality of performance data. These include internal checking mechanisms, internal and external audit reviews, and a comprehensive review of the monthly integrated Performance Report by the Executive Team prior to being presented to the board.

kEY STRATEGIC RISkS

We have a range of key strategic risks, which we have identified and are proactively managing. The board considers the board Assurance Framework (bAF) at every board meeting in public, and at the final meeting of 2016/17 (in march 2017) the submitted bAF had seven red risks.

The red rated risks related to the following categories: hospital handover delays and associated risks to patient safety at Queen Alexandra Hospital in Portsmouth; the availability of resources to achieve the national response time standards and provide safe services; managing sickness absence; the ability to recruit and retain staff; risks to achieving financial targets and cost improvement programmes; the mobilisation of the new Surrey and Sussex NEPTS contracts.

Comprehensive action plans are in place for all of the risks reported in the bAF.

NHS FOUNDATION TRUST LICENCE CONDITION 4 – FT GOVERNANCE

The Trust undertakes periodic reviews of its position against all of the conditions contained within its provider licence, and reports to the board accordingly. No risks have been identified within 2016/17.

in terms of Condition 4 – FT governance, the Trust has undertaken a number of steps during 2016/17 to identify any potential risks. These include carrying out a high-level review of the Trust’s corporate governance arrangements against the monitor Code of Governance, including a review of the board’s sub-committees and non-executive director responsibilities (a number of changes have been made).

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INVOLVEMENT OF PUBLIC STAkEHOLDERS

Public stakeholders are involved in the management of risks which impact on them through the work of the governors, public meetings of the board, and our attendance at Health Overview and Scrutiny Committee meetings. Our engagement with our stakeholders produces an additional layer of scrutiny and challenge from broad representative areas of our population groups and therefore enables SCAS to remain grounded and responsive to the communities we serve.

7.5 COMPLIANCE WITH CQC REGISTRATION REQUIRMENTSThe Foundation Trust is fully compliant with the registration requirements of the Care Quality Commission (CQC). The last CQC inspection of SCAS took place in may 2016, and the Trust was rated as ‘Good’.

7.6 COMPLIANCE WITH NHS PENSION SCHEME REGULATIONSAs an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments into the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations.

7.7 COMPLIANCE WITH EQUALITY, DIVERSITY AND HUMAN RIGHTS LEGISLATIONControl measures are in place to ensure that all the organisation’s obligations

under equality, diversity and human rights legislation are complied with. Equality impact assessments are integrated into the core business of the Trust, and reports on the Trust’s position in relation to equality and diversity are regularly considered by the board.

7.8 COMPLIANCE WITH CLIMATE CHANGE ADAPTATION REPORTING TO MEET THE REQUIREMENTS OF THE CLIMATE CHANGE ACTThe Foundation Trust has undertaken risk assessments and carbon reduction delivery plans are in place in accordance with emergency preparedness and civil contingency requirements, as based on UKCiP 2009 weather projects, to ensure that this organisation’s obligations under the Climate Change Act and the adaptation reporting requirements are complied with.

7.9 REVIEW OF ECONOMY, EFFICIENCY AND EFFECTIVENESS OF THE USE OF RESOURCESThere are a number of key processes in place to ensure that resources are used economically, efficiently and effectively, which include:

è The board has regularly reviewed the economy, efficiency and effectiveness of resources through the regular performance management reports (the integrated Performance Report, finance reports, and quality and safety reports) considered at each meeting

è Savings targets are set annually in the form of cost improvement programmes, and the Trust has a very strong track record in terms of delivering annual savings targets. Although the full target for 2016/17 was not achieved, nearly £5.7m of cost savings were realised

(72% of the original budget for the year). Robust arrangements are in place to ensure that cost improvement programmes in no way compromise the quality of services

è The Trust’s monthly operational performance reviews are designed to review performance against key financial, operational, clinical and workforce targets as agreed at the start of the year. in addition, a programme of visits by directors across the service gives additional assurance on the management of the organisation

è The Trust routinely carries out benchmarking reviews of its performance and efficiency levels with other NHS bodies, including those in the ambulance sector (for example, in 2016/17, North East Ambulance Service). it also benchmarks sickness and recruitment and retention rates

è The board receives regular reports on the performance of the estate against a set of key performance indicators. These have been developed to report on criteria such as the physical condition, statutory compliance, functional stability, efficient utilisation and energy performance of the estate

è The Trust has in place governance and financial policies which include standing financial instructions, standing orders and a scheme of delegation. These policies prescribe the Trust’s policy for the effective procurement of goods and services within the Trust

è An annual programme of internal audits, monitored closely by the Audit Committee, allows further assurance to be given to the board on the use of its resources

7.10 INFORMATION GOVERNANCEinformation governance and data security risks are identified through the use of the NHS Connecting for Health information Governance Toolkit. Risks are recorded in the risk register and managed via specific action plans which are subject to regular review by the Trust’s information Governance Steering Group. The Trust has carried out a self-assessment against the 2016/17 information Governance Toolkit, achieving an overall score of 74%. This compares with a score of 72% in 2015/16.

There has been one reportable information security breach during 2016/17. This involved the leaking of a high profile call audio recording, and resulted in a SiRi investigation which is ongoing at the time of writing.

7.11 ANNUAL QUALITY REPORTThe directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 (as amended) to prepare Quality Accounts for each financial year. NHS improvement has issued guidance to NHS Foundation Trust boards on the form and content of annual Quality Reports which incorporate the above legal requirements in the NHS Foundation Trust Annual Reporting Manual.

in preparing the Quality Report which is included within the Annual Report, the Trust’s directors have taken steps to satisfy themselves that:

è The content of the Quality Report meets the requirements set out in the NHS Foundation Trust Annual Reporting manual 2016/17

è The content of the Quality Report is not inconsistent with internal and external sources of information

è The officers accountable for the preparation of the Quality Report have the necessary skills and experience

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è Appropriate processes have been used to develop and quality assure the Quality Report ensuring that it represents a balanced view of performance; this has included scrutiny by the Audit Committee and Quality and Safety Committee

è The performance information reported in the Quality Report is reliable and accurate

è There are proper internal controls over the collection and reporting of the measures of performance included in the Quality Report, and these controls are subject to review to confirm they are working effectively in practice

è The data underpinning the measures of performance reported in the Quality Report are robust and reliable, conforms to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review

7.12 REVIEW OF EFFECTIVENESSAs Accounting Officer, i have responsibility for reviewing the effectiveness of the system of internal control. my review of the effectiveness of the system of internal control is informed by the work of the internal auditors, clinical audit and the executive managers and clinical leads within the NHS Foundation Trust who have responsibility for the development and maintenance of the internal control framework.

i have drawn on the content of the Quality Report attached to this Annual Report and other performance information available to me. my review is also informed by comments made by the external auditors in their management letter and other reports. i have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the board, the Audit Committee, the Quality and Safety Committee, and the Risk Assurance and Compliance Committee, and a plan to address weaknesses and ensure continuous improvement of the system is in place.

Executive managers within the organisation who have responsibility for the development and maintenance of the system of internal control provide me with assurance. The board Assurance Framework itself provides me with evidence that the effectiveness of controls that manage the risks to the organisation achieving its principal objectives have been reviewed. my review during 2016/17 has also been informed by:

è internal and external audit reports

è The Annual Audit/management Letter

è The Head of internal Audit Opinion

è Reports to the board from the Audit Committee, and Quality and Safety Committee

è Reviews of serious incidents requiring investigation and the associated learning from these

è Reports to the Executive management Committee from its relevant sub-committees, as well as the work of the Risk, Assurance and Compliance Committee

è The monthly integrated Performance Report, which covers clinical, operational, service development, financial and human resources

è Staff satisfaction surveys

è Care Quality Commission reports

è The Quality Accounts and Annual Report

There have been three particular key sources of assurance for me in 2016/17:

è in may 2016, a planned inspection of SCAS and its services was undertaken by the Care Quality Commission. This resulted in a ‘Good’ overall rating for the Trust

è We retained a “green” governance rating from our regulator NHS improvement

throughout 2016/17 whilst a formal governance rating was awarded (this has now been superseded by a new inspection regime)

è We received an annual Head of internal Audit Opinion for 2016/17 of “moderate assurance”, defined as “generally a sound system of internal control designed to achieve system objectives with some exceptions”

7.13 CONCLUSIONmy review confirms that South Central Ambulance Service NHS Foundation Trust has a generally sound system of internal control that supports the achievement of its policies, aims and objectives.

No significant internal control issues have been identified in relation to the 2016/17 financial year.

Signed

Will Hancock Chief Executive

date: 25 may 2017

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The Trust’s board of directors (the “board”) held six board meetings in public between 1 April 2016 and 31 march 2017. The agendas, papers, presentations and minutes of board meetings are available on the Trust’s website.

DECISIONS TAkEN BY THE BOARD AND DELEGATED TO MANAGEMENT

The board has overall and collective responsibility for the exercising of the powers and the performance of the Trust, and its duties include to:

è Provide effective and proactive leadership of the Trust

è Ensure compliance with the provider licence, constitution, mandatory guidance issued by monitor (now part of NHS improvement (NHSi)), and other relevant statutory obligations

è Set the Trust’s strategic aims at least annually, taking into consideration the views of the Council of Governors, ensuring that the necessary resources are in place for the Trust to meet its main priorities and objectives

è Ensure the quality and safety of healthcare services for patients, education, training and research delivered by the Trust, applying the relevant principles and standards of clinical governance

è Ensure that the Trust exercises its functions effectively, efficiently and economically, including in relation to service delivery

è Set the Trust’s visions, values and standards of conduct and ensure that its obligations to patients and other key stakeholders are delivered

All board members (executive and non-executive) have joint responsibility for decisions of the board and share the same liability. All members also have responsibility to constructively challenge the decisions of

the board and help develop proposals on priorities, risk mitigation, values, standards and strategy.

The board delegates certain powers to its sub-committees (not including executive powers unless expressly authorised). The executive team is responsible for the day-to-day running of the organisation and implementing decisions taken at a strategic level by the board.

BOARD OF DIRECTORS BALANCE

The board continually reviews its composition to ensure that it reflects the skills and competencies required to enable the Trust to fulfil its obligations.

The board started 2016/17 with seven non-executive directors (NEds), including the Chairman, and seven executive directors, including the Chief Executive. during the first part of the year, the Chairman had a second/casting vote for any decisions requiring a vote of the board of directors.

Two non-executive directors, Sumit biswas and Lena Samuels, joined the board during the course of 2016/17 (in July 2016 and January 2017 respectively): meaning the board ended the year with nine non-executive directors, including the Chairman, and seven executive directors, including the Chief Executive. All sixteen members had voting rights.

Lena Samuels was appointed as a non-executive director/Chair designate, and assumed the Chair position on 1 April 2017.

in addition, the director of Strategy, business development, Communications and Engagement was appointed into the role of deputy Chief Executive with effect from 1 April 2016.

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BOARD OF DIRECTORS PERFORMANCE EVALUATION AND REVIEW

The board reviews its functioning and performance on an ongoing basis throughout the year. in line with the current ‘well-led’ regulatory guidance, an external and independent review of the board also takes place every three years; the last review took place in 2014, and on current plans the next review will be carried out in 2017.1

during 2016/17 there have been a number of reviews with direct implications for the board, including:

è The Trust was the subject of a full and comprehensive Care Quality Commission inspection in may 2016. The Trust received an overall rating of ‘Good’, and the well-led element (which is a reflection of leadership and the role of the board) was also assessed as being ‘Good’

è The Council of Governors’ Nominations Committee, supported by the Chairman, deputy Chairman, director of Human Resources and Organisational development and Company Secretary, have reviewed the non-executive director arm of the board as part of a formal succession planning process. This considered, in particular, the skills and expertise required going forward and resulted in the appointment of Lena Samuels (ultimately as Chair) and Sumit biswas

in addition, to the processes outlined above, the board has a systematic approach to assessing its collective performance including through the appraisal system. Reviews of the effectiveness of the key board committees (e.g. audit, quality and safety, charitable funds and remuneration) are undertaken annually and presented to the board.

8.1 GOVERNANCEThe board uses monitor’s (now part of NHSI) NHS Foundation Trust Code of Governance as best practice advice to improve governance practices across the Trust. Furthermore, the effectiveness of the Trust’s governance arrangements is regularly assessed, including through internal audit.

The Trust was compliant with its Constitution at all times during 2016/17. However, as a result of the new non-executive director appointments SCAS exceeded the number of non-executive directors stipulated in the Constitution. To address this, an amendment was made to the Constitution with the approval of both the board of directors and Council of Governors.

The board operates within a comprehensive structure and with robust reporting arrangements, which facilitates good information flows between the board of directors, various committees, and the Council of Governors.

The Trust maintains a register of board members’ interests, gifts and hospitality, and this is presented on an annual basis at one of the Trust’s board meetings in public. board members are also asked to declare any new interests at each meeting of the board, or highlight any existing interest that might be relevant to the discussions at that meeting.

The board continues to apply the Fit and Proper Person Requirement regulations, satisfying itself that all current and newly appointed board members fulfil the requirements. At each board meeting in public, board members are asked to declare whether there are any new factors which may impact on their ability to be regarded as ‘fit and proper’.

SCAS has a clear and detailed Quality and Safety Committee structure up to Trust board and throughout the services in the organisation. Each group has a robust terms of reference.

The Quality Account provides a public declaration of quality improvements and initiatives for the coming year as well as looking back at achievements in quality governance.

1 The ‘well-led’ governance requirements are currently being reviewed by NHS improvement/the Care Quality Commission

Each service area – NEPTS, 999 and NHS 111 – has clinical governance leads now, supporting the operational managers to deliver internal and external quality requirements and provide assurance on the delivery of quality improvements.

Each of the above has external assurances through internal and external auditors.

The Trust can report that there are no material inconsistencies between the following:

è The Annual Governance Statement

è The annual and quarterly statements submitted by the board of directors to NHSi against the Risk Assessment Report

è The Quality Report 2016/17

è The Annual Report 2016/17

è Reports arising from Care Quality Commission planned and responsive reviews of the Trust

South Central Ambulance Service NHS Foundation Trust has applied the principles of the NHS Foundation Trust Code of Governance on a comply or explain basis. The NHS Foundation Trust Code of Governance, most recently revised in July 2014, is based on the principles of the UK Corporate Governance Code issued in 2012.

8.2 NON-EXECUTIVE DIRECTORSNon-executive directors are members of the board of directors. They are not involved in the day to day running of the business, but are instead guardians of the governance process and monitor the executive activity as well as contributing to the development of strategy. They have four specific areas of responsibility – strategy, performance, risk and people – and should provide independent views on resources, appointments and standards of conduct.

Non-executive directors have a particular duty to ensure appropriate challenge is made, and that the board acts in the best interests of the public. They should:

è bring independence, external skills and perspectives, and challenge strategy development

è Scrutinise the performance of, and hold to account, the executive management in meeting agreed objectives, receive adequate information, and monitor the reporting of performance

è Satisfy themselves as to the integrity of financial, clinical and other information, and that financial and clinical quality controls and systems of risk management and governance are robust and implemented

è be responsible for determining appropriate levels of remuneration of executive directors and have a prime role in appointing, and where necessary removing, executive directors, and in succession planning

The Chair is one of the non-executive directors and is personally responsible for the leadership of the board of directors and the Council of Governors, ensuring their effectiveness on all aspects of their role and setting their agenda.

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NEd dATE APPOiNTEd TO FT bOARd

CURRENT TERm OF OFFiCE

TERm (RESET AT FT)

Trevor Jones (Chair) 1 march 2012 31 march 2017 Second/final

Alastair mitchell-baker (vice-Chair / Senior independent director)

1 march 2012 31 march 2018 Second/final - extended

Sumit biswas 1 July 2016 30 June 2019 First

ilona blue 1 march 2012 28 February 2018 Second

Nigel Chapman 1 march 2016 28 February 2019 First

mike Hawker 1 January 2014 31 december 2019 Second

Keith Nuttall 1 march 2012 31 march 2017 Second/final

Lena Samuels 1 January 2017 31 march 2020 First

Professor david Williams 1 march 2012 31 december 2017 Second

Trevor Jones and Keith Nuttall left the Trust, as planned, on 31 march 2017. Lena Samuels assumed the Chair position.

details of each non-executive director, including any declared interests, can be seen on the Trust’s website at www.scas.nhs.uk

8.3 EXECUTIVE DIRECTORSThe executive directors are responsible for the day-to-day running of the organisation, and the Chief Executive, as Accounting Officer, is responsible for ensuring that the organisation works in accordance with national policy and public service values, and maintains proper financial stewardship. The Chief Executive is directly accountable to the board for ensuring that its decisions are implemented.

At the end of the 2016/17 financial year there were seven voting executive directors on the Trust board:

EXECUTivE diRECTOR POSiTiON

Will Hancock Chief Executive

James Underhay deputy Chief Executive (director of Strategy, business development, Communications and Engagement)

Philip Astle Chief Operating Officer

John black medical director

Charles Porter director of Finance

deirdre Thompson director of Patient Care

melanie Saunders director of Human Resources and Organisational development

details of each executive director, including any declared interests, can be seen on the Trust’s website at www.scas.nhs.uk

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during 2016/17 the Trust had nine serving and voting non-executive directors, all of whom are independent:

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8.4 BOARD COMMITTEESThe board has four committees: Audit, Quality and Safety, Remuneration, and Charitable Funds.

The Audit and Quality and Safety Committees jointly oversee governance, quality and risk within the organisation and provide assurance to the board.

The Audit Committee also seeks assurance that financial reporting and internal control principles are applied. its members at the end of 2016/17 were mike Hawker (Chair), Sumit biswas, ilona blue and Professor david Williams, and six meetings were held during 2016/17.

The main focus of the Quality and Safety Committee is to enhance board oversight of quality performance, and probe quality and care issues. its members at the end of 2016/17 were Professor david Williams (Chair), Alastair mitchell-baker, Keith Nuttall, Nigel Chapman and Sumit biswas, and four meetings were held during 2016/17.

The Remuneration Committee is responsible for ensuring that a policy and process for

the appointment, remuneration and terms of service, and performance review and appraisal, of the Chief Executive, executive directors and senior managers are in place. its members at the end of 2016/17 were Alastair mitchell-baker (Chair), Trevor Jones, Lena Samuels and ilona blue, and five meetings were held during 2016/17.

The Charitable Funds Committee acts with delegated authority from the board (the corporate trustee) to ensure that the South Central Ambulance Charity operates with appropriate governance. its members at the end of 2016/17 were Keith Nuttall (Chair), Lena Samuels, mike Hawker, and Nigel Chapman. Nigel Chapman will become the Chair of the Committee from 1 April 2017. Five meetings were held during 2016/17.

8.5 ATTENDANCE AT MEETINGS 2016/17The attendance at meetings during 2016/17 of those who have served on the board, and reflecting their membership of the various committees, is as follows:

NON EXECUTivE diRECTORS

Name Trust board Audit Committee

Quality and Safety Committee

Remuneration Committee

Charitable Funds

Committee

Total meetings 6 6 4 5 5

Trevor Jones 6 N/A N/A 5 N/A

Alastair mitchell-baker 6 N/A 3 4 N/A

Sumit biswas2 5/5 3/3 3/3 N/A N/A

ilona blue 6 6 N/A 5 N/A

Nigel Chapman 6 N/A 4 N/A 3

mike Hawker 6 6 N/A N/A 3

Lena Samuels 2/2 N/A N/A 1/1 1/1

Keith Nuttall 6 N/A 4 N/A 5

Professor david

Williams5 6 4 N/A N/A

EXECUTivE diRECTORS

Name Trust board Audit Committee

Quality and Safety Committee

Remuneration Committee

Charitable Funds

Committee

Total meetings 6 6 4 5 5

Will Hancock 6 N/A N/A 3/3 N/A

James Underhay

6 N/A 3 N/A 1/2

Philip Astle 5 3/3 2/2 N/A N/A

John black3 3 N/A 2 N/A N/A

Charles Porter 6 6 N/A N/A 1/2

deirdre Thompson

6 4/4 4 N/A N/A

melanie Saunders

6 N/A 3 5 N/A

The table includes attendance by the executive director or nominated deputy (with the agreement of the committee chair).

2 Sumit biswas attended two out of three Quality and Safety Committee meetings as an observer 3 John black was absent on sick leave from November 2016 to the end of the financial year

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The Audit Committee is a statutory committee of the board comprising non-executive directors of the Trust, all of whom are considered independent. There were six meetings during 2016/17 and all of its members attended each of those meetings. members of the Audit Committee were mike Hawker (Chair), ilona blue and Professor david Williams. Sumit biswas, Non-Executive director was appointed as a member of the Audit Committee during the year. He attended three meetings.

Other managers are regular attendees of the Audit Committee which includes the director of Finance, director of Patient Care and the Company Secretary. Representatives of External Audit, internal Audit and the Counter Fraud Team are also in regular attendance. Other managers also attend the Audit Committee on an irregular basis.

The Audit Committee’s responsibilities include:

è Review Trust’s draft accounts and make recommendations with regard to their approval to the board

è Provide assurance to the board as to the effectiveness of internal controls and the risk management processes that underpin them

è Agree annual plans for external audit, internal audit and counter fraud

è make recommendations to the Council of Governors regarding the appointment of the external auditors

in discharging its responsibilities, the Committee reviews taking into account the board Assurance Framework, the Trust’s Risk Registers and the work of other board Committees such as the Quality and Safety Committee.

EXTERNAL AUDIT

The Trust appointed KPmG as its auditors, following a competitive tender process, for the 2012/13 financial statements for an initial period of three years with an option to extend for a further two years. Following a recommendation made from the Committee to the Council of Governors (COG), KPmG’s term of office was extended for a further two years. KPmG attend every committee reporting on progress and developments that are likely to impact on the final accounts. The effectiveness of internal and external audit is reviewed on a periodic basis by the Audit Committee. KPmG has attended COG meetings from time to time. There was some non-audit work undertaken by KPmG on behalf of the Trust in 2016/17 i.e. £18k which included the Quality Audit. The value of statutory audit work undertaken was £52k compared to £52k in 2015/16 which included the audit of the Trust’s subsidiary accounts.

SIGNIFICANT ISSUES

At its meeting on 4 may 2017, the Audit Committee considered matters relating to the 2016/17 accounts which included the following:

Accounting for South Central Fleet Services Ltd

The Audit Committee was requested to note that the Trust Accounts included the results of South Central Fleet Services Ltd which is a wholly owned subsidiary of SCAS. The accounting statements included the results of the Group which included Trust and the Company and Trust results excluding the Company.

Recognition of Income

Over 98% of the Trust’s income is received from other NHS organisations, and over 92% is receivable from CCGs. The Trust participates in the department of Health’s agreement of balances exercises. This exercise seeks to identify all income and expenditure transactions and payable and receivables balances that arise from Whole Government Accounting (WGA) bodies. The Audit Committee is satisfied that by participating with this exercise it helps to provide further assurance that the vast majority of income and expenditure with WGA have been properly recognised and WGA receivable and payable balances are appropriately recorded. The Trust’s external auditors will review the outcome of the exercise and report their findings to the Audit Committee.

NHS Direct (NHSD) Activities

Ongoing activities in relation to NHSd were discussed by the Committee and the accounting treatment of these activities was discussed by the Committee.

Analysis of Notes relating to Expenditure

The Committee further discussed at length the presentation of expenditure. The Committee agreed reclassification of some expenditure from agency to purchase of healthcare-related activities from non-healthcare bodies along with previous year comparatives.

Going Concern

The Committee discussed going concern and agreed that they could recommend to the board that they could adopt the accounts on the basis that the Trust remained a going concern.

Mike Hawker Audit Committee Chairman 25 may 2017

//70 //71

//72 //73

The Group, which includes the results of the Trust and South Central Fleet Services Ltd reported a surplus in 2016/17 of £0.701m. This included a benefit of £2.4m relating to lower NHSd direct liabilities which was a reversal of expenditure recognised in discontinued activities in previous accounts.

The Trust has faced significant operational pressures which has resulted in increased costs. Therefore despite an increased income base, Trust expenditure has risen faster than income.

The NHSi in year measure of finance performance and sustainability was amended in year to a use of resource measure. At the year-end, the Trust achieved a 1 for the use of resource measure (where 1 is the highest rating).

10.1 SUMMARY OF FINANCIAL PERFORMANCEOn income and Expenditure, the Trust reported a continuing operations deficit of £1.7m for the year and a surplus of £0.7m after taking into account discontinued activities.

Earnings before interest, Tax, depreciation and Amortisation (EbiTdA) of £7.4m represented 4.5% of turnover which is £1.2m below last year and £1.9m above plan for the year.

Capital expenditure was £4.7m (£5.9m in 2015/16) with ambulances being the largest single item.

The year-end cash balance was £20.3m which was an increase of £0.3m when compared to the previous year. The main increases in cash were due to capital payments lower than depreciation (£5.3m) offset by loan and dividend repayments (£3.4m) and working capital movements (£1.6m).

it has been a financially challenging year but we still managed to achieve £5.7 million of cost improvements in 2016/17.

Total revenue income to meet pay and other day to day running costs reached £183.7m of which the majority was secured through various service level agreements with clinical care commissioning groups and hospital NHS trusts.

The accounts are stated in accordance with international Financial Reporting Standards. Total fixed assets (land, buildings and capital equipment) of the Trust were valued at £66.3m (£69.4m in 2016).

The Trust formed a subsidiary company (South Central Fleet Services Ltd) to provide fleet services which was incorporated in September 2015 and commenced trading on 1 November 2015. The results of the activities of the company are included in the group results with the company recording a surplus of £21k for the year ending 31 march 2017.

10.2 ANALYSIS OF INCOMEThe Trust reported income of £183.8 million for the year end 31 march 2017 (2016: £175.0 million). The increase of over 5.0% was firstly due to increased 999 income relating to more patients calling the 999 service. Secondly it related to higher income in our non–emergency patient transport services following the expansion of the service in Thames valley and Hampshire.

The Trust’s principal source of income is from local NHS commissioning contracts for the provision of the emergency service. This income totalled £128.6 million (£124.6 million in 2016) which represented 70.0% of the Trust turnover (2016: 71.2%).

The Trust confirms that the NHS income it receives for the provision of healthcare exceeds its income received for any other purpose in accordance with the requirements of the Health and Social Care Act 2012. The amount of income that the Trust received in this regard for 2016/17 was £175.3m representing 95.3% of total income.

//72 //73

999 128.6

NEPTS 25.9

HART 3.0 HART 3.1

NHS 111 12.1

Other 14.2

Trust income £m 2016/17 Trust income £m 2015/16

999 124.6

NEPTS 22.4

Other 13.5

NHS 111 11.4

//74 //75

10.2 ANALYSIS OF OPERATING EXPENDITURETotal operating expenditure for the Group (excluding depreciation, amortisation and impairments) was £176.3 million for the year ended 31 march 2017 (2016: £168.9 million). The increase of 4.4% was mainly due to increased staff costs arising from the

expansion of the non-emergency transport service and costs relating to the additional emergency frontline staff recruited and the development of our frontline workforce.

Staff costs represent 65.7% of total operating expenditure (2016: 65.0 %). The increase in other expenditure is due to an increase in use of frontline ambulance private providers.

10.3 CAPITAL INVESTMENTinvestment in capital resources for 2015/16 was £5.9 million (2014: £11.4 million) which was within the initial capital plan and within

resources generated internally within the Trust. The Trust was able to replace all necessary frontline ambulances and fund necessary infrastructure costs.

10.4 DISCLOSURE OF INFORMATION TO AUDITORSAs far as each of the directors is aware, there is no relevant audit information of which the auditors are unaware. Each director has taken all the steps a director ought to have taken to make themselves aware of any relevant audit information and to establish that the auditors are aware of such information.

10.5 COST ALLOCATION AND CHARGINGSouth Central Ambulance Service NHS Foundation Trust has complied with the cost allocation and charging requirements set out in Hm Treasury and Office of Public Sector information guidance.

10.6 INCOME FROM THE PROVISION OF GOODS AND SERVICESThe Trust confirms that the income that it has received from other activities has not had any impact on its provision of services for the purposes of the health service in England.

10.7 SICKNESS ABSENCEThe overall sickness rate for the Trust for 2016/17 was 6.04% (6.3% in 2015/16) which equated to 13.6 days lost per person (14.2 days lost in 2015/16). Note that the figures used are for each calendar year.

Trust Expenditure £m 2016/17

Capital Investment £m 2016/17

Trust Expenditure £m 2015/16

Capital Investment £m 2015/16

Staff costs 115.9

Other expenses 52.3

Clinical suppliers and drug

expenditure 3.5

vehicle fuel 4.6

vehicle fuel 4.5

Clinical suppliers and drug

expenditure 2.8

Staff costs 109.9

Other expenses 51.7

Other 0.7

Fleet 1.3

Estates 1.1

iT 1.6

Other 0.4

Fleet 3.0

Estates 1.0

iT 1.5

//76 //77

ANNUAL STATEMENT FROM CHAIR OF REMUNERATION COMMITTEEThe Remuneration Committee regularly reviews the Remuneration Policy; the Committee is satisfied that the policy provides a framework for agreeing salaries and is consistent with the monitor FT Code of Governance and the NHS Act 2006.

The Committee benchmarks against similar sized foundation trusts but must also take into account other factors when reviewing executive director pay, to ensure pay is proportionate and justifiable. These include the local employment market, being situated in a high cost area, and also competing with the London recruitment market. As a result, remuneration levels are set to be sufficient to attract, retain and motivate executive directors of the quality and with the skills and experience required to lead the Trust.

The Committee reviews performance of each director each year before any decision regarding remuneration is made. The Trust takes its responsibility in approving all salaries seriously and acts in accordance with its responsibilities towards protecting public money. The Trust only has one executive director on a higher salary than the Prime minister; this is a result of the comprehensive review taking into account the scope of the role and the local labour market. Any future salary above £142,500

would only be recommended to the board by the Remuneration Committee where there was clear and justifiable evidence that this was appropriate.

The Remuneration and Nominations Committee met six times during 2016/17, and in accordance with its terms of reference, considered and agreed the remuneration and terms of service of the Chief Executive and executive directors. Following the inclusion of director of Sales, Operations and development, deputy medical director and Charities CEO during 2015/16, the Committee also considered and reviewed the terms and conditions for these three very Senior managers (vSm).

in accordance with the policy, the Committee undertook a review of salaries informed by a benchmarking report, and agreed that salaries of four of the executive team remained within current market rates. With the backing of the full non-executive membership of the board, the Committee approved inflationary increase of 1% of salaries for four of the executive team and the three vSms from 1 April 2016. in accordance with the policy, the Committee had agreed in 2013, that 5% of executive salaries be available in 2016/17 for payment of non-consolidated bonuses where performance targets had been met in 2015/16. For consideration of a bonus to be paid, the Committee would first be assured that the Trust had met corporate targets; only then would the performance of individual directors be reviewed.

Having undertaken this review, the Committee approved non-consolidated bonuses to be paid to four of the executive directors and two of the vSms in July 2016. in 2016, the Committee again agreed that no more than 5% of executive and vSm salaries be available in 2016/17 for payment of non-consolidated bonuses where performance targets had been met in 2015/16.

during 2016/17 no decisions were made regarding the loss of office of senior Trust staff resulting in severance payments.

Remuneration and Nominations

Committee – Attendance List 2016/17

date Amb TJ ib mS WH

5 may 2016 (tel.

con)Yes Yes Yes Yes N/A

30 June 2016

(mtg)Yes Yes Yes Yes Yes

14 July 2016 Yes Yes Yes Yes Yes

4 October 2016

(mtg)No Yes Yes Yes N/A

15 december

2016 (mtg)Yes Yes Yes Yes Yes

29 march 2017

(mtg)Yes Yes Yes Yes N/A

Alastair Mitchell-Baker Chair Remuneration and Nominations Committee

//76 //77

//78 //79

11.1 DIRECTORS SALARIES AND BENEFITS FOR THE YEAR ENDED 31 MARCH 2017

2016/17 2015/16

Name and Title Sal

ary

(ban

ds o

f £5

,000

) £00

0

Taxa

ble

bene

fits

to

the

near

est

£100

Ann

ual p

erfo

rman

ce r

elat

ed b

onus

es in

ba

nds

of £

5,00

0

All

pens

ion

rela

ted

bene

fits

(ban

ds o

f £2

,500

)

Tota

l in

band

s of

£5,

000

Sal

ary

(ban

ds o

f £5

,000

) £00

0

Taxa

ble

bene

fits

to

the

near

est

£100

Ann

ual p

erfo

rman

ce r

elat

ed b

onus

es in

ba

nds

of £

5,00

0

All

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ion

rela

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bene

fits

(ban

ds o

f £2

,500

)

Tota

l in

band

s of

£5,

000

Trevor Jones (Chairman) 35-40 35 - 40 Note 1

Alastair mitchell - baker (Non - Executive director) 15-20 15 - 20

ilona blue (Non - Executive director) 0 0

Keith Nuttall (Non - Executive director) 10-15 10 - 15

Professor david Williams (Non - Executive director ) 15-20 15 - 20

mike Hawker (Non - Executive) 15-20 15 - 20

Nigel Chapman (Non - Executive) 10-15 0 - 5

Sumit biswas 5-10 Note 2

Lena Samuels 0-5 Note 3

William Hancock (Chief Executive) 155-160 5300 5-10 42.5 - 50 210 - 215 150 - 155 47.59 5-10 52.5-55 215-220 Note 4

deirdre Thompson (director of Patient Care) 110-115 5-10 22.5 - 25 140 – 145 110 - 115 0-5 15-17.5 130-135 Note 4

Charles Porter (director of Finance) 115-120 0-5 27.5 - 30 145 - 150 110 - 115 0-5 25-27.5 140-145 Note 4

Philip Astle (Chief Operating Officer) 120-125 32.5 - 35 150 - 155 5 - 10 5-10 Note 5

James Underhay (director of Strategy and business development) 120-125 4300 0-5 50 - 52.5 180 - 185 110 -115 35.93 0-5 25-27.5 140-145 Note 4

melanie Saunders (director of Human Resources and Organisational development 95-100 2000 97.5 - 100 195 - 200 0-5 0-5 Note 6

John black (medical director) 110 -115 4100 110 - 115 105 - 110 56.61 Note 7

Band of highest paid Director’s Total 157.5 157.5

median Total Reumeration (£000) 24.88 25.48

6.33 6.18

Notes

1. Trevor Jones left the Trust on 31 march 2017

2. Sumit biswas joined the Trust on 1 July 2016

3. Lena Samuels joined the Trust on 1 January 2017 becoming Chair of the Trust on 1 April 2017

4. Will Hancock, Charles Porter, James Underhay and deirdre Thompson were awarded an annual bonus based on individual performance against objectives, overall contribution to organisational performance and their leadership

5. Philip Astle joined the Trust on 14 march 2016

6. melanie Saunders became a voting executive director on 23 march 2016

7. dr John black is a recharge from Oxford University Hospitals NHS Foundation Trust

//80 //81

11.2 PENSIONS FOR THE YEAR ENDED 31 MARCH 2017

Name and Title Rea

l inc

reas

e in

pen

sion

at

age

60 (b

ands

of

£2,5

00)

Rea

l inc

reas

e in

pen

sion

lum

p su

m a

t ag

e 60

(b

ands

of

£2,5

00)

Tota

l acc

rued

pen

sion

at

age

60 a

t 31

mar

ch

2016

(ban

ds o

f £5

,000

)

Lum

p su

m a

t ag

ed 6

0 re

late

d to

acc

rued

pe

nsio

n at

31

mar

ch 2

016

(ban

ds o

f £5

,000

)

Cas

h E

quiv

alen

t Tra

nsfe

r val

ue a

t 31

mar

ch

2017

Cas

h E

quiv

alen

t Tra

nsfe

r val

ue a

t 31

mar

ch

2016

Rea

l inc

reas

e in

Cas

h E

quiv

alen

t Tra

nsfe

r va

lue

31 m

arch

201

7

£000 £000 £000 £000 £000 £000 £000

Will Hancock (Chief Executive)

2.5 - 5 0 - 2.5 50 - 55 135 - 140 841 751 90

Deirdre Thompson (Director of Patient Care)

0 - 2.5 5 - 7.5 35 - 40 105 - 110 630 581 48

Charles Porter (Director of Finance)

0 - 2.5 0 - 2.5 15 - 20 35 - 40 255 223 32

Philip Astle (Chief Operating Officer)

0 - 2.5 0 0 - 5 0 28 0 28

James Underhay (Director of Strategy and Business Development)

2.5 - 5 0 10 - 15 0 192 147 46

Melanie Saunders (Director of Human Resources and Organisational Development

5 - 7.5 7.5 - 10 25 - 30 65 - 70 370 294 76

11.3 CASH EQUIVALENT TRANSFER VALUEA Cash Equivalent Transfer value (CETv) is the actuarially completed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme.

A CETv is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme.

The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETv figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme.

They also include any additional pension benefit accrued to the member as a result of

their purchasing additional years of pension service in the scheme at their own cost.

CETvs are calculated within the guidelines and framework prescribed by the institute and Faculty of Actuaries.

REAL INCREASE IN CETV

This reflects the increase in CETv effectively funded by the employer. it takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.

Government Actuary department (GAd) factors for the calculation of CETvs assume that benefits are indexed in line with CPi which is expected to be lower than RPi which was used previously and hence will tend to produce lower transfer values.

11.4 EXPENSESdetails of number and value of expenses claimed by governors and directors are detailed below:

2016/17 2015/16

Total Number in Office

Total Number Receiving Expenses

Aggregate Sum of Expenses paid (£00)

Total Number in Office

Total Number Receiving Expenses

Aggregate Sum of Expenses paid (£00)

Governors 23 16 53 24 13 37

directors 15 13 198 15 10 162

//82 //83

11.5 OFF-PAYROLL ENGAGEMENTS

11.5.1: For all off-payroll engagements as of 31 Mar 2017, for more than £220 per day and that last for longer than six months

No. of existing engagements as of 31 mar 2017 9

Of which:

Number that have existed for less than one year at the time of reporting. 1

Number that have existed for between one and two years at the time of reporting. 5

Number that have existed for between two and three years at the time of reporting. 1

Number that have existed for between three and four years at the time of reporting 1

Number that have existed for four or more years at the time of reporting 1

Confirmation:

All existing off-payroll engagements, outlined above, have at some point been subject to a risk based assessment as to whether assurance is required that the individual is paying the right amount of tax and, where necessary, that assurance has been sought.

11.5.2: For all new off-payroll engagements, or those that reached six months in duration, between 1 Apr 2016 and 31 Mar 2017, for more than £220 per day and that last for longer than six months

Number of new engagements, or those that reached six months in duration between 1 Apr 2016 and 31 mar 2017 3

Number of the above which include contractual clauses giving the trust the right to request assurance in relation to income tax and national insurance obligations 3

Number for whom assurance has been requested 3

Of which:

Number for whom assurance has been received 3

Number for whom assurance has not been received 0

Number that have been terminated as a result of assurance not being received 0

11.5.3: For any off-payroll engagements of Board members, and/or senior officials with significant financial responsibility, between 1 Apr 2016 and 31 Mar 2017

Number of off-payroll engagements of board members, and/or, senior officials with significant financial responsibility, during the financial year. 0

Number of individuals that have been deemed “board members and/or senior officials with significant financial responsibility”. This figure should include both off-payroll and on-payroll engagements. 6

FOREWORD TO THE ACCOUNTSSouth Central Ambulance Service NHS Foundation Trust

These accounts, for the year ended 31 march 2017, have been prepared by South Central Ambulance Service NHS Foundation Trust in accordance with paragraphs 24 and 25 of Schedule 7 within the National Health Service Act 2006.

Signed

Will Hancock, Chief Executive date: 25 may 2017

//84 //85

STATEMENT OF COMPREHENSIVE INCOMEGroup Trust

2016/17 2015/16 2016/17 2015/16

Note £000 £000 £000 £000

Operating income from patient care activities 3 175,315 168,655 175,315 168,655

Other operating income 4 8,403 6,392 8,155 6,392

Total operating income from continuing operations 183,718 175,047 183,470 175,047

Operating expenses 5,7 (183,884) (177,194) (183,644) (177,137)

Operating surplus/(deficit) from continuing operations (166) (2,147) (174) (2,090)

Finance income 10 46 70 46 70

Finance expenses 11 (117) (135) (117) (135)

Finance expense - unwinding of discount on provisions (9) (36) (9) (36)

PdC dividends payable (1,627) (1,465) (1,627) (1,465)

Net finance costs (1,707) (1,566) (1,707) (1,566)

Gains on disposal of non-current assets 169 14 156 14

Deficit for the year from continuing operations (1,704) (3,699) (1,725) (3,642)

Gain/ (loss) from absorption and discontinuance of operations 13 2,405 2,505 2,405 2,505

Surplus/(deficit) for the year 701 (1,194) 680 (1,137)

Total comprehensive income/(expense) for the period 701 (1,194) 680 (1,137)

The notes on pages 84 to 137 form part of these accounts

STATEMENTS OF FINANCIAL POSITIONGroup Trust

31 March 2017

31 March 2016

31 March 2017

31 March 2016

Note £000 £000 £000 £000

Non-current assets

intangible assets 14 3,694 3,403 3,677 3,369

Property, plant and equipment 15 62,588 66,005 58,843 63,239

Other investments 16 - - 441 441

Other financial assets 19 - - 2,400 2,700

Total non-current assets 66,282 69,408 65,361 69,749

Current assets

inventories 17 938 1,031 590 684

Trade and other receivables 18 12,074 11,414 11,895 11,191

Other financial assets 19 - - 300 300

Non-current assets for sale 20 2,700 2,950 2,700 2,950

Cash and cash equivalents 21 20,272 19,926 19,921 19,754

Total current assets 35,984 35,321 35,406 34,879

Current liabilities

Trade and other payables 22 (17,684) (15,364) (16,149) (15,206)

borrowings 23 (1,738) (1,738) (1,738) (1,738)

Provisions 24 (2,821) (4,637) (2,821) (4,637)

Total current liabilities (22,243) (21,739) (20,708) (21,581)

Total assets less current liabilities 80,023 82,990 80,059 83,047

Non-current liabilities

Trade and other payables 22 (15) (18) (15) (18)

borrowings 23 (3,140) (4,878) (3,140) (4,878)

Provisions 24 (6,117) (8,044) (6,117) (8,044)

Total non-current liabilities (9,272) (12,940) (9,272) (12,940)

Total assets employed 70,751 70,050 70,787 70,107

Financed by

Public dividend capital 57,874 57,874 57,874 57,874

Revaluation reserve 10,885 10,998 10,885 10,998

Other reserves (350) (350) (350) (350)

income and expenditure reserve 2,342 1,528 2,378 1,585

Total taxpayers’ and others’ equity 70,751 70,050 70,787 70,107

The financial statements on pages 84 to 86 were approved by the board on 25 may 2017 and signed on its behalf by:

Signed

Will Hancock, Chief Executive date: 25 may 2017

//86 //87

CONSOLIDATED STATEMENT OF CHANGES IN EQUITY FOR THE YEAR ENDED 31 MARCH 2017

Group

Public dividend

capital

Revaluation reserve

Other reserves*

Income and expenditure

reserveTotal

£000 £000 £000 £000 £000

Taxpayers’ and others’ equity at 1 April 2016 - brought forward 57,874 10,998 (350) 1,528 70,050

Surplus/(deficit) for the year - - - 701 701

Transfer to retained earnings on disposal of assets - (113) - 113 -

Taxpayers’ and others’ equity at 31 March 2017 57,874 10,885 (350) 2,342 70,751

CONSOLIDATED STATEMENT OF CHANGES IN EQUITY FOR THE YEAR ENDED 31 MARCH 2016

Group

Public dividend

capitalRevaluation

reserveOther

reserves

Income and expenditure

reserve Total

£000 £000 £000 £000 £000

Taxpayers’ and others’ equity at 1 April 2015 - brought forward 57,874 11,061 (350) 2,659 71,244

Surplus/(deficit) for the year - - - (1,194) (1,194)

Other transfers between reserves - (63) - 63 -

Transfer to retained earnings on disposal of assets - - - - -

Taxpayers’ and others’ equity at 31 March 2016 57,874 10,998 (350) 1,528 70,050

*Other reserves

This reflects a residual balance required in 2006 when the Trust was formed from ambulance predecessor trusts to balance opening net assets with taxpayers’ equity.

STATEMENT OF CHANGES IN EQUITY FOR THE YEAR ENDED 31 MARCH 2017

Trust

Public dividend

capital

Revaluation reserve

Other reserves*

Income and

expenditure reserve

Total

£000 £000 £000 £000 £000

Taxpayers’ and others’ equity at 1 April 2016 - brought forward 57,874 10,998 (350) 1,585 70,107

Surplus/(deficit) for the year - - - 680 680

Other transfers between reserves - - - - -

Transfer to retained earnings on disposal of assets - (113) - 113 -

Taxpayers’ and others’ equity at 31 March 2017 57,874 10,885 (350) 2,378 70,787

STATEMENT OF CHANGES IN EQUITY FOR THE YEAR ENDED 31 MARCH 2016

Trust

Public dividend

capitalRevaluation

reserveOther

reserves

Income and expenditure

reserve Total

£000 £000 £000 £000 £000

Taxpayers’ and others’ equity at 1 April 2015 - brought forward 57,874 11,061 (350) 2,659 71,244

Surplus/(deficit) for the year - - - (1,137) (1,137)

Other transfers between reserves - (63) - 63 -

Transfer to retained earnings on disposal of assets - - - - -

Taxpayers’ and others’ equity at 31 March 2016 57,874 10,998 (350) 1,585 70,107

*Other reserves

This reflects a residual balance required in 2006 when the Trust was formed from ambulance predecessor trusts to balance opening net assets with taxpayers’ equity.

//88 //89

STATEMENT OF CASH FLOWSGroup Trust

2016/17 2015/16 2016/17 2015/16

£000 £000 £000 £000

Cash flows from operating activities

Operating surplus/(deficit) (166) (2,147) (174) (2,090)

Non-cash income and expense:

depreciation and amortisation 7,613 8,249 7,302 8,247

(increase)/decrease in receivables and other assets (704) (2,951) (748) (2,729)

(increase)/decrease in inventories 93 (85) 94 262

increase/(decrease) in payables and other liabilities 518 419 248 264

increase/(decrease) in provisions (3,752) (3,065) (3,752) (3,065)

Net cash generated from/(used in) operating activities 3,602 420 2,970 889

Cash flows from investing activities

interest received 48 70 48 70

Purchase and sale of financial assets - - - (441)

Purchase of intangible assets (1,227) (1,132) (1,226) (1,177)

Purchase of property, plant, equipment and investment property (1,667) (5,818) (1,501) (3,057)

Sales of property, plant, equipment and investment property 647 14 634 97

Net cash generated from/(used in) investing activities (2,199) (6,866) (2,045) (4,508)

Cash flows from financing activities

movement on loans from the department of Health (1,738) (1,738) (1,738) (1,738)

Other interest paid (110) (135) (110) (135)

PdC dividend paid (1,614) (1,360) (1,614) (1,360)

Financing cash flows of discontinued operations 2,405 2,505 2,405 2,505

Cash flows from (used in) other financing activities - - 300 (3,000)

Net cash generated from/(used in) financing activities (1,057) (728) (757) (3,728)

increase/(decrease) in cash and cash equivalents 346 (7,174) 168 (7,347)

Cash and cash equivalents at 1 April 19,926 27,100 19,753 27,100

Cash and cash equivalents at 31 March 20,272 19,926 19,921 19,753

NOTES TO THE ACCOUNTS

1. ACCOUNTING POLICIES AND OTHER INFORMATION

BASIS OF PREPARATION

NHS improvement, in exercising the statutory functions conferred on monitor, is responsible for issuing an accounts direction to NHS foundation trusts under the NHS Act 2006.

NHS improvement has directed that the financial statements of NHS foundation trusts shall meet the accounting requirements of the department of Health Group Accounting manual (dH GAm) which shall be agreed with the Secretary of State. Consequently, the following financial statements have been prepared in accordance with the dH GAm 2016/17 issued by the department of Health. The accounting policies contained in that manual follow iFRS and Hm Treasury’s FRem to the extent that they are meaningful and appropriate to NHS foundation trusts.

The accounting policies have been applied consistently in dealing with items considered material in relation to the accounts.

Where the statements show Group, this includes the results for both the NHS Foundation Trust and its wholly owned subsidiary, i.e. South Central Fleet Services Ltd

ACCOUNTING CONVENTION

These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities.

GOING CONCERN

The Foundation Trust Accounts have been prepared on a “going concern” basis. This means that the Trust expects to operate into the future and that the Statement of Financial Position (assets and liabilities) reflects the ongoing nature of the Trust’s

activities. The Trust board of directors has considered and declared that; “After making enquiries, the board of directors has a reasonable expectation that the Trust has adequate resources to continue in operational existence for the foreseeable future”. For this reason, they continue to adopt the going concern basis in preparing the accounts.

1.1 CONSOLIDATION

NHS CHARITABLE FUND

South Central Ambulance NHS Foundation Trust is the Corporate Trustee to South Central Ambulance Service (SCAS) NHS Charity. South Central Ambulance NHS Foundation Trust has considered the materiality of the current annual value of transactions and as a result has not consolidated the charitable fund results in to the Trust accounts.

The SCAS Charity had total assets of £914k as at 31 march 2017 (31 march 2016: £526k). during 2016/17 the Charity received income of £706k (2015/16: £122k) and incurred expenditure of £318k (2015/16: £189k).

OTHER SUBSIDIARIES

On 5 September 2015 the Trust established a wholly owned subsidiary company ‘South Central Fleet Services Ltd’. The Accounts show results for the Group and the Trust.

The company began trading on 1 November 2015 and provides a range of fleet services to the Trust. The Trust’s investment in the company is £441,340 of share capital.

Subsidiary entities are those over which the Trust is exposed to, or has rights to, variable returns from its involvement with the entity and has the ability to affect those returns through its power over the entity. The income, expenses, assets, liabilities, equity and reserves of subsidiaries are consolidated in full into the appropriate financial statement lines. Where subsidiaries accounting policies are not aligned with the Trust (including where they report under UK FRS102) then amounts are adjusted during consolidation where the differences are material. The

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amounts consolidated are drawn from the financial statements of South Central Fleet Services Ltd. intra-entity balances, transactions and gains/losses are eliminated in full on consolidation.

1.2 INCOMEincome in respect of services provided is recognised when, and to the extent that, performance occurs and is measured at the fair value of the consideration receivable. The main source of income for the Trust is contracts with commissioners in respect of health care services.

Where income is received for a specific activity, which is to be delivered in a subsequent financial year, that income is deferred.

income from the sale of non-current assets is recognised only when all material conditions of sale have been met, and is measured as the sums due under the sale contract.

1.3 EXPENDITURE ON EMPLOYEE BENEFITS

SHORT-TERM EMPLOYEE BENEFITS

Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees. The cost of annual leave entitlement earned, but not taken by employees at the end of the period, is recognised in the financial statements to the extent that employees are permitted to carry-forward leave into the following period.

PENSION COSTS

NHS Pension Scheme

Past and present employees are covered by the provisions of the NHS Pension Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, general practices and other bodies, allowed under the direction of Secretary of State, in England and Wales. it is not possible for the NHS

Foundation Trust to identify its share of the underlying scheme liabilities. Therefore, the scheme is accounted for as a defined contribution scheme.

Employer’s pension cost contributions are charged to operating expenses as and when they become due.

Additional pension liabilities arising from early retirements are not funded by the Scheme except where the retirement is due to ill-health. The full amount of the liability for the additional costs is charged to the operating expenses at the time the Trust commits itself to the retirement, regardless of the method of payment.

1.4 EXPENDITURE ON GOODS AND SERVICESExpenditure on goods and services is recognised when, and to the extent that they have been received, and is measured at the fair value of those goods and services. Expenditure is recognised in operating expenses, except where it results in the creation of a non-current asset such as

property, plant and equipment.

1.5 PROPERTY, PLANT AND EQUIPMENT

RECOGNITION

Property, plant and equipment is capitalised where:

è it is held for use in delivering services or for administrative purposes

è it is probable that future economic benefits will flow to, or service potential be provided to, the Trust

è it is expected to be used for more than one financial year and the cost of the item can be measured reliably

è The item has a cost of at least £5,000, or collectively a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets

are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control

è items form part of the initial equipping and setting-up cost of a new building, irrespective of their individual or collective cost

Where a large asset, for example a building, includes a number of components with significantly different asset lives, e.g. plant and equipment, then these components are treated as separate assets and depreciated over their own useful economic lives.

MEASUREMENT

Valuation

All property, plant and equipment assets are measured initially at cost, representing the costs directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at fair value. Land and buildings, used for the Trust’s services, or for administrative purposes, are stated in the Statement of Financial Position at their revalued amounts, being the fair value at the date of revaluation less any impairment.

Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that

would be determined at the end of the reporting period. Fair values are determined as follows:

è Land and non-specialised buildings – market value for existing use

è Specialised buildings – depreciated replacement cost

An item of property, plant and equipment, which is surplus, with no plan to bring it back into use, is valued at fair value under iFRS 13, if it does not meet the requirements of iAS 40 of iFRS 5.

Subsequent expenditure

Subsequent expenditure relating to an item of property, plant and equipment is recognised as an increase in the carrying amount of the asset when it is probable that additional future economic benefits, or service potential, deriving from the cost incurred to replace a component of such item, will flow to the enterprise and the cost of the item can be determined reliably. Where a component of an asset is replaced, the cost of the replacement is capitalised, if it meets the criteria for recognition above. The carrying amount of the part replaced is de-recognised. Other expenditure, that does not generate additional future economic benefits or service potential, such as repairs and maintenance, is charged to the Statement of Comprehensive income in the period in which it is incurred.

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Depreciation

items of property, plant and equipment are depreciated over their remaining useful economic lives in a manner consistent with the consumption of economic or service delivery benefits. Freehold land is considered to have an infinite life and is not depreciated.

Property, plant and equipment, which has been reclassified as ‘held for sale’, ceases to be depreciated upon the reclassification. Assets in the course of construction and residual interests in off-Statement of Financial Position PFi contract assets are not depreciated until the asset is brought into use or reverts to the Trust, respectively.

Revaluation gains and losses Revaluation gains are recognised in the revaluation reserve, except where, and to the extent that, they reverse a revaluation decrease that has previously been recognised in operating expenses, in which case they are recognised in operating income.

Revaluation losses are charged to the revaluation reserve to the extent that there is an available balance for the asset concerned, and thereafter are charged to operating expenses.

Gains and losses recognised in the revaluation reserve are reported in the Statement of Comprehensive income as an item of ‘other comprehensive income’.

Impairments

in accordance with the dH GAm, impairments that arise from a clear consumption of economic benefits, or of service potential in the asset, are charged to operating expenses. A compensating transfer is made from the revaluation reserve to the income and expenditure reserve of an amount equal to the lower of (i) the impairment charged to operating expenses; and (ii) the balance in the revaluation reserve attributable to that asset before the impairment.

An impairment that arises from a clear consumption of economic benefit or of service potential is reversed when, and to the extent that, the circumstances that gave rise to the loss is reversed. Reversals are recognised in operating income to the extent that the asset is restored to the carrying amount it would have had if the impairment had never been recognised. Any remaining reversal is recognised in the revaluation reserve. Where, at the time of the original impairment, a transfer was made from the revaluation reserve to the income and expenditure reserve, an amount is transferred back to the revaluation reserve when the impairment reversal is recognised.

Other impairments are treated as revaluation losses. Reversals of ‘other impairments’ are treated as revaluation gains.

De-recognition

Assets intended for disposal are reclassified as ‘held for sale’ once all of the following criteria are met:

è The asset is available for immediate sale in its present condition subject only to terms which are usual and customary for such sales

è The sale must be highly probable, ie:

• management are committed to a plan to sell the asset

• An active programme has begun to find a buyer and complete the sale

• The asset is being actively marketed at a reasonable price

• The sale is expected to be completed within 12 months of the date of classification as ‘held for sale’

• The actions needed to complete the plan indicate it is unlikely that the plan will be dropped or significant changes made to it

Following reclassification, the assets are measured at the lower of their existing carrying amount and their ‘fair value less costs to sell’. depreciation ceases to be charged. Assets are de-recognised when all material sale contract conditions have been met.

Property, plant and equipment, which is to be scrapped or demolished, does not qualify for recognition as ‘held for sale’ and instead is retained as an operational asset and the asset’s life is adjusted. The asset is de-recognised when scrapping or demolition occurs.

Donated, government grant and other grant funded assets

donated and grant funded property, plant and equipment assets are capitalised at their fair value on receipt. The donation/grant is credited to income at the same time, unless the donor has imposed a condition that the future economic benefits, embodied in the grant, are to be consumed in a manner specified by the donor, in which case, the donation/grant is deferred within liabilities and is carried forward to future financial years to the extent that the condition has not yet been met.

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The donated and grant funded assets are subsequently accounted for in the same manner as other items of property, plant and equipment.

Useful economic lives of property, plant and equipment

Useful economic lives reflect the total life of an asset and not the remaining life of an asset. The range of useful economic lives are shown in the table below:

Min life Max life

Years Years

Land - -

buildings, excluding dwellings 20 70

dwellings 20 70

Plant & machinery 5 15

Transport equipment 5 10

information technology 3 5

Furniture & fittings 5 15

Finance-leased assets (including land) are depreciated over the shorter of the useful economic life or the lease term, unless the foundation trust expects to acquire the asset at the end of the lease term in which case the assets are depreciated in the same manner as owned assets above.

1.6 INTANGIBLE ASSETSRecognition

intangible assets are non-monetary assets without physical substance which are capable of being sold separately from the rest of the Trust’s business or which arise from contractual or other legal rights. They are recognised only where it is probable that future economic benefits will flow to, or service potential be provided to, the Trust and where the cost of the asset can be measured reliably.

Internally generated intangible assets

internally generated goodwill, brands, mastheads, publishing titles, customer lists and similar items are not capitalised as intangible assets.

Expenditure on research is not capitalised.

Expenditure on development is capitalised only where all of the following can be demonstrated:

è The project is technically feasible to the point of completion and will result in an intangible asset for sale or use

è The Trust intends to complete the asset and sell or use it

è The Trust has the ability to sell or use the asset

è How the intangible asset will generate probable future economic or service delivery benefits, e.g., the presence of a market for it or its output, or where it is to be used for internal use, the usefulness of the asset

è Adequate financial, technical and other resources are available to the Trust to complete the development and sell or use the asset

è The Trust can measure reliably the expenses attributable to the asset during development

Software

Software which is integral to the operation of hardware, e.g. an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software which is not integral to the operation of hardware, e.g. application software, is capitalised as an intangible asset.

Measurement

intangible assets are recognised initially at cost, comprising all directly attributable costs needed to create, produce and prepare the asset to the point that it is capable of operating in the manner intended by management.

Subsequently intangible assets are measured at current value in existing use. Where no active market exists, intangible assets

are valued at the lower of depreciated replacement cost and the value in use where the asset is income generating. Revaluation gains and losses and impairments are treated in the same manner as for property, plant and equipment. An intangible asset which is surplus, with no plan to bring it back into use, is valued at fair value under iFRS 13, if it does not meet the requirements of iAS 40 of iFRS 5.

intangible assets held for sale are measured at the lower of their carrying amount or “fair value less costs to sell”.

Amortisation

intangible assets are amortised over their expected useful economic lives in a manner consistent with the consumption of economic or service delivery benefits.

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Useful economic life of intangible assets

Useful economic lives reflect the total life of an asset and not the remaining life of an asset. The range of useful economic lives are shown in the table below:

min life max life

Years Years

Purchased intangible assets - Software 3 5

1.7 REVENUE GOVERNMENT AND OTHER GRANTSGovernment grants are grants from government bodies other than income from commissioners or NHS trusts for the provision of services. Where a grant is used to fund revenue expenditure, it is taken to the Statement of Comprehensive income to match that expenditure.

1.8 INVENTORIESinventories are valued at the lower of cost and net realisable value. This is considered to be a reasonable approximation to fair value due to the high turnover of stocks.

1.9 FINANCIAL INSTRUMENTS AND FINANCIAL LIABILITIESRecognition

Financial assets and financial liabilities, which arise from contracts for the purchase or sale of non-financial items (such as goods or services), which are entered into in accordance with the Trust’s normal purchase, sale or usage requirements, are recognised when, and to the extent which, performance occurs, i.e. when receipt or delivery of the goods or services is made.

De-recognition

All financial assets are de-recognised when the rights to receive cash flows from the assets have expired or the Trust has transferred substantially all of the risks and rewards of ownership.

Financial liabilities are de-recognised when the obligation is discharged, cancelled or expires.

Classification and measurement

Financial assets are categorised as loans and receivables.

Financial liabilities are categorised as other financial liabilities.

Financial assets and financial liabilities at “fair value through income and expenditure”

Financial assets and financial liabilities at “fair value through income and expenditure” are financial assets or financial liabilities held for trading. A financial asset or financial liability is classified in this category if acquired principally for the purpose of selling in the short-term.

These financial assets and financial liabilities are recognised initially at fair value, with transaction costs expensed in the income and expenditure account. Subsequent movements in the fair value are recognised as gains or losses in the Statement of Comprehensive income.

Loans and receivables

Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. They are included in current assets.

The Trust’s loans and receivables comprise: cash and cash equivalents, NHS receivables, accrued income and “other receivables”.

Loans and receivables are recognised initially at fair value, net of transactions costs, and are measured subsequently at amortised cost, using the effective interest method. The effective interest rate is the rate that discounts exactly estimated future cash receipts through the expected life of the financial asset or, when appropriate, a shorter period, to the net carrying amount of the financial asset.

interest on loans and receivables is calculated using the effective interest method and credited to the Statement of Comprehensive income.

Other financial liabilities

All other financial liabilities are recognised initially at fair value, net of transaction costs incurred, and measured subsequently at amortised cost using the effective interest method. The effective interest rate is the rate that discounts exactly estimated future cash payments through the expected life of the financial liability or, when appropriate, a shorter period, to the net carrying amount of the financial liability.

They are included in current liabilities except for amounts payable more than 12 months after the Statement of Financial Position date, which are classified as long-term liabilities.

interest on financial liabilities, carried at amortised cost, is calculated using the effective interest method and charged to finance costs. interest on financial liabilities taken out to finance property, plant and equipment or intangible assets is not capitalised as part of the cost of those assets.

Impairment of financial assets

At the Statement of Financial Position date, the Trust assesses whether any financial assets, other than those held at “fair value through income and expenditure” are impaired. Financial assets are impaired and impairment losses are recognised if, and only if, there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset.

For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in the Statement of Comprehensive income and the carrying amount of the asset is reduced directly.

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1.10 LEASESFinance leases

Where substantially all risks and rewards of ownership of a leased asset are borne by the NHS foundation trust, the asset is recorded as property, plant and equipment and a corresponding liability is recorded. The value at which both are recognised is the lower of the fair value of the asset or the present value of the minimum lease payments, discounted using the interest rate implicit in the lease.

The asset and liability are recognised at the commencement of the lease. Thereafter the asset is accounted for an item of property plant and equipment.

The annual rental is split between the repayment of the liability and a finance cost so as to achieve a constant rate of finance over the life of the lease. The annual finance cost is charged to Finance Costs in the Statement of Comprehensive income. The lease liability is de-recognised when the liability is discharged, cancelled or expires.

Operating leases

Other leases are regarded as operating leases and the rentals are charged to operating expenses on a straight-line basis over the term of the lease. Operating lease incentives received are added to the lease rentals and charged to operating expenses over the life of the lease.

Leases of land and buildings

Where a lease is for land and buildings, the land component is separated from the building component and the classification for each is assessed separately.

1.11 PROVISIONSThe NHS Foundation Trust recognises a provision where it has a present legal or constructive obligation of uncertain timing or amount; for which it is probable that there will be a future outflow of cash or other resources; and a reliable estimate can be made of the amount. The amount recognised in the Statement of Financial Position is the best estimate of the resources required to settle the obligation. Where the effect of the time value of money is significant, the estimated risk-adjusted cash flows are discounted using the discount rates published and mandated by Hm Treasury.

Clinical negligence costs

The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the NHS Foundation Trust pays an annual contribution to the NHSLA, which, in return, settles all clinical negligence claims. Although the NHSLA is administratively responsible for all clinical negligence cases, the legal liability remains with the NHS Foundation Trust. The total value of clinical negligence provisions carried by the NHSLA, on behalf of the NHS Foundation Trust, is disclosed at note 25 but is not recognised in the NHS Foundation Trust’s accounts.

Non-clinical risk pooling

The NHS Foundation Trust participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. both are risk pooling schemes under which the Trust pays an annual contribution to the NHS Litigation Authority and in return receives assistance with the costs of claims arising. The annual membership contributions, and any “excesses” payable in respect of particular claims, are charged to operating expenses when the liability arises.

1.12 CONTINGENCIESContingent assets (that is, assets arising from past events, whose existence will only be confirmed by one or more future events not wholly within the entity’s control) are not recognised as assets, but are disclosed in note 30 where an inflow of economic benefits is probable.

Contingent liabilities are not recognised, but are disclosed in note 26, unless the probability of a transfer of economic benefits is remote.

Contingent liabilities are defined as:

è Possible obligations arising from past events whose existence will be confirmed only by the occurrence of one or more uncertain future events not wholly within the entity’s control

è Present obligations arising from past events but for which it is not probable that a transfer of economic benefits will arise or for which the amount of the obligation cannot be measured with sufficient reliability

1.13 PUBLIC DIVIDEND CAPITALPublic dividend capital (PdC) is a type of public sector equity finance based on the excess of assets over liabilities at the time of establishment of the predecessor NHS Trust. Hm Treasury has determined that PdC is not a financial instrument within the meaning of iAS 32.

A charge, reflecting the cost of capital utilised by the NHS Foundation Trust, is payable as public dividend capital dividend. The charge

is calculated at the rate set by Hm Treasury (currently 3.5%) on the average relevant net assets of the NHS Foundation Trust during the financial year. Relevant net assets are calculated as the value of all assets less the value of all liabilities, except for (i) donated assets (including lottery funded assets), (ii) average daily cash balances held with the Government banking Services (GbS) and National Loans Fund (NLF) deposits, excluding cash balances held in GbS accounts that relate to a short-term working capital facility, and (iii) any PdC dividend balance receivable or payable. in accordance with the requirements laid down by the department of Health (as the issuer of PdC), the dividend for the year is calculated on the actual average relevant net assets as set out in the “pre-audit” version of the annual accounts. The dividend, thus calculated, is not revised should any adjustment to net assets occur as a result the audit of the annual accounts.

1.14 VALUE ADDED TAXmost of the activities of the NHS Foundation Trust are outside the scope of vAT and, in general, output tax does not apply and input tax on purchases is not recoverable. irrecoverable vAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged, or input vAT is recoverable, the amounts are stated net of vAT.

1.15 CORPORATION TAXSouth Central Ambulance NHS Foundation Trust has determined that it has no corporation tax liability as the Trust’s profit generated from non-operational income falls below the threshold amount of £50,000.

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1.16 FOREIGN EXCHANGEThe functional and presentational currencies of the Trust are sterling. A transaction, which is denominated in a foreign currency, is translated into the functional currency at the spot exchange rate on the date of the transaction.

Where the Trust has assets or liabilities denominated in a foreign currency at the Statement of Financial Position date:

è monetary items (other than financial instruments measured at “fair value through income and expenditure”) are translated at the spot exchange rate on 31 march

è Non-monetary assets and liabilities measured at historical cost are translated using the spot exchange rate at the date of the transaction

è Non-monetary assets and liabilities measured at fair value are translated using the spot exchange rate at the date the fair value was determined

Exchange gains or losses on monetary items (arising on settlement of the transaction or on re-translation at the Statement of Financial Position date) are recognised in income or expense in the period in which they arise. Exchange gains or losses on non-monetary assets and liabilities are recognised in the same manner as other gains and losses on these items.

1.17 THIRD PARTY ASSETSAssets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the NHS Foundation Trust has no beneficial interest

in them. However, they are disclosed in a separate note to the accounts in accordance with the requirements of Hm Treasury’s FRem.

1.18 LOSSES AND SPECIAL PAYMENTSLosses and special payments are items that Parliament would not have contemplated when it agreed funds for the Health Service or passed by legislation. by their nature, they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled. Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses, which would have been made good through insurance cover had NHS Foundation Trusts not been bearing their own risks (with insurance premiums then being included as normal revenue expenditure).

However the losses and special payments note is compiled directly from the losses and compensations register, which reports on an accrual basis, with the exception of provisions for future losses.

1.19 EARLY ADOPTION OF STANDARDS, AMENDMENTS AND INTERPRETATIONSNo new accounting standards or revisions to existing standards have been early adopted in 2016/17.

1.20 STANDARDS, AMENDMENTS AND INTERPRETATIONS IN ISSUE BUT NOT YET EFFECTIVE OR ADOPTEDAt the date of authorisation of these financial statements, the following Standards and interpretations which have not been applied in these financial statements were in issue but not yet effective. None of them are expected to impact upon the Trust’s financial statements:

è iFRS9 Financial instruments

è iFRS14 Regulatory draft Accounts

è iFRS15 Revenue from Contracts with Customers

è iFRS16 Leases

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1.21 CRITICAL ACCOUNTING ESTIMATES AND JUDGEMENTSin the application of the Foundation Trust’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.

The following are the critical judgements, apart from those involving estimations (see below), that management has made in the process of applying the Foundation Trust’s accounting policies and that have the most significant effect on the amounts recognised in the financial statements.

indexation has not been applied to any Non Current assets as no material changes were reflected in any relevant price indices.

information provided by the NHS Litigation Authority has been used to determine provisions required for potential employer liability claims and disclosure of Clinical Negligence liability.

The NHS Pensions Agency has provided information with regard to disclosure and calculation of ill health retirement liability.

key sources of estimation uncertainty

The following are the key assumptions concerning the future, and other key sources of estimation uncertainty at the end of the reporting period, that have a significant risk of causing a material adjustment to the carrying amounts of assets and liabilities within the next financial year.

These valuations are judgemental and future events (such as a change in economic conditions) could cause these valuations to change. Non current assets relating to land and buildings had a carrying value of £38.4m as at 31 march 2017 (31 march 2016: £39.7m). The Trust undertakes a full valuation exercise every five years. The last quinquennial exercise was undertaken in 2013/14.

2. OPERATING SEGMENTSEach segment is reported separately in the monthly board report. Emergency Services include the 999 service, NHS 111 call handling, Education and Training and the Hazardous Area Response Team. Non-Emergency Services include Non-Emergency Patient Transport Services (NEPTS), Logistic Services and Commercial Training income.

direct costs include employee and non employee costs (staff costs, drugs, medical equipment, vehicle costs etc). The Trust only reports contribution before overheads by service line reporting to the Trust board at Public board meetings.

Emergency-Services

Non- Emergency Services

Total

2016/17 2016/17 2016/17

£000’s £000’s £000’s

income 154,847 28,624 183,471

direct Costs (124,905) (25,555) (150,460)

Contribution Operational Activities 29,942 3,069 33,011

Total Overheads (25,564)

depreciation and amortisation (7,613)

Total Costs Before Dividends and Interest (33,177)

Operating Surplus(Deficit) (166)

2015/16 2015/16 2015/16

£000’s £000’s £000’s

income 147,425 27,622 175,047

direct Costs (119,529) (24,810) (144,339)

Contribution Operational Activities 27,896 2,812 30,708

Total Overheads (24,606)

depreciation and amortisation (8,249)

Total Costs Before Dividends and Interest (32,855)

Operating Surplus(Deficit) (2,147)

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3. OPERATING INCOME FROM PATIENT CARE ACTIVITIES

3.1 INCOME FROM PATIENT CARE ACTIVITIES (BY NATURE)

Group

2016/17 2015/16

£000 £000

Ambulance services

A & E income 148,058 143,637

NEPTS income 26,328 24,023

Other income 929 995

Total income from activities* 175,315 168,655

*All income from patient care activities derived from the Trust.

3.2 INCOME PATIENT CARE ACTIVITIES (BY SOURCE)

Group

Income from patient care activities received from: 2016/17 2015/16

£000 £000

CCGs and NHS England 169,888 161,798

Local authorities 23 92

Other NHS foundation trusts 1,679 1,045

NHS trusts 1,607 1,788

NHS other 380 2,551

NHS injury scheme (was RTA) 393 439

Non NHS: other 1,345 942

Total income from activities 175,315 168,655

Of which:

Related to continuing operations 175,315 168,655

injury cost recovery income is subject to a provision for impairment of receivables of 22.94% of all claims to reflect the percentage probability of not receiving the income. This is in line with the advice issued by the compensation recovery unit for 2016/17 as instructed by the GAm.

4. OTHER OPERATING INCOME

Group

2016/17 2015/16

£000 £000

Education and training 1,647 1,872

Receipt of capital grants and donations - 160

Non-patient care services to other bodies 1,601 2,472

Sustainability and Transformation Fund income 2,413 -

income in respect of staff costs where accounted on gross basis 573 -

Other income* 2,169 1,888

Total other operating income 8,403 6,392

Of which:

Related to continuing operations 8,403 6,392

*Other income includes £532k of funding for implementation of Electronic Patient Record Forms (2015/16: £584k), £368k commercial training (2015/16: £383k), £253k radio mast income (2015/16: £272k) and £293k income covering costs incurred in the management of NHS LmO (2015/16: £398k). Other operating income is made up of Trust income £8,155k (2015/16: £6,392k) and SCFS Ltd £248k (2015/16: £nil).

4.1 INCOME FROM ACTIVITIES ARISING FROM COMMISSIONER REQUESTED SERVICESUnder the terms of its provider licence, the Trust is required to analyse the level of income from activities that has arisen from commissioner requested and non-commissioner requested services. Commissioner requested services are defined in the provider licence and are services that commissioners believe would need to be protected in the event of provider failure. This information is provided below:

£144m of income received relates to Commissioner Requested Services (£140m in 2015/16).

All other income relates to Non-Commissioner Requested Services.

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5.1 OPERATING EXPENSES

Group

2016/17 2015/16

£000 £000

Purchase of healthcare from non NHS bodies 16,579 14,322

Employee expenses - executive directors 929 787

Remuneration of non-executive directors 250 211

Employee expenses - staff 114,671 108,069

Supplies and services - clinical 3,165 2,491

Supplies and services - general 1,061 1,179

Establishment 3,608 3,321

Transport 19,254 18,350

Premises 2,872 3,099

information Technology 2,871 3,304

increase/(decrease) in provision for impairment of receivables (227) (31)

drug costs 381 267

Rentals under operating leases 5,027 4,794

depreciation on property, plant and equipment 6,677 7,151

Amortisation on intangible assets 936 1,098

Audit fees payable to the external auditor;

audit services - statutory audit 43 43

other auditor remuneration (external auditor only) 18 20

Clinical negligence 838 754

Legal fees 214 115

Consultancy costs 198 532

internal audit costs 77 82

Training, courses and conferences 888 881

Hospitality 11 16

insurance 1,364 1,459

Other services, e.g. external payroll* 1,376 3,746

Other** 803 1,134

Total*** 183,884 177,194

Of which:

Related to continuing operations 183,884 177,194

*Other services includes £1,293k from NHS 111 managed service contract (2015/16: £852k)

**Other includes £504k for additional injury benefit provision (2015/16: £276k)

***Other operating expenses is made up of Trust £183,644k (2015/16: £177,137k) and SCFS Ltd £240k (2015/16: £57k).

5.2 OTHER AUDITOR REMUNERATION

Group

2016/17 2015/16

£000 £000

All other assurance services 18 20

Total 18 20

5.3 LIMITATION ON AUDITOR’S LIABILITYThe Group contract with its auditors for 2016/17, as set out in the engagement letter, limited the auditor’s liability to £1m (2015/16: £1m).

6. IMPAIRMENT OF ASSETSThere were no impairments identified or reversals of previous impairments identified in relation to non current assets.

7. EMPLOYEE BENEFITS

Group

2016/17 2015/16

Total Total

£000 £000

Salaries and wages 91,138 85,328

Social security costs 8,906 6,362

Employer’s contributions to NHS pensions 11,615 10,703

Termination benefits - -

Temporary staff (including agency) 3,776 6,463

Total gross staff costs 115,435 108,856

Recoveries in respect of seconded staff 165

Total staff costs 115,600 108,856

//108 //109

7.1 RETIREMENTS DUE TO ILL-HEALTHduring 2016/17 there were two early retirements from the Trust agreed on the grounds of ill-health (one in the year ended 31 march 2016). The estimated additional pension liabilities of these ill-health retirements is £184k (£97k in 2015/16).

The cost of these ill-health retirements will be borne by the NHS business Services Authority - Pensions division.

7.2 DIRECTORS’ REMUNERATIONThe aggregate amounts payable to directors were:

Group

2016/17 2015/16

£000 £000

Salary 846 704

Social Security Costs 105 83

Performance related bonuses 20 20

Employer’s pension contributions 102 87

Total 1,073 894

Further details of directors’ remuneration can be found in the remuneration report which is included in the Trust Annual Report 2016/17.

The above costs exclude the Trust’s Clinical director. He is employed by another NHS Trust and therefore the Trust charged a fee for his services being £110k 2016/17 (£105k 2015/16).

in the year ended 31 march 2017, six directors (2016: six) accrued benefits under a defined pension scheme.

during the year to 31 march 2017, the highest paid director for the Trust was the Chief Executive who was paid a salary between £155k and £160k and was assessed as in receipt of benefit in kind of £5.3k.

The Trust appointed an additional voting executive director towards the end of 2015/16 (i.e. director of Human Resources and Organisational development). The full year impact of this appointment is reflected in the 2016/17 costs.

7.3 AVERAGE NUMBER OF EMPLOYEES (WTE BASIS)

Group

2016/17 2015/16

Permanent Other Total Total

Number Number Number Number

Ambulance staff 1,674 15 1,689 1,624

Administration and estates 957 27 984 808

Healthcare assistants and other support staff 339 13 352 374

Nursing, midwifery and health visiting staff 77 7 84 92

Nursing, midwifery and health visiting learners - - - -

Total average numbers 3,047 62 3,109 2,898

Of which:

Number of employees (WTE) engaged on capital projects - - - -

7.4 REPORTING OF COMPENSATION SCHEMESThe Group had six compensation package cases in 2016/17 at a total cost of £55k (2015/16: nil cases).

The Group had no other non-compulsory departure costs in 2016/17 (2015/16: nil).

8. PENSION COSTSPast and present employees are covered by the provisions of the two NHS Pensions Schemes. details of the benefits payable and rules of the Schemes can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. both are unfunded defined benefit schemes that cover NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. They are not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, each scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.

in order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the FRem requires that “the period between formal valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows:

a) Accounting valuation

A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary’s department) as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data for the current reporting period, and are accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 march 2017, is based on the valuation data as at march 2016, updated to 31 march 2017 with summary global member and accounting data. in undertaking this actuarial assessment, the methodology prescribed in iAS 19, relevant FRem interpretations, and the discount rate prescribed by Hm Treasury have also been used.

//110 //111

The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Pension Accounts. These accounts can be viewed on the NHS Pensions website and are published annually. Copies can also be obtained from The Stationery Office.

b) Full actuarial (funding) valuation

The purpose of this valuation is to assess the level of liability in respect of the benefits due under the schemes (taking into account their recent demographic experience), and to recommend the contribution rates payable by employees and employers.

The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 march 2012. The Scheme Regulations allow for the level of contribution rates to be changed by the Secretary of State for Health, with the consent of Hm Treasury, and consideration of the advice of the Scheme Actuary and appropriate employee and employer representatives as deemed appropriate.

The next actuarial valuation is to be carried out as at 31 march 2016. This will set the employer contribution rate payable from April 2019 and will consider the cost of the Scheme relative to the employer cost cap. There are provisions in the Public Service Pension Act 2013 to adjust member benefits or contribution rates if the cost of the Scheme changes by more than 2% of pay. Subject to this ‘employer cost cap’ assessment, any required revisions to member benefits or contribution rates will be determined by the Secretary of State for Health after consultation with the relevant stakeholders.

c) National Employment Savings Trust (NEST)

The Pensions Act 2008 introduced new duties on employers in providing access to a workplace pension for all of its employees. The NHS Pension Scheme is not available to all employees and the Trust has provided access to a scheme for these employees which is operated by the

National Employment Savings Trust (NEST). NEST is a defined contribution scheme where a minimum contribution is paid by the employer. South Central Ambulance NHS Foundation Trust currently contributes 1% of qualifying earnings to the scheme and employees contribute 1% of pensionable pay.

NEST levies a contribution charge of 1.8% and an annual management charge of 0.3% which is paid from the employer contributions. There are no separate employer charges levied by NEST and the Trust is not required to enter into a contract to utilise NEST qualifying pension schemes.

Staff who are recruited by South Central Fleet Services Ltd will be auto-enrolled into the NEST Pension Scheme.

9. OPERATING LEASES

9.1 OPERATING LEASE INCOMEThe Group had no operating lease income in 2016/17 (2015/16: nil).

9.2 OPERATING LEASE EXPENDITURE

Group

2016/17 2015/16

£000 £000

Operating lease expense

minimum lease payments 5,027 4,794

Less sublease payments received - -

Total 5,027 4,794

31 March 2017

31 March 2016

£000 £000

Future minimum lease payments due:

- not later than one year; 3,376 3,286

- later than one year and not later than five years; 8,711 8,521

- later than five years. 10,487 11,472

Total 22,574 23,279

The Group leases property, vehicles and equipment under operating leases. The figures in the table above are identical for both the Group and the Trust.

10. FINANCE INCOMEFinance income represents interest received on assets and investments in the period.

Group

2016/17 2015/16

£000 £000

interest on bank accounts 46 70

interest on loans and receivables - -

Other - -

Total 46 70

//112 //113

11. FINANCE EXPENDITURE

Group

2016/17 2015/16

£000 £000

Interest expense:

Loans from the department of Health 117 135

Commercial loans - -

Total interest expense 117 135

Other finance costs - -

Total 117 135

11.1 THE LATE PAYMENT OF COMMERCIAL DEBTS (INTEREST) ACT 1998No interest payments were made by the Group in the reporting period.

12. CORPORATION TAXThe Trust has determined that it has no corporation tax liability from its subsidiary, South Central Fleet Services Ltd, in the qualifying period. The Trust does not have any other qualifying income from any of its other activities.

13. DISCONTINUED OPERATIONS

2016/17 2015/16

£000 £000

movement in provisions for liabilities on discontinued operations 2,405 2,505

The Trust is the appointed successor body to NHS direct which ceased providing services on 31 march 2014.

14. INTANGIBLE ASSETS

14.1 INTANGIBLE ASSETS 2016/17 - GROUP

Software licences

Intangible assets under construction Total

£000 £000 £000

Valuation/gross cost at 1 April 2016 - brought forward 6,633 1,284 7,917

Additions 51 1,176 1,227

Reclassifications 1,002 (1,002) -

disposals / derecognition - - -

Gross cost at 31 March 2017 7,686 1,458 9,144

Amortisation at 1 April 2016 - brought forward 4,514 - 4,514

Provided during the year 936 - 936

disposals / derecognition - - -

Amortisation at 31 March 2017 5,450 - 5,450

Net book value at 31 March 2017 2,236 1,458 3,694

Net book value at 1 April 2016 2,119 1,284 3,403

14.2 INTANGIBLE ASSETS 2015/16 - GROUP

Software licences

Intangible assets under construction Total

£000 £000 £000

Valuation/gross cost at 1 April 2015 - as previously stated 4,719 2,236 6,955

Additions 362 770 1,132

Reclassifications 1,767 (1,722) 45

disposals / derecognition (215) - (215)

valuation/gross cost at 31 march 2016 6,633 1,284 7,917

Amortisation at 1 April 2015 - as previously stated 3,631 - 3,631

Provided during the year 1,098 - 1,098

disposals / derecognition (215) - (215)

Amortisation at 31 march 2016 4,514 - 4,514

Net book value at 31 March 2016 2,119 1,284 3,403

Net book value at 1 April 2015 1,088 2,236 3,324

//114 //115

14.3 INTANGIBLE ASSETS 2016/17 - TRUST

Software licences

Intangible assets under construction Total

£000 £000 £000

Valuation/gross cost at 1 April 2016 - brought forward 6,511 1,284 7,795

Additions 50 1,176 1,226

Reclassifications 1,002 (1,002) -

disposals / derecognition - - -

Gross cost at 31 March 2017 7,563 1,458 9,021

Amortisation at 1 April 2016 - brought forward 4,425 - 4,425

Provided during the year 919 - 919

Reclassifications - - -

disposals / derecognition - - -

Amortisation at 31 March 2017 5,344 - 5,344

Net book value at 31 March 2017 2,219 1,458 3,677

Net book value at 1 April 2016 2,086 1,284 3,370

14.4 INTANGIBLE ASSETS 2015/16 - TRUST

Software licences

Intangible assets under construction Total

£000 £000 £000

valuation/gross cost at 1 April 2015 - as previously stated 4,719 2,236 6,955

Additions 362 770 1,132

Reclassifications 1,767 (1,722) 45

disposals / derecognition (338) - (338)

Valuation/gross cost at 31 March 2016 6,510 1,284 7,794

Amortisation at 1 April 2015 - as previously stated 3,631 - 3,631

Provided during the year 1,098 - 1,098

Reclassifications - - -

disposals / derecognition (304) - (304)

Amortisation at 31 March 2016 4,425 - 4,425

Net book value at 31 March 2016 2,085 1,284 3,369

Net book value at 1 April 2015 1,088 2,236 3,324

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//116 //117

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//118 //119

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//120 //121

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16. INVESTMENTS IN SUBSIDIARIESSouth Central Ambulance Service NHS Foundation Trust purchased 441,340 ordinary shares of £1 each in South Central Fleet Services Ltd.

This represents a 100% direct ownership of South Central Fleet Services Ltd which is incorporated in England and Wales. This subsidiary company is included in the consolidation.

17. INVENTORIESGroup Trust

31 March 2017

31 March 2016

31 March 2017

31 March 2016

£000 £000 £000 £000

Consumables 797 946 449 599

Energy 141 85 141 85

Total inventories 938 1,031 590 684

There were no inventories recognised in expenses during the reported period (2015/16: nil).

18. RECEIVABLES

18.1 TRADE RECEIVABLES AND OTHER RECEIVABLES

Group Trust

31 March 2017

31 March 2016

31 March 2017

31 March 2016

£000 £000 £000 £000

Current

Trade receivables due from NHS bodies 1,340 1,419 1,340 1,419

Other receivables due from related parties 4 - 4 -

Provision for impaired receivables (342) (569) (342) (569)

Prepayments (non-PFi) 3,060 2,999 3,036 2,954

Accrued income 5,653 5,671 5,653 5,670

interest receivable 3 5 3 5

PdC dividend receivable 29 42 29 42

vAT receivable 456 371 475 -

Other receivables 1,871 1,476 1,697 1,670

Total current trade and other receivables 12,074 11,414 11,895 11,191

The Trust had no non-current trade or other receivables.

The majority of trade receivables are due from clinical commissioning groups, as commissioners for NHS patient care services. As clinical commissioning groups are funded by Government no credit scoring of them is considered necessary.

//122 //123

18.2 PROVISION FOR IMPAIRMENT OF RECEIVABLES

Group Trust

2016/17 2015/16 2016/17 2015/16

£000 £000 £000 £000

At 1 April as previously stated 569 600 569 600

increase in provision - - - -

Amounts utilised (227) (31) (227) (31)

Unused amounts reversed - - - -

At 31 March 342 569 342 569

The provision relates to £234k injury cost recovery (2015/16: £399k), £33k trade receivables (2015/16: £94k) and £75k overpaid salaries (2015/16: £76k).

18.3 ANALYSIS OF FINANCIAL ASSETS

Group 31 March 2017 31 March 2016

Trade and other

receivables

Investments & Other financial

assetsTrade and other

receivables

Investments & Other financial

assets

Ageing of impaired financial assets £000 £000 £000 £000

0-30 days - - - -

30-60 days - - - -

60-90 days - - - -

90-180 days - - - -

Over 180 days 342 - 569 -

Total 342 - 569 -

Ageing of non-impaired financial assets past their due date

0-30 days 272 - (72) -

30-60 days 15 - 95 -

60-90 days (1) - 67 -

90-180 days 6 - 4 -

Over 180 days 33 - 19 -

Total 325 - 113 -

The Trust’s impaired receivables are identical to the Group figures stated above.

19. OTHER FINANCIAL ASSETS

Group Trust

31 March 2017

31 March 2016

31 March 2017

31 March 2016

£000 £000 £000 £000

Non-current

Available for sale financial assets - - - -

Held to maturity investments - - - -

Loan and receivables - - 2,400 2,700

Other financial assets held by NHS charitable funds - - -

Total - - 2,400 2,700

Current

Available for sale financial assets - - - -

Held to maturity investments - - - -

Loan and receivables - - 300 300

Other financial assets held by NHS charitable funds - - - -

Total - - 300 300

Other financial assets represent a loan made to South Central Fleet Services Ltd to purchase front line ambulances.

The long term loan of £3.0m is repayable over a 10 year period and attracts interest of 3.5%. Repayments commenced on 10 June 2016.

//124 //125

20. N

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21. CASH AND CASH EQUIVALENT MOVEMENTSCash and cash equivalents comprise cash at bank, in hand and cash equivalents. Cash equivalents are readily convertible investments of known value which are subject to an insignificant risk of change in value.

Group Trust

2016/17 2015/16 2016/17 2015/16

£000 £000 £000 £000

At 1 April 19,926 27,100 19,753 27,100

Prior period adjustments

At 1 April (restated) 19,926 27,100 19,753 27,100

At start of period for new FTs

Transfers by absorption - - - -

Net change in year 346 (7,174) 168 (7,346)

At 31 March 20,272 19,926 19,921 19,754

broken down into:

Cash at commercial banks and in hand 364 194 13 22

Cash with the Government banking Service 19,908 19,732 19,908 19,732

deposits with the National Loan Fund - - - -

Other current investments - - - -

Total cash and cash equivalents as in SoFP 20,272 19,926 19,921 19,754

bank overdrafts (GbS and commercial banks) - - - -

drawdown in committed facility - - - -

Total cash and cash equivalents as in SoCF 20,272 19,926 19,921 19,754

21.1 THIRD PARTY ASSETSThe Group held no third party assets as at 31 march 2017 (31 march 2016: nil).

//126 //127

22. TRADE AND OTHER PAYABLES

Group Trust

31 March 2017 31 March 2016 31 March 2017 31 March 2016

£000 £000 £000 £000

Current

Receipts in advance - - - -

NHS trade payables 474 375 474 375

Amounts due to other related parties 1,591 1,507 1,571 1,507

Other trade payables 2,418 1,323 2,248 1,295

Capital payables 2,561 762 1,451 759

Social security costs 1,412 1,051 1,393 1,051

vAT payable - - - 125

Other taxes payable 916 863 903 851

Other payables 49 51 49 17

Accruals 8,263 9,432 8,060 9,226

PdC dividend payable - - - -

Total current trade and other payables 17,684 15,364 16,149 15,206

Non-current

Other payables 15 18 15 18

Accruals - - - -

Total non-current trade and other payables 15 18 15 18

Amounts due to related parties represents £1,591k outstanding pension contributions as at 31 march 2017 (31 march 2016: £1,507k).

22.1 EARLY RETIREMENTS IN NHS PAYABLES ABOVEThere were no early retirement payments in the above

22.2 BETTER PAYMENT PRACTICE CODE

Measure of compliance March 2017 March 2017 March 2016 March 2016

Number £000 Number £000

Non-NHS Payables

Total Non-NHS Trade invoices Paid in the Year 43,392 82,843 45,179 77,553

Total Non-NHS Trade invoices Paid Within Target 38,098 78,127 37,452 71,716

Percentage of Non-NHS Trade invoices Paid Within Target 87.8% 94.3% 82.9% 92.5%

NHS Payables

Total NHS Trade invoices Paid in the Year 644 2,957 539 2,484

Total NHS Trade invoices Paid Within Target 576 2,648 459 2,377

Percentage of NHS Trade invoices Paid Within Target 89.4% 89.6% 85.2% 95.7%

The Trust will continue to try to pay invoices from its suppliers promptly and will strive to pay all valid invoices by the due date, or within 30 days of receipt of invoice in accordance with the better Payment Practice Code.

//128 //129

23. BORROWINGS

Group Trust31

March 2017

31 March

2016

31 March

2017

31 March

2016

£000 £000 £000 £000

Current

Loans from the Department of Health 1,738 1,738 1,738 1,738

Other loans - - - -

Obligations under finance leases - - - -

Total current borrowings 1,738 1,738 1,738 1,738

Non-current

Loans from the Department of Health 3,140 4,878 3,140 4,878

Other loans - - - -

Obligations under finance leases - - - -

Total non-current borrowings 3,140 4,878 3,140 4,878

The Trust has one capital loan of £3,551k (payable over 10 years) taken out in 2008/09 at an interest rate of 4.28% and one of £7,000k (payable over 5 years) taken out in 2014/15 at an interest rate of 1.48%.

24. PROVISIONS FOR LIABILITIES AND CHARGES ANALYSIS

Group

Current Non-current

31 Mar 2017 31 Mar 2016 31 Mar 2017 31 Mar 2016

£000 £000 £000 £000

Pensions relating to other staff 220 238 3,648 3,582

Other legal claims 564 298 0 166

Restructurings 304 267 0 0

Redundancy 0 250 0 0

Other* 1,733 3,584 2,469 4,296

Total 2,821 4,637 6,117 8,044

*The other provisions include £2,616k ongoing costs arising from the management of closure activities including the retention of clinical records, £99k staff related costs, £319k property dilapidations, £102k for lease car related costs and £658k provision for credit notes.G

rou

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//130 //131

25. CLINICAL NEGLIGENCE LIABILITIESAt 31 march 2017, £35,542k was included in provisions of the NHSLA in respect of clinical negligence liabilities of South Central Ambulance Service NHS Foundation Trust (31 march 2016: £31,921k).

26. CONTINGENT ASSETS AND LIABILITIES

Group Trust

31 March

2017

31 March

2016

31 March

2017

31 March

2016

£000 £000 £000 £000

value of contingent liabilities

NHS Litigation Authority legal claims (83) (87) (83) (87)

Other - - - -

Gross value of contingent liabilities (83) (87) (83) (87)

Amounts recoverable against liabilities - - - -

Net value of contingent liabilities (83) (87) (83) (87)

Additional liability on legal claims at 100% probability.

27. CONTRACTUAL CAPITAL COMMITMENTS

Group Trust

31 March

2017

31 March

2016

31 March

2017

31 March

2016

£000 £000 £000 £000

Property, plant and equipment 2,031 185 2,031 185

intangible assets 139 77 139 77

Total 2,170 262 2,170 262

28. FINANCIAL INSTRUMENTSFinancial reporting standard iFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. because of the continuing service provider relationship that the Foundation Trust has with clinical commissioning groups and the way those clinical commissioning groups are financed, the Foundation Trust is not exposed to the degree of financial risk faced by business entities. Also financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The Foundation Trust has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the Trust in undertaking its activities.

The Foundation Trust’s treasury management operations are carried out by the finance department, within parameters defined formally within the Foundation Trust’s standing financial instructions and policies agreed by the board of directors. Foundation Trust treasury activity is subject to review by the Trust’s internal auditors.

Currency risk

The Foundation Trust is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The Foundation Trust has no overseas operations. The Foundation Trust therefore has low exposure to currency rate fluctuations.

Interest rate risk

The Foundation Trust’s borrowings are from Government, the borrowings are for 1 – 10 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The Foundation Trust therefore has low exposure to interest rate fluctuations.

Credit risk

because the majority of the Foundation Trust’s income comes from contracts with other public sector bodies, the Foundation Trust has low exposure to credit risk. The maximum exposures as at 31 march 2017 are in receivables from customers, as disclosed in the trade and other receivables note. The Trust’s procurement process is robust and the Trust restricts prepayments to suppliers.

Liquidity risk

The Foundation Trust’s operating costs are incurred under contracts with clinical commissioning groups, which are financed from resources voted annually by Parliament. The Foundation Trust is not exposed to significant liquidity risks.

//132 //133

28.1 FINANCIAL ASSETS - GROUP

Loans and receivables

Assets at fair value

through the I&E

Held to maturity

Available-for-sale Total

£000 £000 £000 £000 £000 Assets as per SoFP as at 31 March 2017Trade and other receivables exclud-ing non financial assets 7,518 - - - 7,518

Other financial assets - - - - - Cash and cash equivalents at bank and in hand 20,272 - - - 20,272 Total at 31 March 2017 27,790 - - - 27,790

Loans and receivables

Assets at fair value

through the I&E

Held to maturity

Available-for-sale Total

£000 £000 £000 £000 £000 Assets as per SoFP as at 31 March 2016Trade and other receivables excluding non financial assets 7,658 - - - 7,658

Other financial assets - - - - Cash and cash equivalents at bank and in hand 19,926 - - 19,926 Total at 31 March 2016 27,584 - - - 27,584

28.2 FINANCIAL LIABILITIES - GROUP

Other financial

liabilities

Liabilities at fair value

through the I&E Total

£000 £000 £000

Liabilities as per SoFP as at 31 March 2017

borrowings excluding finance lease and PFi liabilities 4,878 - 4,878

Trade and other payables excluding non financial liabilities 17,144 - 17,144

Other financial liabilities - - -

Provisions under contract 3,593 - 3,593

Total at 31 March 2017 25,615 - 25,615

Other financial

liabilities

Liabilities at fair value

through the I&E Total

£000 £000 £000

Liabilities as per SoFP as at 31 March 2016

borrowings excluding finance lease and PFi liabilities 6,616 - 6,616

Trade and other payables excluding non financial liabilities 14,712 - 14,712

Other financial liabilities - - -

Provisions under contract 6,356 - 6,356

Total at 31 March 2016 27,684 - 27,684

28.3 MATURITY OF FINANCIAL LIABILITIES - GROUP

31 March 2017

31 March 2016

£000 £000

in one year or less 20,073 18,660

in more than one year but not more than two years 2,052 2,318

in more than two years but not more than five years 1,985 4,636

in more than five years 1,505 2,070

Total 25,615 27,684

28.4 FAIR VALUES OF FINANCIAL ASSETS - GROUPThe Group held no non-current financial assets as at 31 march 2017 (31 march 2016: nil).

//134 //135

28.5 FAIR VALUES OF FINANCIAL LIABILITIES AT 31 MARCH 2017 - GROUP

Book value Fair value

£000 £000

Provisions under contract 1,229 1,229

Loans 3,140 3,140

Other - -

Total 4,369 4,369

28.1 FINANCIAL ASSETS - TRUST

Loans and receivables

Assets at fair value

through the I&E

Held to maturity

Available-for-sale Total

£000 £000 £000 £000 £000

Assets as per SoFP as at 31 March 2017

Trade and other receivables excluding non financial assets 7,502 - - - 7,502

Other investments 441 - - - 441

Cash and cash equivalents at bank and in hand 19,921 - - - 19,921

Total at 31 March 2017 27,864 - - - 27,864

Loans and receivables

Assets at fair value through the I&E

Held to maturity

Available-for-sale Total

£000 £000 £000 £000 £000

Assets as per SoFP as at 31 March 2016

Trade and other receivables excluding non financial assets 7,658 - - - 7,658

Other investments 441 - - - 441

Cash and cash equivalents at bank and in hand 19,754 - - - 19,754

Total at 31 March 2016 27,853 - - - 27,853

28.2 FINANCIAL LIABILITIES - TRUST

Other financial

liabilities

Liabilities at fair value

through the I&E Total

£000 £000 £000

Liabilities as per SoFP as at 31 March 2017

borrowings excluding finance lease and PFi liabilities 4,878 - 4,878

Trade and other payables excluding non financial liabilities 15,618 - 15,618

Other financial liabilities - - -

Provisions under contract 3,593 - 3,593

Total at 31 March 2017 24,089 - 24,089

Other financial

liabilities

Liabilities at fair value

through the I&E Total

£000 £000 £000

Liabilities as per SoFP as at 31 march 2016

borrowings excluding finance lease and PFi liabilities 6,616 - 6,616

Trade and other payables excluding non financial liabilities 14,476 - 14,476

Other financial liabilities - - -

Provisions under contract 6,356 - 6,356

Total at 31 March 2016 27,448 - 27,448

28.3 MATURITY OF FINANCIAL LIABILITIES - TRUST

Trust

31 March

2017

31 March

2016

£000 £000

in one year or less 18,547 18,424

in more than one year but not more than two years 2,052 2,318

in more than two years but not more than five years 1,985 4,636

in more than five years 1,505 2,070

Total 24,089 27,448

28.4 FAIR VALUES OF FINANCIAL ASSETS - TRUSTThe Trust held no non-current financial assets as at 31 march 2017 (31 march 2016: nil).

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28.5 FAIR VALUES OF FINANCIAL LIABILITIES AT 31 MARCH 2017 - TRUST

Book value Fair value

£000 £000

Provisions under contract 1,229 1,229

Loans 3,140 3,140

Total 4,369 4,369

29. LOSSES AND SPECIAL PAYMENTS

2016/17 2015/16

Group

Total number of cases

Total value of

cases

Total number of cases

Total value of

cases

Number £000 Number £000

Losses

Cash losses - - 52 31

Fruitless payments - - - -

bad debts and claims abandoned 1 63 4 50

Stores losses and damage to property and vehicles 113 392 103 279

Total losses 114 455 159 360

Special payments

Ex-gratia payments 2 1 3 1

Total special payments 2 1 3 1

Total losses and special payments 116 456 162 361

All losses are derived from the Trust.

30. PRIOR PERIOD ADJUSTMENTSThere were no prior period adjustments.

31. RELATED PARTIESduring the year none of the board members or members of the key management staff or parties related to them has undertaken any material transactions with South Central Ambulance Service NHS Foundation Trust.

The department of Health is regarded as a related party. during the year South Central Ambulance Service NHS Foundation Trust has had a significant number of material transactions with the department, and with other entities for which the department is regarded as the parent department. These entities are listed opposite:

Income/Expenditure Receivables/Payables

Payments to Related Party

Receipts from Related Party

Amounts owed to

Related Party

Amounts due from Related

Party

£’000 £’000 £’000 £’000

Health Education England 0 1,874 0 57

Oxford University Hospital NHS Foundation Trust 149 1,221 30 97

buckinghamshire Healthcare NHS Trust 0 1,604 10 0

NHS Oxfordshire CCG 0 28,018 0 253

NHS West Hampshire CCG 0 23,470 0 590

NHS Aylesbury vale CCG 0 8,142 0 84

NHS Chiltern CCG 0 13,001 0 240

NHS Southampton CCG 0 10,783 28 0

NHS milton Keynes CCG 0 10,152 0 153

NHS Fareham & Gosport CCG 0 9,724 0 225

NHS Portsmouth CCG 0 9,205 0 47

NHS South Eastern Hampshire CCG 0 9,070 0 150

NHS Slough CCG 0 6,452 0 73

NHS North Hampshire CCG 0 7,800 0 102

NHS South Reading CCG 0 5,742 0 38

NHS Windsor, Ascot & maidenhead CCG 0 5,228 0 198

NHS Wokingham CCG 0 5,279 0 57

NHS bracknell & Ascot CCG 0 5,095 0 24

NHS Newbury & district CCG 0 4,327 0 76

NHS North & West Reading CCG 0 4,335 0 38

South Central Fleet Services Ltd 5,009 552 128 0

during the period South Central Ambulance NHS Foundation Trust had charitable funds of £0.9m as at 31 march 2017 (2016 £0.5m).

//138 //139

ACCOUNTING OFFICER’S STATEMENT OF RESPONSIBILITIESStatement of the Chief Executive’s responsibilities as the Accounting Officer of South Central Ambulance Service NHS Foundation Trust

The NHS Act 2006 states that the Chief Executive is the Accounting Officer of the NHS foundation trust.

The relevant responsibilities of the accounting officer, including their responsibility for the propriety and regularity of public finances for which they are answerable, and for the keeping of proper accounts, are set out in the NHS Foundation Trust Accounting Officer memorandum issued by NHS improvement.

NHS improvement, in exercise of the powers conferred on monitor by the NHS Act 2006, has given Accounts directions which require South Central Ambulance Service NHS Foundation Trust to prepare for each financial year a statement of accounts in the form and on the basis required by those directions.

The accounts are prepared on an accruals basis and must give a true and fair view of the state of affairs of South Central Ambulance Service NHS Foundation Trust and of its income and expenditure, total recognised gains and losses and cash flows for the financial year.

in preparing the accounts, the Accounting Officer is required to comply with the requirements of the department of Health Group Accounting manual and in particular to:

è Observe the Accounts direction issued by NHS improvement, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis

è make judgements and estimates on a reasonable basis

è State whether applicable accounting standards as set out in the NHS Foundation Trust Annual Reporting manual (and the department of Health Group Accounting manual) have been followed, and disclose and explain any material departures in the financial statements

è Ensure that the use of public funds complies with the relevant legislation, delegated authorities and guidance

è Prepare the financial statements on a going concern basis

The Accounting Officer is responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the NHS foundation trust and to enable him/her to ensure that the accounts comply with requirements outlined in the above mentioned Act.

The Accounting Officer is also responsible for safeguarding the assets of the NHS foundation trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

To the best of my knowledge and belief, i have properly discharged the responsibilities set out in the NHS Foundation Trust Accounting Officer memorandum.

Signed

Will Hancock, Chief Executive

date: 25 may 2017

//140 //141//140 //141

//142 //143

PART 1 è 1.1 CHiEF EXECUTivE’S STATEmENT ON QUALiTY

è 1.2 OvERviEW – WHAT WE dO ANd THE WAY WE WORK

è 1.3 REGULATiON, COmPLiANCE ANd QUALiTY iNdiCATORS

è 1.4 OPERATiNG mOdEL OF SERviCES ANd CARE

è 1.5 TRUST STRATEGY

è 1.6 SiGN UP TO SAFETY

è 1.7 WORKFORCE EQUALiTY STANdARd

è 1.8 STAFF SURvEY

è 1.9 dUTY OF CANdOUR

è 1.10 ENGAGEmENT

PART 2 è 2.1 CHOOSiNG ANd PRiORiTiSiNG QUALiTY imPROvEmENT iNiTiATivES

è 2.2 QUALiTY PRiORiTiES FOR 2017/18

è 2.3 STATEmENT OF ASSURANCE FROm THE bOARd

è 2.4 NHS imPROvEmENT mANdATEd QUALiTY iNdiCATORS

PART 3 è 3.1 REPORT ON PROGRESS WiTH 2015/16 QUALiTY PRiORiTiES

è 3.2 OTHER QUALiTY imPROvEmENTS ANd iNFORmATiON

è ANNEX 1: STATEmENTS FROm COmmiSSiONERS, HEALTHWATCH, OvERviEW ANd SCRUTiNY COmmiTTEES

è ANNEX 2: STATEmENT OF diRECTORS’ RESPONSibiLiTiES

//142 //143

//144 //145

11.1 CHIEF EXECUTIVE’S STATEMENT ON QUALITYi am pleased to present our Quality Report and Accounts for 2016/17. This foreword will set out in summary our key strategic direction for continuous quality improvement as well as looking back at our achievements, quality improvements and challenges from last year.

SCAS, like other ambulance trusts, has been busier than ever in terms of demand on all our services during the last year. We are continuing to work with our partners and stakeholders across health and social care to look at innovative ways of meeting this demand whilst continuing to improve the outcomes and experience of our patients. A number of these initiatives you will see in this report.

despite high demand for our services, our 999, NHS 111 and Non-Emergency Patient Transport Service (NEPTS) have performed well through the commitment and professionalism of our staff and due to our focus on continually assessing our level of resources and resilience.

The Trust has been continually working hard to ensure patients can obtain the right care, first time, every time to appropriately meet their clinical and treatment needs, via 999, NHS 111 telephone service or from the NEPTS delivered by SCAS. All of this has

to be done, of course, in a finite financial envelope without losing any quality or safe care and ensuring a positive experience for our patients.

Feedback from staff and patients/carers and other partners remains essential to improving services and we are actively using the quality intelligence to learn and implement service improvements.

CQC and compliance

Our CQC report, published in September 2016, was a testament to the hard work, dedication and commitment shown by all staff working across all our services. The CQC said we have the most caring, compassionate and dedicated staff working for us. in particular the NEPTS was identified as delivering ‘outstanding’ care to patients, with staff developing supportive and trusted relationships with regular users.

The Trust welcomed the inspection which was thorough, robust and comprehensive in its approach. The CQC inspection team of 51 covered all of our services, visiting 20 resource centres, air ambulance sites, clinical co-ordination centres and 10 acute hospitals. They observed thirteen emergency ambulance crews, seven NEPTS crews and spoke to around 350 members of staff across the Trust.

Overall rating for the Trust Good

Are services at this trust safe? Good

Are services at this trust effective? Requires improvement

Are services at this trust caring? Good

Are services at this trust responsive? Good

Are services at this trust well-led? Good

The CQC noted that we have an open culture which encourages the reporting, thoughts and feedback from staff in order to provide learning and improvements for staff and for patients.

Over four million people rely on the services we provide which means SCAS, more than ever, is committed to continue, at pace, to deliver the improvements already identified by the CQC and continue to work in partnership with other stakeholders in achieving this.

Whilst we have demonstrated excellence in many of our services, there are also areas we know we need to carry on improving and some of this is identified in the next sections of this Quality Report.

The CQC recognised that we are operating in an environment of unprecedented demand yet despite this we are committed to finding a way to manage that demand to enable us to meet response times to ensure we respond to patients safely and appropriately. The national shortage of paramedics was recognised and the CQC noted the Trust was actively recruiting and developing all grades of staff to improve this.

The CQC also acknowledged that we have focused on improving the health and wellbeing of our staff and we need to continue to improve on that. This will be achieved through continuing to review rotas to improve staff work/life balance and ensuring that we support staff through development.

Finally it was clear to them that we work closely with communities, partner organisations and universities to develop our services and career development.

New business

SCAS is expanding its business across the south of England from 1 April 2017. We were awarded the NEPTS contract in Surrey and the step in contract for Sussex NEPTS; both of which expand our working footprint greatly geographically and for the quality of services we need to provide. SCAS will be working closely with commissioners, sub-contractors and patients to ensure we deliver the highest standard of service to these new areas.

Part 1

//146 //147

Electronic Patient Records (ePR ) and sharing information

We have been rolling out ePR which will enable efficiencies to be made when we are on scene and ensure timely use of data and transfer of patient information to where it’s needed quickly.

The electronic tablets also contain a wealth of clinical decision tools, incident reporting capability and care pathways information as well as being linked to special situation notes for patients.

SCAS has been securing the necessary platforms and information to make sharing patient information across health and social care a reality and as such we are dedicated to the further development and use of Summary Care Records (SCRs).

Transformation programmes and new models of care

it is our view that ambulance services can use their unique position in the healthcare system to improve pathways and access for patients and we will have to keep transforming in order to meet demand and improve services.

The priorities for quality improvement described in this report reflect our key goals across all services to enhance safety, effectiveness and experience particularly through our Accelerated Clinical Transformation (ACT) programme where we develop our new models of care through projects and workstreams with tight governance and evaluation. An example is improvements to end of life care as highlighted in this report.

NHS 111 is already a vital service in helping all people with urgent care needs get the right advice in the right place, first time. The national integrated urgent care programme is something we are fully engaged with and committed to. SCAS is working on a co-production integrated model in the Thames valley region which will include the digital shift to front end NHS 111 calls. Patients will ultimately be able to call one number and be directed to the right care pathway in one episode and to do this using different

methods of technology with access to a clinician. NHS 111 will be the primary route to urgent care eventually.

Thanks

Together with my colleagues on the Trust board, i remain fully committed to improve all services and aim for SCAS to be recognised as an outstanding organisation. i am proud to lead teams who are committed to deliver the best possible care, be it face to face or on the telephone, and who work incredibly hard to achieve this every day.

i hope that the public, our staff, partners in healthcare and key stakeholders will enjoy reading this quality report and appreciate the huge effort and work we are doing to improve the quality and efficiency of our services.

i would like to record my sincere appreciation and thanks to all SCAS staff for their continuing commitment to their patients and the quality of care that they provide, and to the organisations that work with us every day to deliver the most appropriate care. i would also like to give my thanks to the many volunteers who do so much to support the service.

This Quality Account has been prepared and written by South Central Ambulance Service NHS Foundation Trust under the National Health Service (Quality Accounts regulations) 2010 statutory instrument No 279. The Trust has reviewed all the data and information available on the quality of care that all the service arms provide on a daily basis. To the best of my knowledge the information in this document is accurate.

Will Hancock Chief Executive

//147

//148 //149

1.2 OVERVIEW – WHAT WE DO AND THE WAY WE WORKSouth Central Ambulance Service NHS Foundation Trust (SCAS) is part of the National Health Service (NHS). SCAS was established on the 1 July 2006 following the merger of four ambulance trusts and covers the counties of berkshire, buckinghamshire, Hampshire and Oxfordshire. This area covers approximately 3,554 square miles with a residential population of over four million. On 1 march 2012, the Trust became a Foundation Trust.

From 1 April 2017 SCAS began providing non-emergency patient transport services for patients in Sussex and Surrey.

The Trust provides an emergency and urgent care service to respond to 999 calls, a NHS 111 telephone service for when medical help is needed, a non-emergency patient transport service (NEPTS) and logistics and commercial services. The Trust also provides resilience and specialist operations offering medical care in hostile environments such as industrial accidents and natural disasters including a Hazardous Area Response Team (HART) based in Hampshire.

Services are delivered from the Trust’s main headquarters in bicester, Oxfordshire, and a regional office in Otterbourne, Hampshire. Each of these sites includes a clinical coordination centre (CCC) where 999, NHS 111 and NEPTS calls are received, clinical advice is provided and from where emergency vehicles are dispatched if needed.

The Trust also works with air ambulance partners; Thames valley and Chiltern Air Ambulance (TvAA) and Hampshire and isle of Wight Air Ambulance (HiOWAA).

The Trust also offers the following services: first aid training to organisations and the public, a commercial logistics collection and delivery service for our partners in the NHS, and community first responders (volunteers trained by SCAS to provide lifesaving treatment).

è Non-emergency patient transport and logistics - Providing routine and non-emergency patient transport services

è Clinical coordination centres - Facilitating delivery of the NHS 111 Health Helpline service and 999 and NEPTS calls

è mobile urgent healthcare - Providing 999 responses and care in a community setting

607 VEHICLES3,000+ STAFF 1,271 COMMUNITY& CO RESPONDERS

1,238,568CALLS TO NHS 111

541,080CALLS TO 999

513,787NEPTS JOURNEYS

78 SITES

POPULATION4.6 MILLION

SCASIN NUMBERS

What is quality and a quality account?

Quality accounts are mandatory annual statements as required by the NHS Act 2009, written for the public by all NHS organisations that provide healthcare. They are set against

the context of three overlapping key themes, which were first identified by Lord darzi and later enshrined in the Health and Social Care Act. These themes define quality of care and SCAS uses them to form its quality agenda and frameworks for quality governance.

//150 //151

THE THREE DIMENSIONS OF QUALITY

1.3 REGULATION COMPLIANCE AND QUALITY INDICATORSThese Quality Accounts are aligned with the requirements and targets set by the NHS standard contract for ambulance services, the NHS England National Ambulance indicators, the CQUiN (Commissioning for Quality improvements) payment framework and those of our regulators, NHS improvement and the Care Quality Commission.

Care Quality Commission and compliance with the fundamental standards

in may 2016 SCAS was inspected and rated by the CQC. The Trust was very pleased to receive a ‘Good’ rating (the first ambulance trust to do so).

We welcomed this comprehensive inspection of SCAS as an opportunity to gain external assurance on the quality of our services and to extract learning from both the CQC’s findings and our own extensive internal assessments, known as ‘holding the mirror’, which we conducted during the pre-inspection phases.

The CQC assessment - how does the CQC assess providers?

To get to the heart of patients’ experiences of care, the CQC always ask the following five questions of every service and provider:

These five key questions are tested against the core services provided; the four core services tested in this inspection (5 may 2016) were:

è Emergency operations centres (EOC) sometimes we call this CCC (clinical coordination centres)

è Emergency and urgent care, 999

è Non-emergency patient transport services (NEPTS)

è NHS 111 telephone service

Each question and service is judged against the characteristics for Outstanding, Good, Requires Improvement and Inadequate. Each service is then rated following the judgements.

The Trust is then awarded an overall rating.

The table below shows the SCAS rating.

Safe Effective Caring Responsive Well-led Well-led

Emergency operations centre

Good Good Good Good Good Good

Emergency and urgent care services

Good Requires improvement Good Good

Requires improvement

Requires improvement

Patient transport services

Requires improvement Good Outstanding Good Good Good

NHS 111 Good Requires improvement Good Good Good Good

Overall rating for the trust Good Requires

improvement Good Good Good Good

SCAS recent CQC activity-rated inspection, May 2016

The CQC inspection team reviewed a range of external information and asked other organisations to share what they knew about us. The intelligence came from a variety of sources:

Clinical Effectiveness

Patient Safety

Patient Experience

CREWS

Caring?

Are we….

Responsive?

Effective?

Well led?

Safe?

//152 //153

è local clinical commissioning groups (CCGs)

è local quality surveillance groups

è the health regulator, NHS improvement

è NHS England

è Health Education England (HEE)

è College of Emergency medicine

è General dental Council

è General medical Council

è Health & Safety Executive

è Health and Care Professions Council

è Nursing and midwifery Council

è National Peer Review Programme

è NHS Litigation Authority

è Parliamentary and Health Service Ombudsman

è Public Health England

è the medical Royal Colleges

è local authorities

è local NHS Complaints Advocacy Service

è local Healthwatch groups

è local health overview and scrutiny committees

è NHS Choices

è other mediums such as Twitter

The inspection teams also spoke with a range of SCAS staff including:

è call handlers

è clinical advisors

è dispatchers

è paramedics

è ambulance technicians

è emergency care assistants

è emergency care practitioners

è community first responders

è NEPTS staff

è emergency operation centre managers

è resilience staff

è staff at director level

è clinical governance leads

è NHS 111 management team (including directors, senior managers and clinical managers)

è the lead pharmacist

è the safeguarding lead

è the infection prevention and control lead

è the patient experience lead

è the mental health lead

è representatives from the staff unions

è clinical leads

è operational managers

As part of the internal inspection, the CQC inspection teams visited:

è 20 resource centres/stations and associated areas

è Numerous stand points

è Headquarters

è Northern Clinical Coordination Centre

è Northern Contact Centre

è South Clinical Coordination Centre

è Southern Contact Centre

è 10 acute hospitals

The CQC inspection teams also:

è Rode and observed on thirteen emergency ambulances

è Rode and observed on seven NEPTS vehicles

è visited air ambulance sites

è Spoke with in the region of 380 members of staff

The inspectors identified a number of areas of outstanding practice for which we are incredibly proud. These included the Trust strategy of bringing new services to patients

to ensure that we deliver the right care to patients, at the right time and in the right place and working within the service and with external partners to ensure that we can manage the ever increasing demands placed on patient services. They also commented that SCAS gives good staff support through peer and management support and provides innovative training which includes the use of a specialist simulation vehicle. Finally it was clear to them that we work in partnership with communities, organisations and universities to engage with them on our services and on careers.

Rated inspection – overall findings we are most proud of. The CQC said:

è Staff across all services were caring, compassionate and treated patients with dignity and respect

è Staff supported patients to cope emotionally with their care and treatment. They were also supportive and reassuring when dealing with patients who were distressed

è Care was outstanding in NEPTS where patients reported well developed, supportive, caring and trusted relationships; particularly regular users, such as renal or mental health patients. Patients appreciated this personal approach and the respect shown by staff for their social and emotional needs

è New services were being introduced to manage demand, avoid admissions and refer patients to alternative non-urgent care

è The provider responded to feedback from other services and there was evidence of change as a result

è New NEPTS contracts had extended the operating hours of the service, to support the development of a seven-day NHS. The service had also used feedback from staff and patients to provide services which responded to specific local needs

è Staff were committed to providing good care to patients

è There was effective coordination of services with other providers and good multidisciplinary working to support seamless care, admission avoidance and alternative care pathways

è Learning was shared and changes made as a result of this to improve the safety of services

è Risk management was comprehensive, well embedded and recognised as the responsibility of all staff

è Staff told us how they were able to report concerns freely without the fear of reprisals

è All staff we spoke with said they loved their job and working in their own teams

è Staff referred to a culture that was supportive, encouraging and patient centred

è There was a strong focus on continuous learning and improvement at all levels within the service

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Our action plan was created and is monitored daily by the Head of Compliance, and bi-weekly by our executive management committee. below is a list of the actions we were required to take for which each point has a detailed improvement plan.

The CQC said we MUST:

As a result of the inspection we have an action plan for improvement.

There are elements on the action plan that are common to the sector nationally: these include actions to strive to meet national targets, supporting our staff through appraisal and supervision, ensuring our staff meet our targets for statutory and mandatory training, recruiting across all services and consistently applying and continue to evolve governance across our services.

CQC said We did

Staff in urgent and emergency care are supported with their development through supervision

We have:

ü Commenced a rota review to ensure the inclusion of; clinical supervision time, protected bi-annual one to one meetings and team leader (TL) administration time in the rotas across all nodal areas and are currently rolling out across our area

üHave accomplished a TL development centre

ü implemented training vehicles across all nodal areas

ü improved clinical mentorship capacity through new rosters and planning of staff, utilising specialist paramedics to support mentorship

ü Advertised and utilised alternative methods to provide supervision including: Scascade/Clinical memos/eLearning

üdeveloped an effective format to capture and evaluate all current formal and informal supervision including: - double emergency care assistant assessments - Student assessments/supervision - Appraisals - Secondment/alternative opportunities - Clinical assessments with mentors and peers

üUtilised team training days for supervision opportunities

Governance arrangements in emergency and urgent care services must ensure that staff are aware of risks and safe practices are consistently applied.

We have:

ü Formalised the emergency and urgent care (E&UC) services operational structure to ensure ownership and visibility

ü Allocated clinical governance (CG) resource to the E&UC directorate using a business partner model

ü Continued to mature CG reporting to include all elements of clinical governance and compliance for E&UC, making CG reports more inclusive and descriptive

üdeveloped the governance structure within E&UC to improve practice and demonstrate consistency / standardisation and to share innovative practice including quarterly CG reporting

üdeveloped risk registers for E&UC, from frontline to board

ü Ensured consistent risk management, datix refresher training and resources are made available for all investigation officers within E&UC

ü invited more subject matter experts to attend the CG meetings; for example infection control, mental health and pharmacy

ü Changed the format of Level 2 meetings to include; governance, HR and finance as standing items

Serious incidents investigations identify underlying causes, themes and human factors so that appropriate Trust actions are identified.

We have:

ü included a human factors section into our SiRi investigations guidance

ü Ensured our investigating managers attended additional training in human factors

ü Reviewed our serious incident report template to ensure human fac-tors are clearly indicated and underlying causes are clearly identified within any reports

ü included serious incident investigations causes and themes into our aggregated learning report

ü Cascaded actions in a number of forms, across the Trust, when themes are identified including in our ‘Safety matters’ reports

The governance process needs to improve to ensure complaints are appropriately monitored and timely action is taken to improve how complaints are handled and the quality and tone of complaint responses.

We have:

ü An improvement trajectory and plan for our open complaints

ümonitoring regular reporting of complaint response timeliness to our Patient Experience Review Group (PERG) and board

üUndertaken a mapping exercise to review our internal processes

ü Reviewed supporting guidance notes for our investigation officers (iOs)

üUndertaken a series of monthly campaigns for supporting iOs

üdeveloped dashboards, so that all divisions can access real-time data concerning all open complaints

ü Ensured complaints are reported and discussed at divisional CG meetings

ü invited external auditors to undertake a review of our complaints processes

A full report from the inspection is available at http://www.cqc.org.uk/provider/RYE

//156 //157

1.4 OPERATING MODEL OF SERVICES AND CARE

The diagram below outlines the current model of SCAS services.

SCAS role Strategic objectives

Care Coordination To enable you to identify and access the care you need

è To develop our assessment, signposting and advice services

è To coordinate care across systems, sharing infrastructure with partners

mobile Healthcare To save lives and improve outcomes

To enable you to stay safely in your home or local community

è To enhance our 24/7 mobile healthcare service

è To offer person-centred care, coordinating services with health, social care and voluntary partners

Patient Transport To enable you to travel safely between home and care settings

è To modernise and enhance our patient transport services

è To offer services to support people returning home from hospital

Helicopter view To support efficient and effective flow around systems of care

è To transform our analytical capability and capacity

è To offer a ‘helicopter view’ of flows around local care systems

Past

Right care, first time

Future

//158 //159

1.5 TRUST STRATEGY

The Trust Strategy was approved in 2014 and covers a five-year period to 2019.

SCAS aims Strategic objectives

Provider of choice To secure our competitive position and to win contracts, in order to deliver our service strategy

è To improve clinical outcomes and ensure patient safety

è To provide a positive patient experience

è To achieve call answer and response time standards consistently

Partner of choice To ensure right care, first time è To offer person-centred and locally-responsive pathways of care

è To develop and grow our services to meet a range of customer needs

è To work with partners to improve pathways across local care systems

Employer of choice To attract, recruit, develop and retain the workforce to deliver our service strategy

è To lead and engage staff in a culture of learning and improvement

è To motivate and enable our people to deliver excellence

Sustainable and dynamic organisation

To ensure sound governance, value for money and a strong financial-standing

è To transform our cost base

è To ensure future sustainability by winning viable contracts

Developing the clinical coordination centres

SCAS will make proactive welfare calls and monitor the health of people who are frail, at risk of deterioration in their health or who suffer from mental health issues.

Our services will be accessible 24/7, either on the telephone or via online and digital services. These services will be supported by a highly resilient platform and virtual telephony.

We will have rapid, streamlined assessment processes, so that we can identify people in life-threatening situations quickly and dispatch emergency clinicians immediately to scene if needed.

Our services will be underpinned by a comprehensive and up-to-date directory of Services in each local area, with direct access to relevant care pathways.

New specialist paramedic role

Some of our clinicians will have advanced practitioner skills, to enhance the clinical assessment and broaden the range of diagnostics and treatment offered on scene.

Our mobile clinicians will have mobile devices so that they can access multi-agency care plans and clinical records electronically while on scene.

in line with the national agreement, some ambulance nurses, paramedics and HART operatives will have new specialist roles.

The revised national profile not only recognises the increased educational requirements of the role, but also the greater depth of judgement and expectations required of staff to meet the needs of the urgent and emergency care agenda in terms of ‘see and treat’ and ‘hear and treat’. We realise that this change not only recognises the development of the role but also provides a springboard to continue to develop our services to patients for the future.

//160 //161

There is also a programme which aims to provide a more structured approach to properly integrate and supports newly qualified paramedics into the workplace, providing individuals with the time and support to consistently apply their academic knowledge, skills and placement experience into confident practice. This programme has been designed to provide a supportive transition to an effective, confident and fully autonomous clinician. Furthermore, the programme will empower individuals to develop their practice and to demonstrate their transition from novice to expert.

Alternative patient transport

SCAS will enable people to travel safely between home and health care settings. We are looking at alternative modes of transport in 2017 to free up frontline ambulances, and to provide the most appropriate form of transport for some of our lower acuity patients.

We will match the nature of the transport to the needs of the patient.

The Trust has been continually working to ensure patients can obtain the right care, first time, every time to appropriately meet their clinical and treatment needs, via 999, NHS 111 or from the non-emergency patient transport service delivered by SCAS.

We have embarked on a pilot scheme for patients who need to reach an onward

healthcare destination within an agreed timescale, who have already been clinically assessed as not being of an emergency or of an urgent nature. This pilot will use alternative ways to safely transport patients who have low acuity needs, following a clinical assessment by using licensed private hire vehicles for this purpose.

Other NHS ambulance trusts are already operating similar schemes which have demonstrated positive outcomes for patient experience. Such schemes also lead to a reduction in the number of low acuity patients who need to be conveyed by a 999 clinical ambulance which results in more clinician and ambulance availability for the highest acuity patients.

Following a SCAS clinical assessment, either face to face or from within the Clinical Coordination Centre (999 & NHS 111), staff will be able to refer a patient to be conveyed by a private hire vehicle. SCAS clinicians include:

è NHS 111 clinicians

è Clinical Support desk (CSd) clinicians

è Operational clinicians who have assessed patients face to face

New ways of working

As part of our strategic direction of travel we have been exploring ways to offer tailored care for each individual patient, using robust clinical assessment, sign-posting and advice services, whether they are ill, injured or concerned about their health.

Accelerated Clinical Transformation (ACT)

The Accelerated Clinical Transformation (ACT) programme began in 2016 to accelerate the pace of planned change which was hoped to bring clinical benefits for patients and staff alike and improve patient outcomes. in addition it would increase SCAS and partner provider efficiency, enable us to generate new ideas using modern technology and joint working with our partners, to support people in their own homes and to test pilot concepts.

Mental health

A mental health (mH) nurse is available in the Clinical Co-ordination Centre between 18:00 – 04:30hrs seven days a week to take calls from people in mental health crisis, and to provide information/advice and support to frontline crews on scene with patients in mental distress.

The innovative service (in partnership with Oxford Health NHS Foundation Trust [OHFT]) was established as part of the local National mH Crisis Care Concordat action plan, in order to improve the quality of service (and timely response) to people in mental distress who call NHS 111 or 999, by having a mental health professional in the SCAS Clinical Co-ordination Centre (CCC).

Several benefits have been realised:

è Patients receive specialist advice and support almost immediately

è improved access to information in OHFT clinical records and care plans to support shared care approaches

è direct referral to mH teams

è identification of patients with complex, or changing needs, so that care can be reviewed promptly and appropriately

è Provision of additional training and advice to call takers in NHS 111 and 999 - to support confidence, capability and capacity in managing calls from people in mental distress/crisis

è Reduction in numbers attending the local emergency department (Ed) inappropriately

è Reduction in the number of frontline ambulances being used to convey patients to Ed unnecessarily

Non-Injury Falls Pilot

SCAS is piloting a different response in Hampshire to some non-injured falls patients.

Hampshire Fire and Rescue Service (HFRS) will respond to some non-injured falls patients in a designated geographical area (Wickham / Fareham). The aim of the pilot is to evolve and further develop an appropriate and clinically safe response, when NHS Pathways triage has determined that the patient is non-injured and has a requirement for moving and handling and does not require an emergency ambulance response.

designated HFRS responders have been trained in falls patient assessment and moving and handling.

As SCAS is not directly attending the patient, the triage process for these patients is different. These patients remain the responsibility of SCAS throughout the duration of the incident and all clinical and referral decisions are made by CSd clinicians.

The patient will be assessed and triaged four times throughout the incident. CSd clinicians are responsible for the appropriate deployment of HFRS to non-injured falls patients and are responsible for final triage and onward referral of the patient.

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è NHS Pathways assessment at time of call – non-injury fall

è CSd assessment, to qualify the patient as suitable for HFRS response

è HFRS assessment at scene utilising the SCAS algorithm, prior to moving and handling

è CSd handover and final triage of patient (includes PRF and frailty assessment) and onward referral. All patients managed in this way will be onward referred by CSd

This initiative will reduce the waiting time for non-injured falls patients, who require moving and handling assistance.

End of Life

The End of Life pilot is currently running in the West berkshire area of SCAS. PallCall is the berkshire West palliative care co-ordination service managed by qualified nurses. it is a first point of contact for patients, families, carers and health and social care professionals who require 24 hour advice, care and support for patients in the last year of their life.

The service has been designed to improve the overall experience and continuity of

care, and to support health and social care professionals involved in caring for patients at the end of life.

Qualified nurses, skilled in palliative care, will triage calls to identify the most appropriate local provider to respond to the caller’s needs.

Consistency with quality priorities in local STPs (Sustainability and Transformation Plans)

SCAS Clinical Strategy is extremely well aligned with the STPs. Our clinical strategy identifies 16 groups of conditions where we believe there is scope for improvement by looking across services and developing more integrated pathways. many of the STPs have identified similar condition groups in their delivery plans and workstream structure.

Green call project

The Trust has undertaken full clinical review of all Green calls (30 minutes and 60 minutes) and end point dispositions during November and december 2016. This was to explore a more effective demand management process to reduce inappropriate frontline ambulance dispatches and ensure patients receive timely care and advice with the right outcome.

The outcome of the review proposed adopting a three month initial pilot following an Accelerated Clinical Triage (ACT) telephone assessment process to assess a pre-determined number of Green call symptom types in a more effective and clinically appropriate way. The call types selected for the proposed pilot have been reviewed for clinical safety and are low risk/low acuity conditions. These patient groups, where appropriate, will be referred directly to alternative care pathways as appropriate.

Green Review Objectives

è Evaluate current Green demand profile (including time of day) at SCAS level and by nodal areas

è Specific focus was to be directed to non-injury falls and mental health crisis patients and those categories which can result in long waits

è design an updated model to support Green patient flows on a 24/7 basis for non-ambulance attendance or possible redirection to other healthcare providers within the SCAS footprint

è develop new transportation arrangements for management of Green 30 and 60 minute response patients which is clinically safe and appropriate for a non-ambulance journey (e.g. private hire vehicle or other mode of attendance and/or transportation) to a place of assessment or care within agreed timeframes following clinical telephone assessment using NHS Pathways

The process is to include eight low acuity/low risk Green conditions would be clinically suitable for Accelerated Clinical Triage (ACT) and these are as follows:

è Lower back pain

è Catheter problems

è Expected death

è diarrhoea

è Headache

è dizziness and vertigo

è mental health conditions

è minor medical conditions

key Benefits Using Accelerated Clinical Triage

The pilot and review will enable SCAS call centre clinicians to deliver a more intelligent form of triage to a select group of low acuity conditions presenting in callers. Transferring the call from emergency call taker (ECT) to clinician earlier in the call process will enable the clinician to utilise additional clinical knowledge and skills to negotiate NHS Pathways triage to an appropriate disposition for the individual patient, accessing specific patient data and care plans where appropriate as risk stratification.

Early clinical intervention will mean a single assessment for the patient with a single outcome on the first call made to the service.

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NHS England Ambulance Response Programme (ARP)

The NHS England Ambulance Response Programme began in 2015. SCAS joined the national programme to work on the potential changes to ambulance response standards in July 2015. Since SCAS joined the national programme it has established an internal project implementation team working on proposed ARP changes being introduced locally.

during October 2015, SCAS implemented these operational changes and now operates a 240 second (4 minute) dispatch on disposition (dod) timeframe for Red 2 and Green calls categories. This has proved beneficial in improving the assessment needs of patients and allowing the Trust to appropriately send the right clinical response more effectively.

Programme aims

The key aims of ARP are to address improving response times to critically ill patients. it will make sure that the best, high quality, most appropriate response is provided for each patient first time. it is expected that the national programme will improve clinical outcomes for all patients contacting the 999 ambulance service, with a generally reduced clinical risk throughout.

High Level Benefits of ARP:

è Ensuring a timely response to patients with life-threatening conditions

è Providing the right clinical resources to meet the needs of patients based on presenting conditions

è Reducing multiple dispatches

è Reducing the diversion of resources

è increasing the ability to support patients through hear and treat

è increasing the ability to support patients through see and treat

è Having a transporting resource available for patients who need to be taken to a definitive place of care

The national programme is overseen by a national steering group, an expert reference group, stakeholder reference group as well as by an academic partner.

1.6 SIGN UP TO SAFETYSCAS has included Sign up to Safety workstreams as part of our quality priorities for this year.

Pledges and Actions

Put Safety First

è Review incidents, complaints, claims and aggregate this data. Analyse the aggregated data to identify and address areas of risk and demonstrate shared learning.

è Focus on key themes such as sepsis and engage with regional groups to support a multiagency approach to reducing risk.

è To continue to complete long wait audits and monthly meetings.

Continually Learn

è Promote an open reporting culture and ensure a campaign is completed in 2017/18.

è increase individual learning with feedback from incidents reported via the incident reporting system.

è develop our health care professional feedback routes across services as expanding footprint in 2017/18.

Honesty

è Continue to participate in multiagency reviews and share lessons learnt.

è Continue the use of patient stories across the organisation.

è Ensure patients and their families are kept informed throughout any investigation.

Collaborate

è Continue with initiatives where health care professionals are invited to work with/alongside our staff.

è Work closely with sub-contractors to ensure feedback/learning is shared.

è Continue to work with commissioners and other stakeholders in regards to ‘end to end’ reviews

Support

è Encourage internal/external walk rounds supporting staff to be confident in showcasing area.

è Ensure staff involved in investigations have access to training.

è Campaign topics of key themes to be identified.

1.7 WORKFORCE EQUALITY STANDARDOn 3 may 2016, South Central Ambulance Service NHS Foundation Trust was inspected by the CQC as previously described.

The findings published in September 2016 rated SCAS as ‘Good’ in the well led domain. The report highlighted positives across all five Key Lines of Enquiry (KLOEs) and assessed SCAS as ‘Outstanding’ for equality and diversity.

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The report had this to say about SCAS:

“The Trust had evaluated its equality delivery system (EDS) uniquely, using community groups to do so. The EDS aims to improve patient outcomes and patient access to services and to have a representative and supportive workforce and inclusive leadership. The majority of indicators were achieved. The Trust was taking further action to reduce discrimination and recruitment bias (also identified in the staff survey) in the Trust and ensure patient safety.”

SCAS was able to demonstrate that it is an organisation that adheres to the broad principles of the CQC KLOEs:

è Staff are positive about working for the Trust and recognised the value of their service

è Providing safe, caring, responsive and well led services

è diverse board that reflects a diverse workforce and therefore decision making that considers diversity

è monitors the diversity of its users and reassures itself with accurate data

Workforce Race Equality Standards

in July 2014 the EdC proposed a National Workforce Race Equality Standard, to tackle the lack of black and minority ethnic (bmE) representation at senior levels in the NHS, and to galvanise cultural and organisational change. The Standard, underpinned by commissioning and regulatory action, is aimed at helping to address the treatment of bmE staff including adverse outcomes throughout recruitment and promotion, access to non-mandatory training, over-representation in disciplinary procedures, bullying and harassment.

There are nine metrics; four are specifically related to workforce data and four are based on the national NHS Staff Survey indicators. The latter highlights any differences between the experience and treatment of white staff and black and minority ethnic staff in

the NHS, with a view to closing the gaps highlighted by those metrics. The final metric requires SCAS to ensure that the board is broadly representative of its workforce.

SCAS has now published its board approved 2016/17 WRES (Workforce Race Equality Standard) report/action plan and its equality and diversity working group and steering group are now working to deliver on the actions as acknowledged by the CQC.

Highlighted below are some of our actions for improvement.

Relative likelihood of staff being appointed from shortlisting across all posts.

è Ensure robust completion of all interview packs returned to the recruitment team.

è monitor, analyse and report recruitment data to the E&d steering group.

è Long term goal, ensure interview panels are more diverse and unconscious bias trained.

kF 25. Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months

è Review datix database for SCAS recorded data (staff reporting bullying, harassment or abuse from patients).

è Communication strategy to encourage bmE/white staff and managers to report bullying, harassment and abuse by patients.

kF 26. Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months

è Review data collection, analyse data for white staff, communication strategy to encourage bmE staff and managers to report bullying, harassment and abuse by staff.

1.8 STAFF SURVEYThe national 2016 staff survey was completed by 59.6% of staff (55.5% in 2015). This was the highest return for an ambulance trust (highest in 2015).

Overall survey result

è The overall survey was our best ever and a fantastic overall result

è Locally, there are some variations and differences in survey scoring

è SCAS had only one question below the NHS ambulance average

è SCAS had 17 questions that were significantly higher than other ambulance trusts

è SCAS recorded the top survey result out of ALL Picker Trusts (not just the ambulance sector)

è SCAS had no weaker scores than 2015

è SCAS had 39 significantly improved scores since 2015

Staff engagement rating

è SCAS has a score of 3.51 (1-5 rating) which is above the average of ALL ambulance trusts

è The 2016 engagement score is the highest since SCAS formed in 2006

è SCAS has the fastest growing engagement score of ALL ambulance trusts

è SCAS was asked to present its top-ranked results to the NHS Staff Survey Workshop

due to the excellent result, we will now focus on strengthening five areas of least satisfaction:

è Appraisals: deliver and quality of PdPs

è Senior management: communication and engagement

è Resources: workforce numbers and utilisation of resources

è Decision making process: lack of engagement at team level

è Staff health and wellbeing: line management engagement at local level

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Engagement plans

è Each area will be designated an HR survey advisor to monitor and support activities

è managers will work with their teams to identify areas for improvements

è Create local engagement plans in teams

è identify and publicise four pledges for improvement

è Staff engagement plans are added as standing agenda items at all team meetings

è managers are asked to monitor and be able to report on progress

è managers will produce articles for Staff matters, communicating actions

è Set objectives in managers’ appraisals to improve the results in some areas

1.9 DUTY OF CANDOURCandour is about being open and honest when things go wrong and making improvements from learning.

SCAS has a robust and established policy in place for informing patients and carers when things go wrong. We monitor this by conducting audits, our serious incident review meeting and the datix (incident reporting) group.

SCAS has a robust risk management strategy in place to assure that we will learn from mistakes and work in partnership with others including families using the principles below.

è Learning to improve and change the way care is provided

è Candour to support sharing information with others, including families

è Accountability if failures are found

The CQC thought SCAS overall had a safety culture where incidents were appropriately reported and followed up. Learning was shared and changes made as a result of this to improve the safety of services.

Senior clinical staff were aware of the duty of Candour regulation and the importance of being open and transparent with patients and families. Trust staff overall, were aware and understood their responsibility to be open.

1.10 ENGAGEMENTit is important that we maintain a good level of engagement with people from all backgrounds from across our geography.

SCAS has 13,500 Foundation Trust public members and membership engagement through the Council of Governors enables the Trust to engage with, and listen to the local population, reflecting its accountability to the communities that SCAS serves. Anyone living in (or with a connection with) the SCAS area can run for election to its Council of Governors which is made up of three different types of membership:

Public Governors

Elected by public Foundation Trust members living in their county

Staff Governors

Elected by SCAS staff members

Appointed Governors

Elected from organisations that work closely with SCAS such as local charities and CCGs

The Trust uses various types of engagement activities to ensure that it meets its duty to involve and consult with patients and the public in the way it develops and designs services. Throughout the year SCAS representatives attend events where they meet with members of the public and provide information about our services and listen to their views.

Events include various large ones such as Pride days; Hayling Island 999 Emergency Services Day; Art in the Park, milton Keynes; Hampshire 999 Emergency Show, bordon; Bucks County Show, near Aylesbury; Wallingford BunkFest, Oxfordshire and Newbury Culture Fest, berkshire.

The Trust also holds community engagement roadshows in shopping centres and market squares across its coverage area together with talks at career job fairs, schools and various organisations such as elderly groups, Rotary clubs and ethnic minority associations.

Furthermore SCAS undertakes regular patient surveys such as the annual members and patients surveys together with public consultations at its county forums.

in 2016 SCAS launched four new websites (main SCAS one, SCA Charity, SCASKids and SCASJobs) and increased considerably its followers on Twitter, Facebook and scas999 YouTube thanks to the associated videos in SCASkids and SCASJobs websites and bespoke public awareness campaigns.

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2Part 22.1 CHOOSING AND PRIORITISING QUALITY IMPROVEMENT INITIATIVESin this part of the report we will outline a number of areas where we have identified that quality improvements can and should be made. Priorities are identified through scrutiny of a wealth of information collated through robust operational and engagement practices which are shared at board level through our governance structure.

We engage with our clinical commissioning groups and other external partners when defining our goals for quality improvement and we place high importance on the feedback we receive from patients and other healthcare professionals.

è Surveys – staff and patients

è HCP (healthcare professional) feedback

è Public feedback including complaints, concerns, compliments

è Serious incidents

è Adverse incidents

è CQC compliance actions

è Audits (internal and external)

è Committee reports

è Leadership walk-rounds

è Feedback from key stakeholders (Healthwatch, HOSCs, patient forums, commissioners)

Leadership walk-rounds by the executive and non-executive directors also provide intelligence to develop areas for improvement and helped to engage frontline and support staff in discussions and debates about our clinical and patient priorities.

Finally as a Foundation Trust we are fortunate to be able to draw on the input of our Council of Governors who provide a picture of the needs of the community which we serve.

Priorities were assessed in terms of:

è Impact – by considering the likely improvement in safety, outcomes and experience.

è Feasibility – The ease of implementation, resources required and likely time to completion or delivery.

è Measurability – Can the priority we have set be measured accurately in order that we can show improvements?

è Outcomes – Will the initiative improve patient outcomes in the areas of safety, effectiveness and experience?

2.2 QUALITY PRIORITIES FOR 2017/18Following consultation with the Trust board, our Council of Governors, Quality and Safety Committee, the senior leadership team and staff representation the following priorities have been approved and confirmed for the Quality Accounts.

Patient Safety

1a To improve the recognition of sepsis in adults

1b To complete a clinical governance review of the Emergency and Urgent Care (E&UC) 999 service and implement the recommendations

1c To ensure a consistent approach to medicines management processes which are compliant with the regu-latory standards

1d To implement the workstreams in the national Sign up to Safety campaign to improve patient safety across all services

QUALITY ACCOUNT

PRIORITIES

Francis Keogh berwick

internal and External Audit

Aggregated Learning from incidents and

Claims

NHS Operating

Framework

Complaints, Compliments, Concerns & Feedbacks

Leadership walkabouts

Patient and Staff Surveys

Contract Schedules

CQC Fundamental

Standards

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Clinical Effectiveness

2a To demonstrate an improvement in call abandonment for NEPTS, 999, NHS 111 and HCPs (Healthcare Professionals) (2 year priority)

2b To evaluate and develop clinical assessments in call centres (CCC) ensuring consistent methods and application across the services (3 year priority)

Patient Experience

3a To report on the Friends and Family test (FFT), staff and patients, and actively demonstrate that we seek feedback and act on results

3b To evidence learning from HCP (Healthcare Professional) feedback in all services (NHS 111, NEPTS and 999)

3c To develop systems that engage and seek feedback from hard to reach groups

Each of our priorities and our proposed initiatives for 2017/18, are described in detail on the following pages. They will be monitored through the quality improvement plans that are presented to the executive and senior management teams and the Quality and Safety Committee. External audit assurance is provided by KPmG and through an internal audit programme.

Priority 1 - Patient Safety

1a. To improve the recognition of sepsis in adults

Why have we chosen this indicator

Sepsis is a time-critical and life-threatening condition that can lead to organ damage, multi-organ failure, septic shock and eventually death. it is caused by the body’s immune response to a bacterial or fungal infection. it commonly originates from the lungs, bowel, skin and soft tissues and urinary tract. Rarer sources include the lining of the brain (meningitis), liver, or indwelling devices such as catheters.

Sepsis is one of the leading causes of death in the developed world.

Early recognition of life-threatening sepsis is essential to enable the ambulance service to initiate lifesaving therapy and issue a pre-arrival alert to the hospital. We have been responding to national campaigns on sepsis and improving clinical assessments from an initial call to responding to patients. in last year’s quality report we improved the way we dealt with sepsis in children and are working hard to continue this for adults.

To aid early recognition of sepsis by our frontline ambulance clinicians the Trust has developed both a paediatric and adult sepsis screening tool. These tools promote appropriate management of septic patients

using a structured and systematic ‘check-list’ approach; they do not however replace clinical judgment or clinical experience.

Through effective distribution and application of these tools SCAS aims to reduce adverse incidents relating to sepsis and reduce patient harm.

To achieve this we are going to:

è Review and reissue the sepsis tools throughout all SCAS areas and ensure staff understanding in all areas of business

è Create a further sepsis campaign approach that aligns to the calendar of Trust-wide campaign events

è monitor the use of the tool through audit of adverse incident data and patient clinical records

è Continue to work with national groups and initiatives on sepsis awareness and training

Board Sponsor John black Medical Director

Implementation Lead mark Ainsworth-Smith Consultant Pre-Hospital Practitioner

1b. To complete a clinical governance review of the Emergency and Urgent Care (E&UC) 999 service and implement the recommendations

Why we have chosen this indicator

during our CQC inspection and subsequent feedback it was recognised that there are some inconsistencies in the E&UC service governance. SCAS has a well-established risk and governance team supporting the operations in 999 services but there are some areas that could be developed.

Governance arrangements in the Trust are continually being reviewed and we have a comprehensive and detailed integrated performance report, and risk and quality issues are being appropriately escalated to the board though the divisional structures. Although some risks and mitigating actions, and the assurances around these, are not always consistently and clearly identified.

Therefore to ensure governance arrangements in emergency and urgent care services are consistently applied, SCAS will undertake a review to ensure that staff are aware of risks and safe practices.

To achieve this we are going to:

è Set out terms of reference for a thorough and robust review of clinical governance in E&UC

è Conduct the review methodically

è Report on the review through the Patient Safety Group and to the Quality and Safety Committee

è Ensure compliance with the CQC fundamental standards – report to Executive management Committee

è implement any recommendations

Board Sponsor Philip Astle Chief Operating Officer

Implementation Lead mark Ainsworth Director of Operations Pete Warren/Laura mathias 999 Clinical Governance Leads

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1c. To ensure a consistent approach to medicines management processes which are compliant with the regulatory standards

Why we have chosen this indicator

SCAS is committed to ensure safe medication processes for storage, recording and administration at all times in line with all regulatory requirements. We are improving these processes to ensure a SCAS-wide consistent approach and to learn from any reported incidents.

To achieve this we are going to:

è Ensure actions from the CQC fundamental standards review are implemented

è Achieve a 10% reduction in controlled medicines incidents

è Utilise SCAScade regularly and effectively to communicate learning themes to staff from reflections on practice

è Create and deliver a medicines campaign approach that aligns to the calendar of Trust-wide campaigns events

è identify any improvement actions for process and information issues and monitor through the medicines management group

è develop a standardised system and process for PGds (Patient Group directions)

Board Sponsor John black Medical Director

Implementation Lead Ed England Medicines and Research Manager

1d. To implement the workstreams in the national Sign up to Safety campaign to improve patient safety across all services

Why we have chosen this indicator

SCAS is committed to working with local and national partners on delivering safety improvements and learning from incidents to improve patient care. As outlined in Part 1 of this report we will be refreshing the pledges in the Sign up to Safety campaign and implement improvements.

To achieve this we are going to:

è Review and reissue the pledges SCAS made as part of the Sign up to Safety campaign

è increase incident reporting each quarter by 1% above baseline

è As per indicator 1a audit the use of the sepsis tool

è Encourage staff to share ideas for innovation through the bright ideas scheme and increase numbers submitted by five per year

è Ensure the workstreams are delivering and reported on in an aggregated way to Patient Safety Group identifying improvement plans

Board Sponsor

Director of Quality and Patient Care

Implementation Leads

Jane Campbell/debbie marrs Assistant Directors of Quality

Priority 2 - Clinical Effectiveness

2a. To demonstrate an improvement in call abandonment for NEPTS, 999, NHS 111 and HCPs (Healthcare Professionals) (2 year priority)

Why we have chosen this indicator

We have identified a two-year priority for demonstrating an improvement in call abandonment rates.

We already have a robust integrated workforce plan in place to ensure workforce numbers are aligned to demand levels and budget but we need to continually review this. We have reviewed all call centre metrics and introduced standardised activity codes within the telephony platform across 999 and NHS 111 services to ensure call taker availability is robustly and fairly managed.

As we introduced a dynamic skills based routing process within NHS 111 to ensure calls are answered more efficiently to reduce call answer delays that lead to abandoned calls, we need to demonstrate a sustained rate of below 1% which is the national standard.

To improve the call abandonment rate in NEPTS we will continue to inform our callers via the call announcements of the information required to enable our call centre staff to deal with the call efficiently.

To improve the call abandonment threshold we will ensure that our online system is encouraged through our call announcements and call script to enable our call handlers to be released to deal with complex and on the day activity.

We know through our feedback from the public that call answering and messages is important to those calling us.

To achieve this we are going to:

è Conduct a review of our call announcements on our HCP and patient facing lines to ensure that our online system is promoted – creating a baseline measure of callers that use online services

è We will review our call scripts to ensure that our staff promote pre-planned activity being placed via our online system

è Review our patient zone and release this functionality to the NEPTS contracts that this is not currently contractually bound to deliver

è We will review our call announcements on our HCP and patient facing lines to ensure that our online system is promoted

è Ensure an abandonment rate of below 1% in line with the national threshold

Board Sponsors

Philip Astle Chief Operating Officer

Director of Quality and Patient Care

Implementation Leads

Luci Stephens Director for Clinical Coordination Centres

Paul Stevens Director of Commercial Services

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2b. To evaluate and develop clinical assessments in call centres (CCC) ensuring consistent methods and application across the services (3 year priority)

Why we have chosen this indicator

As outlined in Part 1 of this report we are working hard with national projects and local partners to ensure patients are given timely information and advice and are directed to the right resource to meet their needs. The national integrated and Urgent Care review means that we are increasing our clinical interventions from 20-30% and have introduced a clinical advice line within the NHS 111 Call Centre that focusses on ambulance and emergency department dispositions that are transferred to a clinician.

We are currently exploring a pilot of NHS 111 online and are working with external providers of online symptom checkers to enable demand to be managed more effectively giving members of the public the ability to self-assess their symptoms. The plan is to operationalise this by the end of 2017.

We have introduced a Live Link pilot in the 999 Call Centre where patients in high intensity user care homes who dial 999 are assessed by a clinician who can see the patient via Skype for SCAS to manage demand more effectively. This is live with two care homes, one based in the Hampshire area and one in the Thames valley area.

We have undertaken a demand analysis on low acuity green calls and have identified eight low risk conditions that will be identified at the outset of the call and then immediately transferred to a clinician. This aims to continually improve our hear and treat rates and see and treat rates and increase ambulance vehicle availability. This has the real potential to improve patient experience.

Ambulance dispositions from NHS 111 calls that require a Green time (i.e. 30 or 60 minutes) will be re-triaged by a clinician in the call centre to determine the pathway required. This may not mean a frontline ambulance to hospital but a different pathway for the patient such as a pharmacist or walk-in centre.

To achieve this we going to:

è implement the Green project (30 and 60 minute calls) for eight clinical conditions in Year 1

è Establish the baseline % of long waits for these Green calls and set an improvement target to commence in Year 2

è To further model the Green project after implementation and by the end of 2017

è Ensure 80% of all eligible calls (Green ambulance disposition) are transferred to an enhanced desk for further clinical assessment

è Evaluate the Live Link pilot and analyse the data to demonstrate an improvement in non-conveyance

è implement the NHS 111 online symptom checker in Year 1

Board Sponsors

Philip Astle Chief Operating Officer

Director of Quality and Patient Care

Implementation Lead

Luci Stephens Director of Clinical Coordination Centres

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Priority 3 - Patient Experience

3a. To report on the Friends and Family test (FFT), staff and patients (in all services) and to continue to seek feedback and act on results.

Why we have chosen this indicator

SCAS firmly believes in actively seeking feedback and using the information received to improve patient care and the working lives of staff. The Friends and Family test is one of a variety of ways we can do this and we will be seeking new ways of gaining feedback. All staff groups across SCAS are invited to feedback through a FFT survey each year.

We recognise FFT is a national initiative and aim to improve the response rates where we can.

To achieve this we are going to:

è Refresh the response cards and methods for FFT surveys for patients in the first half of the year and report on numbers of responses, themes and learning

è Utilise and improve the range of ways we seek feedback

è Report on the findings and implement any improvements based on responses

è increase the response rate from the baseline in 2016/17

Board Sponsor

Director of Quality and Patient Care

Implementation Leads

Amanda Painter Head of Patient Experience

Jane Campbell Assistant Director of Quality

3b. To evidence learning from HCP (Healthcare Professional) feedback in all services (NHS 111, NEPTS and 999)

Why we have chosen this indicator

SCAS recognises the challenges we face in utilising and processing all the strands of HCP feedback. As we interface with a large range of partners we encourage the professionals to feedback to us in order to learn and improve. We have a standardised system in datix now for receiving and auditing all feedback across our services.

Healthcare professional (HCP) feedback supports the aim of improving quality and safety of patients by identifying areas of concern and highlight areas of good practice. it also supports the development of future services. We will now be concentrating on collation of data to identify themes and trends to ensure learning across the organisation.

To achieve this we are going to:

è Ensure the process used to review and respond to feedback is robust and facilitates aggregated learning practices

è Engage with our HCP partners to ensure they are aware of and able to access our feedback processes across all areas of service provision giving assurance that feedback will be dealt with in a timely way

è include the new partners in Surrey and Sussex NEPTS services in all governance reports as a quality indicator

è Report widely on feedback themes, trends and actions taken

è develop a trajectory for consistently responding on time (30 days) – improve by 10 per month

Board Sponsor

Director of Quality and Patient Care

Implementation Leads

Clinical Governance Leads in NHS 111, NEPTS and 999

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3c. To develop systems that engage and seek feedback from hard to reach groups

Why we have chosen this indicator

SCAS recognises that improvements can be made to listening to and seeking feedback from hard to reach groups across all of its services. We are aware that we need to adopt different approaches to seeking this feedback to enhance the services for certain groups of users.

To achieve this we are going to:

è Conduct focus groups across the SCAS footprint to engage harder to reach groups

è Work closely with CCGs to ensure management of wider engagement

è develop feedback mechanisms through patient forums

è Feedback the information through our Patient Experience Review Group (PERG)

Board Sponsor

Director of Quality and Patient Care

Implementation Leads

Amanda Painter Head of Patient Experience

Jane Campbell Assistant Director of Quality

2.3 STATEMENT OF ASSURANCE FROM THE BOARDAll NHS Foundation Trusts are asked to provide common areas of information which demonstrate assurance on the Trust’s commitment and actions to improve the quality of their service and provision of care. This section provides the requirements and statements as specified by the Quality Account regulations.

1. during 2016/17 South Central Ambulance Service NHS Foundation Trust (SCAS) provided and/or sub contracted three relevant services:

è Emergency 999 Ambulance Service

è Non-Emergency Patient Transport Service

è NHS 111 Telephone Advice Service

1.1 SCAS has reviewed all the data available to it on the quality of care in these three services. Along with qualitative data, the board has sought assurance from a variety of sources:

è Patient surveys

è Staff surveys

è Narrative from complaints and feedback and their resolution

è Patient stories at public board meetings

è Root cause analysis of incidents and identified leaning

è internal audit reports

è External reviews of quality including the CQC

è Leadership walk-rounds

è Committee meetings

è Staff meetings

1.2 The income generated by the relevant services reviewed in 2016/17 represents 100% of the total income generated from the provision of relevant services by SCAS for 2016/17.

2. during 2016/17, 10 national clinical audits and nil national confidential enquiries covered relevant health services that SCAS provides.

2.1 during 2016/17, SCAS participated in 100% national clinical audits and 0% national confidential enquiries of the national clinical audits and national confidential enquiries which it was eligible to participate in.

2.2 The national clinical audits and national confidential enquires that SCAS was eligible to participate in during 2016/17 were as follows:

è Acute myocardial infarction and other ACS (miNAP)

è National Clinical Performance indicator Asthma

è National Clinical Performance indicator Febrile Convulsions

è National Clinical Performance indicator below Knee Fractures

è National Clinical Performance indicator Elderly Falls

è Ambulance Service Clinical Quality indicator Stroke Care bundle

è Ambulance Service Clinical Quality indicator Cardiac Arrest ROSC Rates (and separate witnessed arrest ROSC rates)

è Ambulance Service Clinical Quality indicator Cardiac Arrest Survival to discharge (STd) Rates (and separate witnessed arrest STd rates)

è Ambulance Service Clinical Quality indicator ST elevation myocardial infarction Care bundle

è Ambulance Service Clinical Quality indicator Primary Percutaneous Coronary intervention (pPCi) call to balloon within 150 minutes

//182 //183

2.3 The national clinical audits and national confidential enquires that SCAS participated in during 2016/17 were as follows:

è Acute myocardial infarction and other ACS (miNAP)

è National Clinical Performance indicator Asthma

è National Clinical Performance indicator Febrile Convulsions

è National Clinical Performance indicator below Knee Fractures

è National Clinical Performance indicator Elderly Falls

è Ambulance Service Clinical Quality indicator Stroke Care bundle

è Ambulance Service Clinical Quality indicator Cardiac Arrest ROSC Rates (and separate witnessed arrest ROSC rates)

è Ambulance Service Clinical Quality indicator Cardiac Arrest Survival to discharge (STd) Rates (and separate witnessed arrest STd rates)

è Ambulance Service Clinical Quality indicator ST elevation myocardial infarction Care bundle

è Ambulance Service Clinical Quality indicator Primary Percutaneous Coronary intervention (pPCi) call to balloon within 150 minutes

2.4 The national clinical audits and national confidential enquiries that SCAS participated in, and for which data collection was completed during 2016/17, are listed below alongside the numbers of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry.

National clinical audit Number of cases

% submitted

Acute myocardial infarction and other ACS (miNAP) - entered in to the audit by acute trusts; data quality checked by South Central Ambulance Service NHS Foundation Trust.

2854

April 2016 to march 2017

100%

National Clinical Performance indicator Asthma 556 June 2016 & dec 2016

100%

National Clinical Performance indicator Febrile Convulsions 109 Aug 2016 & Feb 2017

100%

National Clinical Performance indicator below Knee Fractures 154 July 2016 & Jan 2017

100%

National Clinical Performance indicator Elderly Falls 600 Sept 2016 & mar 2017

100%

Ambulance Service Clinical Quality indicator Stroke Care bundle 4924 April 2016 to dec 2016

100%

Ambulance Service Clinical Quality indicator Cardiac Arrest ROSC Rates (and separate witnessed arrest ROSC rates)

125 April 2016 to dec 2016

100%

Ambulance Service Clinical Quality indicator Cardiac Arrest Survival to discharge (STd) Rates (and separate witnessed arrest STd rates)

65 April 2016 to dec 2016

100%

Ambulance Service Clinical Quality indicator ST elevation myocardi-al infarction Care bundle

788 April 2016 to dec 2016

100%

Ambulance Service Clinical Quality indicator Primary Percutaneous Coronary intervention (pPCi) call to balloon within 150 minutes

850 as at mar 2017

100%

2.5 and 2.6 The reports of 10 national clinical audits were reviewed in 2016/17 and the Trust intends to take the following actions to improve the quality of health care provided:

è improve compliance with NCPis with the use of compliance tools in the Electronic Patient Records (ePR) to enable non-compliant fields to be flagged to staff prior to closing whereby they can enter in that page to gain compliance

è improve the quality of data entry by making available an ePR solution to private ambulance providers utilised by the Trust and additional resources that do

not have the main Trust ePR. This will be achieved utilising an application that can feed into the Trust data systems

è improve call to depart scene time for stroke patients and early identification of patients affected by stroke

è improve private provider data integration

è Continue to improve long wait data analysis

è Continue to review the appropriateness of conveyance decisions

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//184 //185

2.7 The reports of four local clinical audits were reviewed in 2016/17 and the Trust intends to take the following actions to improve the quality of health care provided:

Audit of Identified Issues Actions

delayed responses è inappropriate call

è increase in demand

è These are being fed back to the HCP that booked the transfer

è Resources being reviewed against demand

Trauma Pathway è To identify the geographical location of trauma incidents

è The information is being shared with Police and other partner agencies to highlight black spots including time of day and gender-based incident data

Safeguarding referral completion audit è The detail of the referral was unclear if it was welfare or safeguarding being reported

è The feedback from social services is very rarely provided

è Ensure that the safeguarding or welfare tick box is completed

è Work is being undertaken with social services via CCGs to ensure feedback is provided

ACQi data quality è minor recommendation of recording of rejection criteria which was highlighted on one case only

è The system has been updated to require rejection comment before being able to close

3. The number of patients receiving NHS services provided or sub contracted by SCAS in 2016/17 that were recruited to participate in research, approved by a research ethics committee: 1172.

Conference presentations and publications demonstrate our commitment to transparency and desire to improve patient outcomes and experience across the NHS.

Our engagement with clinical research also demonstrates the Trust’s commitment to testing and offering the latest medical treatment and techniques. The areas of engagement are outlined below.

in June 2016 SCAS hosted its first research conference ‘Research & me’.

Publications

deakin Cd, Koster R. Chest compression pauses during defibrillation attempts. Current Opinion in Critical Care. 2016; 22: 206–211.

deakin.d. England.S. diffey.d. maconochie.i. Can ambulance telephone triage using NHS

Pathways accurately identify paediatric cardiac arrest? Resuscitation. march 2017.

Pocock H, deakin Cd, Quinn T, Perkins Gd, Horton J, Gates S. Human Factors in Prehospital Research: Lessons from the PARAmEdiC trial. Emergency medicine Journal 2016; 33(8): 562–568.

Hawkes C, booth S, Ji C, brace-mcdonnell SJ, Whittington A, mapstone J, Cooke mW, deakin Cd, Gale CP, Fothergill R, Nolan JP, Rees N, Soar J, Siriwardena AN, brown TP, Perkins Gd; OHCAO collaborators. Epidemiology and outcomes from out-of-hospital cardiac arrests in England. Resuscitation 2016; 110: 133-140. doi: 10.1016/j.resuscitation.2016.10.030.

Perkins Gd, Quinn T, deakin Cd, Nolan JP, Lall R, Slowther A, Cooke m, Lamb SE, Petrou S, Finn J, Jacobs iG, Carson A, Smyth m, Han K, Rees N, moore F, Fothergill R, Stallard N, Long J, Horton J, Kaye C, Gates S. Pre-hospital Assessment of the Role of Adrenaline: measuring the Effectiveness of drug administration in Cardiac arrest

(PARAmEdiC-2): Trial protocol. Resuscitation 2016 Sep 17. pii: S0300-9572(16)30446-4. doi: 10.1016/j.resuscitation.2016.08.029.

Rajagopal S, Kaye CR, Lall R, deakin Cd, Gates S, Pocock H, Quinn T, Rees N, Smyth m, Perkins Gd. Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest. Resuscitation 2016; 109: 110-115. doi: 10.1016/j.resuscitation.2016.09.014.

durham m, Faulkner m, deakin Cd. Targeted Response? An exploration of why ambulance services find government targets particularly challenging. british medical bulletin 2016 doi: 10.1093/bmb/ldw047.

Gräsner JT, Lefering R, Koster RW, masterson S, böttiger bW, Herlitz J, Wnent J, Tjelmeland ib, Ortiz FR, maurer H, baubin m, mols P, Hadžibegoviç i, ioannides m, Škulec R, Wissenberg m, Salo A, Hubert H, Nikolaou Ni, Lóczi G, Svavarsdóttir H, Semeraro F, Wright PJ, Clarens C, Pijls R, Cebula G, Correia vG, Cimpoesu d, Raffay v, Trenkler S, markota A, Strömsöe A, burkart R, Perkins Gd, bossaert LL; EuReCa ONE Collaborators. EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation. 2016;105:188-95.

deakin Cd, England S, diffey d. Ambulance Telephone Triage Using NHS Pathways to identify Adult Cardiac Arrest. Heart 2016 in press.

Presentations

Pocock H. Human Factors in Pre-hospital research: Lessons from the PARAmEdiC trial. In: Celebrating Trauma Research in the Thames Valley. Reading, Berkshire, January 2016.

Pocock H. PARAmEdiC2: The Adrenaline Trial. In: SWAST research showcase, Exeter, March 2016.

Pocock H. Adaptation of a tool measuring attitudes towards pain in paramedics: a small-scale qualitative study. In: SCAS Research & Me conference, Newbury, June, 2016.

Pocock H. Prehospital Assessment of the Role of Adrenaline: measuring the Effectiveness of drug administration in Cardiac arrest. In: BASICS conference, Leamington Spa, October 2016.

Pocock H. ExPLAiN. The 3rd Berkshire Trauma Conference. Reading, February 2017

Poster presentations

Asghar Z, Pocock H, Lord W, Foster T, Williams J, Phung v-H, Shaw d, Snooks H, Siriwardena AN. Exploring factors increasing Paramedics’ likelihood of administering Analgesia in pre-hospital pain: cross sectional study (ExPLAiN). In: 999 EMS Research Forum Conference: The way forward for emergency care research: inclusion, collaboration; sustainability. Bristol, March 2017.

4. A proportion of the Trust’s income in 2016/17 was conditional upon achieving quality improvement and innovation goals agreed between SCAS and the clinical commissioning groups, and any person or body they entered into a contract, agreement or arrangement with for the provision of relevant health services, through the Commissioning for Quality and innovation (CQUiN) payment framework.

4.1 CQUiNS achievements show that SCAS actively engages in quality improvements that cross the boundaries of our organisation. For this year the goals relate to, but not exclusively, the following:

è Health and wellbeing (national)

è Flu vaccination (national)

è Care homes making the right choices (local)

è Rolling out electronic GP discharge summaries (local)

//186 //187

4.2 A proportion of SCAS income in 2016/17 was conditional upon achieving quality improvement and innovation goals agreed between SCAS and the clinical commissioning groups, and any person or body they entered into contract, agreement or arrangement with for the provision of relevant health services, through the Commissioning for Quality and innovation payment framework.

The total for CQUiN related income for 2016/17 is expected to be approximately £2,833,130. CQUiN goals are set nationally and by contract and will be fully visible when agreed. The CQUiN income for 2015/16 was £1,901,997 and for 2014/15 was £2,417,690.

5. SCAS is required to register with the Care Quality Commission (CQC) and is currently registered without conditions in all fundamental standards.

5.1 The Care Quality Commission has not taken enforcement action against SCAS during 2016/17.

6. Removed from the legislation by the 2011 amendments.

7. and 7.1 SCAS had not participated in any special reviews or investigations by the Care Quality Commission during the reporting period.

8. and 8.1 SCAS did not submit records during 2016/17 to the Secondary Uses Service for inclusion in the Hospital Episode Statistics which are included in the latest published data.

9. The Trust’s information Governance Assessment Report overall score for 2016/17 was 74% and was graded green from the iGT Grading scheme.

10. and 10.1 The Trust was not subject to the Payment by Results clinical coding audit during the reporting period by the Audit Commission.

11. SCAS will be taking the following actions to improve data quality:

è Provision of an integrated Performance Report that outlines all quality, operational and financial data

è Regular review by the Clinical Review Group of accuracy of data and reliability

è EpR record analysis

è Ensure alignment and consistency across contract schedules working with internal and external information teams

è internal clinical audit plan to validate relevant data

è internal auditors reports monitored through the Audit Committee

è board assurance framework and corporate risk register to escalate data quality concerns

2.4 NHS IMPROVEMENT MANDATED QUALITY INDICATORSSet by NHSi, mandated indicators are intended to strengthen the reporting processes and create a comparable set of targets across all UK ambulance trusts. The mandated core quality indicators are outlined.

The percentage of Category A telephone calls (Red 1 and Red 2 calls) resulting in an emergency response by the trust at the scene of the emergency within 8 minutes of receipt of that call during the reporting period.

Red 1 2016/17 Red 2 2016/17

73.3% 73.1%

Red 1 2015/16 Red 2 2015/16

71.9% 72.7%

Red 1 2014/15 Red 2 2014/15

75.0% 74.5%

The percentage of Category A telephone calls resulting in an ambulance response by the trust at the scene of the emergency within 19 minutes of receipt of that call during the reporting period.

RED 19 Min 2016/17 94.7%

REd 19 min 2015/16 94.4%

REd 19 min 2014/15 95.5%

//188 //189

The South Central Ambulance Service NHS Foundation Trust considers that this data is as described for the following reasons; the Trust has a robust data quality process for ensuring performance reporting which is benchmarked, and that data is scrutinised internally by the Executives and Board and by commissioners. Information generated from NHS Pathways to CAD is sent to the data warehouse and IT systems for analysis.

SCAS is working with national ambulance services on Dispatch on Disposition (DoD) – ambulance response targets and ensuring CAD has full back up and fall back plans in place to improve this and so the quality of its services, by ensuring patients with a Red or Green disposition receive the right response.

STEMI Care Bundle Performance

The percentage of patients with a pre-existing diagnosis of suspected ST elevation myocardial infarction who received an appropriate care bundle from the Trust during the reporting period.

NOTE: This is YTD data in line with national reporting validation processes.

in 2015/16 compliance was 98.5%

Stroke Care Bundle Performance

The percentage of patients with suspected stroke assessed face to face who received an appropriate care bundle from the Trust during the reporting period.

NOTE: This is YTD data in line with national reporting validation processes.

in 2015/16 compliance was 98.5%

100

80

60

40

20

0

Apr 16

may

16

Jun 1

6Ju

l 16

Aug 16

Sep16

Oct 16

Nov 16

dec 16

Jan 1

7

m1 Aspirin

m2 GTN

m3 2pain scores

m4 morphine

m5 Analgesia

m6 SpO2

Care bundle

110

100

90

80

70

60

50

Apr 16

may

16

Jun 1

6Ju

l 16

Aug 16

Sep16

Oct 16

Nov 16

dec 16

Jan 1

7

m1 Aspirin

m2 GTN

m3 2pain scores

m4 morphine

m5 Analgesia

m6 SpO2

Care bundle

S1 complete Fast Test

S2 blood Glucose

S3 blood Pressure

S4 Time of Onset

Care bundle

100.5

100

99.5

99

98.5

98

97.5

97

96.5

96

Apr 16

may

16

Jun 1

6Ju

l 16

Aug 16

Sep16

Oct 16

Nov 16

dec 16

//190 //191

The South Central Ambulance Service NHS Foundation Trust considers that this data is as described for the following reasons; the Trust has a robust data quality process through the Board and committees and reports on that data. Information is collated as per guidance for ambulance quality indicators and commissioners scrutinise the data.

SCAS has electronic patient records and collates data as per national reporting requirements. Board reports and external contract reports reflect this. (as described)

Ambulance Clinical Quality Indicators YTD Apr to November 2016/17 against national average (YTD)

Clinical Quality Indicator Lower Upper DifferenceNational Average

South Central

Greater or lower

than Average

STEmi - Care 58.33% 90.65% 32.32% 77.99% 72.31%

Stroke - Care 94.37% 99.64% 5.27% 97.63% 98.59%

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

The South Central Ambulance Service NHS Foundation Trust considers that this data is as described for the following reasons; FFT responses by staff groups and on postcard submissions, website feedback, robust analysis at internal group of Patient Experience and through external reports to commissioners.

SCAS intends to take the following actions to improve this and so the quality of its services

by relaunching the new FFT postcards and making the website function easier to use and reporting to the Patient Experience Review Group on themes and learning.

The number and, where available, rate of patient safety incidents reported within the Trust during the reporting period, and the number and percentage of such patient safety incidents that resulted in severe harm or death.

2014/15 2015/16 2016/17

Number of incidents 570 447 282

Number and % severe harm/death 52 (9.1%) 21 (4.7%) 13 (4.6%)

Note: Rate is not calculated for ambulance services and national benchmark is not yet available. Note: SCAS process revised with NRLS – reporting figures accurately checked.

The South Central Ambulance Service NHS Foundation Trust considers that this data is as described for the following reasons; external auditors review of risk management in the Trust, Datix reports, Board reports and scrutiny of data at the incident reporting group, NRLS confirmation.

SCAS intends to take the following actions to improve this indicator and so the quality of its services, by training staff on incident reporting and the use of Datix, reviewing numbers and themes of incidents at the Patient Safety Group and Trust Board and including learning from themes in staff updates and aggregated learning reports.

Your Trust 2016

Average (median) for ambulance trusts

Your Trust 2015

Q21a “Care of patients / service users is my organisation’s top priority 58% 58% 49%

Q21b “my organisations acts on concerns raised by patients / services users” 66% 63% 60%

Q21c “i would recommend my organisation as a place to work” 49% 46% 39%

Q21d “if a friend or relative needed treatment, i would be happy with the standard of care provided by this organisation 72% 70% 63%

KF1. Staff recommendation of the organisation as a place to work or receive treatment (Q21a, 21c-d) 3.51 3.46 3.27

//192 //193

3.1 REPORT ON PROGRESS WITH 2015/16 QUALITY PRIORITIES

An overview of our achievements on last year’s priorities can be seen in the table below.

Priority Achieved

1a. improve the recognition of sepsis in children under five years old in CCC √

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

√

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

√

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

√

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

On track

2c. improve compliance with limb fracture care bundle In progress

3a. To improve the number of formal complaints responded to on time by the Trust

√

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

√

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

On track

Part 3

Patient Safety

1a. Improve the recognition of sepsis in children under five years old in clinical co-ordination centres (CCC)

We achieved this indicator but have continued the theme in priorities for this year as we know it’s important to continue to get it right every time (refer to indicator 1a for 2016/17 priorities).

SCAS has focussed on the recognition of sepsis in children during training for new staff joining SCAS during 2016. We are ensuring that all clinical staff in the CCC, attend training in the recognition of sick children. The NHSE “recognising sepsis tool” for all staff, has been rolled out.

SCAS took part in the national trial on sepsis recognition in children and we were able to inform changes to NHS Pathways as a result. during this time SCAS reviewed and audited calls relating to sepsis and found call handler recognition to be good.

SCAS has been working with NHS Pathways, HSCiC (data centre) and NHS England to assist in work relating to the early recognition of sepsis. A pilot was launched and data has been collected and provided in a redacted form to the organisations involved. This data was subject of a joint multi agency professional review. At this review all redacted calls were listened to and a range of consultants and senior nurses focused on specific areas and questions which could help to identify sepsis.

The outcome of this work has resulted in a series of changes that have been made to the NHS Pathways triage system, these went through clinical authoring and were put into NHS Pathways version 12 which was launched in late 2016.

data is currently being collected around these new questions/criteria which will inform future releases of NHS Pathways.

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

We achieved our aims in this indicator.

SCAS has worked with the clinical commissioning groups and GPs to ensure the clinical information on discharge summaries is appropriate and the GP discharge summary is running across Hampshire and Thames valley areas.

most GPs have a secure email address to receive the summaries, for those GPs still to create nhs.net accounts, commissioners are working with practice managers to achieve this.

There were pilot practices across SCAS to test the technology which was successful prior to roll out.

The information in the discharge summary has now been approved by Wessex and Thames valley LmCs (Local medical Councils).

A survey in April and may 2017 is planned to ensure that GPs are satisfied with the information being received.

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

We achieved our aims in this indicator.

SCAS has been training and developing relevant managers’ knowledge around recording, analysing and feeding back on HCP feedback. This information is reported on to Trust board and to commissioners through contract review meetings across all services (NHS 111, NEPTS and Emergency and Urgent Care).

HCP feedback is now formally recorded in the patient experience module of datix (incident reporting system). HCP feedback forms were agreed with commissioners for each area.

The use of datix for logging HCP feedback has meant a standardised and clearer view of that feedback which is really important in shaping improvements to services. The reporter can then receive a timely response to the outcomes and risk levels can be assigned and recorded. The documents section on datix supports any investigation and closure dates are entered.

2. Clinical Effectiveness

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

We achieved our aims in this indicator.

The Trust’s long waits audit has matured significantly during 2016/17.

Joint clinical governance and operations meetings occur every month in the North and South areas of SCAS. Group membership includes representatives from Emergency & Urgent Care (E&UC), clinical governance, the Emergency Operations Centre (EOC) and business intelligence (bi) with NHS 111 now being represented at every meeting. The group is well supported by the director of Operations with E&UC’s Senior Operations manager chairing both groups.

3

//194 //195

A sample of long waits is reviewed by the group through their journey with SCAS including Red, Green and HCP calls; each incident is risk graded and patient experience evaluated by the group. Any incident which flags as high risk is reported via datix for a full investigation.

As each incident is reviewed actions are identified and allocated a responsible owner. Clinical governance leads hold responsibility for ensuring actions are completed and the log is updated; this is shared with commissioners for assurance.

The clinical governance leads have also developed a quarterly report which shows themes and trends for long waits from the audit findings and highlights actions and recommendations. This report is reviewed internally via the Patient Safety Group and also with senior E&UC management at level two meetings before being shared externally. Joint workshops with commissioners have also been conducted. We will continue to develop this approach to ensure outcomes for patients are monitored and improvements made alongside the Green project.

Grades of all Long Wait Calls - July 2015 to September 2016

Final Grade of Long Wait by Year, Month YTD

July Aug Sep Oct Nov dec Jan Feb mar Apr may Jun Jul Aug SepReds 9 5 6 3 9 9 8 13 14 5 13 15 15 13 1030’s 14 18 19 19 17 16 14 10 9 21 10 9 9 9 1760’s 14 15 2 11 8 7 13 8 10 5 10 12 12 14 7HCP 2 1 0 11 7 6 8 5 8 6 7 5 4 4 4 5HCP 4 0 0 1 0 0 0 0 1 0 0 0 0 0 0 1

Apr 16 may 16 Jun 16 Jul 16 Sep 16 Oct 16 Nov 16 dec 16Reds 5 13 13 13 13 16 16 16Green 30 21 10 9 9 8 8 8 9Green 60 5 10 12 2 5 8 8 8HCP 1hr 7 5 4 1 2 4 4 2HCP 2hr 0 0 0 1 4 4 4 5

Vo

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um

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ents

25

20

15

10

5

0

25

20

15

10

5

0

//196 //197

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

We partially achieved this indicator in 2016/17.

High intensity users are those patients who call the ambulance service frequently, often for specific health or social reasons. SCAS has introduced case managers for demand management across the SCAS footprint to help this group of patients find the right and appropriate care. We work with our health and social care partners to do this.

We have premises/patient management plans (PmPs) on our iT systems to enable either CSd (clinical support desk) or NHS 111 clinicians to triage the patient to the principal provider, if the patient presents as ‘normal’ (for that individual). These plans assist our clinicians in signposting the patient to the right place for ongoing issues and are supported by primary or secondary care clinicians across the health economy.

if an ambulance dispatch is required, there is a second opportunity for crews at the scene

to align the patient’s care appropriate to need through use of the plans.

SCAS has had a number of demand practitioners working across the different CCG areas. The demand practitioners receive patient referrals from operational and call centre clinicians, as well as reviewing the frequent caller demand activity by locality, to identify patients where intervention would be beneficial. Frequent calling patients mostly have genuine needs, but often this is not a need for an emergency ambulance response.

The demand practitioners review the demand and clinical information that SCAS holds, as well as discussing with the patient, to identify the root cause of need and then work with the patient, relevant health and social care professionals to get the patient’s needs met and managed. in addition, all of these patients are routinely referred back to primary care for review and intervention.

We directly support and navigate the patient in the healthcare system, the demand practitioners will develop a Patient management Plan (PmP), to enable the

future effective and efficient management of the patient aligned to need and the most appropriate provider, who can meets those needs. This enables SCAS clinicians to provide the optimum care for the patient.

SCAS currently has 190 patients with ‘active’ patient management plans, which are directly linked to CAd and are immediately visible to 999 and NHS 111 CCC staff. if a crew is dispatched to the patient, the information is provided to attending responders.

The following examples are patients who previously received an emergency response.

49 year old presented to 999, 270 times and received 238 ambulance attendances in twelve months. Presenting as fitting and seizures. Demand practitioner intervention provided patient support and worked with a specialist service and their GP. A Patient Management Plan was produced. The patient has had only four ambulances in the last five months.

51 year old presented to 999 and NHS 111, 110 times in twelve months. The patient has overdosed, low mood and a tight chest. The demand practitioner produced a Patient Management Plan and in the last three months of 2016 the patient reduced to 33 presentations.

52 year old presented to 999 and NHS 111 with chest pain and dizziness and often anxiety 299 times in twelve months. After intervention the patient has had 83 presentations.

73 year old who presented to 999 and NHS 111, 39 times in twelve months. Demand practitioner intervention and Patient Management Plan produced. Patient often has chest pain and is frail. Following intervention the patient has been moved into a suitable facility with no calls.

2c. Improve compliance with limb fracture care bundle

We partially achieved this indicator.

SCAS is committed to providing the optimum care for patients with limb fractures and although compliance with the care bundle has been challenging we don’t receive intelligence to tell us that those patients are not cared for appropriately.

The care bundle has two main elements – immobilisation of the fracture and pain relief.

during 2016/17 there have been loses and gains in different elements of the care bundle. SCAS has improved on immobilisation but pain scores are not always recorded therefore reducing our compliance score.

improvements have been made in the Electronic Patient Record (ePR) to remedy the early issues of recording pain scores working on a compliance tool for the new Spring release in July 2017.

The ePR system has had a new tool constructed to prompt staff at the completion of the record to populate the fields that have not been completed based on the primary condition recorded.

Limb fracture care bundle compliance is monitored monthly through the integrated Performance Report to the board and to commissioners in contract review meetings.

Root Cause of Long Wait -Catergory by Quarter

//198 //199

3. Patient Experience

3a. To improve the number of formal complaints responded to on time by the Trust

We achieved this indicator.

The organisation reports on key performance indicators for patient experience, monthly to the Executive management Committee and Trust board. Performance against the 25 day response for complainants has improved throughout the year as demonstrated in the chart below.

MONTH % Performance Number Received Number Closed

April 10.7 36 56

may 8.5 55 60

June 12.9 49 63

July 21.4 45 42

August 29.7 51 74

September 48 34 52

October 44 43 35

November 32 40 54

december 36 27 47

January 24 20 70

February 74.3 42 39

march 78.3 27 37

TOTAL 57.25 469 629

The organisation ensures that responses to complaints provide the complainant with a full explanation of where things have gone wrong, if they have, and how the organisation has learned and implemented necessary change. The quote below is from a complainant following a complaint response.

“….as you candidly admit in your letter the response time was unacceptable I have to say that I was both surprised and pleased by the detail and candour of your letter. You have clearly investigated the matter thoroughly and written me an honest, accurate appraisal.”

The organisation uses an aggregated learning approach which will not only ensure that learning from complaints is cascaded throughout the organisation, but that this is used together with learning from risk, patient experience surveys and claims, to ensure that the learning recognises themes from across the previously mentioned areas, as well as demonstrate how this learning is implemented and embedded.

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

We achieved this indicator.

The Accelerated Clinical Transformation (ACT) programme began in 2016 to accelerate the pace of planned change which was hoped to bring clinical benefits for patients and staff alike and improve patient outcomes. in addition it would increase SCAS and partner provider efficiency, enable us to generate new ideas using modern technology and joint working with our partners, to support people in their own homes and to test pilot concepts. One of those important concepts is the End of Life pilot.

The End of Life pilot is currently running in the West berkshire area of SCAS. PallCall is the berkshire West palliative care co-ordination service managed by qualified nurses. it is a first point of contact for patients, families, carers and health and social care professionals who require 24 hour advice, care and support for patients in the last year of their life.

The service has been designed to improve the overall experience and continuity of care, and to support health and social care professionals involved in caring for patients at the end of life.

Qualified nurses, skilled in palliative care, will triage calls to identify the most appropriate local provider to respond to the caller’s needs.

120

100

80

60

40

20

0

Apr 16

may

16

Jun 1

6Ju

l 16

Aug 16

Sep16

Oct 16

Nov 16

dec 16

Jan 1

7

Feb 1

7

mar

17

F12 Plan Scores

F2 Analgesia

F3 immobilisation

F4 Circulation tested

FC Care bundle

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Benefits for patients, their families and carers:

è A first point of contact that is responsive and that allows timely access to the services they require

è Flexible care provision in line with the patient’s choices and preferences that supports them, their families and carers to achieve the best quality of life and outcomes

è more opportunities to receive end of life care at home and to minimise the need for hospital admission in an emergency

è improved continuity of care for patients, their families and carers

è medication reviews to keep patients comfortable at home

è Higher skills and knowledge base in staff who are delivering their care thanks to a structured training programme for staff

è improved overall experience of end of life care for patients, their families and carers

PallCall went live with a soft launch in November 2016 and the analysis in march 2017 showed:

Hospital Avoidances x42

GP Avoidances x60

Telephone Calls x564

A survey was conducted to receive staff feedback on the project, some of the findings are shown below:

è 57% of people that used the service found it helpful however, not all of them used the PallCall part of the service

è For those who did use it, the average call back time from PallCall was 5-15 minutes

è PallCall had access to patient’s notes 75% of the time

è Overall the call handlers from PallCall were helpful, only one was reported as unhelpful

è 75% of people who used the service would use it again

è There was a 100% positive outcome for the patients across the area

è 60% of those patients were left at home the remaining 40% were referred on but unsure were as the clinician had not filled in the ‘specify’ section of the survey

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

We achieved this indicator.

We partially achieved this indicator.

We have improved our responses to NHS Choices feedback, however, two of the NHS Choices reviews posted this year were not responded to in two working days. Although the indicator was only partially met the Trust can show an improvement this year. All feedback was though, responded to.

Q1 – one review responded to outside target time

Q2 – all reviews responded to in a timely manner

Q3 – all reviews responded to in a timely manner

Q4 – one review responded to outside target time

Patient surveys are reported to our Patient Experience Review Group and in commissioner reports for contract review meetings. The board receive survey data at each meeting. Themes are included in the Trust’s quarterly aggregated learning report from which actions are collated and effectiveness monitored.

3.2 OTHER QUALITY IMPROVEMENTS AND INFORMATION

The next section of this report highlights other successes in quality improvement which SCAS has made to improve the quality of our services to patients.

è The safeguarding team now produce an overview report for the SiRi group (Serious incidents Requiring investigation) with regard to serious case reviews, safeguarding adult reviews, domestic homicide reviews and partnership reviews every six weeks to inform the group of these reports and their progress.

è Every complaint, investigation and SiRi now has a safeguarding guidance sheet sent out to the investigating manager to ensure that we meet our statutory safeguarding requirements when completing any of the above investigations.

è Section 42 enquiries (these are safeguarding alerts raised against our staff for alleged harm/abuse caused to our patients by our staff) now have a checklist, guidance notes and a form to complete so the safeguarding team can collate and complete the Section 42 inside the strict 28 day timescale.

è mental health nurses in the call centres project has been completed. All key outcomes achieved positive results showing a 14% reduction in the number of unnecessary journeys to emergency departments. There has been positive feedback from service users, SCAS staff (NHS 111/999 and frontline) and partners. Our lead commissioner is taking the

results to the Commissioning board to seek additional funding to widen the area included (currently Oxfordshire and buckinghamshire). We now have three nurses covering six days a week 18:00 – 04:30hrs.

è The Trust mH Lead is a member of the Trust Health and Wellbeing Group and provides specialist advice and guidance. Funding for staff to receive mind training for managers has been secured.

è A pocket sized aide memoire (mental Capacity/mental Health Acts and the new suicide risk assessment tool) has been produced and funding secured for these to be printed and made available to all frontline staff.

è A mental health raising awareness campaign was delivered in September, in conjunction with the communications team. Five topics were covered in Staff matters (the staff magazine published weekly). These included bipolar disorder; Suicide Awareness (to coincide with the World Suicide Prevention day); depression; dementia and Anxiety.

è We are a leader in dementia Awareness within ambulance services, and were one of the first to have a named dementia education lead. This was positively recognised by the CQC in 2016 and other trusts have contacted SCAS for support in achieving similar outcomes. The SCAS dementia Strategy has been adopted by other Trusts and is currently being adapted to form ‘best practice’ guidelines nationally.

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è The Trust mH Lead was part of the specialist group who produced a new ‘mental health’ chapter in the UK Ambulance Service Clinical Practice Guidelines (JRCALC, 2016). This is the first time a chapter has been included on mental health, and this also included a new suicide risk assessment tool (educational resources developed for SCAS to support the implementation of this have been shared nationally).

è The Trust is currently involved in a national pilot to test a mental health screening tool, being developed for use in the pre hospital emergency care environment. This is part of the AACE developments to support implementation of the NHS Five Year Plan.

è SCAS has extended its labour line service increasing the number of midwives we have in our call centres to improve the quality of care and outcomes for maternity patients.

ANNEX 1: STATEMENTS FROM COMMISSIONERS, HEALTHWATCH, OVERVIEW AND SCRUTINY COMMITTEESBracknell Forest Council’s Overview and Scrutiny response to the SCAS priorities is as follows (April 2017):

bracknell Forest Council’s Health Overview and Scrutiny Panel welcomes the opportunity to comment on South Central Ambulance Service’s proposed quality priorities, going forward.

We commend the widespread engagement undertaken by the Trust to formulate these draft priorities.

We are supportive of all the priorities, but we recommend that:

è SCAS should confirm that clear and measurable outcome indicators will be in place for all the stated priorities.

è Given the pressure on hospital A&E admissions nationally, we suggest that SCAS raises with NHS England the need for a further, mandated indicator to gauge the effectiveness of the ‘Hear and Treat’, and ‘See and Treat’ actions by ambulance service trusts.

è The adequacy of staffing has a crucial bearing on the practicality of all the quality priorities. Continuing our long-held concerns about the pressure on paramedic resources, we therefore suggest an additional indicator on the lines of, ‘improve recruitment and retention of paramedics, and reduce the reliance on agency staff.’ We also request that this is supported by SCAS giving evidence of what has been achieved to date, in terms of a reduction in the usage of - and expenditure on - agency paramedics.

è indicator 3C is well-intentioned but lacks a robust evidence base. We suggest adding at the start, ‘Through direct feedback from clinical commissioning groups and patients’ fora, ensure a service that is....’

many thanks and kind regards

Richard beaumont

Comments by Bracknell Forest Council’s Health Overview & Scrutiny Panel (07/05/17)

General comments

è We welcome the opportunity to comment on the Trust’s Quality Accounts (QA) Report for 2016-17.

è The Health Overview & Scrutiny Panel appreciates the continuing good dialogue with the Trust. This has included a regular meeting every two years with the Trust’s Chief Executive, in public, to review the ambulance service’s performance and plans.

è With the national focus on the adequacy of resourcing of the NHS, it would be helpful if the QA gave some indication of whether the Trust is adequately resourced going forward, and if not, what measures are to be taken.

è We are impressed by the good innovations made by the Trust, for example piloting NHS 111 online, the use of Skype for high intensity care homes (page 176), and the management of high intensity users (page 196), and would like to know whether SCAS share these innovations with other ambulance trusts?

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Specific comments

è The Panel congratulates the Trust on its overall ‘Good’ rating from the Care Quality Commission (CQC), achieved during the year, which reflects much credit on the way the Trust is run for the benefit of patients. We particularly welcome the significant improvement in the Non-Emergency Patient Transport Service (previously identified as being weak) and the way that the Trust is responding to other opportunities for further improvement identified by the CQC (pages 144-145).

è We support the Trust’s strategic aims (page 158 onwards) and would welcome some more detail on these, for example on ‘To transform our cost base’ some indication of how this will be done and the desired outcome; and ‘winning viable contracts’ would presumably be confined to those which are consistent with the Trust’s statutory duties as an ambulance service?

è it would be interesting to know whether the new specialist paramedic role (page 159) is a national or local initiative, and how this will impact on staff retention in this vital area.

è The statement ‘SCAS will enable people to travel safely between home and health care settings’ should not be so broad, as many people visit health care settings (e.g. their GP surgery) with no involvement of SCAS.

è Having a mental health nurse available in the Clinical Contact Centre seems to be a valuable innovation (page 161). it would be helpful to comment on whether this partnership endeavour is to be extended to the berkshire Healthcare Trust.

è The QA makes a brief mention of the Sustainability and Transformation Plans on page 162. it would be helpful to add whether (and if so, how) this major development will entail any changes to the delivery of the Trust’s services. in that

regard, it would be interesting to know the current position in relation to delayed transfers of patients from ambulances to hospitals’ emergency departments, which has continued to be reported in the national media.

è The improved feedback from staff in the annual staff survey is to be commended (page 167).

è The Panel is supportive of the Quality Priorities for 2017-18 (page 171), and we contributed our views on the draft priorities earlier in 2017.

è Could the call abandonment rate be improved by publicising the number of unnecessary calls received, so as to discourage undue demands on the Trust’s time (page 175)?

è We could not see any reference to the staff vacancy rate in the Trust, despite this having been a priority action previously. We suggest the QA comments on this, particularly in relation to paramedics. Looking further ahead, it would be interesting to know whether the Trust has formulated any plans to address the possible impact of bREXiT.

è The use of private ambulances is mentioned on page 183. it would be helpful to have a statement on the Trust’s policy on using private ambulances, and the extent of their usage, particularly as they are seen to be more costly than the Trust’s own ambulances.

è We appreciate that meeting the national time targets to attend emergencies have become increasingly challenging due to growing demands on the Trust. Nevertheless, as the targets have been underachieved slightly, we suggest that the report states the targets (75% for Red calls, and 95% for 19 minute calls) and comments on the reasons for the performance levels as well as any further actions (page 187).

è The Panel commends the level of achievement of the Trust’s quality priorities for 2015-16 (page 192).

è We suggest that the report describes what is being done to speed up the response to complaints, to meet the 25 days target (page 198).

è The Panel commends the leading work by the Trust in relation to dementia Awareness (page 201).

è We suggest the QA includes more information on the effect on the Trust’s work of falls by elderly people.

The Oxfordshire Joint Health Overview and Scrutiny Committee (HOSC) considered SCAS’s emerging quality priorities for 2017-18 at its meeting on 6 April 2017 and since then Committee members have reviewed the full draft Quality Account for 2016-17.

The Committee takes a great interest in the service provided by SCAS to Oxfordshire residents and its effect on patient outcomes. Whilst we recognise the influence of a range of health and social care services on the quality of clinical outcomes, ambulance handover delays at Oxfordshire A&E departments are a particular area of concern for the Committee.

As such, HOSC would like to see a greater focus on partnership working in the Trust’s quality priorities for next year and to see the Trust take steps to further develop operational protocols with Oxfordshire’s hospitals to ensure ‘call-to-needle’ times are improved.

moreover, the Committee would encourage SCAS to actively engage with health partners in Oxfordshire to shape the transformation proposals under the buckinghamshire, Oxfordshire and berkshire West Sustainability and Transformation Plan. The Ambulance Service is an essential partner in the delivery of responsive care and therefore, must be a key contributor to the plans for change.

The Committee would welcome further discussion at a future HOSC meeting about the progress being made against the Trust’s 2017-18 priorities.

Yours Sincerely

Cllr Yvonne Constance ObE

Chairman Oxfordshire Joint Health Overview & Scrutiny Committee

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Healthwatch Milton keynes, 12 May 2017

Thank you for giving us the opportunity to comment on the draft Quality Account for 2016/17. We found that the report contained clearly stated objectives, with a useful and informative introduction by the Chief Executive. We would have appreciated a more detailed list of contents or index, in order to make the report more accessible and easier to navigate. A more extensive and focussed glossary of terms and acronyms would also be helpful.

As an overall description and assessment of the work performed by SCAS the report was informative at a general level, but from the viewpoint of Healthwatch milton Keynes, there was virtually no local information (we only found a single casual reference). We understand that localisation presents difficulties for an organisation with such a broad geographical remit, but we know from other QAs that it is possible to provide an element of local perspective. Without this component, the QA is bound to underplay an excellent performance record which we appreciate from our direct experience.

We were also surprised to see no reference to the work of SCAS in relation to STP planning and future quality service delivery.

Yours sincerely

maxine Taffetani

CEO, Healthwatch milton Keynes

Milton keynes Council, Health and Adult Social Care Committee, 11 May 2017

General

The Quality Accounts (QA) for 2016/17 is an improvement upon the QA for 2015/16.

The Panel commends the following in the QA:

è Priorities which were clearly outlined and could be understood.

è Chief Executive’s statement was informative providing a useful summary of the issues to be explored in the QA.

è The very good CQC report which judged the SCAS to be “delivering outstanding care to patients”, and “staff developing supportive and trusted relationships with regular users”.

è However the Panel was disappointed with the general standard of the QA, which lacked focus and reference to milton Keynes. The overall impression was that it was a generalised report providing inadequate information with which service quality in milton Keynes could be judged.

The Panel was particularly concerned about the following aspects of the QA:

è There was inadequate local detail; the Panel has experience of having reviewed QAs presented by other healthcare organisations providing services across geographically disparate areas which have been able to provide local detail for milton Keynes on a whole and areas within milton Keynes that they serve. A similar critique was provided of the QA submitted last year, but with no improvement in this year’s publication.

è The index was not as user friendly and comprehensive as had been hoped. Recommendation also made that the Glossary published by other NHS bodies in their QAs be used as a guide to bring about improvement in the Glossary provided.

è There was inadequate evidence of how the “patient experience” was factored into or reflected in the QAs. Whereas it is not being said that this was not included in the QA, it should however have been more apparent.

è There was very little evidence of how the Sustainability and Transformation Plan (STP) and associated health service integration is planned for so as to ensure quality service delivery in future. How do the services provided by SCAS link into the STP? What will be the relationship with the STP Team?

è The reported high performance outlined in the QA needs to be made clearer especially as relates to service performance in milton Keynes.

è The QA could be better structured with page numbering. The QA focusses on the future and then on the current period, whereas it is felt it would have been better if the QA focussed on the current and then the future period.

Summary

The Panel appreciates that the QA for SCAS is supposed to provide insight to a general readership of progress in health service provision. However for the audience in milton Keynes the QA failed owing to a lack of borough specifics or reference. The QA was difficult to navigate due to improvement needed in the index. it is strongly recommended that for future QAs, a page at least dedicated to areas where service is provided such as milton Keynes be included as this would be extremely useful in the overall QA. This is done by other health service providers in their QA.

Thames Valley CCGs, 11 May 2017

berkshire West Clinical Commissioning Group (CCG) Federation has reviewed the South Central Ambulance Service NHS Foundation Trust Quality Account and is providing this response on behalf of Newbury and district CCG, North and West Reading CCG, South Reading CCG, and Wokingham CCG and all associate CCGs. The Quality Account 2016/17 provides information across a wide range of quality measures and gives a comprehensive view of quality of care and upcoming priorities to be undertaken by the Trust during 2017/18. There is evidence that the Trust has relied on internal governance structures to maintain oversight and external assurance mechanisms triangulating the available data to maintain and improve safety, quality and effectiveness of the patient population.

The CCGs are satisfied with the accuracy of the data and information contained in the Account. The CCGs agree that the nine key priorities, within the domains of patient safety, clinical effectiveness and patient experience identified by the Trust are appropriate and a true reflection of findings and discussions we have had with them throughout the year.

QUALITY ACCOUNT 2016/17

The Quality Account for 2016/17 clearly identified the successes of South Central Ambulance Service to date and also areas for further improvement and continuing focus. The CCGs support the Trust’s openness and transparency and is committed to working with the Trust to achieve further progression and successes in the areas identified within the Quality Account. This will be carried out through a number of both proactive and reactive mechanisms and collaborative, integral and multi-agency working.

CQC REPORT

The CCGs are pleased to note the positive achievement of South Central Ambulance Service being the first Ambulance Service to receive an overall rating of Good. The CCGs are also very pleased to note the achievement of the Caring element of the

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Patient Transport Service being rated as Outstanding. The comprehensive action plan produced by South Central Ambulance Service as a result of the inspection is robustly monitored internally, and via CCG assurance mechanisms.

PATIENT SAFETY: THREE IMPROVEMENT PRIORITIES

We are pleased that the Trust has reached achievement in all of the three areas, with demonstrable positive examples provided in work around recognising children with sepsis, and sending discharge summaries electronically. The work around utilising datix for recording healthcare professional feedback is positive, and has also been completed alongside work under the Patient Experience domain.

it is positive to see that work regarding recognition of sepsis in children will be expanded on in 2017/18 by undertaking work to improve the recognition of sepsis in adults.

CLINICAL EFFECTIVENESS: THREE IMPROVEMENT PRIORITIES

The Trust has made significant progress during 2016/17 with regards to the long wait reviews which have matured throughout the year and now produce a quarterly report on

the themes and trends that are identified, along with any identified actions. The work regarding very High intensity Users has likewise matured, and the work has now become business as usual for the Trust.

it is acknowledged that the Trust has experienced difficulties all year in meeting the limb fracture care bundle thresholds, which the CCGs have been kept fully appraised of the actions associated with improvement via a number of forums. However, it is with acknowledgement that there still requires improvement of which the Trust has identified actions to demonstrate measurable changes.

in 2016/17, the Trust has also not been able to consistently deliver the ambulance response time standards for Red 1, Red 2 and Red 19 for the Thames valley contract. This was due to a number of factors, including workforce pressures due to difficulties in recruiting to paramedic posts and increased demand. Recovery action plans have been developed and the CCGs welcome the quality priorities to ‘complete a clinical governance review of the Emergency and Urgent Care 999 service and implement the recommendations,’ and ‘evaluate and develop clinical assessments in call centres ensuring consistent methods and application across the services’, to support in this area of work.

PATIENT EXPERIENCE: THREE IMPROVEMENT PRIORITIES

The CCGs welcome the improvement to the number of formal complaints responded to on time, due to the continued poor performance the CCGs issued a Contract Performance Notice in January 2017 and are pleased at the rapid improvement in performance.

it is pleasing to see the Trust providing timely responses to reviews left on NHS Choices. The Trust also has clear routes for receiving patient feedback via a number of sources and ensuring that this is gathered and reviewed to consider any actions that are required.

South Central Ambulance Service are reporting that they have achieved their priority regarding increased support for patients in their own home when they are reaching their end of life. The CCGs would note that there is not any narrative within the Quality Account to confirm this achievement, however reviewing the planned actions from the 2015/16 Quality Account, the CCGs have received evidence via other forums that confirm that the planned priorities have been undertaken.

The Trust has clear plans for 2017/18 to develop their collection of, and actions from, feedback in order to drive improvements within all of the services that are delivered by South Central Ambulance Service.

OVERALL

We are pleased that the Trust has chosen to continue the focus on the priorities of patient safety, clinical effectiveness and patient experience, the CCG recognises that

a vast amount of work has been undertaken over the past year; however there is also recognition that further work is required in an increasingly challenging environment for ambulance trusts and the CCGs feel that the priority areas chosen adequately focus on the key areas for improvement.

We support the Trust in its continuing focus on the positive results from the 2016/17 priorities, overall Good rating from CQC and their continuing work to further those improvement and strengthen priorities over the coming financial year. Overall, there have been many positive highlights for the Trust and the CCG has gained assurance via a number of forums and by the undertaking of quality assurance visits, therefore remain positive that the Trust are committed to offering high quality and safe care to our patients.

Fareham and Gosport Clinical Commissioning Group, 18 May 2017

Fareham and Gosport Clinical Commissioning Group (F&GCCG), as lead commissioner, and its associate commissioners of Southampton, Hampshire and Portsmouth (SHiP) welcome the opportunity to participate in the governance “sign off’’ process for the 2016/17 Quality Account of South Central Ambulance Service NHS Foundation Trust (SCAS) for 999, non-emergency patient transport (NEPT) and the 111 Services.

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Commissioner Introductory Statement

Commissioners are grateful for the opportunity to comment on the Trust’s annual quality account for 2016/17 and have determined that it meets the required regulatory requirements. Commissioners are disappointed that the submission of the draft quality account did not allow the 30 day response timeframe that is nationally mandated, as this was highlighted to SCAS in the previous year’s sign off process.

Report Structure

The draft report reviewed is logically structured and is written in a style which would seem accessible to the public, stakeholders and commissioners alike. Commissioners have been advised by SCAS that the final report will meet the NHS mandated guidance for publications.

Commissioner Assessment Summary

The quality account reflects the positive outcomes from the Care Quality Commission (CQC) visit which took place in 2016, together with supporting narrative for other work that has taken place. The report would benefit from clearer outcomes, both qualitative and quantitative, which clearly demonstrate the positive impact that this work has had for the benefit of patients and the wider health system. Any outcomes and data that are reflected in future should clearly differentiate between the three services that SCAS provides.

Positive work has taken place in the recruitment of staff for the SHiP locality for the frontline 999 service . However, issues remain with high levels of vacancies being noted within call centres for NEPTS, 111 and 999 during the year, together with ongoing vacancies for clinical advisors. in

respect of workforce; it is positive to note that improving the delivery and quality of appraisals has been identified as a focus area following the 2016 staff survey results. Commissioners also look forward to seeing positive improvements with statutory and mandatory training during the year for all three services.

SCAS rightly reference their engagement with commissioning for quality innovation schemes (CQUiN). The report may have been enriched by including the positive outcomes from these schemes, including the work undertaken within the health and wellbeing across all three services which is reflected in the improved outcomes from the staff survey.

it would be helpful to make clearer how information relating to staff experiences recorded on datix is cross-referenced/informs action planning following the annual staff survey, Equality and diversity System (EdS2) and Workforce Race Equality Standard (WRES) staff monitoring. Compliance with, and achievement against, the NHS Equality delivery System is noted and action plans in relation to Workforce Race Equality Standard welcomed. Provision of additional training and advice to call takers in NHS 111 to support confidence, capability and capacity in managing calls from people in mental distress/crisis is welcomed, together with training of investigating officers.

SCAS are actively engaged in system wide work for high intensity users and it will be positive to see the continued collaborative working within the wider health system.

The continued engagement of SCAS in participating in the system-wide work is essential with the current increases in demand. Reducing inappropriate patient

conveyance or conveyance to alternative pathways must be a priority for 2017/18 together with the participation in schemes that focus on these areas with a minimum level of risk to patients.

Commissioners welcome and acknowledge the other improvements that have been identified in 2016/17 as detailed within the quality report, including your campaign regarding mental health awareness. We also recognise your engagement with the specialist group who produced a new ‘mental health’ chapter in the UK Ambulance Service Clinical Practice Guidelines (JRCALC 2016). it is also positive to note the improvements made with the electronic patient record (ePR) and the work that has taken place with clinical commissioning groups and GPs to ensure that the clinical information on discharge summaries is appropriate and received electronically.

PART 1

The Chief Executive’s quality statement provided includes recognition of the increased activity experienced across the whole health economy during the 2016/17 contractual year. SCAS has clearly identified the various services they provide. Additional information may have included that virtual call centres are operated within their organisation which provides resilience to the overall services. it is positive to note the personal thanks from the CEO.

There is clear information on what a quality account is and what needs to be provided in order to meet the statutory obligations . SCAS have clearly identified how the CQC inspection in may 2016 was conducted, together with the actions they ‘must do’ following the publication of the report in September 2016. Whilst SCAS have included

what they have done following the CQC visit the report may have been enhanced by identifying any improvements in outcomes that have since occurred. Although actions have been put in place following the CQC visit, areas of concern still remain for eg: compliance with appraisals and levels of statutory and mandatory training.

The Quality Account references the changes in the operating model of services and care. it would have been beneficial to explain the consultation process through the Trust’s board and how the impact of these changes will be measured to ensure they are achieving the desired outcomes.

much of the work identified within the clinical co-ordination centres is already in place, with evidence of welfare checks seen within the long waits reviews and within the quality innovation productivity prevention (QiPP) scheme for high intensity users of the SCAS services.

The specialist paramedic role has been in place for over 12 months and the report would have benefited from inclusion of qualitative data illustrating the impact that this role has had on patients and the wider health system.

in respect of the alternative transport scheme using private hire vehicles that has been included; commissioners are aware that this service was piloted during 2016/17 and a presentation has been received that provided assurance and outlined the governance arrangements supporting the scheme. The scheme has now been embedded within the Portsmouth and South East Hampshire area and is already being rolled out more widely. The report would have benefited from the inclusion of the current outcomes from the scheme.

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it is positive to note the work that has taken place in the Oxfordshire area for patients with mental health issues, with the provision of a mental health nurse within the clinical coordination centre (CCC) and the outcomes that this has achieved. it would be good to see this rolled out into the SHiP area and commissioners acknowledge the challenges SCAS has experienced in being able to identify mental health nurses to work within this locality.

Commissioners have been made aware that the non-injury falls pilot is already in place and the report would again, have benefited from quantitative and qualitative data regarding the outcomes to date.

SCAS are fully engaged with the Portsmouth System A&E delivery board in the progression of the green call project; to identify alternative pathways for patients with lower acuity symptoms who reach a disposition of attendance within 30 or 60 minutes through the Pathways algorithm (Green 30 and 60 patients). The benefits of this pilot being successful are acknowledged by commissioners. However, there is concern for delivery in view of the current vacancy rate for clinical advisors being available for roles of emergency call takers (ECT) to transfer the calls to within the CCCs and on-going challenges for recruiting to the clinical advisor role. An explanation of what the NHS Pathways algorithm is would be helpful to readers .

The details regarding the ambulance response programme (ARP) are clearly described within the report. An update was due to be provided nationally in April but unfortunately due to the notification of a general election and purdah being in place no update can currently be provided.

The sign up to safety pledges are noted and commissioners are pleased to report that a positive amount of work has taken place within the SCAS Patient Experience Team (PET). The pledges and actions detailed recognise feedback identified from

the manchester Patient Safety Framework (maPSaF) that have been shared with commissioners through the year. SCAS has also participated in multi-agency reviews and are open and welcoming for commissioners to visit teams, services, localities and participate in workshops in order to learn and obtain assurance.

it is positive to note the outcomes from the CQC review of the workforce equality standard as being ‘outstanding’ together with the actions identified in order to improve the workforce race equality standards . The positive outcomes from the 2016 annual staff survey clearly reflect the internal work that has been on-going through the year. This is also reflected in the staff engagement rating and commissioners congratulate SCAS on their outcomes.

Commissioners note the comments made in respect of duty of Candour and evidence of this is clearly seen within their investigations for serious incidents.

The statement of assurance from the board is noted and it is positive to see that the board has sought assurance from a variety of information. it is also positive to see the national clinical audits and national confidential enquiries that SCAS has participated in, which shows commitment to a national plan for improvement. As stated in last year’s statement, it would be beneficial for the report to note what quality benefit this has had for the organisation . The clinical research and conference involvement and publications again show a commitment to keeping up to date with medical and technical changes in the delivery of emergency care.

The Quality Account would be enriched from illustrating how SCAS is performing when compared with other trusts in respect of ambulance quality indicators (AQls) and performance etc over the last 12 months.

PART 2

Quality Improvement Priorities for 2017/18

SCAS outlined its priorities for 2017/18 and all Hampshire associate commissioners had the opportunity to review these. A written response with our comments on those initially identified, together with improvements and suggestions of alternative/additional areas of focus were shared with SCAS but the priorities included for 2017/18 do not reflect the feedback provided.

it is positive to see that SCAS has recognised the need to improve data quality. Challenges regarding the timeliness and accuracy of data have been discussed across all services during the year. The recognition of the need to improve data seems at odds with comments included under the NHS improvement mandated Quality indicators where reference is made to the Trust having ‘robust data quality process for ensuring performance reporting’.

Patient Safety

1a. To improve the recognition of sepsis in adults

Sepsis has been a priority for two years via CQUiN, Sign up to Safety and a quality account priority for SCAS for the recognition of sepsis in the under 5s last year. As SCAS state within their report; the tools have already been developed and are in use. SCAS

were previously unable to provide outcomes due to challenges with the acute trust data. Without knowing the final diagnosis of sepsis from the acute trusts commissioners believe it will be challenging for SCAS to identify those patients they need to audit. Commissioners therefore seek more understanding of what SCAS are proposing and how improved quality will be measured.

1b. To complete a clinical governance review of the Emergency and Urgent Care (E&UC) 999 service and implement the recommendations.

it would be beneficial to understand how this element will improve quality and what the measureable improvements that will be reported are.

1c. To ensure a consistent approach to medicines management processes which are compliant with the regulatory standards.

Commissioners are aware that during 2016/17 a medicines management task and finish group has already been established. Outcomes to date have been shared and have been reviewed by commissioners. Commissioners are therefore keen to understand what the anticipated measureable outcomes will be, other than a 10% reduction in controlled medicines incidents, as incidents are also being reported with medications that are not controlled medication.

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1d. To implement the workstreams in the national ‘Sign up to Safety’ campaign to improve patient safety across all services

Commissioners agree with the proposal but would be keen to understand what the deliverables have been from the campaign to date.

Commissioners had proposed that SCAS may also like to consider the continuation to develop risk management strategies to ensure that those patients experiencing a long wait are prioritised in accordance with their needs to avoid harm.

Clinical Effectiveness

2a. To demonstrate an improvement in call abandonment for non-emergency patient transport (NEPT), 999, NHS 111 and healthcare professionals (HCPs) (2 year priority)

increasing on-line booking for NEPTS is an area of focus for SCAS at the current time so commissioners question whether this should be combined with an improvement in call abandonment as well. it would be essential that each service (NEPT, 999 and 111) is clearly measured for improvement separately. Work on improving the rate for the 111 service has resulted in the rate being below the threshold of <5% for 2016/17 and this would be expected to be maintained as a matter of course.

2b. To evaluate and develop clinical assessments in clinical coordination centres (CCCs) ensuring consistent methods and application across the services (3 year priority)

Commissioners agree with the proposal but it would be beneficial to know how will this be measured and what qualitative outcomes are anticipated? Please also note commissioner comments regarding concerns for 80% of eligible green calls to be transferred for further clinical assessment in view of on-going workforce challenges.

Commissioners had also proposed that SCAS may like to consider providing qualitative data on the impact of specialist paramedics on providing the right care, in the right place and the right time and avoiding inappropriate hospital admissions.

Commissioners had also requested that SCAS consider the need to improve and maintain the required standards for all statutory and mandatory training compliance as this area was identified during the CQC visit. Commissioners have also had concerns throughout the contractual year as for the third consecutive year training compliance levels have not been at the required levels.

Finally for clinical effectiveness commissioners had proposed an area of focus which should be to clearly identify performance and progress split between the 999, 111 and NEPT services so that areas requiring improvement are clearly identified. data is currently often provided collectively for the three services and as an organisation.

Patient Experience

3a. To report on the Friends and Family Test (FFT), staff, patients and actively demonstrate that we seek feedback and act on results.

Commissioners acknowledge the inclusion of the mandated requirement to report on FFT to obtain staff and patient feedback. Commissioners are aware that SCAS, in collaboration with all national ambulance trusts, are in discussions with NHS England regarding ceasing using this metric due to the on-going challenges in obtaining this feedback from 999 service users. Commissioners are therefore supportive of the identification of news way of obtaining feedback. Commissioners also look forward to SCAS identifying and evidencing how they have acted upon that feedback and made changes. An App might also usefully be considered to improve responses.

3b. To evidence learning from HCPs feedback in all services (999, 111 and NEPTS)

Commissioners would suggest that SCAS look to improve and learn from all feedback including HCP, complaints, concerns, incidents, Quasar (commissioners reporting tool) and safeguarding. it would be beneficial to understand how SCAS propose evidencing that learning has been identified and what impact that this had, together with how this will be cascaded through the organisation.

3c. To develop systems that engage and seek feedback from hard to reach groups

Commissioners welcome these developments.

Part 3

Achievements reported against the 2016/17 priorities and overall quality experience

Throughout 2016/17 there has been a contract performance notice (CPN) in place due to under performance across the Red 1, Red 2 and Red 19 categories. The Trust developed a recovery action plan (RAP) that has been monitored via the Contract Review meetings (CRm). At the end of the 2016/17 financial year SCAS reported that they had not reached the nationally mandated targets for Red 1 and Red 2 (75%) or Red 19 (95%) for the Southampton, Hampshire and Portsmouth (SHiP) contracted locality.

Throughout the year SCAS have been engaged with the A&E delivery boards across the SHiP locality. The multi-agency delivery boards have been established to address the urgent and emergency care system-wide pressures and challenges that have been experienced through the year.

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Patient Safety

1a. Improve the recognition of sepsis in children under five years old in clinical coordination centres (CCCs)

Commissioners recognise the national work that SCAS have been involved in, including identifying changes to be made to the NHS Pathways audit tool. However, the report would have benefited from the inclusion of qualitative data that supported their statement that audited calls relating to sepsis recognition was found to be good. Without any information being compared to an agreed baseline it is challenging for commissioners to determine whether the recognition of sepsis in under 5 year olds has been improved.

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

As identified in last year’s commissioner statement; much of this work had already been completed. it is positive to note however that this is now fully rolled out across Hampshire and Thames valley. SCAS have also made progress in the year regarding private providers also being able to send discharge summaries electronically to GP Practices within the contracted areas. Commissioners recognise that SCAS will be impacted by practices merging within a changing primary care landscape. There is therefore a need for CCGs to ensure that SCAS are kept informed of these changes so that the appropriate secure e-mail addresses are made available.

1c. To develop feedback mechanisms for healthcare professionals (HCPs) who report incidents via the Datix system.

Training and development of relevant managers’ knowledge using datix around recording, analysing and feeding back from HCP feedback and reporting to the

Trust board is welcomed. Now that the datix system has been developed and fully embedded within the Patient Experience Team (PET) commissioners look forward to SCAS using this system to clearly identify themes and trends that will lead to lessons learned and changes in practises; quality priority 3b for 2017/18. Commissioners anticipate that SCAS will use feedback from all areas eg: complaints, concerns, incidents etc in this analysis and not just HCP feedback.

Clinical Effectiveness

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

Commissioners participated in a long wait audit for assurance and to support on-going development and look forward to seeing their proposals included in the future. Challenges have been experienced in receiving the outcomes from the long wait audits in a timely way and reviews have not always provided adequate evidence that all actions are monitored or how effectiveness is measured. Commissioners acknowledge that the audits did lead to the identification of the need to amend the end of shift policy and meal break policy. As you will note from the second table the main category for the long wait has been identified as ‘other’, with no clear root cause identified; this does not support the statement included from SCAS that themes and trends for long waits from the audit findings are used to highlight actions and recommendations. The tables included would have benefited from a narrative explaining that they are from the review of those long waits randomly selected for review and not a reflection of all long waits experienced within the reporting period. Commissioners look forward to improved reporting that provides triangulation and assurance going forward.

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

There is clear explanation of a high intensity user within this section of the report and it is positive to see the examples of the effect on patients for this quality account priority. different schemes have been in place across different localities and the report would have benefited from this being reflected in the narrative. This section of the report may have been improved by reflecting the wider health system impact both before and after the implementation of the patient management plan. Overall quantitative data would have enhanced the positive impact that these schemes have the potential to deliver. Within the SHiP locality commissioners used Quality innovation Productivity and Prevention (QiPP) funding in order to financially support SCAS in the provision of demand practitioners for the Portsmouth and South East Hampshire CCG localities. The pilot commencement date was 1 November 2016 and the pilot is due to run for 12 months. it is therefore not currently possible to determine what the impact has been for this particular scheme.

2c. Improve compliance with limb fracture care bundle

SCAS has made commissioners aware throughout the year of difficulties in recording the pain scores for limb fracture . We have also been kept up to date regarding the proposed developments of the electronic patient record (ePR) in order to improve the capture of this data. Commissioners have also not been made aware of any intelligence that patients have not been cared for appropriately in respect of these two indicators. The table could be further enhanced by including the comparison for the previous 12 months with other trusts, as this is a nationally reported indicator.

Patient Experience

3a. To improve the number of formal complaints responded to ‘on time’ by the Trust

Commissioners are aware that SCAS have been undertaking a robust review of historical feedback. The review is to ensure that all feedback has been appropriately reviewed and closed. Commissioners were made aware that this historical review would impact on the reporting of timescales for formal complaints to be responded to ‘on time’. in addition SCAS currently report on the closing of complaints against their own internal 25 day target rather than reporting against complaints being closed within the mutually agreed timescale set with the complainant. Following an invitation from SCAS to visit their Patient Experience Team (PET) in march 2017 commissioners are assured that there is a robust complaint process in place which demonstrates that a number of improvements have been implemented to ensure that all complaints, concerns and HCP feedback are now responded to in a timely manner. Commissioners look forward to receiving confirmation that the review of historical feedback has been completed. Now the datix reporting system is being used across the organisation there is improved opportunity for analysis and learning that can lead to changes in practise for the benefit of patients.

//218 //219

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

Commissioners acknowledge the work that has taken place in West berkshire but as this is not part of the SHiP contract we are unable to comment on the outcomes. However, quantitative and qualitative data would have enhanced this section of the report and may have provided an opportunity for local commissioners to determine whether the scheme could be considered for the SHiP population. The report would also have benefited from SCAS identifying any work that they have participated in for the SHiP locality in order to evidence whether this quality account priority had been achieved in our locality.

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

Commissioners are aware that a complainant satisfaction survey was distributed in January 2017 and look forward to receiving the outcomes. Surveys remain outstanding for both the non-emergency patient transport service and the 999 service for vulnerable adults, although commissioners recognise the challenges in obtaining feedback from this cohort of patients. Commissioners therefore welcome a focus area for the 2017/18 quality account to develop systems that engage and seek feedback from hard to reach groups. As part of the commissioner visit in march 2017 recommendations were made to consider: development of a complaints leaflet and poster and to send out a complainant’s satisfaction quarterly. SCAS may have enriched this section of the report by detailing the wide variety of public engagement activities that they also participate in, the details of which are often included within the public board papers.

Commissioners look forward to a continued positive working relationship with South Central Ambulance Service NHS Foundation Trust as a valued health care partner who identifies and engages in ways to improve the outcome of patients in our locality.

Yours sincerely,

Alex berry, Chief Operating Officer

Fareham & Gosport and South Eastern Hampshire Clinical Commissioning Groups

ANNEX 2: STATEMENT OF DIRECTORS’ RESPONSIBILITIESThe directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations to prepare Quality Accounts for each financial year.

NHS improvement has issued guidance to NHS foundation trust boards on the form and content of annual quality reports (which incorporate the above legal requirements) and on the arrangements that NHS foundation trust boards should put in place to support the data quality for the preparation of the quality report.

in preparing the Quality Report, directors are required to take steps to satisfy themselves that:

è The content of the Quality Report meets the requirements set out in the NHS foundation trust annual reporting manual 2016/17 and supporting guidance

è The content of the Quality Report is not inconsistent with internal and external sources of information including:

• board minutes and papers for the period April 2016 to march 2017

• Papers relating to quality reported to the board over the period April 2016 to march 2017

• Feedback from commissioners dated 11/05/2017

• Feedback from governors dated 01/02/2017

• Feedback from local Healthwatch organisations dated 12/05/2017

• Feedback from Overview and Scrutiny Committees dated 20/03/2017 and 07/05/17.

• The Trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, quarter 4 updated to HSCiC on 28/04/17

• The national staff survey march 2017

• The Head of internal Audit’s annual opinion of the Trust’s control environment dated 26/04/2017

• CQC inspection report dated 20/09/2016

è The Quality Report represents a balanced picture of the NHS foundation trust’s performance over the period covered

è The performance information reported in the Quality Report is reliable and accurate

è There are proper internal controls over the collection and reporting of the measures of performance included in the Quality Report, and these controls are subject to review to confirm that they are working effectively in practice

è The data underpinning the measures of performance reported in the Quality Account is robust and reliable, conforms to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review

è The Quality Report has been prepared in accordance with NHS improvement’s annual reporting manual and supporting guidance (which incorporates the Quality Accounts regulations) as well as the standards to support data quality for the preparation of the Quality Report.

The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the Quality Report.

by order of the board

Will Hancock Chief Executive

Lena Samuels Chair

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GLOSSARY

AACP Ambulance Anticipatory Care Plan

ACP Anticipatory Care Plan

ACS Acute Coronary Syndrome

ARP Advanced medical Priority dispatch System

ATP Adenosine Trio Phosphate Testing

bASiCS british Association for immediate Care

bmJ british medical Journal

CAd Computer Aided dispatch System

CARS Clinical Audit Record System

CbRN Chemical, biological, Radiological, Nuclear

CCG Clinical Commissioning Group

CEO Chief Executive Officer

CFR Community First Responder

CNST Clinical Negligence Scheme for Trusts

CPd Continuous Professional development

CPi Clinical Performance indicator

CQC Care Quality Commission

CQUiN Commissioning for Quality and improvement

CSd Clinical Support desk

dCA dual Crewed Ambulance

dH department of Health

ECA Emergency Care Assistant

ECP Emergency Care Practitioner

ECT Emergency Call Taker

EmC Executive management Committee

EOC Emergency Operations Centre

EoLC End of Life Care

ePR Electronic Patient Record

FFT Friends and Family Test

FT Foundation Trust

HALO Hospital Ambulance Liaison Officer

HART Hazardous Area Response Team

HCP Health Care Provider

HOSC Health Overview and Scrutiny Committee

JRCALC Joint Royal Colleges Ambulance Liaison Committee

KLOE Key line of enquiry (CQC)

Ld Learning disability

//222 //223

mCA mental Capacity Act

mH mental Health

miNAP myocardial ischaemia National Audit Project

NEPTS Non-Emergency Patient Transport Services

NHSLA NHS Litigation Authority

PALS Patient Advice and Liaison Service

PCi Primary Angioplasty

PCT Primary Care Trust

PCR Patient Clinical Record

PERG Patient Experience Review Group

PRF Patient Report From

PPCi Primary Percutaneous Coronary intervention

RAG Red, Amber, Green

RCN Royal College of Nursing

ROSC Return of Spontaneous Circulation

SCAS South Central Ambulance Service NHS Foundation Trust

SCiE Social Care institute for Excellence

Sid Serious incident desk

SiRi Serious incidents Requiring investigation

SLA Service Level Agreement

SOP Standard Operating Procedure

STEiS Strategic Executive information System

STEmi ST Elevation myocardial infarction (Heart Attack)

TARN Trauma Audit and Research Network

TUb Trauma Unit bypass

udNACPR Unified do Not Attempt Cardio-Pulmonary Resuscitation

Invite to Feedback on the Quality Account

Please tell us what you thought of this report.

Did you find it useful?

Did the report tell you what you wanted to know?

Do you agree with our priorities for 2017/18?

Is there anything else you would like to see included in future reports?

Please tell us by contacting SCAS in the following ways:

Email: patientexperience@scas.nhs.uk

Phone: 0300 1239280

Post: debbie marrs Assistant director of Quality

South Central Ambulance Service NHS Foundation Trust 7 & 8 Talisman business Centre Talisman Road bicester Oxfordshire OX26 6HR

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INDEPENDENT AUDITORS REPORT TO THE COUNCIL OF GOVERNORS OF SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST ON THE QUALITY REPORTWe have been engaged by the Council of Governors of South Central Ambulance Service NHS Foundation Trust to perform an independent assurance engagement in respect of South Central Ambulance Service NHS Foundation Trust’s Quality Report for the year ended 31 march 2017 (the ‘Quality Report’) and certain performance indicators contained therein.

Scope and subject matter

The indicators for the year ended 31 march 2017 subject to limited assurance consist of the following two national priority indicators (the indicators):

è Category A call – emergency response within 8 minutes; and

è Category A call – ambulance vehicle arrives within 19 minutes.

We refer to these national priority indicators collectively as the ‘indicators’.

Respective responsibilities of the directors and auditors

The directors are responsible for the content and the preparation of the Quality Report in accordance with the criteria set out in the NHS Foundation Trust Annual Reporting Manual issued by NHS improvement.

Our responsibility is to form a conclusion, based on limited assurance procedures, on whether anything has come to our attention that causes us to believe that:

è The Quality Report is not prepared in all material respects in line with the criteria set out in the NHS Foundation Trust Annual Reporting Manual and supporting guidance;

è The Quality Report is not consistent in all material respects with the sources specified in the Detailed requirements for quality reports for foundation trusts 2016/17 (‘the Guidance’); and

è The indicators in the Quality Report identified as having been the subject of limited assurance in the Quality Report are not reasonably stated in all material aspects in accordance with the NHS Foundation Trust Annual Reporting Manual and the six dimensions of data quality set out in the Detailed Requirements for external assurance for quality reports for foundation trusts 2016/17.

We read the Quality Report and consider whether it addresses the content requirements of the NHS Foundation Trust Annual Reporting manual and consider the implications for our report if we become aware of any material omissions.

We read the other information contained in the Quality Report and consider whether it is materially inconsistent with:

è board minutes and papers for the period April 2016 to may 2017;

è Papers relating to quality reported to the board over the period April 2016 to may 2017;

è Feedback from commissioners, dated 11 may 2017;

è Feedback from governors, dated 1 February 2017;

è Feedback from local Healthwatch organisations, dated 12 may 2017;

è Feedback from Overview and Scrutiny Committee, dated 7 may 2017;

è The trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009;

è The national staff survey, dated march 2017;

è Care Quality Commission inspection, dated 20 September 2016;

è The 2016/17 Head of internal Audit’s annual opinion over the trust’s control environment, dated 26 April 2017; and

è Any other information included in our review

We consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with those documents (collectively, the ‘documents’). Our responsibilities do not extend to any other information.

We are in compliance with the applicable independence and competency requirements of the institute of Chartered Accountants in England and Wales (iCAEW) Code of Ethics. Our team comprised assurance practitioners and relevant subject matter experts.

This report, including the conclusion, has been prepared solely for the Council of Governors of South Central Ambulance Service NHS Foundation Trust as a body, to assist the Council of Governors in reporting the NHS Foundation Trust’s quality agenda, performance and activities. We permit the disclosure of this report within the Annual Report for the year ended 31 march 2017, to enable the Council of Governors to demonstrate they have discharged their governance responsibilities by commissioning an independent assurance report in connection with the indicator. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Council of Governors as a body and South Central Ambulance Service NHS Foundation Trust for our work or this report, except where terms are expressly agreed and with our prior consent in writing.

Assurance work performed

We conducted this limited assurance engagement in accordance with international Standard on Assurance Engagements 3000 (Revised) – ‘Assurance Engagements other than Audits or Reviews of Historical Financial information’, issued by the international Auditing and Assurance Standards board (‘iSAE 3000’). Our limited assurance procedures included:

è Evaluating the design and implementation of the key processes and controls for managing and reporting the indicator;

è making enquiries of management;

è Testing key management controls;

è Limited testing, on a selective basis, of the data used to calculate the indicator back to supporting documentation;

è Comparing the content requirements of the NHS Foundation Trust Annual Reporting Manual to the categories reported in the Quality Report; and

è Reading the documents.

A limited assurance engagement is smaller in scope than a reasonable assurance engagement. The nature, timing and extent of procedures for gathering sufficient appropriate evidence are deliberately limited relative to a reasonable assurance engagement.

Limitations

Non-financial performance information is subject to more inherent limitations than financial information, given the characteristics of the subject matter and the methods used for determining such information.

//226 //227

The absence of a significant body of established practice on which to draw allows for the selection of different, but acceptable measurement techniques which can result in materially different measurements and can affect comparability. The precision of different measurement techniques may also vary. Furthermore, the nature and methods used to determine such information, as well as the measurement criteria and the precision of these criteria, may change over time. it is important to read the quality report in the context of the criteria set out in the NHS Foundation Trust Annual Reporting Manual and supporting guidance.

The scope of our assurance work has not included governance over quality or the non-mandated indicator, which was determined locally by South Central Ambulance Service NHS Foundation Trust.

Conclusion

based on the results of our procedures, nothing has come to our attention that causes us to believe that, for the year ended 31 march 2017:

è The Quality Report is not prepared in all material respects in line with the criteria set out in the NHS Foundation Trust Annual Reporting Manual and supporting guidance;

è The Quality Report is not consistent in all material respects with the sources specified in the Detailed requirements for quality reports for foundation trusts 2016/17 (‘the Guidance’); and

è The indicators in the Quality Report subject to limited assurance have not been reasonably stated in all material respects in accordance with the NHS Foundation Trust Annual Reporting Manual and the six dimensions of data quality set out in the Guidance.

KPmG LLP

Chartered Accountants, bristol

INDEPENDENT AUDITORS REPORT TO THE COUNCIL OF GOVERNORS OF SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST ONLY

Opinions and conclusions arising from our audit

1. Our opinion on the financial statements is unmodified

We have audited the financial statements of South Central Ambulance Service NHS Foundation Trust for the year ended 31 march 2017 set out on pages 83 to 137. in our opinion:

è The financial statements give a true and fair view of the state of the Group and the Trust’s affairs as at 31 march 2017 and of the Group and the Trust’s income and expenditure for the year ended; and

è The Group and the Trust’s financial statements have been properly prepared in accordance with the department of Health’s Group Accounting manual 2016/17.

Overview

Materiality: Group and Trust financial statements

£3.6m (2015/16: £3.5m) 2% of total income from operations (2015/16: 2%)

Risks of material misstatement vs 2015/16

Recurring risks Recognition of NHS and non-NHS income

//228 //229

2. Our assessment of risks of material misstatement

in arriving at our opinion above on the financial statements, the risks of material misstatement that had the greatest effect on our audit were as follows:

The risk Our response

NHS and non-NHS income

income: (£183.7m; 2015/16: £175.0m)

Refer to page 70 (Audit Committee Report), page 90 (accounting policy) and page 104 to 105 (financial disclosures)

Recognition of NHS and non-NHS income:

Of the Group’s reported total income, £170.0m (2015/16, £161.8m) came from commissioners (Clinical Commissioning Groups (CCG) and NHS England). income from CCGs and NHS England make up 94.5% of the Group’s income. The ma-jority of this income is contracted on an annual basis, however actual achievement is based on completing the planned level of activity and achieving key performance indicators (KPis). if the Trust does not meet its contracted KPis then commissioners are able to impose fines, reducing the level of income achievement.

in 2016/17, the Group received transforma-tion funding from NHS improvement. This is received subject to achieving defined finan-cial and operational targets on a quarterly basis. The Group was allocated £1.7m of transformation funding. Additional funding of £0.7m was also received at the year end as the Group achieved certain financial targets.

An agreement of balances exercise is un-dertaken between all NHS bodies to agree the value of transactions during the year. ‘mismatch’ reports are available setting out discrepancies between the submitted balances from each party in transactions and variances over £250,000 are required to be reported to the National Audit Office to inform the audit of the department of Health consolidated accounts.

The Group reported total income of £11.3m (2015/16: £13.2m) from other activities, principally Education or Research. much of this income is generated by contracts with other NHS and non-NHS bodies which are based on varied payment terms, including payment on delivery, milestone payments and periodic payments.

Our procedures included:

Contract agreement: We agreed commis-sioner income to the signed contracts and selected a sample of the largest balances (comprising 75.2% of income from com-missioners) to agree that they had been in-voiced in line with the contract agreements and payment had been received;

Income recognition: We carried out testing of invoices for material income from other NHS organisations, in the month before and after the year end, to determine whether income was recognised in the correct accounting period, in accordance with the amounts billed to corresponding parties;

Agreement of balances: We assessed the outcome of the agreement of balanc-es exercise with other NHS bodies and compared the values they are disclosing within their financial statements to the value of income captured in the financial statements. We sought explanations for any variances over £250,000 and challenged the Group’s assessment of the level of income they were entitled to and the receipts that could be collected;

Transformation funding: We agreed the transformation funding due at the year end to the confirmation received from NHSi and agreed that this was appropriately recorded within the financial statements;

Other income testing: We agreed a sam-ple of other income to supporting invoices and subsequent cash receipts.

3. Our application of materiality and an overview of the scope of our audit

The materiality for the financial statements of the Group and Trust was set at £3.6m (2015/16: £3.5m), determined with reference to a benchmark of income from operations (of which it represents approximately 2%).

We consider income from operations to be more stable than a surplus-related benchmark. We report to the Audit Committee any corrected and uncorrected identified misstatements exceeding £0.2m (2015/16: £0.2m), in addition to other identified misstatements that warrant reporting on qualitative grounds.

4. Our opinion on other matters prescribed by the Code of Audit Practice is unmodified

in our opinion:

è The part of the directors’ Remuneration Report to be audited has been properly prepared in accordance with the NHS Foundation Trust Annual Reporting manual 2016/17; and

è The information given in the Annual Report for the financial year for which the financial statements are prepared is consistent with the financial statements.

5. We have nothing to report in respect of the matters on which we are required to report by exception

We are required to report to you if, based on the knowledge we acquired during our audit, we have identified information in the Annual Report that contains a material inconsistency with either that knowledge of the financial statements, a material misstatement of fact, or that is otherwise misleading.

in particular, we are required to report to you if:

è We have identified material inconsistencies between the knowledge we acquired during our audit and the

directors’ statement that they consider the Annual Report and financial statements taken as a whole is fair, balanced and understandable; or

è The Audit Committee’s commentary on page 70 of the Annual Report does not appropriately address matters communicated by us to the Audit Committee.

Under the Code of Audit Practice we are required to report to you if, in our opinion:

è The Annual Governance Statement does not reflect the disclosure requirements set out in the NHS Foundation Trust Annual Reporting manual 2016/17, is misleading or is not consistent with our knowledge of the Trust and other information of which we are aware from our audit of the financial statements.

è The Trust has not made proper arrangement for securing economy, efficiency and effectiveness in its use of resources.

in addition we are required to report to you if:

è Any reports to the regulator have been made under schedule 10(6) of the National Health Service Act 2006.

Total income from operations

£183.7m (2015/16: £175.0m) £3.6m whole financial statements materiality (2016/16:£3.5m)

£0.2m misstatements reported to the Audit Committee (2015/16: £0.2m)

Total income from operations Materiality

Materiality

//230 //231

Any matters have been reported in the public interest under Schedule 10(3) of the National Health Service Act 2006 in the course of, or at the end of the audit.

We have nothing to report in respect of the above responsibilities.

6. We have completed our audit

We certify that we have completed the audit of the accounts of South Central Ambulance Service NHS Foundation Trust in accordance with the requirements of Schedule 10 of the National Health Service Act 2006 and the Code of Audit Practice issued by the National Audit Office.

Scope and responsibilities

As described more fully in the Statement of Accounting Officer’s Responsibilities on page 138 the accounting officer is responsible for the preparation of the financial statements that give a true and fair view. Our responsibility is to audit, and express an opinion on, the financial statements in accordance with applicable law and international Standards on Auditing (UK and ireland). Those standards require us to comply with the UK Ethical Standards for Auditors. A description of the scope of an audit of financial statements is provided on our website at www.kpmg.com/uk/auditscopeother2014. This report is made subject to important explanations regarding our responsibilities as published on that website, which are incorporated into this report as if set out in full and should be read to provide an understanding of the purpose of this report, the work we have undertaken and the basis of our opinions.

The Trust is responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources. Under Section 62(1) and Schedule 10 paragraph 1(d), of the National Health Service Act 2006 we have a duty to satisfy ourselves that the Trust has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. We are not required to consider, nor have we considered, whether all aspects

of the Trust’s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively. We have undertaken our review in accordance with the Code of Audit Practice, having regard to the specified criterion issued by the Comptroller and Auditor General, as to whether the Trust has proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people. We planned our work in accordance with the Code of Audit Practice. based on our risk assessment, we undertook such work as we considered necessary.

The report is made solely to the Council of Governors of the Trust, as a body, in accordance with Schedule 10 of the National Health Service Act 2006. Our audit work has been undertaken so that we might state to the Council of Governors of the Trust, as a body, those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Council of Governors of the Trust, as a body, for our audit work for this report or for the opinions we have formed.

Rees batley

For and on behalf of KPmG LLP

Chartered Accountants and Statutory Auditor 66 Queen Square, bristol, bS8 4bE

26 may 2017

GLOSSARY

A&E Accident & Emergency

AACP Ambulance Anticipatory Care Plan

ACP Anticipatory Care Plan

ACS Acute Coronary Syndrome

AmPdS Advanced medical Priority despatch System

ARP Ambulance Response Programme

ATP Adenosine Trio Phosphate Testing

bASiCS british Association for immediate Care

bmJ british medical Journal

CAd Computer Aided dispatch System

CARS Clinical Audit Record System

CbRN Chemical, biological, Radiological, Nuclear

CCG Clinical Commissioning Group

CEO Chief Executive Officer

CF Clinical Fellow

CFR Community First Responder

CNST Clinical Negligence Scheme for Trusts

CPd Continuous Professional development

CPi Clinical Performance indicator

CQC Care Quality Commission

CQUiN Commissioning for Quality and improvement

CSd Clinical Support desk

dH department of Health

E&d Equality & diversity

ECA Emergency Care Assistant

ECT Emergency Call Taker

EmC Executive management Committee

//232 //233

EOC Emergency Operations Centre

EoLC End of Life Care

ePR Electronic Patient Record

FFT Friends and Family Test

FRem Financial Reporting manual

FT Foundation Trust

GbS Government banking Service

GPS Global Positioning System

HALO Hospital Ambulance Liaison Officer

HART Hazardous Area Response Team

HCP Health Care Provider

HOSC Health Overview and Scrutiny Committee

iAS international Accounting Standards

iFRS international Financial Reporting Standards

JRCALC Joint Royal Colleges Ambulance Liaison Committee

KLOE Key line of enquiry (CQC)

KPmG Trust’s appointed external auditors

Ld Learning disability

mCA mental Capacity Act

mH mental Health

miNAP myocardial ischaemia National Audit Project

NEPTS Non-Emergency Patient Transport Services

NHSLA NHS Litigation Authority

PbL Prudential borrowing Limit

PCi Primary Angioplasty

PCR Patient Clinical Record

PdC Public dividend Capital

PERG Patient Experience Review Group

PFi Public Finance initiative

PRF Patient Report From

PPCi Primary Percutaneous Coronary intervention

RAG Red, Amber, Green

RCN Royal College of Nursing

ROSC Return of Spontaneous Circulation

SCAS South Central Ambulance Service NHS Foundation Trust

SCiE Social Care institute for Excellence

Sid Serious incident desk

SiRi Serious incidents Requiring investigation

SLA Service Level Agreement

SOP Standard Operating Procedure

STEiS Strategic Executive information System

STEmi ST Elevation myocardial infarction (Heart Attack)

TARN Trauma Audit and Research Network

TUb Trauma Unit bypass

udNACPR Unified do Not Attempt Cardio-Pulmonary Resuscitation

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