South Western Ambulance ServiceNHS Trust

South Western Ambulance ServiceNHS Trust

We respondquickly and safely

to save lives,reduce anxiety,

pain and suffering

annualreport2008/09

02 03

Contents

about the Trust 05

Chairman’s review 09

directors’ report 13

business review 19

board of directors 27

looking forward 31

financial performance 35

operational and clinical performance 41

organisational structure 55

valuing staff 61

patient experience 69

theTrust theTrust

annualreport08/09

Our vision is to deliver high performing emergency and urgent care and non urgent patient transport services that are responsive, safe, clinically effective, financially viable, legally constituted and well governed.

about the Trust

South Western Ambulance Service NHS Trust is undergoing transformational change which dates

back to the government’s national reforms ‘Commissioning a Patient Led NHS’ and the review of

ambulance services ‘Taking Healthcare to the Patient: Transforming NHS ambulance services’; both

released in 2005. The former resulted in the July 2006 milestone when the Trust was created from

the merger of two successful organisations; Dorset and Westcountry.

The new Trust has built on the success and strong reputation of both former services and has

established itself as a high performing and well respected service; consistently known for delivering

fast, high quality and safe clinical care. Our combined services receive over a million calls a year

from patients and in response our business operates a complex 24 hour service every single day of

the year.

The Trust provides emergency and urgent care services and non-urgent patient transport services

for the resident and transient populations of a large geographical area, as well as providing out

of county transport to specialist centres across the country. The Trust covers a population of 2.8

million throughout Cornwall and the Isles of Scilly, Devon, Dorset and Somerset. The area has an

influx of holidaymakers and visitors estimated to be around 16.5 million each year. The four counties

cover 17,094 square kilometres which includes 32,000 kilometres of road and 1,331 kilometres of

coastline.

04 05

of county transport to specialist centres across the country. The Trust covers a population of 2.8

million throughout Cornwall and the Isles of Scilly, Devon, Dorset and Somerset. The area has an

influx of holidaymakers and visitors estimated to be around 16.5 million each year. The four counties

cover 17,094 square kilometres which includes 32,000 kilometres of road and 1,331 kilometres of

coastline.

theTrust theTrust

annualreport08/09

The region is predominantly rural with a number of major urban centres such as Bournemouth and

Poole with a population of over 300,000; and Plymouth with a population of over 250,000. The

south west has one of the lowest ethnic minority populations of all English regions, but has the

oldest age profile which reflects the demographic make up of the majority of our callers.

Alongside our staff we train and manage nearly one thousand responders who consistently support

our mission ‘to respond quickly and safely to save lives, reduce anxiety, pain and suffering’. We are

fortunate to have strong support from our communities and an example of this is the tireless work

of the three air ambulance charities who fund four helicopters. This work supports us to provide

patients with the fastest possible life saving response; especially helpful for our rural communities.

We belong to one of the largest and most respected employers in the world; the NHS and take this

responsibility seriously. The opportunities this presents in terms of supporting local employment

and contributing to environmental initiatives which support climate change benefits have yet to be

fully exploited by the Trust. We aspire to make a greater contribution to sustainable initiatives; even

though we recognise the challenge this presents as we rely on our fleet to deliver the majority of

our services. We will work hard and look forward to building on our first steps in 2008 of agreeing

an Environmental Strategy.

In 2008/09 the Trust income was £122.318 million and we continued to employ a workforce of over

2000 whole time equivalent personnel; the majority of whom are clinically trained professionals.

We also work with bank staff and sessional GPs who support our Urgent Care Service which

operates across Dorset, Somerset and a small part of Wiltshire.

We remain committed to employing a workforce that is culturally diverse and that provides

opportunities for those from differing ethnic backgrounds. Changing our culture will transform how

we engage with different groups to overcome the challenge of having the lowest ethnic minority

population in the country, to achieve this ambition to create a workforce that truly reflects our

population.

As an aspirant Foundation Trust we believe that building on the work of our patient and public

involvement will provide us with many more opportunities to strengthen our external relationships

and continue to support our equality and diversity ambitions.

The Trust has struggled to engage with the vast landscape of strategic partnerships, such as the

Joint Needs Assessments teams, Local Strategic Partnerships, local government and primary care

trust networks. The Darzi review has created a climate of change for our Trust to contribute to

World Class Commissioning with the Board team pivotal to the success of a high level strategic

engagement programme to shift current perceptions of our service contributions.

We know one of the critical success factors of our future depends on the continuing commitment

and dedication of our staff and we will work hard to recruit and retain the very highest calibre.

This annual report is a tribute to our existing workforce who are exemplars for the service.

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08 09

Chairman’s review

This year’s success has been externally validated by assessors and provides the Board with

confidence and assurance that our Trust has ended the year in a consolidated and positive position.

Many of these achievements are highlighted throughout this annual report with further details on

our website www.swast.nhs.uk.

I am proud to announce that we were ranked as the top ambulance trust in England for Category

A8 by achieving 78.01%, against a target of 75% for reaching more patients with life threatening

emergency calls within eight minutes. My congratulations to all staff for this outstanding

accomplishment.

Throughout the year staff have continued to celebrate their professional achievements with

numerous awards and accolades received. Quality services can only be delivered by highly trained

staff and we were pleased to be the only ambulance service in the country to be accredited with the

Health Professions Council status for its training colleges which is currently only available through

universities. The Board would like to congratulate the Training Department for this outstanding

accomplishment.

During the year, the Board has actively debated the need to become more outward facing to

develop stronger relationships with strategic partners such as our commissioners. The Board’s

commitment to become a Foundation Trust has accelerated a work programme of engagement

which has been informed by a market assessment and perception audit. The results have reinforced

the view of the Board that we as a Trust need to better articulate and explain to patients and

partners how meeting our long, medium and short term goals and objectives will also meet their

needs. This annual report provides the Board with a real opportunity to begin the journey of

strengthening our external facing relationships by clearly defining highlights of our work.

NHS South West has supported our Trust to develop a practice learning programme so health

partners how meeting our long, medium and short term goals and objectives will also meet their

needs. This annual report provides the Board with a real opportunity to begin the journey of

strengthening our external facing relationships by clearly defining highlights of our work.

NHS South West has supported our Trust to develop a practice learning programme so health

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chairman’sreview

10 11

professionals who train with our frontline clinicians are assured their learning experience is of

the highest quality. The Board has focused a great deal of time on corporate governance issues

and are fully supportive of the more open and transparent approach being taken by our Trust.

This demonstrates the Board’s awareness of its corporate responsibility to consider and debate

governance matters on an equal platform to performance and finance reporting; ensuring early

warning system reports, swift mitigating action plans and lessons learned are fully debated with

clear leadership to embed continuous improvements. Conversely, the Board is not risk averse and

has taken some difficult decisions to support new ways of working such as our pilot on behalf of all

ambulance services to trial the role of an Emergency Care Assistant. In parallel, strong governance

arrangements and sound processes and practices have been put into place to mitigate risks to

ensure patient safety remains a top priority. This is captured by our Trust’s incident and complaint

reporting systems with reports regularly received at Board and by commissioners.

During the December 2008 and January 2009 prolonged winter pressures, our Trust instigated

an NHS and Social Care clinical leadership initiative across the four counties it serves; resulting

in patients receiving more seamless services. All NHS organisations share a common purpose, to

provide optimum clinical services to all patients, and our Trust’s leadership during such difficult

times were praised by commissioners who fed back that our Trust was seen as a ’safe pair of hands’

in times of such complexities and challenge. I would like to personally thank the Executive Director

team led by our Chief Executive, Ken Wenman, for such a ground breaking initiative which provided

the Board with real confidence in the Trust’s leadership and focus on the patient. It was an excellent

example for our commissioners on how working together across organisational boundaries can

better meet the needs of our patients. To remain focused on the needs of patients the Board was

pleased to formally nominate and agree two patient representative champions during the transition

of national arrangements to establish Local Involvement Networks. I welcome the opportunities that

being a Foundation Trust will bring by establishing a fully representative membership and a Council

of Governors which aligns us to the pledges of the NHS Constitution which the Board considered,

endorsed and responded to in 2008.

The Board has focused its strategic intent on formalising its social responsibility and agreed an

Environmental Strategy. The challenges for our service are great but the Board are fully committed

to developing policies which focus on procurement, equality, sustainability, local employment and

training practices to support the national imperatives of important climate change initiatives. We

have appointed a Board champion to promote the leadership of this aspiration.

The continuing development of our Workforce, Estates, Fleet and Information, Technology and

Communication Strategies will be a strong focus under our Foundation Trust application. The Board

believe this will enable our Trust to fully exploit new opportunities to ensure we demonstrate strong

leadership in tackling not only the big issues such as climate change but the local challenges of

delivering equitable services across a poor road network in rural areas by supporting best use of

modern technologies.

I was pleased to welcome Non Executive Director Richard Handley during the year who is the

Trust’s Audit Chairman. He brings with him a wealth of experience from the business sector and is

a chartered accountant. I was also pleased to welcome Mrs Jennie Kingston to the role of Director

of Finance and Performance and Dr Andy Smith who joined the Board as Associate Director of GP

Primary Care.

Finally, I would like to congratulate all staff; including the Board for their continuing commitment

and dedication in positioning our Trust as one of the top ambulance services in the country. The

Board recognise there are still many challenges ahead, such as ensuring all national performance

targets are met but this consolidated year end position presents the Trust with real potential to

secure Foundation Trust status in the year 2010. Achieving this aspiration will further demonstrate

that our Trust can sustain and continue to rank amongst the top performing NHS Trusts in future

years.

Board recognise there are still many challenges ahead, such as ensuring all national performance

targets are met but this consolidated year end position presents the Trust with real potential to

secure Foundation Trust status in the year 2010. Achieving this aspiration will further demonstrate

that our Trust can sustain and continue to rank amongst the top performing NHS Trusts in future

years.

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Our Medicines Management Team have made significant progress by implementing an Action Plan which is driving improvements such as better morphine management to help ease patients’ pain and contributing to joint public health work led by the Controlled Drug Local Intelligence Networks.

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directors’report

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directors’ report

Serving the public, responding to emergency and urgent care calls, and transporting patients to save

lives, reduce anxiety, pain and suffering, is the business we are proud to be leading. We can only

do this by ensuring our business delivers high quality care that is financially viable, well governed

and legally constituted. During 2008/09 the Trust maintained its strong track record of achieving all

financial targets. Operational performance broke our historical records by delivering the highest ever

performance since ambulance targets were introduced.

These results place the Trust in a strong position, ranking amongst one of the top performing

ambulance services in the country. This outstanding accomplishment was set against a backdrop

of unprecedented worldwide economic downturn, soaring fuel prices, adverse winter weather

conditions and the implementation of ambitious new national targets. This achievement is testament

to the tremendous hard work, dedication and commitment of our staff and its leadership at all levels

of the organisation. Despite such a challenging and complex operational environment, the Trust also

achieved a good position in the NHS performance ratings regulated by the Healthcare Commission

for 2007/08; predicting an Annual Health Check result of ‘good’ for use of resources and ‘good’ for

quality of financial management for 2008/09. The Care Quality Commission will announce all NHS

Trusts’ results in October 2009.

A significant highpoint for the Trust has been the successful introduction of the government’s new

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‘Call Connect’ response measures. This changed the way life threatening calls were responded

to and removed the hidden wait of 90 seconds for patients; the clock now starts when calls are

connected. Delivering these new targets has seen a dramatic improvement in the patient experience

with thousands more patients receiving a faster life saving response than ever before. To support

the Trust’s transformation and to continue to meet the focus on patient safety, quality and clinical

leadership, a clinical leadership programme first trialled in 2007 was fully implemented within the

two 999 Control Rooms (Clinical Hubs) during the year. This has resulted in increased efficiency of

the service with a noteworthy contribution to the whole health and social care system by reducing

unnecessary hospital admissions; patients tell us this is what they want – to be treated as close to or

at home.

During this year the Trust implemented a comprehensive programme to support its infection

prevention and control measures. The ambulance service is committed to working in partnership

with other parts of the NHS to help drive down the occurrences of healthcare associated infections.

The year ended with a Healthcare Commission inspection in February 09. In partnership with the

region’s stroke networks and South East Coast Ambulance NHS Trust, the Trust became the first

organisation outside the USA to pilot an innovative advanced stroke care course for emergency

medical professionals involved in stroke care. Adrian South our Clinical Effectiveness Manager is

commended for leading this work and ensuring we remain at the forefront of best practice.

In December 2008 the Trust was assessed and accredited against Level 1 of the Clinical Negligence

Scheme for Trusts (CNST); a solid clinical position to end the calendar year on. Staff are the lifeblood

of the Trust. We are supporting them to drive forward organisational development by investing in

leadership, management and clinical training programmes. These opportunities are a result of our

natural progression as an ambulance service but the Foundation Trust co-working by different staff

groups has accelerated the developmental opportunities for our junior and middle managers.

The Trust was delighted with the outcome of the Health Services Journal (HSJ) announcement that

the Trust had won the best ambulance service to work for in England in their prestigious annual

awards ceremony, hosted in London in March. This coveted award was derived from a staff survey

of Foundation and NHS Trusts, as well as private organisations. High levels of staff satisfaction are

linked to high levels of patient satisfaction and we are pleased that our emerging culture for staff

and patients received an external accolade and recognition to reinforce our high level commitment

to developing the right culture.

Yet despite these changes, there is more to be done to improve patient care. Outcomes for patients

with immediately life threatening conditions, such as heart attack, stroke and major trauma, lag

behind the best performing services in the world. Too many patients with urgent care needs, such

as older people who have fallen, and patients with exacerbated long term physical and mental

health conditions (who make up the vast majority of our patients), still end up being taken into

hospital when they could be treated in the community or at home. The Trust is responding by

contributing to national work being led by the ambulance Chief Executive Group and Ambulance

Service Network, as well as our clinicians contributing to local initiatives.

Looking forward, we anticipate one of the most difficult working environments as the economy

continues its downturn and the NHS, alongside other parts of the public sector, faces little or no

new growth after years of investment, with greater competition and choice high on the agendas

of Commissioners. The commercial framework within and outside the NHS will influence the new

ambulance contract arrangements and funding negotiations will continue to be challenging. We

welcome Commissioners’ intentions to market test the Patient Transport Services contract and we

are aware the Urgent Care contract tender will also be tested in the future. We believe there is now

a greater prospect of market testing for the A&E contract which provides the greatest proportion of

funding for the Trust. We are preparing to embrace these challenges by transforming our services to

meet Commissioners, acute hospitals and patients needs; we do not underestimate the work ahead.

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Our commitment to continue to play an active part in the south west health community by

sustaining our services has been set out in the numerous responses we have provided to partners

during their respective consultations. Commissioner intentions and those of the NHS South West

have been analysed and the Trust is in the process of setting up high level engagement meetings.

Our service offerings are also being articulated through our Foundation Trust application work and

our five year Integrated Business Plan. We believe paying due regard to our combined duties under

the new NHS Constitution and the pledges it sets out for patients will act as a catalyst to create a

south west culture of mutual cooperation across the health and social care system.

The Trust is ambitious. We are on plan to create a solid operating financial base for sustaining

service delivery. We will drive forward a programme to improve efficiency of back office functions,

exploit technology and all other modern work practices. The development of compelling business

cases to support our longer term plans will be presented again to Commissioners. The success of

these will be critical for our reform programme to reshape and grow our business to meet the needs

of national imperatives highlighted in Lord Darzi’s report ‘High Quality Care for all 2008’, our local

Commissioners, our population and our staff.

Assessing the risk to patients of not achieving our service developments will be a top priority. Our

Corporate Risk Register will continue to inform our strategic decision making. Potential risks to

patient safety will be shared across the health community to ensure mitigating actions are put into

place to protect those we serve and deliver the best possible services within the funding allocated

by our Commissioners. Our intention is to create high level conversations at the appropriate levels to

build understanding of our strategy and objectives.

Our Commissioners will market test the contract for Patient Transport Services in the future. We welcome open co-operation and competition and are responding by modernising the service.

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business review

Financially, the Trust has performed extremely well in 2008/09, declaring a small surplus of £0.325

million in line with the revised target of a surplus of £0.300 million agreed with the South West

Strategic Health Authority. We have delivered a 3% cost improvement programme of £3.120

million which includes an amount of £0.090 million brought forward from 2007/08 which was

only delivered non recurrently in that financial year. We are confident we will meet the required

efficiencies of 3% for 2009/10 by delivering a further cost improvement programme of £3.232

million.

The Trust has considered the risks and opportunities to its business; underpinned by a detailed

SWOT (strengths, weaknesses, opportunities and threats). This has identified some change

management issues for the Trust comprising:

❙ Bid for 3 digit number single point of access pilot dependent on confirmed funding;

❙ National Ambulance Contract;

❙ Primary Care Trust World Class Commissioning (provider and commissioner separating);

❙ Potential market testing for Patient Transport and potential tender of Urgent Care Service

Contracts;

❙ Market leader with strong position to form new business partnerships;

❙ Foundation Trust assessment and subsequent developmental action plan;

❙ Workforce skill mix and greater integration, implementation and roll out across the health and

social care system;

20 21

❙ Delays to the ICT Connecting for Health and Ambulance Radio Programmes;

❙ Delivery of in hours and out of hours primary care services;

❙ Economic downturn and recession resulting potentially in future lower investment levels for the

NHS;

❙ Monitor (independent regulator) risk rating changes for modelling in response to financial

forecasts.

The Trust is currently focusing on managing the risks and potential threats, as well as exploiting

the opportunities these present. The Trust’s new business planning processes and performance

management regime is providing the impetus for embedding performance management into the

culture of the Trust. The Corporate Performance Report presented to the Board each month will be

refined in 2009/10 to report not only on financial and operational performance but also on quality

indicators which reflect our patients’ experiences.

An ongoing ‘enhanced performance regime’ was successfully implemented in September 2008;

initially led by the Chief Executive, this has since delivered Category B19 performance at 95% and

is on plan to deliver for the rolling year to 30 June 2009. This is the first time in the Trust’s history

that this particularly challenging target has been achieved. A Performance Improvement Plan Group

meets regularly to monitor the new regime with real time data reports.

Commissioners and acute hospitals have benefited from the new web based dashboard reporting

systems which show inbound arrival of ambulance vehicles at acute hospitals to enable patient

handover to be recorded. As a result, demand management is now better understood across the

health and social care community. It has also improved the patient experience by reducing handover

delays from the ambulance service to hospitals.

The Trust has secured national recognition for its equality and diversity workstreams throughout

the year. The Department of Health’s Pacesetter programme enabled the Trust to develop a

‘farmers market’ health promotion initiative which complemented the Trust’s public health strategy

aspirations. Other initiatives ranged from literature designed with users for those with learning

disabilities and a DVD produced for migrant workers to overcome barriers of accessing services.

Union representation is well established within the Trust’s committee and group structures with

numerous internal and external communication systems in place to ensure effective, regular and

timely information is shared with two way communication channels embedded across the Trust.

Information technology is exploited by the Trust to overcome the difficulties experienced with

communicating across disparate sites across four counties in a 24 hour dynamic service environment.

Sustainability and environmental issues are another top priority and the Trust recognises the need to

change our procurement decisions which could reduce our carbon footprint to contribute to the NHS

2009 strategy ‘Saving Carbon, Improving Health’. We aim to progress this work under the auspices

of our public health strategy.

Significant changes to Commissioner’s contracts under World Class Commissioning will take place

in 2009/10 with additional changes expected around developing a tariff for ambulance services.

Moving from block contracts to a more sophisticated contract model that better reflects the work

and values of our services is welcomed.

The Board regularly receives reports on tributes to staff through its patient experience reports. The

Board has added their own congratulations and appreciation to the workforce for their outstanding

achievements during the year with four special awards ceremonies hosted to thank staff and their

families. These were also attended by patients whose lives had been saved by our staff with the

unanimous view that this is the ultimate reward for the work that we do.

families. These were also attended by patients whose lives had been saved by our staff with the

unanimous view that this is the ultimate reward for the work that we do.

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Remuneration

The remuneration and expenses for the Trust’s most senior managers (Executive Directors who

are members of the Board of Directors) operates in accordance with the very senior managers pay

framework for current and future financial years. All Director salaries and uplifts are agreed at the

Remuneration Committee and with the NHS South West.

Executive Directors are employed on contracts of service and are substantive employees of the

Trust. Their contracts are open ended contracts which can be determined by either party with three

months notice, or six months in the case of the Chief Executive. The Trust’s normal disciplinary

policies apply to senior managers, including the sanction of instant dismissal for gross misconduct.

The Trust’s redundancy policy is consistent with the NHS redundancy terms for all staff.

During the year a consultant was employed on a part-time and temporary basis as Director of HR

and Workforce. The interim arrangement commenced on 1 October 2008 and continued to the

end of the financial year. The arrangement will continue until the recruitment of a substantive post

planned to take place during the new financial year.

Salary and pension entitlements 2008-09 and 2007-08

Salaries of very senior managers and Non Executive Directors are illustrated below; including pension

entitlements under the NHS Pensions Scheme for very senior managers. Contributions are made

by both the employer and employee in accordance with the rules and the national scheme which

applies to all NHS staff in the scheme. As Non-Executive members do not receive pensionable

remuneration, there are no entries. All benefits in kind are car and fuel benefits.

SALARYName and Title

2008-09 2007-08

Sa

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(b

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f £5

00

0)£0

00

Oth

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Re

mu

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rati

on

(ban

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£50

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£00

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Be

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in K

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ded

to

the

nea

rest

£10

0

Sa

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(b

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f £5

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0)£0

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Oth

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(ban

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£50

00)

£00

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Be

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to

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£10

0

H Strawbridge (Chairman)

£20-25 £800 £20-25 £900

B Howard (Non Executive Director)

£5-10 £1,100 £5-10 £300

R Lock (Non Executive Director) (until 21.01.08)

£0-£5 £200

R Handley (Non Executive Director) (from 02.05.08)

£5-10 £300

C Russell (Non Executive Director)

£5-10 £1,200 £5-10 £500

T Ware (Non Executive Director)

£5-10 £700 £5-10 £300

M Watkins (Non Executive Director)

£5-10 £800 £5-10 £300

K Wenman (Chief Executive)

£120-125 £9,700 £125-130 £3,200

N Lane (Clinical & Urgent Care Director)

£75-80 £5,000 £75-80 £2,300

S Davies (Director of Finance) (until 18.01.08)

£75-80 £75-80 £6,300

J Kingston (Interim Director of Finance & Performance) (from 07.01.08)

£70-75 £25-30

J Kingston (Director of Finance & Performance) (from 01.11.08)

£40-45 £3,200

J Liggett (Director of Human Resources & Workforce Development) (until 18.09.08)

£30-35 £1,800 £75-80 £3,300

S Pryor (Director of Operations on secondment)

£25-30 £6,300 £80-85 £4,000

J Kingston (Director of Finance & Performance) (from 01.11.08)

£40-45 £3,200

J Liggett (Director of Human Resources & Workforce Development) (until 18.09.08)

£30-35 £1,800 £75-80 £3,300

S Pryor (Director of Operations on secondment)

£25-30 £6,300 £80-85 £4,000

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24 25

From October 2008 a consultant has supported the Trust as an interim arrangement to lead the

Human Resources & Workforce Development department. The total cost to March 2009 was

£42,056.24 including VAT. A recruitment process will take place in 2009.

PENSIONName and title

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K Wenman (Chief Executive)

£0-(2.5)£(2.5)-(5.0)

£45-50 £140-145 959 755 204

N Lane (Clinical & Urgent Care Director)

£0-2.5 £2.5-5 £25-30 £85-90 510 377 133

J Kingston (Director of Finance & Performance) (From 01.06.08)

£0-2.5 £2.5-5 £20-25 £65-70 413 150 263

J Liggett (Director of HR & Workforce Development)

£0-2.5 £0-2.5 £5-10 £15-20 101 71 30

S Pryor (Director of Operations)

£2.5-5 £7.5-10 £30-35 £100-105 694 481 213

Cash Equivalent Transfer Value (CETV)

A Cash Equivalent Transfer Value is the actuarially assessed 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.

The significant difference when you compare this year’s values with last years is due to a change in

the factors used to calculate CETVs, which came into force in 1st October 2008 as a result of the

Occupational Pension Scheme (Transfer Value Amendment) regulations.

These placed responsibility on the calculation method for CETVs (following Actuarial advice) on

Scheme Managers or Trustees. Further regulations from the department of Work and Pensions to

determine cash equivalent transfer values (CETV) from Public Sector Pension Schemes came into

force on 13th October 2008.

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.

from the scheme.

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.

businessreview

annualreport08/09

businessreview

ken

We will create high level conversations to create better understanding of our strategy and objectives to demonstrate how we can significantly contribute to our Primary Care Trusts’ World Class Commissioning ambitions and promises .

board of directors

The Board of Directors provides the Trust with a diverse range of skills, expertise and experience.

During the year the Board participated in the NHS Institute Board Development Tool. The resultant

action plan will inform future Board development work which will complement the findings of the

NHS South West assessment phase which commenced in March 2009 as part of the Trust’s plans to

become a Foundation Trust.

In 2008/09 the membership of the Executive team comprised:

❙ Chief Executive, Mr Ken Wenman

❙ Director of Finance & Performance, Mrs Jennie Kingston (interim January 2008, appointed

November 2008)

❙ Director of Operations, Mr Steven Pryor (secondment October 2008 to date)

❙ Director of Urgent Care and Clinical Services, Mrs Norma Lane

❙ Director of HR & Workforce, Ms Julie Liggett (to 18.09.08)

There are four Associate Directors who form part of the Executive team but they do not have voting

rights and are therefore not formal members.rights and are therefore not formal members.

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boardofdirectors boardofdirectors

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annualreport08/09

There are also six Non Executive Directors comprising of:

❙ Chairman, Mrs Heather Strawbridge

❙ Vice Chairman, Mrs Charlotte Russell

❙ Mr Richard Handley (from May 2008)

❙ Mr Trevor Ware

❙ Professor Mary Watkins

❙ Mr Bjorn Howard

The Board of Directors is not aware of any audit information that

has been withheld from the Trust’s auditors, and

members of the Board take all relevant

steps to make themselves aware of

relevant information and to ensure this

is passed to the external auditors as

appropriate.

The Trust’s external auditors have provided

an opinion on page 17 on our accounts for

2008/09 with independent assurance from the

Trust’s internal auditors - www.swast.nhs.uk.

The Board has adopted the Ombudsman principles

to demonstrate clear leadership and commitment to

listening and responding to patient’s concerns.

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boardofdirectors boardofdirectors

29

annualreport08/09

has been withheld from the Trust’s auditors, and

2008/09 with independent assurance from the

Trust’s internal auditors - www.swast.nhs.uk.

The Board has adopted the Ombudsman principles

to demonstrate clear leadership and commitment to

listening and responding to patient’s concerns.

30 31

looking forward

The Trust is in the process of preparing to become a Foundation Trust. Our mission, vision and

strategic intent has been described and translated onto a poster which has been distributed across

the Trust with the full details illustrated in our draft Mini Integrated Business Plan. This work was

underpinned by staff feedback captured from a series of development days hosted throughout the

year; including the Board. Garnering consensus for the Trust’s strategic intent has clarified our way

forward, drawing on our past strengths, with agreement for five key service developments.

Underpinning the service developments are draft enabling strategies which consist of estates,

information, technology and communication, workforce development, strategic communications and

fleet. However, these will require further refining once more detailed service plans are in place. This

work will take place throughout 2009/10 as part of the ongoing transformation of our services.

Staff are congratulated for their dedication and commitment to the Trust as without their

enthusiasm we would not be in such a strong position to move forward with such confidence

in becoming a Foundation Trust. The thousands of volunteers who support our service are

commended; without their help we would not have accomplished such excellent results throughout

the year. We would like to publicly thank everyone.

We are proud to work with three air ambulance charities, our FLEET charity in Cornwall and the

in becoming a Foundation Trust. The thousands of volunteers who support our service are

commended; without their help we would not have accomplished such excellent results throughout

the year. We would like to publicly thank everyone.

We are proud to work with three air ambulance charities, our FLEET charity in Cornwall and the

lookingforward

annualreport08/09

lookingforward

‘help us to help you’ is our message to members of the public to express an interest to become a member of our Trust. Find out more on 01392 261649 or sign up at www.nhs-membership.co.uk/swas.

32 33

many volunteers who support our fundraising for our various charitable initiatives; including the

Freemasons who consistently provide the Trust with generous donations. More details of our work

with volunteers is showcased on our website www.swast.nhs.uk.

We intend to develop closer working relationships throughout 2009/10 with our seven Primary

Care Trusts and other key stakeholders and will use the opportunities that our Foundation Trust

application provides to better engage, explain and articulate our combined objectives to ensure our

patients receive the optimum healthcare services in the south west region.

We are working towards and developing a patient safety dashboard which will inform our ‘quality

accounts’ due to be in place for April 2010. This work forms part of the NHS reforms under Darzi.

As we continue our journey to become a Foundation Trust one of the priorities will be the

establishment and engagement of a representative membership of 15,000 people. We want to build

and reflect our many diverse communities across the four counties we serve to allow us to build on

the excellent relationships the Trust enjoys with the nine Overview and Scrutiny Committees in our

area. Work to engage with the newly established Local Involvement Networks (LINks) will also be

a top priority for the Trust to ensure we develop meaningful and effective engagement for these

embryonic groups. More information can be found at www.nhs-membership.co.uk/swas.

lookingforward

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lookingforward

34 35

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fi nancialperformance

financial performance

Jennie Kingston, Director of Finance and Performance

I am pleased to report that the Trust has had another successful year in 2008/09 in managing its

financial resources.

A full set of accounts for the financial year 2008/09 are set out at the end of this Annual Report.

This approach is new for the Trust and is in line with the best practice of existing respected

Foundation Trusts who report to the public within one document for ease of access and clarity.

The Trust core business comprises three income streams:

❙ Emergency Ambulance Service (999 ambulance, air ambulance helicopters, volunteer community

first responders, Fire Service co-responders, GP responders) across the counties of Cornwall and

the Isles of Scilly, Devon, Dorset and Somerset;

❙ Urgent Care Service (sometimes referred to as Out of Hours services) provided from 22 local

treatment centres across Dorset, Somerset and the Clinical Hub at St Leonards in Dorset;

❙ Patient Transport Service (non-emergency medical patient transport services) across the counties

of Cornwall and the Isles of Scilly, Devon, Dorset, Somerset, including into the areas of Bath and

Bristol.

Pictured here is a tribute to the late pilot Steve Ford who sadly died in a tragic motorbike accident in October 2008. Steve joined Bond Air Services, the company that leases one of the Devon Air Ambulance helicopters, after a distinguished career as a pilot in the army. He was a remarkable man, much respected and loved by those who were proud to work with him.

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fi nancialperformance

The annual accounts comprise four primary statements:

❙ Income and Expenditure Account;

❙ Balance Sheet;

❙ Statement of Total Recognised Gains and Losses;

❙ Cash Flow Statement.

As an NHS Trust, South Western Ambulance Service is required to achieve a number of financial

targets. Actual performance compared to target is set out over the next pages within this section.

At a glanceWhat we spend taxpayers’ money on

Staff Costs£88.3m

Supplies and Services£3.8mEstablishment

£3mTransport£9.9m

Premises£5.3m

Depreciation£5.1m

Other£5.4m

Breakeven performance

The Trust is required to deliver against the breakeven performance over a three year rolling period.

The actual outturn for 2008/9 is a surplus of £0.325 million. Over the three year period 2006/7 to

2008/9 the Trust has achieved a breakeven cumulative position of £0.083 million with the balance

on the income and expenditure reserve account of £0.030 million.

External Financing Limit

The Trust is given an External Financing Limit which is a cash limit on net external financing and is

a control for cash. The Trust is permitted to undershoot the External Financing Limit. For 2008/09

the Trust was set a negative External Financing Limit of £4.276 million. After financing cash flow

the external financing requirement was a negative £5.247 million. This represents a permissible

undershoot of £0.971 million compared to the External Financing Limit.

Capital Cost Absorption Rate

The Trust is required to absorb the cost of capital at a rate of 3.5% of average relevant net assets.

The rate is calculated as the percentage that dividends paid on public dividend capital, totalling

£1,313,000, bears to the average relevant net assets of £31,371,000, that is 4.2%.

The variance from 3.5% arises from cash in bank of £6,668,000 compared to a plan of £1,144,000.

This is due to £4,200,000 more cash in bank to service provisions and not making a pensions

payment of a £1,000,000 in March 09.

The average assets used in the calculation was also affected by the changes to the reduction in value

of land and buildings of £3,729,368.

Capital Resource Limit

The Trust is given a Capital Resource Limit which it is not permitted to overspend. The Capital

Resource Limit for 2008/09 was £6.313 million. The charge against the Capital Resource Limit was

£6.291 million giving a small permissible under spend of £0.022 million.

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fi nancialperformance

Better Payment Practice Code

Although not a financial target the Trust is measured for its compliance with the Better Payment

Practice Code. The Code requires the Trust to pay all undisputed invoices by the due date or

within 30 days of receipt of goods or a valid invoice whichever is later. The Trust is deemed to be

compliant if it achieves 95% or better against the Code. In 2008/9 the Trust for non-NHS trade

invoices paid 98% in number and 100% in value and for NHS trade invoices paid 95% in number

and 99% by value.

Highlights from the Annual Accounts

❙ The Trust received income from its operating activities of £122.3 million of which £118.8 million

relates to patient activity;

❙ Primary Care Trusts invested an additional £7.48 million in the service level agreement for

accident and emergency services and a further £0.700 million in year to support the escalating

fuel costs;

❙ Primary Care Trusts invested an additional £0.63 million in the service level agreement for urgent

care services;

❙ The Trust committed £120.8 million on operating costs of which £88.3 million (73.1%) was spent

on employing staff;

❙ The Trust invested in service developments of £1.8 million to support the delivery of the category

B19 performance target;

❙ The Trust capital programme invested nearly £5 million in the replacement of its fleet and a

further £1.4 million in Information technology and estates infrastructure;

❙ The Trust is required to deliver an annual efficiency programme. The target in 2008/09 was

£3.232 million equivalent to 3%. This was achieved in full.

External Audit Services

The Trust’s Audit Committee agreed that the Audit Commission should be the Trust’s external

auditor for 2008/09. The Trust incurred £0.128 million in audit services fees in relation to the

programmed audits of the Trust’s accounts to 31 March 2009.

Countering fraud and corruption

The Board of Directors has established policies and procedures to minimise the risk of fraud or

corruption, along with a supportive whistleblowing procedure for staff who suspect inappropriate

actions or behaviours. Details of the Trust’s Local Counter Fraud Specialist and the NHS Fraud and

Corruption reporting line are displayed on the Trust’s intranet and in the Chief Executive weekly

Bulletin. Regular external and internal campaigns to raise awareness of the Trust’s processes are

championed by the Chief Executive’s Directorate throughout each calendar year. All concerns are

investigated by the Trust’s Local Counter Fraud Specialist who reports to the Director of Finance and

Performance who liaises with the NHS Counter Fraud and Security Management Service and Police if

appropriate. Reports of any counter fraud activity are made to the Audit Committee which is a sub

Committee of the Board.

International Finance Reporting System

The 2008 budget included an announcement that all public bodies following the HM Treasury

Financial Reporting Manual (FReM), including NHS Trusts, Primary Care Trusts and Strategic Health

Authories, would follow international accounting standards (IFRS) from 2009/10.

The Audit Commission has assessed that the Trust has adequate arrangements in place for

identifying and reporting its accounting policies (subject to detail specific to the Trust being added);

identifying and reporting UK GAAP (Generally Accepted Accounting Practice in the United Kingdom)

adjusted values; reporting International Finance Reporting System values and restating its notes

to the balance sheet. As a result, the Trust is well positioned to prepare International Finance

Reporting System compliant account in 2009/10.

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operational and clinical performance

We have made huge improvements during 2008/09; ranking amongst the top performing

ambulance services in England for responding to patients with life threatening conditions. All 999

calls assessed as life threatening must be responded to within 8 minutes (480 seconds) in 75% of

all cases. This significant achievement against our main target was accomplished against the new

Call Connect target implemented 1 April 2008. This removed the hidden wait of 90 seconds for

each 999 call because the performance clock now begins when the call is connected and not after a

series of questions by call takers.

The Trust met and surpassed all its national operational performance targets with the exception

of Category B19 (serious but not life threatening calls) which is now on target for delivery for

the rolling year up to 30 June 2009. The detailed annual performance of our national targets are

published in our Annual Business Plan; www.swast.nhs.uk and a summary is on page 35 of this

Report.

An additional statutory function is our status as a Category one responder under the Civil

Contingencies Act 2004 to provide emergency planning to protect the public during major

incidents. The Trust has an agreed major incident plan and works with other organisations

throughout the year to continually plan, test and update all preparatory plans.

Community responders range from volunteers to colleagues from all emergency services; attending 19,029 incidents during the year; many lives have been saved. We sincerely thank our responders who are trained to attend appropriate emergency calls providing first aid until an emergency ambulance arrives. We are proud of our 955 responders working in over 200 dedicated responder teams.

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A significant effort has been underway in the Trust, alongside partner agencies and the Health

Protection Agency, to ensure robust plans were developed and put into place in case of an outbreak

of pandemic flu. This is one of our top risks and is listed on our Corporate Risk Register.

Since the close down of our accounts, our Pandemic flu plans were activated in late April 2009 as

the first cases of Influenza A H1N1 were reported in Mexico; with further cases reported in the

worldwide media as ‘Swine Flu’. More information on the Trust’s ongoing work to protect the

public alongside our partners is available on our website www.swast.nhs.uk.

Accident and Emergency (A&E)

The A&E service is monitored against national targets and the Trust achieved:

❙ Category A8 Minute Performance 78.01% (target 75%)

❙ Category A19 Minute Performance 95.78% (target 95%)

❙ Category B19 Minute Performance 94.25% (target 95%)

The Trust is on plan to deliver Category B19 for the rolling year up to 30 June 2009.

During the year changes were implemented to the management structure with four senior

operational managers repositioned whilst the Director of Operations took the opportunity to accept

a secondment in Wales. These arrangements enabled each of these dedicated senior operational

managers to take responsibility for each of the four counties we serve. This supports our managerial

preparation for service line reporting in preparation for becoming a Foundation Trust.

This approach has been led by the Executive Directors and culminated in an ‘enhanced performance’

programme from September 2008. Since this new regime was introduced the Trust has met all its

national targets; a position never accomplished before in the history of the Trust.

Patients are experiencing real benefits from these faster response times with better clinical outcomes

for those with cardiac arrest and other life threatening conditions. However, the Trust is not

complacent and places great importance on consistently achieving and doing better than all national

targets whilst creating opportunities for service innovation and developments over the longer

term. These plans are highlighted in our Annual Business Plan for 2009/10 and our draft Integrated

Business Plan which spans the six year period 2009 to 2015. www.swast.nhs.uk.

Clinical quality, audit, research and patient safety

The Trust is mindful that response times are not the only factor determining high quality patient

care. We have worked hard and performed equally well for our clinical practice ranking in the top

quartile for national clinical performance indicators.

We take our responsibility seriously for infection control measures and have implemented a ‘Cleaner

Care’ initiative over the past year. We were pleased to welcome the Healthcare Commission who

carried out an inspection across the Trust in February 2009 on our infection control measures. The

results will be released in May but we did not receive any negative feedback nor interventionary

measures during the inspection; a positive initial message.

All clinical staff practise to standards developed and published by the Joint Royal Colleges

Ambulance Liaison Committee (JRCALC) and the National Institute for Health and Clinical Excellence

(NICE). This provides assurance that care is based on the best available evidence where it exists.

Where robust research evidence is lacking, a consensus on practice standards is reached by the

JRCALC guidelines development group which supports our aim to widen the scope of our clinical

practices.

The Healthcare Commission Annual Health Check requires Trust to self assess and predict their

scores against 24 core standards. Under this regime the Trust is required to highlight significant

lapses in compliance to the standards and during the year we reported two; medical devices and

records management. Corrective action is underway so our declaration for the year remains good

for quality of services and good for quality of financial management.

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This process underpins the clinical effectiveness agenda which is at the heart of our clinical

governance framework which is now becoming known and more aptly referred to as patient safety

and clinical quality.

During the year national requirements for ambulance services to participate in audit have focused

on involvement in the National Clinical Performance Indicator programme. The National Clinical

Performance Indicator group is a sub group of the National Ambulance Clinical Audit Steering

Group which demonstrates a clear line of accountability. Our highly experienced Research and Audit

Manager, Sarah Black continues to be closely involved with the development of the national Clinical

Performance Indicators and the Trust has participated by submitting data on all of the current clinical

topics.

Hospital Trusts participate in the Myocardial Ischemia National Audit Project (MINAP). Ambulance

services have access to some of this data via the ambulance outcome database and the Trust

uses this information routinely to monitor all patients with ST segment elevation myocardial

infarction (STEMI); heart attacks which respond to clot busting drugs clinically named thrombolysis.

This information is used to identify anomalies in data and reporting of performance; enabling

communication with Hospital Trusts regarding audit for this patient group.

Our completed programme of local audits during the year has included:

❙ Treatment of patients with heart attacks, including thrombolysis;

❙ Referrals in cases of suspected child abuse and for vulnerable adult protection;

❙ Clinical record keeping, including recognition of life extinct procedures;

❙ Treatment of patients with glycaemic emergencies;

❙ Management of unintentional injuries in children;

❙ Treatment of patients suffering a convulsion;

❙ Alcohol related attendances.

Continued emphasis and importance is placed on empowering clinical staff to participate in local

audit programmes through the conception of a Research and Audit group. Chaired by the Research

& Audit Manager this team of enthusiastic clinicians aim to promote clinician involvement in

evaluating clinical effectiveness through clinical audit and contributing to the evidence base for pre-

hospital care through participation in research.

999 Control Rooms (known as Clinical Hubs because Clinicians also work in this function)

The two Clinical Hubs, our flagship centre in St Leonards, Dorset and the other in Exeter, Devon,

have continued to implement a modernisation programme with the successful integration of a

new software system in the East to match the system already in place in the West. This change has

enabled significant improvements to our call cycle times which has resulted in better support for

frontline clinicians in achieving faster patient responses. The shorter the call cycle time for a caller

the swifter an ambulance response arrives on scene to the patient.

The Trust has pioneered a national development on behalf of all English Ambulance Trusts, a

technical link between the 999 service and NHS Direct nationally.

The Clinical Hubs have improved the quality of call taking and the Trust was delighted that the East

Hub received the ‘Centre of Excellence’ award from the NHS supplier of triage software. Both Hubs

are on track to secure the Trust’s position as the first ambulance service to achieve an ‘Excellence

Award’; building on the work of our two National Advanced Medical Priority Dispatch System

(AMPDS) trainers; of which there are only seven in the country.

The Clinical Supervisors who work in both Hubs who are trained nurses or Emergency Care

Practitioners, have become integral to the successful management of callers who do not require a

life saving response; especially those known as frequent 999 callers. The Clinical Supervisors spend

more time with this high usage caller to liaise with frontline operational staff and other health or

social care professionals to adapt our responses to better suit their requirements. This frees up our

emergency call takers and dispatchers who can focus on patients who require life saving responses.

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Public Health

We have refreshed our public health strategy and in future we will encompass disparate pieces

of work across the Trust which contribute to tackling health inequalities, promoting good health

initiatives and supporting measures to prevent ill health under one public health coherent work plan.

One example of how the Trust can support Commissioners’ public health work is our Safeguarding

function. We have invested more resources during the year to strengthen this expanding work to

meet changing statutory requirements introduced 1 April 2008. This work is led by our full time

Safeguarding Manager, Mary Smeaton who is an experienced and qualified health visitor. Evidence

of this success is the steady increase by our staff for vulnerable adults and child protection referrals;

both groups experience health inequalities. Staff referred 355 (161 adults and 120 children) for

2008/09 compared to 281 (215 adults and 140 children) in 2007/08. It is not our duty to investigate

but to refer these patients to the relevant agencies to take appropriate action.

The protection of children has been high on the news agenda in recent months following the

infamous Baby P case. In response there has been a national drive to re-evaluate all serious case

reviews and the Trust has contributed to this process locally.

The equally high profile Steven Hoskin adult review in Cornwall (www.cornwall.gov.uk) identified

frequency of contact with emergency services as an indicator of vulnerability. In response we have

worked with partner agencies to produce a trigger document that defines frequency for each

service; calling more than three times a month results in the classification as a frequent caller.

The Trust is contributing to the preventive work around drug related deaths and our Safeguarding

and Audit teams are planning to present a workshop at the Drug Related Death conference in April

09 to support this vulnerable group of patients. They are involved in other preventative work such as

domestic abuse. Later this year they will contribute to the Multi Agency Risk Assessment Conference

to assess the risk for victims of the domestic abuse process..

The Safeguarding Manager has contributed to major national consultations including the Dementia

strategy and the review of the ‘No Secrets’ guidance on developing and implementing multi-agency

policies and procedures to protect vulnerable adults from abuse.

Campaigns

Our public health strategy ‘Prevention is Better than Cure’ drives a number of planned campaigns

such as the successful joint initiative with NHS South West for ‘no smoking day’; including others

such as stroke awareness and looking after your heart. Work with external agencies such as the

national Pubwatch organisation and Local Authorities successfully promoted our zero tolerance

approach to violence or aggression against our staff; Police prosecution is pursued if appropriate.

Estate

We are striving to reduce energy consumption and investments in environmentally friendly systems

continue to be implemented across our estate which comprises 65 ambulance stations and two

administration buildings with a capital estate spend in 2008/09 of £0.750 million to improve and

maintain our estate. Environmental assessments of nine major sites were undertaken, with the

main improvements in management, water, pollution and operational waste. All nine sites are now

assessed as good overall.

Fleet

A significant challenge for our service, which relies heavily on its fleet to deliver services, is the

reduction of carbon emissions. The Board recognise that how we procure services is where we can

make the most notable contribution and we will work diligently to consider how we can improve our

carbon footprint to contribute to the overarching NHS pledge to become one of England’s leading

sustainable and low carbon organisations set out in ‘Saving Carbon, Improving Health 2009’.

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The Trust invested £4.3 million in new fleet during the year comprising 38 emergency ambulances,18

rapid response cars, 6 Patient Transport Service vehicles,1 Mobile Control Unit, 7 mobile

decontamination units for resilience, 4 resilience vehicles, 3 training vehicles, 11 vans, 2 cleaning

vehicles. We are the only ambulance service to have worked with the Vehicle Safety Agency (VOSA)

to produce a vehicle safety DVD for our staff.

We are proud of our in house mechanics who work tirelessly alongside operational staff to manage

our busy workshops to maintain our fleet. We were pleased to invest in a new workshop at St

Leonards, Dorset during the year as part of our ongoing review and changes to our estate.

The introduction of a ‘Make Ready’ scheme is supporting our frontline staff which has enabled

frontline operational vehicles to be collected and delivered to our workshops by a dedicated member

of staff. This has ceased the requirement for operational staff to be taken off duty to collect, deliver,

clean and prepare their vehicles for shifts. Under this new scheme all vehicles are inspected for

safety, serviced, repaired as necessary, cleaned and restocked ready to go back on duty.

Urgent Care Service

We manage the Urgent Care Services for the counties of Dorset and Somerset, including a small

population of 100,000 for part of neighbouring Wiltshire. Staff have worked hard to significantly

improve national performance standards during the past year, meeting 10 of the 13 quality

standards. We are keen to further negotiate with Commissioners for funding to be enhanced and

meanwhile we have an improvement trajectory in place to secure delivery of all 13 standards. We

remain the most economical Urgent Care Service in the country with an income of just £6 per head

compared with some providers who receive £13 per head.

The Urgent Care Service is monitored against 13 national quality requirements. The performance

for the year to 31 March 2009 is achievement of 10 of the 13 quality requirements with an

underachievement on the remaining three requirements. The Trust has made significant progress

with the service since its inception in 2005 and has a plan to deliver all 13 in the future.

Activity levels have risen by 8.4% compared to the previous year and our flexible workforce is able

to respond to peak demands for example some Saturdays peak at 1,500 calls.

Throughout the year improvements in performance range from initial call taking, prompt clinical

telephone assessments or arrangements for convenient and timely appointments in local treatment

centres or patient’s homes. A number of initiatives has enabled these improvements:

❙ Employment of more call takers and dispatchers on permanent contracts to improve availability

and retention;

❙ Installation of an updated computer call dispatch system with training for all dispatchers;

❙ Increase in telephone assessment clinicians to better match forecast demand;

❙ Qualified specialists delivered training in clinical telephone assessment and advice;

❙ Review of GP recruitment and induction processes;

❙ Extension of opening times for local treatment centres to match patient demand at peak times;

❙ Extended operating times for GPs at weekends to meet peak demand for home visits;

❙ Use of extra GP stand-by cars at weekends for added cover; required for home visits;

❙ Expansion of use of Emergency Care Practitioners for home visits whilst continuing to support our

A&E business;

❙ Clinical Supervisors trained in decision support software for clinical telephone assessment of

urgent and emergency calls.

❙ Multi-disciplinary clinical teams in Poole local treatment centre working closer with the Emergency

Department at Poole Hospital to assess and treat patients quickly by the most appropriate

clinician;

❙ Working with Yeovil District Hospital who provide secure storage and easy access to palliative care

medication for our staff who can now treat patients who choose to end their lives at home.

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❙ Management of Minor Injury Units, Weymouth and Portland in Dorset;

❙ Management of Newquay Minor Injury Unit in Cornwall during busy Summer months;

❙ Local arrangements across the four counties of our Emergency Care Practitioners working at

community hospitals, for example within West Cornwall;

❙ Trial project at Swanage Minor Injury Unit with NHS Dorset to provide a dedicated ‘out of hours’

medical service from Swanage Hospital; Paramedics and Emergency Care Practitioners based at

the community hospital providing an ‘out of hours’ service to patients in their homes as well as

responding to emergency calls.

These initiatives have enabled our clinical staff to become integrated with other community health

professionals to develop their skills, share expertise and create closer collaborative working that is

benefiting patient care and enabling treatment closer to home or at home.

We will build on this joined up work and instigate more partnership working with community

nursing teams; particularly in the fields of anticipatory care and the management of long-term

conditions in the community which are top priorities for Commissioners. This will further improve

patient care by ensuring treatment and advice provided out of hours is consistent with in-hours

treatment; further reducing unnecessary emergency hospital admissions.

Patient Transport Service (PTS)

Our Patient Transport Service provides non-emergency transport to patients who need to access

health services and are unable to use public transport; including transport to and from hospitals for

hospital outpatient appointments, day units and out of county treatment centres.

There are no national performance targets or standards for the Patient Transport Service. As part

of the Trust’s transformational plans for the service local performance targets are being developed

for reporting purposes to report to Commissioners in the future to demonstrate our commitment to

quality services.

The service is accessed and booked for patients by doctors and healthcare professionals. We

provided 255,031 patient journeys, with over 100,000 calls received by our Clinical Hubs where

our PTS control centres have been successfully relocated during 2009/10. Our patients’ transport

needs can present barriers for access to health services which is why our service is such a critical

component of patients’ health needs to support good health outcomes. The busiest month was

July, with the least activity in the peak holiday month of August.

The service is a challenging, busy and fast moving function, operating in a high demand

environment constricted by a fixed budget. During the year a staff consultation identified a number

of key changes to support transformation of the service to better meet patients needs. Extensive

consultation in partnership with Commissioners has taken place to encourage understanding,

dialogue and feedback from members of the public and key stakeholders.

This feedback has accelerated changes so we can create greater efficiencies, improve productivity

and instigate quality improvements. Numerous improvements for patients have been achieved

which include:

❙ New Information Technology exploiting the very latest transport technology;

❙ E-booking for all major clinics, reducing clinical administrative time and increasing accuracy of

patient bookings;

❙ Implementation of a mobile solution designed to track and trace vehicles and crews to assist a live

planning environment’;

❙ Introduction of automatic planning and scheduling tools to provide significant efficiencies and

economies of scale;

❙ New telephone system installed across both Clinical Hubs;

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❙ Three year single service level agreement drawn up in conjunction with procurement hubs for all

south western trusts;

❙ Single ‘who pays’ approach established across all trusts;

❙ Key performance indicators established;

❙ Local and regional internal development groups set up;

❙ Process redesign programme initiated and control staff restructure implemented;

❙ Resilience project in place;

❙ High quality communications with regular briefings and marketing materials;

❙ Specialist consultancy supported our transformation plans.

Our transformational programme is a significant opportunity to improve our Patient Transport

Service to better meet the needs of our Commissioners and patients. Some of the critical success

factors for the future include:

❙ Roll-out of mobile solution on all vehicles for dynamic re-scheduling;

❙ Auto planning to maximise efficiencies and secure best value for taxpayers;

❙ Demand flattening by providing clinical administrators direct access to transport capacity;

❙ E-booking to reduce booking costs;

❙ Roll-out centralised and on-line resource management to secure savings.

The Trust continues to disinvest in the Voluntary Car Service and is transferring the service to

suitable and more appropriate providers; a phased programme is in place to meet Commissioner

requirements. During the year the Trust supported delivery of 267,971 patient journeys.

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organisational structure

Board of Directors

The role of the Board of Directors is to manage the Trust by:

❙ Setting the overall strategic direction of the Trust within the context of NHS priorities;

❙ Regularly monitoring performance against objectives;

❙ Providing effective financial stewardship through value for money, financial control and planning;

❙ Ensuring that the Trust provides high quality, effective and patient-focused services through

robust clinical governance;

❙ Ensuring high standards of corporate governance and personal conduct;

❙ Promoting effective dialogue between the Trust and the local communities served.

The Board of Directors is made up of our Chairman, Heather Strawbridge, plus five Non-Executive

Directors and five Executive Board Directors, including the Chief Executive. There are also four

Associate Directors who support the Board but they are classed as non members with no voting

rights. The position of Director of Human Resources and Workforce Development is vacant and

our Director of Operations is currently seconded to the Welsh Ambulance Service. Regular Board

meetings host an open section to the public who can pose questions and listen to discussions.

Agendas, papers and minutes are published on our website and issued to the press and key

stakeholders along with dates of future meetings.

The Trust is introducing impressive improvements to its radio airwaves with the ‘Ambulance Radio Project’ (ARP). This sophisticated new system will benefit staff at the frontline who will carry a single portable device to replace a pager, mobile telephone and hand portable radio whilst away from vehicles.

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Attendance at Board of Directors meetingsName Actual / Possible Notes

Mrs H Strawbridge 10/10

Mrs C Russell 7/10

Mr T Ware 7/10

Mr R Handley 8/9 May 2008

Mr B Howard 8/10

Professor M Watkins 8/10

Mr K Wenman 10/10

Mrs J Kingston 8/10 Interim January 2008 appointed November 2008

Mrs N Lane 9/10

Mr S Pryor 5/5 Secondment October 2008

Mrs J Liggett 5/5 until September 2008

Committee Membership

Audit Committee Mr R Handley (Chairman), Mrs C Russell, Mr T Ware, Professor M Watkins, Executive Directors can attend

Equality & Diversity Committee Mr K Wenman (Chairman), Mrs H Strawbridge, Mr S Pryor, Miss L Paramor

Foundation Trust Steering Committee Mr K Wenman (Chairman), Mrs H Strawbridge, Mrs C Russell, Mr T Ware, Mr R Handley, Mr B Howard, Professor M Watkins, Mrs J Kingston, Mrs Norma Lane, Mr S Pryor, Miss L Paramor

Governance Committee Mr T Ware (Chairman), Professor M Watkins, Dr A Smith, Dr G Bryce, Mrs N Lane, Miss L Paramor, Mr B Howard, Mr K Wenman, Mrs J Kingston

Remuneration & Terms of Service Committee Mrs H Strawbridge (Chairman), Mr K Wenman, Mr R Handley, Mr B Howard, Mrs C Russell, Mr T Ware, Professor M Watkins

Trust and Charitable Funds Committee Mr K Wenman (Chairman), Mrs J Kingston, Mrs H Strawbridge

Audit Committee

The Audit Committee comprised Non Executive Directors Mr R Handley (Chairman), Mrs C Russell,

Mr T Ware, Professor M Watkins and monitored both internal and statutory audit and risk

management plans, held meetings with the Director of Finance and Performance, internal and

external audit representatives and scrutinised audit findings and recommendations.

Equality and Diversity Committee

The Committee comprised Mrs H Strawbridge, the Chief Executive (Chairman), Mr S Pryor, Miss L

Paramor, senior managers, patient representatives and Union members.

Foundation Trust Steering Committee

The Committee comprised Mrs H Strawbridge (Chairman), all Executive and Non Executive

Directors, Miss L Paramor, Mrs S Morton (Torbay Care Trust), a union representative and a patient

representative. The time limited committee was formed to oversee and manage the work of the

Foundation Trust Task Groups and establish robust governance and accountability arrangements for

the initial stages of the Trust’s Foundation Trust application.

Governance Committee

The Governance Committee comprised Non Executive Directors Mr T Ware (Chairman) and Professor

M Watkins, Mrs N Lane, Dr G Bryce, Dr A Smith, Miss L Paramor, as well as other senior managers of

the Trust. The Committee was established as part of a framework to provide overall governance of

the Trust.

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Remuneration Committee

The Committee comprised Mrs H Strawbridge (Chairman) and all of the Non Executive Directors and

the Chief Executive Mr K Wenman. It reviewed pay and conditions of service so the Trust remained

competitive and affordable, recommended pay and conditions for the Chief Executive and Executive

Directors, having first considered proposals submitted by the Chief Executive.

Trust & Charitable Funds Committee

The Committee comprised Mrs H Strawbridge (Chairman), the Chief Executive and the Director of

Finance and Performance. It was the Committee that oversaw the application and management of

the charitable trust funds.

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valuing staff

This year’s outstanding success is a reflection of our high quality staff and their unstinting

commitment to delivery high quality, safe and responsive patient care. An independent national

patient survey by NHS Employers resulted in the Trust being declared top for staff reporting that

the Trust ‘puts the care of patients/service users as the top for the focus of everything it strives to

achieve and do’.

We value the contributions of all our staff, whether clinicians at the frontline or non clinical in

administration support functions to our mechanics working in our dedicated workshops to our

newly employed vehicle cleaners out in the 65 ambulance stations across our area. Everyone plays

an equal role for their part in sharing the success of the Trust.

The Trust is ranked at the forefront of many initiatives because it is not risk averse. The Board has

taken challenging decisions in the past to create a leading edge service. One example is the work

on behalf of other ambulance services for the national pilot of a new role Emergency Care Assistant.

This supportive role is similar to that of a healthcare assistant which is now common practice within

a hospital setting. An independent report will be published in 2009 which will identify the lessons

learned and consider the way forward.

Staff in the Trust are very motivated and this is evidenced by the many Queen’s Medals for Long

Our mechanics are dedicated to keeping our fleet at its optimum and deserve recognition for their contribution to securing our Trust’s top position in England for the performance of Category A life saving responses within eight minutes.

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Service for Good Conduct for Frontline Staff and certificates for non-frontline staff presented at our

award ceremonies. John Spindler was given the surprise of his life when the Trust’s PR team secured

a place on the Paul O’Grady show as part of the ITV programmes celebrations for the sixtieth

birthday of the NHS. John was successfully nominated for his contribution to patient care over the

42 years he worked for the ambulance service at the frontline. John and his wife were treated to a

VIP day in London and even went to 10 Downing Street. The day ended with a spectacular finale

with John and his wife being presented with a business class trip to Perth, Australia to see his family.

Well done John and to all the hundreds of staff for their outstanding long service to the Trust and

our patients.

The Trust Human Resources team was delighted to contribute to the work of a group who scooped

a Compact Excellence award for collaborative working at a regional level. This year the Compact

has formed a health interest group through links with NHS South West and built a coalition which

campaigns for public and private sector organisations to reduce poverty in the region. Some of the

other members of the network include the Black South West Network, Citizens Advice, Faith Net,

National Offender Manager Service.

Staff Employed

At 31 March 2009 the Trust recorded 2,469 staff in post (excluding Bank Staff and Doctors).

During the year, 165 staff left the Trust, which represents a turnover of 6.94%. During this same

period there were 200 new starters and 96 staff who were promoted internally, including career

progression through the ambulance clinical career pathway.

Health and welfare

The average sickness rate for the period was 4.80%. The Trust continued to provide health and

welfare support to staff by contributing towards chiropractor and physiotherapy treatment, eye sight

tests for those working with computers, welfare calls during periods of sickness, regular reviews

where individuals had ongoing health problems, referral to occupational health and a counselling

support 24/7.

In total, 144 calls were made by staff / their families members to our counselling helpline, with 67

staff referred for a face to face counselling. Feedback from staff has been positive and shows that

this support has promoted returning to work following sickness absence.

In November 2008 the two NHS Electronic Staff Record (ESR) systems used within the Trust were

merged which supported the move to one payroll department located at Plymouth Financial Shared

Services.

Equal opportunities, equality and diversity

The Trust Board believes it has a leading role to play in promoting equality of opportunity and

valuing diversity which demonstrates the importance we place upon our social responsibility duties

as a major employer and NHS service provider. A time limited sub committee of the Board was set

up to oversee this work and reports can be viewed on our website which demonstrate our statutory

duties have been met; including publication of relevant equality and disability schemes. These will

be drawn together in future under one equality scheme in compliance with new requirements.

A Learning Support Group, involving people with a learning impairment, now assists those in the

Trust who are dyslexic. It is planned to expand the group’s work in helping those staff who have

other impairments. The Diversity in Action course, which aims to ensure staff understand the effects

of bullying and harassment, has been a success.

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Staff involvement

Listening to staff and developing new and innovative ways for establishing two way communication

channels across 65 ambulance stations and a variety of administration sites is a real challenge in a

24 hour emergency and urgent care service. Seeking to involve staff, listening and responding to

their feedback continues to be a high priority for the Trust and the following initiatives to involve

staff in decision making and planning processes demonstrates our commitment to this approach:

Chief Executive internet Chat room

A successful and innovative new way to encourage two way communication with management has

been implemented during the year. Interactive internet chat room sessions are regularly held with

the Chief Executive and senior managers on line for a dedicated two hour session with themed

subjects for any member of staff to log on, pose questions and seek answers.

National NHS Staff Survey

A randomly selected sample of 800 staff were invited to take part in the annual National NHS Staff

Survey which gave staff were given the opportunity to provide feedback on their working lives. A

67% response rate was the highest among ambulance trusts so, outcome reports, issued from the

Healthcare Commission in March, will allow senior managers to develop an action plan to remedy

any issues.

Healthcare 100 Survey

In September 2008 a randomly selected sample of 970 staff were surveyed, by NHS Employers, the

Health Service Journal, and Nursing Times in relation to performance, management, development,

reward, communication, work/life balance, and individual perceptions of the organisation. This

identified the Trust as being one of the top 100 healthcare providers and the top ambulance trust to

work for in the UK.

Staff Suggestion Scheme

This scheme continues to provide the opportunity for staff to identify and share improvements

to the service. Approved suggestions throughout 2008/09 include disposable tourniquets, spare

equipment / furniture database, policy title being reflective of content, avoiding drug wastage, and

being positive about the NHS logo.

Education, Training and Development

The Trust also has redesigned the technician to paramedic pathway using the Institute of Health

& Care Development (IHCD) route, and this was approved by the Health Professionals Council in

February, the only course of its kind to receive such approval in the country. This will allow our

ambulance technician staff to progress to paramedic.

Developments continue with other higher education pathways, including a foundation degree at

Bournemouth University which commenced in October 2007 and a BSc (Hons) in paramedic science

which commenced at Plymouth University in 2008. The national move towards higher education for

ambulance staff is progressing well, and the Trust is on target to ensure all paramedics are recruited

via the degree route before the national target date of 2012.

The Trust has also written a distance learning foundation degree with its partner institution the

Open University, and now has many students studying using this route. The Trust also has a BSc in

emergency and urgent care underway at Bournemouth University.

Paramedic degree students

The Trust is now supporting 90 student paramedics on university programmes. This will increase to

150 in future years. We also have 18 students on emergency care practitioner (ECP) courses and 51

students studying to be paramedics using distance learning with the Open University.

Accreditation has been secured to run clinical supervision and mentorship programmes with clinical

support officers (CSOs) and we have trained over 100 staff in the last year.

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Emergency care practitioner degree

Students have already started year one and two of the ECP degree, and the first students qualified

with a BSc degree in the summer of 2008.

Recertification courses

The Training and Education Department delivered recertification training to 98% of staff who

required it. Staff on long-term sick and maternity leave during this period will attend the course on

return to work.

Satellite centres

As a commercial venture the Trust has been supporting Her Majesty’s (HM) Forces to create military

paramedics using its accreditation. This has assisted in the creation of over 20 Institute of Healthcare

Development Paramedics who are now able to work for the Trust when leaving the Forces.

The Trust was asked by the Institute of Healthcare Development during 2007 to support paramedic

development in South Africa, and has now trained 10 overseas paramedics, three of whom are

already working for the Trust ‘bank’.

The training team have had a busy year hosting national conferences in paramedic education as well

as lecturing both in the UK and abroad. They are involved in national and international research

projects and intend to present much of this pioneering and cutting edge work during 2009/10.

Commercial training

The Commercial Training Department is incredibly active as its prices continue to be competitive

with the other leading first aid companies. A range of accredited training including immediate life

support (ILS) instructor courses, the Institute of Healthcare Development and the Health and Safety

Executive (HSE) are advertised across the four counties.

First Bike on Scene (FBoS)

Commercial Training continues to work closely with the police through the Bike Safe Scheme and

have delivered the FBoS training to Dorset, Devon & Cornwall, Wiltshire police and Avon & Somerset

motorcycle units.

Management Courses

Senior and Middle Managers are enjoying participating in a bespoke leadership and management

course designed to unleash and nuture talent within the organisation.

Foundation Trust Network

Executive and Non-Executive Directors, alongside Senior Managers participate in these national

courses to expand their knowledge of the Foundation Trust processes and requirements.

Kings Fund Top Manager Programme

This programme is designed to support Senior Managers or Associate Directors to become Directors

or Chief Executives. The Trust was pleased to support one Associate Director to attend the

programme.

NHS South West Leadership Programme

This programme is designed to support Directors to become Chief Executives. The Trust was pleased

to support one Director to attend the programme.

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patient experience

Patients are the focus of everything we do and we have created as many opportunities as possible

to listen to their views, as well as the views of relatives and carers. Patient feedback often brings

change within the service and these can have a real impact on our service developments which is

helping us to improve our patients’ experiences. We actively encourage patients to become involved

in the Trust and we report these in detail in our annual patient experience report which is available

on our website.

The Trust was pleased to participate in the Healthcare Commission’s national patient survey

programme; resulting in a survey of 800 patients from our Category C callers during July 2008. The

Trust ranked amongst the top ambulance services for the best response rates. Category C callers

generally suffer from long term conditions; not requiring life threatening ambulance responses.

60% of respondents were female with 40% male. The reasons for calling were 55% falls/accidents,

18% sick specific diagnosis, 13% back or abdominal pain with 14% other. Although a small sample

was surveyed with a response rate of 49% against an average of 45%, we have been very pleased

with the results which include:

The Trust has produced a ‘Respect and Dignity, Our Commitment to You - Your Commitment to us’ leaflet which clearly articulates the expectations of the Trust for both staff and patient behaviour during interaction of service delivery. no matter where that takes place.

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Percentage

❙ 75 overall care excellent;

❙ 91 call was dealt with satisfactorily;

❙ 96 agreed they did not need to be taken to hospital;

❙ 94 ambulance or car was clean;

❙ 87 staff understood their needs;

❙ 82 felt involved in decisions about their care and treatment;

❙ 95 treated with respect and dignity;

❙ 91 staff listened carefully to what they had to say;

❙ 96 felt their friends and relatives were given enough information;

❙ 77 our staff did everything they could to help control their pain;

❙ 84 care and treatment was explained in a way they could understand;

❙ 93 staff were reassuring;

❙ 91 had confidence in our staff;

❙ 91 felt the time they waited was as soon as they felt necessary.

The Trust is preparing an action plan for development areas which will support our Commissioners’

objectives such as helping those with mental health issues; this will inform our ongoing service

developments. The action plan will include greater analysis of smaller weighted responses which

are believed to reflect patients’ perceptions and expectations of our services which at times may be

misunderstood. These comprise:

Percentage

❙ 32 did not consider calling anyone else before the ambulance service;

❙ 27 did not speak to our operators but someone else did on their behalf;

❙ 3 waited longer than half an hour for their call to be answered;

❙ 6 waited longer than they were informed;

❙ 6 felt they could have received more pain control;

❙ 47 were not put in touch with or told who else to contact

❙ 2 felt they were not treated with respect and dignity.

Making Experiences Count - The ‘four C’s’

During the year we participated in the national project ‘Making Experiences Count’ to prepare

for the new complaints handling legislative changes from 1 April 2009 for NHS and Social Care

complaints regulations. As a result the Trust has re-branded its patient feedback mechanisms

as compliments, comments, concerns and complaints referred to as the ‘4 C’s’ under the Trust’s

management of the newly established patient experience team.

Within the team the Patient Advice and Liaison Service (PALS) captures minor issues such as requests

for leaflets, signposting to other agencies and general queries and comments about the Trust.

Formal and serious complaints and concerns are managed through the Making Experiences Count

processes. The new arrangements comply with a patient centred approach.

The Trust received a combined number of 1,852,212 million Patient Contacts (A&E Activity, Patient

Transport and Urgent Care Services) against a total of 735 complaints and concerns. This represents

0.0004% which is the lowest rate of complaints for the whole of the NHS family; consistent with

performance for all ambulance services in England. This equates to a combined total of 40 for formal

complaints and minor issues from PALS received for every 100,000 patient contacts. Restated figures

for 2008/09.

Compliments

The Trust were delighted to receive 978 appreciations during 2008/09.

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You Said We Did

An annual ‘You Said, We Did’ poster has been produced to provide an at a glance view of the

impact of some of the feedback on service development and is displayed on our website.

Learning from Experience Group

The Trust’s ‘Learning from Experience Group’ was established by the Head of Governance, Nicole

Casey to identify, analyse and act upon trends from all patient feedback systems across the

Trust; including incident and health & safety reporting. This patient focused group will produce a

recommendations and actions log to ensure continuous service improvement is influenced by our

patients.

Healthcare Commission reviews

Two requests for an independent review were received during the year. The first the Trust

implemented the recommendations and the second the Trust was able to resolve direct with the

complainant. In addition, one complainant approached the Commission whilst local resolution was

still ongoing and was referred back for us to resolve the issue locally.

The Ombudsman

The Ombudsman is the final stage of appeal in the NHS Complaints procedures and the Trust is

pleased to report a nil return for the year.

Patient and Public Involvement

Patient and public involvement remains a priority for the Trust with a total of 151 events attended by

staff throughout the year. Examples of events supported include: interactive road-shows to celebrate

NHS 60; the official 60th birthday of the NHS, a respect festival, Learn to Live projects aimed at

promoting safe driving among teenagers and a Skills Somerset careers event.

Media and reputation management

The Trust is well respected and has an extremely positive reputation; ranking constantly in the top

quartile of the NHS South West performance monitoring for positive penetration of the print and

broadcast media. The total number of press cuttings received for the year totalled 15,770, which

is the highest figure ever recorded since the Trust’s inception in 2006; only 1% of this coverage

was negative. The number of media enquiries the press office received was 3,174. This equates to

approximately 264 per month; nine per day. Throughout the year a total of 65 press releases and 50

press statements were distributed on either a local, regional or national basis.

VIP and Ministerial visits

The Trust continues to enjoy national recognition and frequently receives a number of Ministerial

visits including a high level visit in year from the Secretary of State Alan Johnson (pictured with our

Chief Executive on page 26) and MP Ben Bradshaw. The Trust’s Chairman and Chief Executive were

also pleased to welcome their Royal Highnesses Prince Charles and the Duchess of Cornwall during

the year.

twentyfourseven

twentyfourseven is the Trust’s quarterly newsletter. This informative publication showcases and

celebrates all the developments from across the Trust area. A communications audit carried out

internally with the use of a questionnaire reported that twentyfourseven ranked as one of the most

popular methods used by the Trust to communicate with staff. Over 3,500 external recipients

including our Overview and Scrutiny Committee members receive a free copy of the newsletter

which demonstrates the Trust’s commitment to engaging with communities. The publication

remains one of the top visited sections of our website.

Parliamentary questions

A joint initiative with the NHS South West was established during the year to ensure a swift

response to colleagues in parliament. Very often facts are clarified or effective rebuttals are

submitted following misrepresentation or unbalanced reporting from the media.

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Awards

The Trust won four national awards including a Special Service accolade from the Ambulance Service

Institute (ASI) in London with numerous regional and local awards received by staff. The Clinical Hub

Manager for the west division was named as Control Manager of the year at an award ceremony in

London. The Trust held its own ceremonies (one in each county) for staff to receive long service and

good conduct medals; including other certificates and accolades.

Governance

Good governance of an organisation is like the human brain and nervous system working together

well. When both function properly they detect and assess threats, make decisions and swiftly put

into place actions to mitigate risks and dangers.

The Trust has undergone a fit for purpose review of its governance functions; comprising corporate

governance, compliance, health, safety and security and risk management. The Board agreed

four top priority actions during the year to take forward in 2009 to ensure strengthening of our

corporate governance framework and board assurance.

The Head of internal audit; supplemented by our External auditor’s letter of opinion have provided

the Trust with significant assurance in our Statement on Internal Control which forms part of this

report. The detailed annual report for our governance work is displayed on our website.

Safe working environments

We are committed to providing a safe working environment for all our staff, patients and visitors

to Trust sites; a complex challenge within a 24hr dynamic work environment. During the year we

implemented an action plan to take forward recommendations from a Health and Safety Executive

(HSE) inspection in January 2008. Nicole Casey, Head of Governance and her team are commended

for their leadership of this work; especially John Dunn our Health, Safety and Security Manager.

To demonstrate our commitment we have invested in accredited training; which commenced in year

with our Board with plans to provide a more intensive Institution of Occupational Safety and Health

(IOSH) Managing Safety course to senior managers throughout 2009. Risk assessment training has

been provided with dynamic risk assessment added to all recertification and operational training for

2009/10. Conflict resolution training is also being rolled out with Trust trainers already up-skilled to

deliver the training in house during 2009/10.

All incident reporting is via a web based system and we regularly communicate to staff the

importance of open reporting to secure swift improvement where areas are found to be weak.

The investigations are fed into our learning from experience work to ensure we embed the lessons

learned across the Trust.

We provide an occupational health service for our staff which provides pre-employment screening of

new staff; including assessments for fitness to work following serious illness and injury. We invest in

an employee support line which offers a range of free advice to staff and their families. Vaccination

and immunisation programmes are regularly offered to both frontline and support staff to reduce

risk of infections in the workplace and support staff to remain free from ill health. A range of health

promotion initiatives complement this approach with numerous high profile campaigns to underpin

our ill health prevention ambitions for our workforce. A staff well-being group will be refreshed in

2009 to drive forward our plans to support work related stress prevention and support.

Policy development supports our commitment to provide staff with the safest working environments

whilst we acknowledge, and staff accept and are attracted to our service, working in a 24 hour

emergency service will mean we cannot plan or mitigate for every single risk. However, the Trust

is proactive and works tirelessly to create the right balance by working with our unions to agree

supportive and protective policies such as those agreed during the year of lone working, violence

and aggression and control of contractors and contracts.

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In 2008/09 there were 528 accidents reported by staff to the Trust. This compares with 478

reported in 2007/08 and signifies an increase. An analysis of these reported accidents reveals that

the top three reported incidents during 2008/09 were manual handling, slips, trips and falls and

violence and aggression.

In 2008/09 there were 37 reported incidents involving physical assault which were reported to the

NHS Security Management Service. This compares with 38 reports of physical assault in 2007/08 and

signifies a decrease.

Freedom of Information (FOI)

The Trust continues to work hard to respond to requests for information under the Freedom of

Information and Data Protection Acts. During the year, our Information Governance function

received 1,056 external requests, 116 for corporate information and 940 for personal or patient

data.

A ‘Model Publication Scheme’ was created in January 2009 and provides an easier route for

members of the public to access information about the Trust. The Scheme is displayed on our

website and we will expand the breadth of information published in the future to continue to

demonstrate our commitment to being an open and transparent organisation.

Keeping Personal Information Safe and Secure

In 2008/09, the spotlight has remained on how securely organisations, in particular public

sector organisations, hold and manage personally identifiable information. In the NHS, Strategic

Health Authorities have been tasked with monitoring and overseeing arrangements in place in

its constituent organisations, and our Trust has been rated as a low risk organisation due to the

measures we have in place to ensure data is handled securely. We are also required by the NHS to

submit an annual assessment of compliance against 47 standards designed to reflect the quality

of the processes, including those to ensure the security of personal data, that we have in place

for handling and managing information. The Trust submitted a return of 83% compliance against

these standards, putting us second against ambulance Trusts nationally. Thanks are recorded here

to Devon and Cornwall Audit Consortia, our internal auditors led by Ian Whyte whose support and

expertise was invaluable.

The following section demonstrates the number of security and confidentiality incidents reported

within the Trust during the year. This figure is low in terms of the sheer volume of care provided

by Trust services but systems and policy have nevertheless been further strengthened in 2008/09

to ensure that information security risks and issues are managed effectively and as required by the

NHS. This includes the appointment of a Senior Information Risk Officer to champion information

security risk at Board level and the launch of a trust wide training programme to ensure all staff are

effectively informed and aware of standards.

Summary of Personal Data Related Incidents in 2008-09

The following is a summary of the incidents reported in 2008-09 that involved personal data. Of

the five incidents where information was lost, it was recovered within a short space of time in all

but two cases, and one of those was an internal matter involving personal information about a

staff member. It is a reflection of the commitment of our staff to maintaining the confidentiality of

information they obtain in the course of providing services on behalf of the Trust that they recognise

and report these incidents. None of the incidents warranted disciplinary action against the staff

concerned, and none fell into the category of a Serious Untoward Incident that must be reported to

both local NHS management services, and to the Information Commissioner.

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Category Nature of Incident Total

I Loss of inadequately protected electronic equipment devices or paper documents from secured NHS premises

1

II Loss of inadequately protected electronic equipment devices or paper documents from outside secured NHS premises

4

III Insecure disposal of inadequate protected electronic equipment, devices or paper documents 0

IV Unauthorised disclosure 7

V Other 7

Total 19

Partnership working

The Trust works with many agencies and organisations with many arrangements formalised through

service level agreements with other collaborative working within multi agency settings and through

the delivery of projects.

A refreshed strategic partnership mapping exercise has resulted in a database of our partnership

work which is helping to raise the Trust’s profile with other organisations and meet shared

objectives across health and social care. Much of this work is published on our website or in our

‘twentyfourseven’ newsletter.

The Trust’s Resilience Manager is integrated into the collaborative working arrangements of the

Dorset Olympic Planning Team hosted by the Dorset Police for the preparations for the 2012

Olympics. Dorset will host the second largest site outside of London for sailing venues which

includes the paralympics. The Trust looks forward to the higher national profiling this will secure.

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If you would like a copy of this report in another format such as braille, audio tape, total communications

(suits the needs of learning disabled) large print, another language or any other format, please contact:

❙ Email: publicrelations@swast.nhs.uk

❙ Tel: 01392 261585

❙ Fax: 01392 261560

❙ Post: Patient Experience Team, South Western Ambulance Service NHS Trust,

Abbey Court, Eagle Way, Sowton Industrial Estate, EXETER, Devon, EX2 7HY