board of directors meeting · 2017-03-01 · board of directors meeting meeting in public . date:...

BOARD OF DIRECTORS MEETING MEETING IN PUBLIC

DATE: Wednesday 13 July 2016

TIME: 17.30pm – 20.30pm VENUE: Dolman 1, Shaw House, Church Road, Newbury, West Berkshire, RG14 2DR ***

VOTING BOARD MEMBERS:

Trevor Jones Chairman

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

Keith Nuttall Non Executive Director Non Executive Director

Prof. David Williams Non Executive Director Will Hancock Chief Executive Philip Astle Chief Operating Officer John Black Medical Director Charles Porter Director of Finance Melanie Saunders Director of Human Resources & Organisational

Development Deirdre Thompson Director of Patient Care James Underhay Director of Strategy & Business Development IN ATTENDANCE: Steve Garside Company Secretary APOLOGIES: None

AGENDA Board of Directors Meeting – Meeting in Public Date: Wednesday 13 July 2016 Time: 17.30pm – 20.30pm Venue: Dolman 1, Shaw House, Church Road, West Berkshire, RG14 2DR ______________________________________________________________

Item Outcome

OPENING BUSINESS 1 Chairman’s Welcome and Apologies for Absence

Trevor Jones – Chairman

Note Verbal

2 Declaration of Directors’ Interests Trevor Jones – Chairman

Note Verbal

3 Minutes from the 25 May 2016 Meeting Trevor Jones – Chairman

Approve

Paper

4 Matters arising from the 25 May 2016 Meeting Steve Garside – Company Secretary

Note Paper

CHAIRMAN AND CHIEF EXECUTIVE REPORTS 5 Chairman’s Report

Trevor Jones – Chairman

Note Verbal

6 Chief Executive’s Report Will Hancock - Chief Executive

Note Paper

DIRECTORS REPORTS 7 Medical Director’s Report

John Black – Medical Director

Note Verbal

8

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

Note

Paper

9a Operational Performance Report – 999, 111 and Fleet Services Philip Astle – Chief Operating Officer

Note Paper

9b Operational Performance Report – Patient Transport Services James Underhay – Director of Strategy

Note Paper

BREAK

DIRECTORS REPORTS continued 9c Finance and Estates Report

Charles Porter – Director of Finance

Note Paper

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

Note Paper

11 Workforce Report Melanie Saunders – Director of Human Resources and Organisational Development

Note Paper

STRATEGY

12 Sustainability and Transformation Plans (STPs) James Underhay – Director of Strategy

Note Paper

13 Accelerated Clinical Transformation Programme Update Deirdre Thompson – Director of Patient Care

Note Paper

14 SCAS NHS Charity – Future Strategy James Underhay – Director of Strategy

Ratify Paper

REGULATORY, COMPLIANCE AND CORPORATE GOVERNANCE

15 NHS Improvement Quarter 1 Return Charles Porter – Director of Finance

Approve Paper

16 Board Assurance Framework Deirdre Thompson – Director of Patient Care

Note Paper

BOARD SUB-COMMITTEE CHAIR REPORTS

17 Board Committee Upward Reports Professor David Williams (Quality and Safety), Mike Hawker (Audit), Keith Nuttall (Charitable Funds)

Note Paper

CLOSING BUSINESS

18 Any Other Business Trevor Jones – Chairman

Note Verbal

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

Note Verbal

20 Date and Time of Next Meeting held in Public: Time tbc, 28 September 2016, Easthampstead Park Conference Centre, Wokingham, Berkshire

Note Verbal

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

Unapproved minutes – 25 May 2016 Page 1 of 6 Author: SG

ITEM 3 - UNAPPROVED MINUTES FROM THE 25 MAY 2016 MEETING BOARD MEETING IN PUBLIC

Unconfirmed minutes of the public meeting of the South Central Ambulance Service NHS Foundation Trust Board of Directors held on 25 May 2016 at Shaw House, Newbury, Berkshire Present Trevor Jones (Chairman); Alastair Mitchell-Baker (NED); Ilona Blue (NED); Nigel Chapman (NED); Mike Hawker (NED); Keith Nuttall (NED); Professor David Williams (NED); Will Hancock (Chief Executive); Philip Astle (Chief Operating Officer); John Black (Medical Director); Charles Porter (Director of Finance); Melanie Saunders (Director of Human Resources); Deirdre Thompson (Director of Patient Care); James Underhay (Director of Strategy, Business Development, Communications and Engagement) In attendance Steve Garside (Company Secretary) Apologies None _________________________________________________________________________ OPENING BUSINESS

16/001 - Chairman’s Welcome and Apologies for Absence The Chairman welcomed all to the first Board meeting of 2016/17, including a number of the Trust’s governors. There were no apologies for the meeting. 16/002 - Declaration of Directors’ Interests Nigel Chapman declared a new interest having recently been elected as a City Councillor in Oxford; this role did not include any specific responsibilities in relation to health and social care, and was therefore not seen to represent a conflict of interest. No new issues impacting on the fit and proper person requirements were declared. 16/003 - Minutes of the Board meeting held in public on 23 March 2016 The minutes of the previous meeting were approved without amendment. 16/004 - Matters arising from the Board meeting held in public on 23 March 2016 Charles Porter gave an update on the one outstanding action in relation to cost improvement programmes (CIPs), and the learning from 2015/16. He highlighted three actions the finance team were proposing to implement this year: • more active reviewing of the projects and key milestones, including on a bi-weekly basis

as part of the turnaround arrangements • more rigorous sign-off of new CIPs • wider involvement of the Senior Leadership Team in monitoring the delivery of CIPs Keith Nuttall asked for an update in terms of vehicles moving into ‘limp home mode’ when they run short of the Adblue solution; Philip Astle explained that this situation was being closely monitored.


CHAIRMAN AND CHIEF EXECUTIVE REPORTS

16/005 - Chairman’s Report The Chairman stated that 2015/16 had been an extremely challenging year for the Trust, but that the focus had very much remained on patient care. He noted that there was learning to take from the last twelve months, but that the Chief Executive, Executive Team and all SCAS staff and volunteers should be thanked for their efforts. The Chairman acknowledged the recent Care Quality Commission inspection, and in particular the group of governors who had attended a meeting with members of the inspection team. The Chairman reported that a process for appointing a new Chair from 1 April 2017 had been approved by the Council of Governors, and that Sumit Biswas would be taking up his NED post on 1 July. He also advised that he had nearly completed the 2015/16 round of NED appraisals. The Board noted that there had been a lively CoG meeting on 11 April, with governors rightly voicing their concerns about performance and long waits. The Chairman explained that the governors had been informed about a comprehensive review of indirect resources (including CFRs) that the Chief Operating Officer was about to embark on. Finally, the Chairman gave an update on his recent stakeholder engagement activity (focusing particularly on commissioner contract negotiations and hospital handover delays at Queen Alexandra Hospital in Portsmouth). He also advised that the Board would be considering a new strategy for the SCAS NHS Charity in the coming weeks. 16/006 – Chief Executive’s Report The Chief Executive highlighted a number of key issues in relation to his report, including: • the improvement in performance in quarter 1 (999 performance was now back on track) • the recent CQC inspection (no significant issues had been reported by the CQC and the

report was now awaited) • his new role in terms of the NHS England Digital Urgent and Emergency Care

Programme Board The Board discussed Sustainability and Transformation Planning (STP), noting particularly important implications in terms of finance and governance. It was acknowledged that, with final plans due to be submitted by the end of June, Board involvement in reviewing iterations of the plans might be required in the intervening period. Keith Nuttall asked about compliance with the Trust’s provider licence, given the current performance challenges. Steve Garside explained that confirmation of compliance was based on the current position but that this would need to be kept under review during the course of the year. In respect of the public sector equality duty report, Mike Hawker suggested that the staff survey should also be used to collect useful intelligence on equality and diversity issues, including to support the process of measuring outcomes. It was acknowledged that data on the other services (e.g. beyond 999) would provide additional benefit. The Board APPROVED the influenza pandemic plan, the NHS Improvement declaration regarding provider licence compliance, and publication of the Public Sector Equality Duty report.


ITEMS PREVIOUSLY CONSIDERED NOW REQUIRING FINAL APPROVAL

16/007 – Annual Accounts, Annual Report and Annual Governance Statement 2015/16 The Chairman explained that the Audit Committee had held a meeting in the morning to consider the Annual Accounts, Annual Report, Annual Governance Statement and Quality Report, following completion of the external audit process. Mike Hawker advised that the Trust had received a clean bill of health from the external auditors, and that the Audit Committee were recommending to the Board approval of all four documents. The Board APPROVED the 2015/16 Annual Accounts, Annual Report, Annual Governance Statement and Quality Report. Steve Garside advised that he had received a question from Jon Cotterell, Hampshire public governor, about the small deficit accrued by SCFS Limited during the period 1 November 2015 to 31 March 2016. He advised that he had informed the governor that this was due to start-up costs, and was in line with the Trust’s expectations for the initial accounting period. 16/008 – Quality Report including Quality Accounts 2015/16 Mike Hawker referred to his commentary under item 16/007 above, advising that the external auditors had issued a “limited audit opinion” on the Quality Accounts, being the best possible option available. The Board confirmed their approval of the Quality Report and Quality Accounts. DIRECTORS REPORTS

16/009 - Medical Director’s Report The Medical Director explained that he did not have a formal, written report for this meeting, but would be able to update on emergency care network reconfigurations in July. 16/010 – Quality and Patient Safety Report including CQC Feedback The paper was taken as read, with Deirdre Thompson providing a verbal update on the CQC inspection, including noting that ten SCAS areas had been subject to an unannounced visit. Ilona Blue asked for some further reassurance in terms of the ‘tail’ of long waits. Professor Williams explained that this was due to be looked at in some detail at next week’s Quality and Safety Committee meeting and that an update would be presented to the Board in July. Nigel Chapman noted the limitations of drawing conclusions from data based on particularly small sample sizes (e.g. patient outcomes post conveyance – patients readmitted within seven days) and Deirdre Thompson explained that these cases would have been subject to a very detailed audit. Professor Williams highlighted that the number of both adult and child safeguarding referrals had doubled in the last year. Deirdre Thompson responded that this was as a result of a number of factors, including greater awareness and media coverage, and that all cases were reviewed to ensure that the referral had been appropriate. On the subject of safeguarding, the Chairman noted that the SIRI Review Group had raised concerns about the lack of safeguarding update reports coming through to the group. Deirdre Thompson advised that reports were being presented, but the issue was around the level of detail being provided, and this was being addressed. The Board discussed call centre related incidents, and Alastair Mitchell-Baker asked for the chart showing the number of clinical incidents by each working area to be improved in terms of presentation.


Mike Hawker asked about the incident involving the assault of a private provider employee. Deirdre Thompson explained that every effort was being made to establish the address of the perpetrator, and that some valuable learning had been taken from this particular case. The Board held an extensive discussion on how to minimise the impact of long waits. A range of issues were considered, including the use of volunteers (subject to a risk assessment/appropriate governance), the role of the clinical support desk, and clinical assessment on a case by case basis. James Underhay commented that the number of reported clinical incidents relating to private providers appeared to be very low. Deirdre Thompson agreed to look into this. Action 16/010 Deirdre Thompson to confirm the accuracy of the reported data for clinical incidents by private providers.

16/011 – Patient Story The patient story was presented by Dave Sherwood (Head of Clinical Excellence) and Paul Phillips (Investigations Manager), and focused on a safeguarding referral made by SCAS staff when they became concerned about the policies and procedures being applied by a residential care home. It was noted that, as a result of the investigation of the concerns, the residents had been relocated. The Board discussed some of the learning in relation to the patient story, noting the challenges for safeguarding that came from increased telephony based work. Deirdre Thompson explained how training arrangements had needed to be tailored accordingly. 16/012 – Operational Performance Report – 999 and 111 Services Philip Astle reported that performance in April had improved considerably, in line with the Trust’s expectations. He added that, following validation of the red 2 figures, the 75% standard had been achieved for April, meaning that all three national response time standards had been delivered. Philip Astle reported that performance was stronger in Thames Valley than Hampshire; this was partly as a result of Milton Keynes now being part of the Thames Valley contract, and hospital handover problems in Portsmouth. Philip Astle advised that the use of indirect resources continued to increase, and that these resources were being applied to support green calls and long waits. The Board discussed efficiency, with Philip Astle highlighting that the key to an improvement in this area was reduced cycle time, with the aim being four minutes on average as a result of changes in auto dispatch, ambulance handover and on-scene practices. Alastair Mitchell-Baker asked about the review of rotas. Philip Astle stated that more active measurement and local tailoring was important, and that staff were being widely consulted over this, with a timescale of September to have completed the review. The Board noted the risks associated with SCAS losing skilled paramedics to other roles in the health economy. The Chairman stated that the Trust needed to find appropriate ways to incentivise staff to work unsocial hours, and John Black commented that SCAS could also potentially benefit from a flow of staff in the other direction, based on core competencies. Philip Astle reported positive news about NHS111 performance, with the 95% target generally being achieved, low call abandonment rates, and good progress being made against the recruitment plan. Finally, Philip Astle updated on his ongoing review of indirect resources (community first responders, fire, military etc), noting that the last formal review had been undertaken three


years ago, and that the Ambulance Response Programme was introducing a new set of codings which could potentially change the way in which volunteers are used. He highlighted the methodology for the review (including consultation and surveys) and advised that the final report should be available in the Autumn. 16/013 – Operational Performance Report – Patient Transport Services James Underhay presented an overview of key issues in relation to patient transport services, including noting that activity continued to be generally higher than plan. He also reported on the new contracts, which were being embedded, and some of the teething issues (for instance, in relation to the TUPE transfer of staff). 16/014 – Finance and Estates Report Charles Porter advised that a deficit of c £900k had been accrued in month 1, against a planned deficit of £368k. He added that this was linked to the contract dispute and not providing for a certain proportion of income at this stage of the negotiations. 16/015 – Integrated Performance Report (IPR) It was noted that nearly all elements of the IPR had been discussed during the course of the meeting. Professor Williams commented on the reference to 111 to 999 transfers increasing when call volumes are lower, and Philip Astle agreed to investigate the rationale for this statement being made. Action 16/015 Philip Astle to clarify the statement regarding 111 transfers to 999 in the Integrated Performance Report that these increase when call volumes are lower.

16/016 – Workforce Report Melanie Saunders highlighted the key aspects of her report, including progress with recruitment, recent whistleblowing cases, and the new regulations in respect of agency usage and costs. The Board noted the forthcoming Healthy Workforce survey, and Melanie Saunders agreed to clarify the timescales. Action 16/016a Melanie Saunders to clarify the timescales for the healthy workforce survey, including reporting of results.

The Board discussed attrition rates and the internal target of 14%, with the Chairman asking what the rate would be for nursing staff in other NHS organisations. Melanie Saunders agreed to collate some further benchmarking data so that the Trust’s target could be validated as being realistic and achievable. Action 16/016b Melanie Saunders to obtain some further information on attrition rates in the NHS in order to validate SCAS’ own internal target of 14%.

REGULATORY, COMPLIANCE AND CORPORATE GOVERNANCE

16/017 – Board Assurance Framework (BAF) The Board noted the BAF, and that certain workforce related risks (e.g. recruitment and retention, attrition etc) had been broken down by service in order to give greater focus and granularity. 16/018 – Equality Delivery System 2: 2016-2020 The Chief Executive presented an overview of the Trust’s plans for the next four years, and this was reinforced by Ludlow Johnson, Equality and Diversity Manager. The Board noted that an assessment of the Trust’s current equality delivery system arrangements by external stakeholders had resulted in a highly creditable score of 89%.


In response to a question from John Black, Ludlow Johnson advised that there was still work to do from an equality and diversity perspective in terms of health outcomes and the composition of the workforce. Noting previous comments made by the Board, Ludlow Johnson explained that a more detailed review of recruitment outcomes was being undertaken. The Chief Executive congratulated Ludlow Johnson on recently securing a NED role in a clinical commissioning group in the West Midlands. BOARD SUB-COMMITTEE CHAIR REPORTS

16/019 - Board Committee Annual Reports 2015/16 The various committee annual reports were noted. Keith Nuttall explained that, in respect of the Charitable Funds Committee, the terms of reference were still being finalised and would be represented at the July Board meeting. CLOSING BUSINESS

16/020 - Any Other Business Philip Astle commended to the Board a new ‘Save a Life’ app which had been developed by SCAS. The Chairman noted in the Annual Report (Quality Report section) that both commissioners and Healthwatch organisations had expressed concern about the amount of time given to feedback comments on the Trust’s Quality Accounts. He asked for this issue to be addressed in 2016/17. Steve Garside highlighted an emergency services day which had been arranged by the Hayling Island CFR scheme and was taking place on 26 June. 16/021 - Questions from Governors, Trust members, and members of the public Steve Garside advised that questions received from Jon Cotterell (annual accounts) and Richard Coates (review of indirect resources) had been answered, but asked Philip Astle to confirm the composition of the team carrying out the indirect resources review. Philip Astle explained the make up of the team, noting that independence would be provided by a senior executive from O2, and that the steering group would comprise two Non Executive Directors, Deirdre Thompson and himself. 16/022 - Date and time of next meeting The next meeting was noted as taking place on Wednesday 13 July 2016 at Shaw House (time tbc). 16/023 - Resolution by the Chairman To resolve that the representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section 1 (2) of the Public Bodies (Admissions to Meetings) Act 1060 refers).

SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST

Agenda Item 4 TRUST BOARD MEETING IN PUBLIC 13 JULY 2016

MATTERS ARISING FROM PREVIOUS BOARD MEETING IN PUBLIC (25 MAY)

Public Board 13 July 2016 Page 1 of 1 Author: SG

No. Minute ref.

Agenda Item Action Resp Target Due Date

Comments/Outcome

1. 16/010 Directors Reports Deirdre Thompson to confirm the accuracy of the reported data for clinical incidents by private providers.

DT ASAP Action completed The incidents reported in the last paper relate to those incidents raised / reported by the private providers (PPs). This will be looked at in greater detail as part of the monthly review meetings with PPs.

2. 16/015 Integrated Performance Report

Philip Astle to clarify the statement regarding 111 transfers to 999 in the Integrated Performance Report that these increase when call volumes are lower.

PA ASAP Action completed Explanation circulated on 27 June.

3. 16/016a Workforce Report Melanie Saunders to clarify the timescales for the healthy workforce survey, including reporting of results.

MS ASAP Action completed The healthy workforce survey closed on 30 June. The Trust will receive a high-level report and the findings will be presented at the September meeting (together with an update on the main staff survey action plans).

4. 16/016b Workforce Report Melanie Saunders to obtain some further information on attrition rates in the NHS in order to validate SCAS’ own internal target of 14%.

MS ASAP Verbal update required Melanie Saunders to provide a verbal update on this issue.

PA Philip Astle MS Melanie Saunders DT Deirdre Thompson

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ITEM 6

BOARD OF DIRECTORS PUBLIC MEETING 13 JULY 2016

CHIEF EXECUTIVE’S REPORT

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

developments since the last Board meeting. RESPONSE TIMES, PERFORMANCE STANDARDS, RESILIENCE & EFFICIENCY Operational, clinical and financial performance 2 Some of the key elements of our performance for the first two months of

2016/17 are as follows:

• after a good first month, where we achieved all three national response time standards (red 1, red 2 and red 19), we have seen a slight downturn in performance in May with demand levels 10% higher than the corresponding month in 2015. At the time of writing, I am confident that we will achieve the red 19 standard for quarter 1, and be close on red 1, and can provide an update at the Board meeting.

• NHS111 performance has been very good, with the call answer targets

being achieved for all contracts. We have been seeing some success with our recruitment plan and the performance levels, coupled with the outcome from the CQC inspection in late 2015 which confirmed our NHS111 service to be safe, effective, responsive and well-led, means we are currently in a strong position in this area. Building resilience for the Autumn/Winter periods is now a key priority.

• financially our position has been impacted by uncertainty around the

outcomes of the contract negotiation process, and what we account for in terms of income. We are setting a deficit budget for 2016/17 and, after the first two months of the year, had accrued an overspend against budget of £1.4m applying a prudent approach around the treatment of income. We have implemented some additional financial controls to 2015/16, including a freeze on all non front-line recruitment

3 The environment in which we are operating continues to be extremely

demanding, but we are producing some very good outcomes which is testament to the hard work of our staff and volunteers. There are a range of reports on today’s agenda which consider operational, financial and clinical performance in greater detail.

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CLINICAL OUTCOMES, PATIENT SAFETY AND PATIENT EXPERIENCE Care Quality Commission (CQC) inspection 4 We are still awaiting the draft report following the CQC inspection of urgent

and emergency care, emergency operations centre, patient transport services, NHS111 and resilience in early May.

5 Initial feedback from the CQC had been positive, with no significant concerns

reported. They reported that they were impressed with all staff they had met, concluding that the workforce is strong, caring and compassionate.

Student Paramedics International Rally of Emergency Simulations (SPIRES) Conference 6 SCAS was delighted to support the SPIRES conference at Oxford Brookes

University, which saw paramedics and student paramedics from across the world come together to compete in the International Rally of Emergency Simulations.

7 The event encouraged participants to test their knowledge and experience in

a range of emergency situations, take part in workshops, and hear from national and international speakers. We were also joined by students from Canada and Turkey who were visiting SCAS to find out all about the service that we provide and the opportunities available for progression.

PORTFOLIO OF COMMERCIALLY VIABLE NON EMERGENCY CONTRACTS Thames Valley NHS111 and Integrated Urgent Care Services contract 8 The Board has approved a bid to respond to the competitive tender being run

by clinical commissioning groups in the Thames Valley for integrated NHS111 and Urgent Care Services. We are the current provider of all NHS111 service contracts in the Thames Valley, and this represents an important contract in terms of the direction of travel being set by the national Urgent and Emergency Care and Five Year Forward View initiatives.

9 The new contract is expected to be awarded at the end of September with a

commencement date of 1 April 2017. LEADERSHIP, STAFF ENGAGEMENT AND WORKFORCE NHS Healthy Workforce survey 2016 10 SCAS is participating in a new NHS initiative to better understand the health

and wellbeing of the workforce. A survey was run throughout June, and the results will help inform health and wellbeing support for NHS staff both within SCAS and across England. Each respondent will receive a confidential, individualised personal health report.

Restructuring of Urgent and Emergency (U&E) Operations Department 11 We are on-target to complete the proposed changes to the U&E Operations

Department by the end of July, following an extensive period of staff

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consultation. Under the detailed proposals, frontline operations will move under the leadership of one Director (Director of Operations U&E), creating a single team to further consolidate working practices and a SCAS way of working. New roles will be created which focus on service delivery and projects that will concentrate on the development of clinical service initiatives, thereby strengthening operational focus whilst maintaining our clinical strength and expertise.

GOVERNANCE, VALUE FOR MONEY AND FINANCIAL STANDING Annual contract 2016/17 12 Following extensive negotiations with commissioners over the last few

months, we are progressing towards having signed contracts in place for 2016/17. The outcome is likely to impact on our budget for the year, and I will provide an update at the Board meeting.

Sustainability and Transformation Planning (STP) 13 As Board members will be aware health, social care and local authority

partners have been working together to develop the strategic priorities for specific geographical areas. These plans aim to articulate a way forward in terms of how available funding will be used to address the health needs of the population, recognising that an integrated approach to the provision of healthcare is required.

14 SCAS is actively involved in the planning process for four particular areas:

• Hampshire and Isle of Wight • Thames Valley (excluding East Berkshire) • Frimley including East Berkshire and North East Hampshire • Milton Keynes and Bedford

15 Final plans were due to be submitted by the end of June and further details

are provided in the strategic update item. NHS Improvement ratings 16 Our 2015/16 Q4 ratings were confirmed as “green” for governance, and “2”

for financial sustainability. The 2016/17 Q1 return is due to be presented at today’s meeting.

Board meetings in public 17 Following today’s Board meeting in public, future Board meeting dates are: 28

September, 30 November, 27 January 2017, and 29 March 2017. The meeting on 28 September will include our Annual General / Members Meeting, and take place at Easthampstead Park Conference Centre in Wokingham, Berkshire.

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PARTNERSHIPS, STAKEHOLDER RELATIONSHIPS AND MEDIA Review of volunteers / indirect resources 18 The Board has agreed the terms of reference for an in-depth review of our

volunteer / indirect resourcing arrangements. This is a review that is carried out periodically, aimed at ensuring we optimise the contribution volunteers make, and will involve a surveying of the volunteers to establish their comments and suggestions.

19 The review, led by the Chief Operating Officer, is underway, and engagement

with staff and volunteers has commenced; the survey is due to be launched shortly. It is expected that the comprehensive review will be completed in the Autumn.

Public governor elections – Autumn 2016 20 We will be running a further round of public governor elections in the Autumn,

with vacancies across all four counties. Further information about the role (including a new ‘Becoming a SCAS Governor’ video) and the election process/timetable can be found at:

http://www.scas.nhs.uk/about-scas/council-of-governors/ Trust membership 21 We have recently launched our Annual Membership and Patient Satisfaction

survey, and this is due to close on 11 July. The Council of Governors’ Membership and Engagement Committee will play a key role in analysing the results and identifying next steps.

Stakeholder engagement 22 The Trust continues to actively engage with key stakeholders. The Chairman

has met with a number of MPs and Trust/CCG chairs, as well as attending events arranged by NHS Providers. I continue to actively engage both nationally and regionally. My recent engagement activity has included the following meetings and events:

• SCAS Long Service Recognition Awards • NHS Providers and NHS Improvement meetings • NHS England Digital Urgent & Emergency Care Programme Board

Meeting • Sustainability and Transformation Planning meetings and workshops • other various health economy / local authority system meetings

Media coverage 23 Recently media activity has included enquiries from local and national media

about the emergency situations and patients that we have responded to, including a number of large scale incidents.

http://www.scas.nhs.uk/about-scas/council-of-governors/

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24 This month’s campaign theme is ‘Country safe’ which encourages people to look after themselves in the countryside. We have been using Facebook and Twitter to spread those messages and have linked through to our main website via our social media channels. SCAS uses Twitter to communicate information about our services and our proactive education campaigns, as well as job vacancies. We now have 9921 Twitter followers on the SCAS999 account alone.

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

Agenda Item: 7

BOARD MEETING IN PUBLIC 13 JULY 2016

Details of the paper

Title Medical Director’s Report

Responsible Director John Black, Medical Director

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

Links to SCAS Business & Risks

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

To deliver clinical excellence by improving clinical outcomes

To achieve operational excellence

To deliver effective stakeholder relationships

To deliver sound governance, VFM & financial standing

To deliver leadership, staff engagement & a learning culture

To develop the portfolio of commercially viable non emergency commercial contracts

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

No direct risk implications

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

No direct regulatory implications

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

No direct financial implications

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

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

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

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

Other

Previous considerations by the Board

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

Background papers / supporting information N/A

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ITEM 7


MEDICAL DIRECTOR’S REPORT

PURPOSE

1. The purpose of my report is to keep the Board abreast of key issues. This month’s report focuses on four particular areas:

• Transformation of Stroke Services in the Thames Valley and Milton

Keynes. • Air Ambulance Extended Hours of Operations Activity Update • Paramedic 2 trial Update (Randomised Control Trial of Adrenaline for Out-

of-hospital cardiac arrest) • Crash 3 Trial Update (Randomised Control Trial of Tranexamic acid for

Severe Head Injury) EXECUTIVE SUMMARY, KEY ISSUES AND UPDATES

A) Transformation of Stroke Services in the Thames Valley and Milton

Keynes. Background:

2. SCAS requires equitable access to high quality Stroke Care for all patients throughout the South Central Region. The provision of ‘time critical stroke care’ at Emergency Hospitals at appropriate geographical locations is vital in order to optimize timely patient access to specialist care pathways as this can have an important impact on clinical outcomes for patients (‘time is brain’).

3. The slide below illustrates that for a significant geographical area bounded by

Milton Keynes Aylesbury and Banbury, where there is currently no local Hyperacute Stroke Unit (HASU) provision, that patients living in this area with a potential acute stroke will require an emergency transfer by ambulance that will take at least 30 minutes to reach the nearest HASU.

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20 minute drive time Isochrones for HASUs located at Luton and Dunstable, High Wycombe, Oxford, Royal Berks and Slough, and Frimley Park

4. Patients with subtle stroke syndromes, including those with posterior strokes, will continue to be assessed at local Emergency Departments, after either self-presenting or being transported by ambulance. Patients who then require an acute stroke admission will require an emergency secondary transfer by Ambulance to a HASU if not on the same hospital site. Such emergency secondary inter-hospital transfers will significantly delay time critical intervention (i.e. thrombolysis) and admission times to acute stroke units for patients with confirmed stroke. This transfer delay would not occur if a HASU was co-located with an Emergency Hospital seeing significant stroke and stroke mimic volumes.

Stroke Care Provision Proposals

5. Current proposals by East Berkshire/Buckingham and Chiltern clinical commissioning groups (CCGs) are to decommission the Acute Stroke Unit and Wexham Park Hospital (WPH) by Q3 2016, and that all potential stroke patients, irrespective of time of onset, should be transferred to the non-emergency hospital site at High Wycombe, which no longer has an Emergency Department and full supporting infrastructure (which is now located at Stoke Mandeville Hospital in Aylesbury).

6. The provision of hyperacute stroke care and stroke care rehabilitation is

currently under review in Oxfordshire by the Oxon Transformation Board/Sustainability and Transformation Plan and details have yet to be proposed.

7. Milton Keynes and Bedfordshire CCGs wish to continue to commission HASU

level care at Luton and Dunstable Hospital only, which involves a lengthy out-

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of-area transfer for patients to the North and West of Milton Keynes. This also has significant operational/ambulance cycle time implications for SCAS, and also presents challenges for patients requiring out of area repatriation to Milton Keynes. Bedfordshire CCG plan to continue to commission an Acute Stroke Unit at Bedfordshire Hospital in order to support patient flows out of Luton and Dunstable HASU for patients in need of stroke rehabilitation in hospital.

8. Milton Keynes Hospital (MKH) and Wexham Park Hospitals (WPH) have

recently bid to provide HASU level of care for patients in their catchment area, which they believe can be delivered at acceptable cost. Commissioner support for this has yet to be secured.

9. There are no plans to change stroke care provision at Reading.

10. The SCAS Medical Director has escalated his clinical concerns about the

proposed clinical model for patients in Buckinghamshire and East Berkshire and long term provision of HASU on the non-emergency Wycombe Hospital site to local CCGs, the Thames Valley Emergency and Urgent Board, and NHS Southern England, because of its potential implications for emergency patient flows and clinical implications within the Thames Valley. Slough has a large population of patients at high risk of stroke.

11. Milton Keynes has a rapidly growing population and is likely to be configured

as an Emergency Hospital within South East Midlands and the provision of a HASU at this location could improve patient access to acute stroke care for patients living to the North and West Aylesbury and for patients living in Milton Keynes.

12. A request has been made for the decision to decommission ASUs at

WPH/MKH to be paused pending a more comprehensive and wider financial/viability impact assessment and review of clinical outcome data by the Sustainability and Transformation Program Boards for patients with acute stroke and stroke mimics in this region. Commissioners and NHS England also need to consider the wider impact of the location of stroke care provision for patients in need of an emergency/urgent care response from SCAS. There is significant opportunity to further improve the outcomes for all patients in South Central and South East Midlands in need of time critical and specialist care within existing financial envelopes by appropriately reconfiguring existing clinical networks.

Action

13. The formal support of the SCAS Board to request a wider strategic review of stoke care provision in Thames Valley and Milton Keynes by the relevant Sustainability and Transformation Plans (STPs) is likely to be helpful and important.

B) Air Ambulance Extended Hours of Operations Activity Update

14. Air Ambulance Operational hours were extended in December 2015 from 0700-1900 hours until 0200 hrs.

15. The Following data covers the period 1st January 2016-13th June 2016

16. Night HEMS

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• Thames Valley Air Ambulance – 11 (2 out of area Hants & IOW) • Hampshire and Isle of White – 15 (6 out of area, Milton Keynes, Bucks,

Oxon, Berks & Wilts)

17. Extended Hours (19:00 – 01:59) – this will include night HEMS within it • Thames Valley Air Ambulance – 35 (12 out of area, Hants, Dorset and IOW) • HM56 – 46 (20 out of area, Berks, Bucks, Dorset, Milton Keynes, Oxon, Wilts)

18. During the same time period the backup rapid response vehicles with HEMS

teams were allocated to 43 missions (combined HIOW and TV).

19. There has been a significant increase in activity in recent months as experience and tasking for night time operations increases – proportionally less missions have been flown in darkness as expected during the summer months.

C) Paramedic 2 trial Update (Randomised Control Trial of Adrenaline for Out-

of-hospital cardiac arrest)

20. One third of the required number of patients have now been recruited (over 3400 patients) nationally. Further roll out of the trial in the Thames Valley will take place in August 2016. It is anticipated that the trial will complete in Q1 2017 and the results of the trial should be known by late 2017.

D) Crash 3 Trial Update (Randomised Control Trial of Tranexamic acid for

Severe Head Injury)

21. Ethics Committee approval for pre-hospital recruitment has been obtained.

22. Training for Thames Valley Air Ambulance Medical Staff and Paramedics currently underway.

23. Further clarification on the role and practicalities of the ‘nominated legal

representative’ for the pre-hospital phase of the trial is awaited from the Crash 3 International chief investigators before recruitment commences and is expected imminently.

RECOMMENDATION

A) The Trust Board is asked to receive and note the report. John Black, Medical Director July 2016


Agenda Item: 8


Title

Quality and Patient Safety Report

Responsible Director

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

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

The Trust Board is asked to receive and note the report








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

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

All clinical risks are detailed in the Trust Corporate Risk Register and Integrated Performance Report

that link to the quality work streams. Key issues and risks that are outlined in the paper are BAF risks: 1.1, 1.2, 1.3, 1.5, 1.6, 4.3, & 5.1

Implications Regulatory and legal implications / impact (e.g. Monitor terms of authorisation and risk

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


Cost of undertaking preparations or actions relating to the CQC inspections

Other

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

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


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


Quality and Safety report is presented at every board meeting

Background papers / supporting information

Berwick (2013) A promise to learn – a commitment to act. Improving the safety of patients in England. National Advisory Group on the Safety of patients in England. London. Hyperlink for the guidance on new CQC regulations April 2015: http://www.cqc.org.uk/sites/default/files/20150324_guidance_providers_meeting_regulations_01.pdf Hyperlink for the 2015 CQC ambulance provider handbook: http://www.cqc.org.uk/sites/default/files/20150326_ambulance_provider_handbook.pdf Hyperlink for the 2015 CQC NHS111 provider handbook: http://www.cqc.org.uk/sites/default/files/20150630_nhs111_provider_handbook.pdf Department of Health (2012/13) The NHS Outcomes Framework Monitor (2013) Quality Governance. How does a board know that its organisation is working effectively to improve patient care. Monitor (2015) The NHS Foundation Trust Annual Reporting Manual 2014/15

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

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

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

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

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

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

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QUALITY AND SAFETY REPORT

PURPOSE

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

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

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

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

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

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

EXECUTIVE SUMMARY CQC Update SCAS 2016 Rated CQC Inspection BAF Risk 4.3

5. The requests for data from the CQC have, at time of writing, ebbed. The breakdown for those received post inspection is illustrated below

6. We have two main activities over the coming weeks a) responding to further

data requests and b) factual accuracy checking 3 draft reports once received; The CQC Inspection team are unable to provide further clarity on timescales or exact methodology.

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7. A Medicines ‘Task and Finish’ group has been established to process map

and refine our procedures for managing medicines and engaging with frontline staff to understand and improve further areas of non-compliance

Other published CQC reports 8. There have been two CQC reports published since the last Board update that

have been of interest to SCAS, these are:

a) Portsmouth Hospitals NHS Trust CQC Inspection Report b) South Western Ambulance Service NHS Foundation Trust (NHS 111 Service) CQC Inspection Report

a) Portsmouth Hospitals NHS Trust (PHT) CQC Inspection Report 9. A CQC report for PHT has been published recently

http://www.cqc.org.uk/sites/default/files/new_reports/AAAC8086.pdf and SCAS was cited within the report. SCAS had no formal notification that this would be the case.

10. As a result there are some PHT actions that SCAS will have to work closely with PHT on and we welcome the opportunity to work together on these. An internal urgent ‘task and finish’ group, involving our key staff, has met and progress of this will be monitored via the follow-up risk summit.

b) South Western Ambulance Service NHS Foundation Trust (NHS 111 Service) CQC Inspection Report

11. A report for South Western Ambulance Service NHS Foundation Trust

NHS111 Service (SWAST NHS111) has been published recently; http://www.cqc.org.uk/sites/default/files/new_reports/AAAF4211.pdf

12. This is the first report to be published that rates an NHS111 service, the background to this inspection is that the CQC brought forward a comprehensive inspection due to intelligence they had received.

13. The CQC overall rating for the SWAST NHS111 service was inadequate

overall and inadequate for 4 out of the 5 domains with the exception of ‘good’ for ‘caring’. The Summary of the Requirement and Enforcement actions from the SWAST NHS111 report are:

Requirement notice

• regulation 15 - work stations and chairs • regulation 15 - systems to assess, monitor and improve the quality

and safety of the service are not operated effectively

Enforcement action • regulation 12 - Calls are not responded to in a timely and effective

manner and there is a lack of systems to ensure associated risks are mitigated for the safety of patient health and welfare

• regulation 18 - insufficient staff are employed and those employed are not deployed or supported effectively

http://www.cqc.org.uk/sites/default/files/new_reports/AAAC8086.pdf

http://www.cqc.org.uk/sites/default/files/new_reports/AAAF4211.pdf

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14. Staffing (Regulation 18) is emerging as both a service wide and sector wide

theme. We will continue to monitor for further intelligence and themes as reports are published and compare our practices / processes etc to ensure compliance across SCAS.

Update Portsmouth Health System BAF Risk 1.6

15. A revised Emergency Department Escalation Policy has been agreed and signed off by the Chief Executives at both PHT and SCAS and ratified at the Hampshire System Resilience Group on 16th June 2016.

16. There has been some improvement in SCAS red and green response times

since May 2016 in the South East Hampshire area. Response to red calls in the South East Hampshire area has improved from 70 calls over 30 minutes at the start of May to 15 calls over 30 minutes in June.

17. There has been an improvement in Ambulance Handover times since May

2016, supporting ambulances to be released from PHT to attend patients quicker in the community (see table below). SCAS data identified one day where PHT has held four or more ambulances for more than 30 minutes when monitored - week beginning 30th May, with further reduction thereafter.

Long Waits Narrative Update BAF Risk 1.1

18. Our current performance against plan and compared to the same period last year remains a concern and a focus. With continued rising demand and challenges in workforce compounding this issue. Compared to April 2016 Red 8 long waits has deteriorated from 0.6% to 1.2%, Red 19 from 1.2% to 1.9% and Green long waits from 14.7% to 17.1%. The teams continue to focus on actions described in detail to the Quality and Safety Committee to deploy all available resource and to mitigate risk for patients. The Trust has also invoked all of the actions of REAP 3 in June to ensure that all available clinical resource is released.

Complaints Responsiveness

19. The Head of Patient Experience supported by the Assistant Director of Quality continues to implement new working practices to increase efficiency. The improvement work continues and we are working hard to drive down complaint response times across the Trust. The Patient Experience Team ‘go digital’ was launched on 1st April 2016 with the Datix system being used

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for all activities, tracking, reporting etc. From September 2016 the plan is to report to Board both the complaint acknowledgement within 3 days and complaint closed / resolved within either a complainant agreed timescale or agreed 25 day target. The trajectory of improvement is as follows; Q2 50%, Q3 85% and Q4 90%.

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

Key Performance Indicators (KPIs) for Risk

20. In May 2016 the Trust declared two serious incidents requiring investigation (SIRI), the details of these are in the table below. The Trust also declared one SIRI in April 2016, the details of this is also below.

21. Since the last report, three SIRIs have been investigated and subsequently

closed by the Trust’s SIRI Review Group. These SIRIs are shaded in the table below.

Incident Date

SIRI Number

Status Clinical Commissioning Group (CCG)

SIRI Closed within 60 days

17/2/2016 2016/4749 Major incident/emergency preparedness resilience and response/suspension of services.

NHS Central Southern Commissioning Support Unit

Yes

23/11/2015

2016/5883 Treatment delay meeting SI criteria.

Bracknell & Ascot CCG

Yes

16/10/2015

2016/8157 Sub-optimal care of the deteriorating patient meeting SI criteria.

NHS Portsmouth CCG.

Yes

21/9/2015 2016/11417 Treatment delay meeting SI criteria.

NHS South Eastern Hampshire CCG

22/7/2016

2/5/2016 2016/12240 Sub-optimal care of the deteriorating patient meeting SI criteria.

NHS Portsmouth CCG

29/7/2016

21/5/2016 2016/14215 Accident e.g. collision/scald meeting SI criteria.

NHS Aylesbury Vale CCG

18/8/2016

SIRIs declared by SCAS in 2014/15, 2015/16 and 2016/17

22. In 2014/15 there were 17 SIRIs declared by SCAS and in 2015/16 there were 15 SIRIs declared and in April and May of 2016/17 there have been 3 SIRIs declared by SCAS. For further details, see the chart below.

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3

2

0

3

0

1

2

0

2 2

0

22

0

1

0

2

0

2

1

0

3

2 2

1

2

0 0 0 0 0 0 0 0 0 000.5

11.5

22.5

33.5

SIRIs declared by SCAS in 2014/15, 2015/16 and 2016/17

2014/15

2015/16

2016/17

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

159 164 160 180214 196

229268 254 246 260 248

291 270

0 0 0 0 0 0 0 0 0 00

50100150200250300350

Clinical Incidents reported in 2015/16 and 2016/17

2015/16

2016/17

Number of clinical incidents reported in May 2016 in relation to the number of operational contacts in May 2016 Detail Number of patient contacts and number

of incidents reported Total number of patient contacts in May 2016 295854

Total number of clinical incidents reported in May 2016

270

Number of incidents as a percentage of the number of contacts

0.09

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Top Ten categories of Clinical incidents reported in May 2016 Category Total Medication 72 Delayed Treatment/Transport 26 Patient Treatment 20 111 Call Centre Issues 17 GPs 17 EOC Issues 16 Clinical Equipment 15 Hospitals 12 Out of Hours Services 8 Feature Request 8

8 233

180

6 1 117 20 9 1 1

020406080

100120140160180200

Clinical incidents by Service Area reported in May 2016

39

67

24

82

01020304050607080

Low Risk Minor Risk ModerateRisk

SignificantRisk

High Risk

The severity of clinical incidents reported in May 2016 as graded by Managers

23. Both high risk incidents in May related to SCAS staff reporting concerns with

external agencies. One relates to a patient who was peri-arrest, the hospital was pre alerted. The CT scanner was not working at the Acute Trust and the crew redirected to another Trust hence longer travel time. Investigation is ongoing.

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24. The second incident relates to the care given by another provider. A safeguarding referral was completed in this case and is being investigated.

Key Performance Factors for Risk

25. Reported medication issues are mainly regarding poor record keeping within drugs modules and not errors in the administration of medicines to patients.

26. Reducing delays in ambulance attendance continues to be a focus within the

Trust with staff reporting all incidents of potential patient harm following a delay. 999 delays are attributable to demand outstripping resource with all available resources being committed to other patients. The incidents in the patient treatment category centred on the 999 service with staff reporting concerns about clinical assessment and treatment of both SCAS staff and external agencies. Staff routinely report concerns regarding external agencies on the Datix system. Such incidents are sent to other providers to investigate and action taken if necessary.

Severity of clinical and non-clinical incidents for each Service area as graded by Managers in May 2016 Severity of Clinical and Non clinical incidents graded by Managers in May 2016 Service Area Low

Risk Minor Risk

Moderate Risk

Significant Risk

High Risk

Total

Health Care Professional

0 2 2 1 0 5

111 Call Centre 1 7 2 0 0 10 111 Clinical Desk 1 0 0 0 0 1 999 Operations 50 88 35 7 2 182 Clinical 1 2 0 0 0 3 PTS Control 0 1 0 0 0 1 EOC 0 2 1 0 0 3 Fleet 0 1 0 0 0 1 PTS Operations 0 4 10 2 0 16 EOC CSD 1 0 0 0 0 1 Air Ambulance 0 1 0 0 0 1 Resilience 0 0 1 0 0 1 Total 54 108 51 10 2 225

The number and category of incidents reported to the National Reporting and Learning System (NRLS) in May 2016 Total Number and categories of incidents reported to the NRLS in May 2016

Categories May 2016 111 Call Centre Issues 1 Delayed Treatment/Transport 3 Manual Handling 3 Medication 4 Patient revisited within 24 hours 2 Patient Treatment 3 Slip, Trip, Fall 4 Total 20

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The number of incidents reported to the NRLS in May 2016 within 30 days Number of incidents reported to the NRLS 20

Number of incidents reported to the NRLS within 30 days

15

Percentage of incidents reported to the NRLS in May within 30 days

75%

Total number of alerts received from the Central Alerts System in May 2016 Total number of alerts received from the Central Alerts System (CAS) in May 2016 Number of Alerts received from CAS in May 2016 25 Number of Alerts which were applicable to SCAS 0 Number of Alerts acknowledged by SCAS within two days

11

The total number of non-clinical incidents reported in May 2016

27. The total number of non-clinical incidents reported in May 2016 was 152. Total number of Non-Clinical incidents reported in 2015/16 and 2016/17

153 150 149183 177 180 190

166183 196 183 175

143 152

0 0 0 0 0 0 0 0 0 00

50

100

150

200

250

Total number of Non-clinical incidents reported in 2015/16 and 2016/17

2015/16

2016/17

The top ten categories of non-clinical incidents reported in May 2016 Top ten categories of non-clinical incidents reported in May 2016 Categories Total Manual Handling 26 Vehicle 24 Physical Assault 17 Slip, Trip, Fall 16 Staff Abuse/Aggression (by patient/third party) 15 Feature Request 11 Contact with/struck by object/vehicle (including hot liquids) 7 Other 6 Security 5 Information Governance 4

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The severity of the non-clinical incidents reported in May 2016 as graded by managers

15

41

27

205

1015202530354045

Low Risk Minor Risk Moderate Risk Significant Risk

Severity of non clinical incidents reported in May 2016 graded by managers

28. With regards to the severity of the 152 non-clinical incidents reported in May 2016, 85 of these incidents have been examined and re-graded by managers investigating the incidents and 15 were deemed as low risk, 41 were minor risk, 27 were moderate risk, two were significant and none were graded as high risk.

Non-Clinical incidents reported by each service in May 2016

6 3

112

2 3 419

1 20

20406080

100120

Non clinical incidents reported by Service area in May 2016

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Non-Clinical incidents reported in May 2016 compared with activity

Number of non-clinical incidents reported in May 2016 in relation to the number of operational contacts in May 2016 Detail Number of patient contacts and

number of non-clinical incidents reported

Total number of patient contacts in May 2016 295,854 Total number of non-clinical incidents reported in May 2016

152

Number of non-clinical incidents per 1,000 contacts in May 2016

0.5

Number of non-clinical incidents as a percentage of the number of contacts

0.05%

Themes of top three categories of non-clinical incidents reported in May 2016

29. The top three categories of non-clinical incidents were ‘manual handling’; ‘vehicle’ and ‘physical assault’.

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

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

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

staff sustaining musculoskeletal injuries when moving, handling, transferring and/or assisting patients in stretchers, wheelchairs, pat slides, scoops and Zimmer frames, often in restricted surroundings.

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

consisted of staff sustaining musculoskeletal injuries when lifting or carrying medical bags and devices.

33. The only discernible theme of the ‘manual handling – patient injury’ incidents

consisted of patients sustaining minor injuries when being moved in carry chairs.

34. In May 2016 six of the manual handling incidents were reported to the Health

and Safety Executive (HSE) in accordance with the Reporting of injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995.

35. The top three sub-categories of the vehicle incidents were: ‘Road traffic

collision’; ‘Defect’ and ‘Vehicle – Close circuit television CCTV’. 36. The main theme of the ‘Road traffic collision’ incidents were third party

vehicles colliding with Trust vehicles and vice-versa resulting in minor damage to both. Thankfully, any injuries were minor.

37. There was no discernible theme to the ‘Defect’ incidents other than the

incidents consisted of vehicles with miscellaneous defects.

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38. The theme of the ‘Vehicle – CCTV’ incidents consisted of Driving Standards being unable to download any imagery from the CCTV.

39. The top three sub-categories of the physical assault incidents were:

‘Physical assault (by patient/third party) – no treatment required’; ‘Attempted assault by patient/third party’; and ‘Clinical assault – struck by fitting patient.’

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

required’ incidents was that staff were assaulted by intoxicated patients/person or patients under the influence of drugs or patients with mental health issues. In three of these incidents the perpetrator was arrested by the police.

41. There were no discernible themes to the ‘Attempted assault by patient/third

party’ and ‘Clinical assault – struck by fitting patient’ incidents. Total number of RIDDOR incidents reported to the Health and Safety Executive (HSE) in 2015/16 and 2016/17

42. In May 2016, there were six incidents reported to the HSE in accordance with RIDDOR whereas in the same period in 2015 there was one incident reported to the HSE. Therefore, when comparing the two periods there has been an increase in the number of incidents reported. For further details see the chart below.

7

1

10

5 54

3

0

78

109

46

0 0 0 0 0 0 0 0 0 002468

1012

Total number of RIDDOR incidents reported to the Health and Safety Executive in 2015/16 and

2016/17

2015/16

2016/17

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

43. In May 2016, there were 15 physical assault incidents reported whereas in the same period in 2015 there were 12 incidents reported. Therefore, when comparing the two periods there has been an increase in the number of incidents reported. For further details see the chart below.

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

44. In May 2016, there were 15 non-physical assault incidents reported whereas in the same period in 2015 there were 18 incidents reported. Therefore, when comparing the two periods there has been a decrease in the number of incidents reported. For further details see the chart below.

1618

1011

10

17

12

6

19

13

19

15

12

15

0 0 0 0 0 0 0 0 0 00

5

10

15

20

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

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

2015/16

2016/17

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

45. In May 2016, there were six security incidents reported whereas in the same period in 2015 there were seven incidents reported. Therefore, when comparing the two periods there has been a slight decrease in the number of incidents reported. For further details see the chart below.

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

46. As part of ongoing work into demand management, a long waits action plan has been created to demonstrate the continuing collaboration between operations, clinical directorate and business intelligence in working to understand and reduce long waits and impact.

47. Clinical audit to assess levels of patient harm continues with the long waits

review group maturing and ad hoc reviews being undertaken for patients affected by queues at specific hospitals. In addition to this, there is increasing engagement between operations and clinical governance leads across all services providing the Trust with both performance and clinical assurance. Where required, thorough independent internal investigations are carried out to identify potential system improvements and support staff through learning.

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

features/alerts on the addresses of patients or others who either assault staff or subject them to physical assault and/or abusive or aggressive behaviour. The details of these special situation features/alerts are shared with the Patient Transport Service (PTS) so that they can place them on their patient address database.

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

out ‘task’ based risk assessments and manual handling assessments. 50. The Head of Risk and Security has provided training to Managers in the

Clinical Contact Centre on how to carry out a display screen equipment assessment and a stress risk assessment respectively.

51. Further training in these issues is to be provided to other managers within

the Trust.

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52. In the interim, the Risk Team continues to carry out display screen equipment risk assessments and the Head of Risk and Security continues to carry out stress risk assessments.

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

54. The Trust is also currently working with the Pubwatch organisation to run a

poster campaign in Wexham asking the public to allow SCAS Staff to attend to patients in public houses free from interruption or violence.

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

55. Please see the three tables below to see the information related to referrals for May 2016:

Table 1 Number of referrals by service area Referral Source Number

Activity

Referrals from EOC 111 177 107,876 Referrals from EOC 999 135 47,434 Referrals from PTS Contact Centre 47,745 Referrals from operational 999 crews 654 38,859 Referrals from operational PTS crews 2 47,745 Referrals from Private Provider crews 6,1095 Referrals where the source is not recorded

1205

Total 2173 Table 2 Number of referrals sent to partner agencies Organisation referrals have been sent to

Number of referrals

Adult Services 1329 Children’s Services 495 Both Adult and Children’s Services 323 Sent to Police 62 Sent to Fire and Rescue Service 62

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Table 3 Number of referrals by type Type of referral Number Domestic Abuse 86 Domestic Violence 208 Physical Abuse 277 Sexual Abuse 26 Emotional/Psychological Abuse 237 Financial Material Abuse 42 Neglect and Acts of Omission 1259 Discriminatory Abuse 15 Fire Risk 62 Total 2212* * Relates to the fact that there are referrals generated which highlights more than one Concern, hence a higher total number in table 3 than that in table 1. SCR and IMR numbers received in the month and our responsiveness to deadlines for open requests

56. During the month of May 2016 the safeguarding team were asked to submit scoping reports for 8 cases which were being considered for serious case

reviews. All 8 requests were responded to and each deadline was met. 57. There were no other requests for other types of investigation during this

month. Audits of the appropriateness of referrals

58. The team currently does not have the opportunity to undertake regular audits, however a manager from service development is working with the team and reviewing processes with a view to the team working smarter. One of the areas that is being looked at relates to the ability for the team to complete audits.

Attendance at Boards that we have been requested to attend

59. During the month of May 2016 the Trust was represented at two boards: Buckinghamshire adults and Hampshire health sub group.

Training figures

60. 81% of staff have undertaken level 1 safeguarding training, 76% have completed level 2 safeguarding training, 98% of staff in high risk areas have undertaken PREVENT RAP 3 and PREVENT basic awareness induction has been completed by 58% of staff.

61. Safeguarding team members have been completing surgeries in EOC South

to cover 111, 999 and CSD.

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SAFEGUARDING FUTURE PERFORMANCE Plans for Sustaining/Improving Performance for Safeguarding

62. Our Commissioners in Thames Valley have reviewed the training package which has been developed by SCAS Head of Safeguarding. With some minor alterations the Thames Valley Commissioners have concluded that this training is equivalent to level 3. Furthermore the Commissioners were impressed with the package and have asked for permission to use it for their staff safeguarding training.

63. The safeguarding team now have a regular slot in the weekly staff matters

which will be used as a platform to highlight areas of safeguarding practice which needs strengthening. In addition Hot News will continue to be used to highlight areas of learning and good practice.

64. The safeguarding team has been working with NHS111 managers to

improve referrals and members of the team have been holding surgeries within NHS111 and EOC in order to highlight best practice.

65. When learning is required following an investigation (such as serious case review, safeguarding adult review, domestic homicide review etc.) the Head of Safeguarding has responsibility for ensuring that any actions are implemented by the relevant manager and service. The safeguarding team will use all processes available to them in order to integrate learning via campaigns, SCAScades, communications, clinical memos etc.

66. A clinician from NHS111 has developed an action plan to ensure that all

NHS111 staff are aware of what is expected of them when completing a safeguarding referral. To reinforce this all NHS111 referrals have to be passed to a NHS111 team leader for review before sending off. Audits will occur on a monthly basis with input from NHS111 Clinical Governance Leads.

67. The safeguarding team continues to work with its partners and are looking at

reducing the number of boards that the Trust attends. The team sees that there are better opportunities for the organisation and its partners if nominated managers attend the health sub group meetings.

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PATIENT EXPERIENCE CURRENT PERFORMANCE Patient Experience BAF Risk 1.5 (CQC REG 16 &13- KLOE- C, R4 & W4) Key Performance Indicators (KPIs) for Patient Experience Patient Experience Contact Received – rolling 13 months data

Raise concern HCP Feedback Raise a complaint Total Compliments

May 2015 46 1 45 92 136 Jun 2015 71 7 49 127 115 Jul 2015 56 19 59 134 90 Aug 2015 56 18 38 112 102 Sep 2015 47 13 68 128 90 Oct 2015 40 27 62 129 74 Nov 2015 49 30 69 148 73 Dec 2015 37 24 55 116 50 Jan 2016 40 28 38 106 86 Feb 2016 70 47 64 181 84 Mar 2016 87 78 66 231 78 Apr 2016 63 86 36 185 53 May 2016 59 75 55 189 68

68. HCP Feedback has increased from January 2016 due to NHS 111 HCP

feedback now being recorded on Datix. These were previously being held on a separate spreadsheet. From 01/06/2016 all PTS HCP feedback will also be captured on Datix.

0

20

40

60

80

100

120

140

160

May

201

5

Jun

2015

Jul 2

015

Aug

2015

Sep

2015

Oct

201

5

Nov

201

5

Dec 2

015

Jan

2016

Feb

2016

Mar

201

6

Apr 2

016

May

201

6

Patient Experiences received by month

May 2015-16

Raise concern

HCP Feedback

Raise acomplaint

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Patient Experience Contacts Received by Service Area – May 2016 data

May 2016 Complaints Concerns HCPs Activity %

111 5 3 28 107,876 0.03

999 Operations 21 10 10 38,859 0.10

PTS 16 31 22 47,745 0.14

EOC 12 12 14 47,434 0.08

Private Provider 1 3 1 6,195 0.08

Total 55 59 75 % relates to complaints, concerns and HCP against activity Patient Experience Contacts Received by Service Area – May 2016 graph

0

5

10

15

20

25

30

35

111 999Operations

PTS EOC PrivateProvider

May 2016 - Received

Complaints

Concerns

HCPs

Patient Experience Contacts Received by Primary Subject Area May 2016

May 2016 Complaints

Received Concerns Received

HCP Received

Clinical Care 4 4 12 Communication 8 3 24 Driving Standards 0 3 0 Delay/Non-Attendance 21 33 30 Patient Care/Handling/Property 6 5 4 Safeguarding 2 0 0 Staff Attitude 13 8 2 Other 1 3 3 Total 55 59 75

69. Top two subjects:

Complaints: Delays/Non-Attendance and Staff Attitude Concerns: Delays/Non-Attendance and Staff Attitude HCP feedback: Delays/Non-Attendance and Communication

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PE Risk Grading of Complaints

70. Data has not been included for May 2016. We are undertaking a review of PE risk grading to design and implement a revised grading system to enhance the recording and analysis and better inform the Trust where improvements should be targeted.

PE Complaints closed in May 2016 Complaints Closed 59 % Upheld 37 62.71 Partly Upheld 5 8.47 Not Upheld 17 28.81

Surveys

71. An NHS111 Survey Plan for 2016/2017 has been implemented to ensure surveys are distributed in a timely way, with responses uploaded to meet Commissioners reporting timescales.

72. Patient Experience Team continues to monitor NHS Choices as a source of

feedback.

Friends & Family Test (FFT) – April 2016

73. Obtaining FFT responses continues to be a challenge across the Trust, particularly from ‘see and treat’ patients, where very low numbers of patients return their forms.

Number of responses received via each mode of collection

SMS/ Text/ Smart phone

app

Electronic tablet

Paper/ Postcard in care/at discharge

Paper survey sent to home

Phone survey

Online survey Other #REF!

0 0 110 0 0 0 0 110

Total responses for users of Patient Transport Services

(PTS)

1 - Extremely

Likely

2 - Likely

3 - Neither

likely nor unlikely

4 - Unlikely

5 - Extremely

unlikely

6 - Don't

Know

Number of patient

transport journeys in the month

Total

73 19 4 6 3 4 43881 109

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Total responses for See & Treat patients

1 - Extremely

Likely

2 - Likely

3 - Neither

likely nor unlikely

4 - Unlikely

5 - Extremely

unlikely

6 - Don't

Know

Count of non-

conveyed / see and treat activity for the month

Total

1 0 0 0 0 0 14856 1

74. The Head of Patient Experience has discussed this matter with other ambulance service representatives at the National Ambulance Services Patient Experience Group (NASPEG), all of whom are receiving extremely low numbers of responses. A co-ordinated response in this regard from all ambulance services will be provided to NHS England.

Patient Experience Activities

75. Hampshire Patient Forum took place on 18th May 2016 at North Harbour Resource Centre. Forum members were invited to take a tour of the facility, led by an Emergency Service Manager (ESM), which was followed by the Patient Forum Meeting.

76. The ESM gave a presentation on SCAS, its structure and service activities,

then took a Q&A session. Rachel Coney, Chief Executive of the SCAS Charity, gave a presentation on the proposed development of the charity. Amanda Painter, Head of Patient Experience, took a Q&A session around complaints and patient feedback.

Key Performance Factors

77. The extensive review of outstanding complaints continues along with the comprehensive data cleanse to ensure Datix reflects the current position of each case as accurately as possible, in turn leading to increased accuracy of reporting. The PE Team are grateful for the continued support provided by all areas of the Trust to this comprehensive complaint review and data cleanse.

78. The Trust’s complaint upheld rate for the month of May is 71%.

79. The highest area of dissatisfaction across all patient experience contact is

issues related to Delays/Non-Attendance. PATIENT EXPERIENCE FUTURE PERFORMANCE Plans for Sustaining/Improving Performance for Patient Experience

80. The Head of PE continues to implement new working practices to increase efficiency. The improvement work continues and we are working hard to drive down complaint response times across the Trust.

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81. PE Team continued to recruit in order to try to meet service demand. The

final post interviews have been undertaken and a new Patient Experience Officer has verbally accepted. Proposed start date is first week of July subject to employment checks.

82. PE Team ‘go digital’ was launched on 1st April 2016. From this date the PE

Team have adopted a much more extensive use of the Datix system in the management of complaints/concerns/HCP feedback to ensure the tracking and responses are completed in a more timely and efficient manner. No paper files are held in PE Team for new cases received after 1st April 2016. All updates and correspondence are now noted on Datix and held in a digital file.

83. The Trust has commissioned Datix to provide technical support days to

ensure that enhanced training and essential changes are made to aid data capture and the reporting of complaints, concerns and HCP feedback. Many of the processes are manual at present, some of which are complex and time consuming. Datix confirmed they will be providing support in early July. PE Team, Risk Team and Clinical Governance Leads will be receiving enhanced Datix training. This will enable the Trust to have a ‘pool’ of super users who can then cascade knowledge and expertise out to the wider Trust.

84. The Patient Experience Team have received requests from some

Operational teams and PTS teams to attend team meetings. This will enable PE Team to share advice and knowledge around complaint handling and Datix use. PE Team will endeavour to attend as many as possible.

85. Twenty of the PTS team have been booked to attend a complaints

investigation training course run by external provider Conflict Masters on 29th June 2016. This will also be attended by a representative of PE Team to ensure a SCAS perspective is engaged. Head of PE is liaising with Conflict Masters to tailor the course appropriately towards PTS.

Case Studies 999 Frontline Operations

86. Crews attended a disabled patient with a non-epileptic seizure disorder who had a care plan in place which states that they should not be given Diazepam. The crew attended and one of the crew members dismissed the care plan and stated 'it's not worth the paper it's written on' and continued to do what they thought rather than what was on the care plan. The other two crews were more willing to understand the care plan and the disorder.

87. The Investigation Officer (IO) interviewed all the crew members and gained statements. The IO also visited the college and spoke to the staff to gain further information. The crew member admitted making comments about the care plan.

88. What we did;

• The IO spoke to a Specialist Neurology Nurse and the care plan has been amended to ensure patient’s needs are fully met in the pre-hospital environment.

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• We apologised to the patient and the family. • The crew member that made the comments will complete a reflective

practice about their behaviour and educating the crew on how issues should be approached in a professional manner.

EOC

89. Patient called 999 at approx. 17.20hrs after a fall whilst holding their 5 month old baby who hit their face and head on the floor. The patient was told an ambulance was on route, then at about 18.30hrs they had a call back to say that the ambulance had been cancelled and the patient was to make their own way to the hospital. The complainant states that the patient has cerebral palsy and has some difficulties. Complainant feels very let down by the service.

90. An investigation was carried out which found that the 1st 999 call was handled correctly and passed audit, however the 2nd call failed audit as the ECT misread the original call outcome.

91. What we did;

• Apologised to the complainant and the patient • The ECT with the failed audit will complete a reflective practice and their

calls will be monitored to ensure compliance.

NHS 111 service

92. We received a call from a patient who disclosed that a family member had just been diagnosed as having a brain tumour. The Call handler disclosed that they knew someone who had died of this. This caused great stress and anxiety to the patient.

93. A full investigation was completed and the calls were audited. This showed that the call failed the audit.

94. What we did;

• We apologised to the patient and admitted that the call had not been handled correctly.

• The call handler is currently not at work, and is being investigated under the trust’s capability procedure, but the outcome of the call was fed back to them.

Patient Transport Service

95. The patient had an appointment at 14.30, transport was due about 14.15. Patient was told on a call that the crew had arrived at property but there was no answer, however the patient was waiting on balcony for the crew to arrive. Patient extremely frustrated with service.

96. A full investigation was completed which included interrogating the system, speaking to the staff involved and speaking to the complainant. This showed that the crew had aborted patient's inward journey in error 3 hours before patient was due in, this was a PDA error.

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97. What we did;

• Apologised to the patient for the inconvenience and upset caused. • Explained the error and re-booked transport for the next appointment that

they had booked. • Put notes on the system to explain the difficulties that they had. • Investigated the error with the PDA’s.

CLINICAL EFFECTIVENESS CURRENT PERFORMANCE Clinical Effectiveness BAF Risk 1.1 & 1.2 (CQC REG 17, KLOE- E1, E2, E3, E4, E5, W2, W3, W5, & S2)

Key Performance Indicators (KPIs) for Clinical Effectiveness May 16 Longest Red 1 wait 00:32:58

Apr 16 – 75% @ 00:08:00 – Achieved by 0 Red 1-8min Incidents | Long Waits Over 30 Mins: 3| Total Incidents: 1031 Audit findings -: All three incidents reviewed were originally lower grade calls which were upgraded following clinical support desk intervention. No patient harm identified in any incident.

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May 16 Longest Red 2 wait 03:56:20

Apr 16 - 75% @ 00:08:05 – Missed by 72 Red2-8min Incidents | Long Waits Over 30 Mins: 102 | Total Incidents: 15588 Audit Findings-: Half of the incidents audited were originally lower grade calls which were upgraded following clinical support desk intervention. One incident was a 24 year old female with an exacerbation of asthma who received a 36 minute response time; a GP was on scene with this patient throughout. A midwife called for an ambulance following a home birth with concerns over the foetal heart rate; a vehicle arrived after 36 minutes, the baby was delivered and stable and not conveyed to hospital. May 16 Red 19 Longest wait 09:15:47

Apr 16 95% @ 00:22:24 ‐ Missed by 218 Red 19 Incidents ‐ Long Waits over 30 minutes: 242 ‐ Total Incidents: 16608. Audit Findings -: No harm identified in this group

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May 16 Green 60 Longest wait 12:09:27

Apr 16 ‐ 90% @ 02:13:26 ‐ Missed by 429 Green 60 Incidents ‐ Long Waits over 2Hours: 256 ‐ Total Incidents: 2119. Audit Findings -: One Green 60 call audited – 54 year old male patient who had fallen whilst transferring to his wheelchair; total response time 1 hour 42 minutes. A fire responder was on scene with this patient who was transported to hospital owing to an ongoing chest infection. National Clinical Performance Indicators (NCPI)

Clinical Quality Indicator Units East Midlands

East of England

Isle of Wight

LondonNorth East

North West

South Central

South East

Coast

South Western

West Midlands

Yorkshire

Asthma Care Bundle % 64.0 46.3 92.9 71.3 68.0 90.8 66.0 79.2 69.7 83.0 77.9Single Limb Fracture Care Bundle % 33.6 27.1 68.2 33.7 44.1 65.3 42.6 57.6 53.7 40.7 42.1 Febrile Convulsion Care Bundle % 56.9 73.8 100.0 31.4 85.7 76.7 82.4 65.2 76.3 76.5 68.4Elderly Falls Care Bundle (pilot) % 11.7 23.3 50.7 20.0 9.3 39.3 44.3 12.3 26.3 2.3 22.3Rag key 1st 2nd 3rd 4th

National Clinical Performance Indicators Cycle 15 Year to Date Upper Quartile Rating June to December 2015

If highlighted represents within upper quartile


East of England

Isle of Wight

LondonNorth East

North West

South Central

South East

Coast

South Western

West Midlands

Yorkshire

Asthma Care Bundle % 72.8 82.4 95.8 62.0 35.0 72.8 69.7 79.0 69.7 82.7 66.1Single Limb Fracture Care Bundle % 47.6 40.5 78.6 40.7 38.2 60 43.8 51 47.8 49.2 43.3Febrile Convulsion Care Bundle % 77.3 76.8 100.0 28.7 59.8 82.8 88.6 84.1 74.7 70.4 91.3Elderly Falls Care Bundle (pilot) %Rag key 1st 2nd 3rd 4th

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

If highlighted represents within upper quartile

98. The two tables above show the care bundle compliance for all the English ambulance Trusts by National Clinical Performance indicator (NCQI) Cycle Rag rated for the upper quartile. SCAS has been rated in the upper quartile for two of the four indicators in cycle 15 and one out of the three for cycle 16, with the falls not yet published.

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Ambulance Clinical Quality Indicators (ACQI)


East of England

Isle of Wight

LondonNorth East

North West

South Central

South East

Coast

South Western

West Midlands

Yorkshire

STEMI - Care % 77.6 82.1 73.5 70.3 86.4 86.2 67.3 67.9 84.4 77.9 83.1Stroke - Care % 97.6 97.7 98.3 97.3 97.8 99.6 98.5 96.5 96.8 96.2 97.9STEMI - 60 % - - - - - - - - - - -STEMI - 150 % 91.0 92.2 45.5 91.1 92.0 86.4 88.2 92.6 76.6 87.2 83.7Stroke - 60 % 53.7 49.7 62.3 62.8 58.3 64.1 50.3 65.6 44.7 54.2 54.8ROSC % 24.2 26.2 24.8 30.0 23.6 33.2 26.7 26.7 24.5 30.2 25.6ROSC - Utstein % 44.5 49.0 69.6 53.8 54.8 55.3 41.3 46.8 49.0 50.0 56.4Cardiac - STD % 6.6 6.5 8.8 8.7 6.3 8.8 13.8 8.1 8.8 8.8 9.5Cardiac - STD Utstein % 21.6 24.8 39.1 30.8 34.5 23.9 27.3 24.0 27.5 24.4 36.1Rag key 1st 2nd 3rd 4th If highlighted represents within upper quartile

Ambulance Clinical Quality Indicators 2015/16 YTD April 15 to Jan 16 Upper Quartile Rating

99. The table above shows SCAS in the upper quartile for three of the eight ACQI’s. This table relates to year to date April 2015 to January 2016 as there is a four month delay in the clinical reporting being published for the Ambulance Clinical Quality Indicators.

NHS Pathways

100. The NHS111 service and 999 services use NHS Pathways as their triage tool. To maintain the licence SCAS must undertake a certain number of audits on each user of the system on a monthly basis. SCAS has met this criterion for NHS111 and has been exceeding the minimum number of required audits since November 2016; however the 999 clinician audit numbers needs to be increased to meet the 100% audit standard. The Team are focusing on this improvement.

Service User Type Month May 2016 April 2016

NHS111 Call Handler 103.84% 119.80% Clinician 106.40% 107.22%

999 Call Handler 110.66% 111.28% Clinician 52.17% 95.65%

Key Performance Factors for Clinical Effectiveness NCPI/ACQI themes and trends

101. SCAS has traditionally been in the upper quartile for all of the NCPI’s and for

5 out of 8 of the ACQI’s. With the transition from paper to electronic patient record (ePR) there has been an effect that has changed reporting in both a positive and negative manner. An example would be the STEMI care bundle where SCAS has always been very poor in compliance due to analgesia not being administered or because it was not recorded as administered. Since the introduction of ePR it has risen by around 20% to above 90%; however the recording of two pain scores has dropped meaning that we have not made a net gain. STEMI performance as per the IPR is 73.6% ahead of the plan and an improvement compared to last year.

NHS Pathways

102. The Audit and Education team look at themes from the audits and from

these collates a learning package for the call handlers and clinicians. This takes the user through a scenario with some questions around what they

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would do. These are marked by the Audit and Education team and fed back to the user by their line manager through their monthly performance meeting. This supports the staff in recognising what they need to be working on to improve their performance which supports increased compliance in audits as well as patient safety and experience.

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

103. The compliance with the asthma and the limb fracture NCPI’s is being improved by using the ePR to ensure compliance by highlighting to the user any fields which have not been completed. This would then take the user back to the field in order for them to complete it and therefore gain compliance. The timescales are for this to be available for all of the NCPI’s and ACQI’s by the end of the calendar year.

104. The STEMI care bundle ACQI compliance tool as described above will be

live in the ePR system by mid-July as it has been designed to test the process and is currently in the test service awaiting release. Once this has been made available in the live system evaluation can be undertaken to improve the other indicators.

NHS Pathways

105. SCAS currently has 11 issues logged with HSCIC regarding events that were triaged through NHS Pathways. The EOC quality assurance and education team log these issues, to facilitate a clinical review of the event by HSCIC and consideration to be given to amending, removing, or adding new information to improve outcomes and patient experience.

106. Representatives from the EOC Education and Development team attended

the National NHS Pathways 999 user group. Meetings are 3 monthly over two days to review themes across services and to prioritise changes that are required from HSCIC to improve the service we deliver.

107. The Audit and Education team have implemented Quality Assurance

Coaches into the NHS 111 service to support new staff as they enter the call centre environment and to support them in difficult situations/calls. As well as these they have also implemented action plans for all non-compliant audits to support staff with continual development and improvement. These are not formal action plans in regard to the requirements of NHS Pathways, but to support staff prior to them requiring a formal action plan. Since both of these initiatives have been implemented there has been a steady increase in the compliancy rates across both call handlers and clinicians. This is now showing that we are consistently over 90% compliant across both staff groups, with reducing numbers of formal action plans required.

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OTHER KEY ISSUES Quality Account Priority – Improving the Recognition of Sepsis in Children Under 5 in the Clinical Coordination Centre (CQC REG- 9, 12, KLOE-E1, E2, E4 & E6)

108. SCAS has partnered with HSCIC and NHS England to run a pilot to focus on improved identification of sepsis in the under 5 years age group. The pilot has highlighted some key themes:

• Remote assessment of unwell young children is very challenging • SCAS call handlers are very skilled at probing • Terms often used to describe breathless children are not in NHS

Pathways supporting information – to be added to next NHS pathways version

• SCAS staff demonstrated excellent methods of assessing neck stiffness in young children – such as asking them to pick up a toy. This will be included in NHS Pathways supporting information in the next release.

109. Taking part in this pilot has enabled SCAS staff to influence changes within

NHS pathways which will improve outcomes for patients in the future.

Bespoke G.P Training Delivered by SCAS

110. SCAS now deliver training to the ST1 / ST2 and ST 3 OOH GPs. The 4 hour sessions are designed to highlight our challenges, tell them about our skills and grades of staff, and allow them to observe real 999 and 111 calls in the hope that they use our services effectively. They are also updated in Basic Life Support and use of an AED to fulfil their professional requirements.

111. Feedback from the GPs has been exceptionally positive and it is hoped that

these sessions will be expanded to pre-existing experienced GPs who are no longer in training. A business case has been prepared to seek additional funding from Commissioners to deliver these sessions.

RECOMMENDATIONS TO THE BOARD

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

Deirdre Thompson Director of Quality and Patient Care July 2016

Agenda Item: 9a



Title Operational Performance Report – 999, 111 and Fleet Services

Responsible Director Philip Astle, Chief Operating Officer

Recommendation (eg. note, approve, endorse) Note










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

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

Operational performance has particular regulatory implications; for example, quarterly reporting to NHS Improvement covers performance on the national response time standards


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

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

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

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


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OPERATIONAL PERFORMANCE REPORT – 999, 111 and FLEET SERVICES

PURPOSE 1. The purpose of the paper is to update the Board on current performance and

provide an update on plans in the 999 and 111 arenas. EXECUTIVE SUMMARY 2. May 999 performance has dropped since April as shown in the charts below.

The figures in the table below show the performance for May and for Q1 to date at the SCAS level and then broken down by contract. The figures do not include the manual clinical support desk (CSD) re-grades that will be completed at the end of Q1 and will have the net effect of increasing Red 19 performance just above the 95% target.

SCAS - Total Demand and PerformanceRed Activity vs PY Red Activity / Day

Total Activity vs PY

Hospital Waits (hrs)

Red 19 Waits Red 75% (mins) Red 19 95% (mins) Call Answer 95% secs

23.62% 590 11.14% 1049 346 08:33 20:15 59

Red 1 Red 2 Red 19 Green 30 Green 60May-16 73.67% 71.53% 94.15% 60.68% 88.29%

Quarter to Date (Q1) 74.37% 72.98% 94.83% 64.01% 89.36%

SHP - Contract Demand and PerformanceRed 1 Red 2 Red 19 Green 30 Green 60

May-16 70.40% 68.25% 92.96% 58.14% 88.68%

Quarter to Date (Q1) 72.55% 70.25% 93.86% 60.46% 86.06%

TV & MK - Contract Demand and PerformanceRed 1 Red 2 Red 19 Green 30 Green 60

May-16 76.15% 74.00% 95.04% 62.55% 87.94%

Quarter to Date (Q1) 75.83% 75.03% 95.56% 66.62% 89.09% 3. The principal reason for the drop in performance is that demand in May was

just over 10% above the same period last year and we were unable to match that demand with additional resource. The increase in demand is shown in the following chart.

999 SCAS and Contract performance – Quarter to May 31st

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4. NHS111 performance is being sustained and we are regularly at the top of the national performance tables. The monthly out-turn for May delivered call answer within 60 seconds at 95.33% and an abandonment rate of 0.54%. The improvement in performance was partly due to demand reducing to planned levels (assuming a 3% growth), an increase in work effective staff, and robust management of call centre metrics.

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0%

2%

4%

6%

8%

10%

May

15

Jun

15

Jul 1

5

Aug

15

Sep

15

Oct

15

Nov

15

Dec 1

5

Jan

16

Feb

16

Mar

16

Apr 1

6

May

16

111 Call Abandonment Rate

5. The performance of 111 should be maintained at current levels over the

coming months as there are more recruits coming on line in the coming weeks and the workforce are becoming more productive. Morale has been lifted which should help retention.

CURRENT PERFORMANCE 999 Performance 6. 999 performance has dropped in May as demand and acuity have risen

above the levels seen in April. Resources have been adjusted to reflect the new demand but performance, particularly in the South, has been difficult to sustain. Private provider hours had been revised reflecting the revised forecast and overtime used to raise hours to meet demand. It is likely that we will hit one of the three red targets in Q1, hitting Red 19 and missing R1 by just over half a % and Red 2 by just over 1.5%.

7. The year on year comparison shows performance lagging behind the Q1

performance of 2015/16. Apart from demand rising by over 10% year on year the acuity has increased significantly (Red % is up over 23% year on year) and we are behind plan with recruiting across the workforce. Hospital handovers have improved from a very low base in March but are still

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significantly worse than they were this time last year as can be seen from the following chart.

240:00:00

480:00:00

720:00:00

960:00:00

1200:00:00

1440:00:00

1680:00:00

1920:00:00

Dela

y (h

ours

)

Hospital Handover and Clear Up Excess

Handover Excesses Clear Up Excesses

8. One of the key deliverables for the Operations team this year is to reduce the

cycle time by four minutes. Without this being delivered we will have to spend more on private providers to achieve performance. The chart below shows the scale of the challenge. The peak in the winter of 2015 gives us a target to aim at and there is a combination of actions that we are taking to reduce the cycle time. The electronic patient reporting tool (ePR) update in July will help and we are addressing delays in GP callback which are an issue out of hours. A significant factor is hospital delays (as can be seen by the shape of the curve compared to the hospital delay table above) which are included in the cycle time, and so we need to work hard at our partnerships with the acute trusts.

01:20:0001:21:0001:22:0001:23:0001:24:0001:25:0001:26:0001:27:0001:28:0001:29:0001:30:00

Tota

l Job

Cyc

le

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

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9. Recruiting. Our recruiting is a significant challenge and is diverging from plan in front line staff, the EOCs and in 111. This is covered in the workforce report and will not be covered further in this section.

111 Performance 10. 111 performance has recovered from the difficult period that our service had

over the winter and that performance is being sustained. The monthly out-turn for May delivered call answer within 60 seconds at 95.33% and an abandonment rate of 0.54%. The improvement in performance was partly due to demand reducing to planned levels (assuming a 3% growth), an increase in work effective staff and robust management of call centre metrics.

0%

2%

4%

6%

8%

10%

May

15

Jun

15

Jul 1

5

Aug

15

Sep

15

Oct

15

Nov

15

Dec

15

Jan

16

Feb

16

Mar

16

Apr 1

6

May

16

111 Call Abandonment Rate

11. The challenge is to balance operational and financial performance over the

summer whilst the volumes are lower. We have had an approach from another 111 provider to take some additional call volumes and that might help with the financial challenge if the system for the transfer of calls can be operationalised.

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OTHER KEY ISSUES U&E Operational Support Activity 12. We are continuing with implementation of the new operational structure. Paul

Jefferies has been appointed as the Assistant Director of Operations. We will finalise interviews for the Senior Operations Manager on the 1st July and we will then advertise for the vacant Heads of Operations roles. We aim to have the full structure in place by the end of September.

13. We are continuing with our development of our team leaders (TLs). We have

met with most of the TLs to review their thoughts on the development centres and how we now support them to deliver in their roles. They are enthusiastic about the challenges we face this year and keen to deliver in their roles. The issue of the pay they receive is a key complication to resolve to ensure we retain these managers.

14. We have been asked to support South East Coast Ambulance Service

(SECAMB) with their operational structure review and both Mark Ainsworth and Paul Jefferies are attending their internal workshops to support this process.

15. The rota project is continuing and we have established local area working

groups who are working up new proposed rotas. We have an aspiration to get Hampshire completed by the end of October. We have commenced consultation with Oxfordshire flexible workers on a new way of working which will conclude by the end of October.

Indirect Resources (IRs)

16. We have begun the review of the IRs and have held briefing sessions with all

the coordinators across our geography. We are working on the questionnaire and the details of a pilot in the Portsmouth area.

17. We are now in a position to sign the Memorandum of Understanding (MoU) to

work with Hampshire Constabulary on a pilot with 10 Special Constables Co Responding for SCAS.

18. We have a new Public Access Defibrillator (PAD) governance framework

where local PAD site owners check and maintain their local AED and report

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back to SCAS monthly on any issues. South Oxfordshire District Council has agreed part funding for future PAD sites.

19. We have now finalised the MOU for Thames Valley Fire services co

responding and the document is with their legal teams and the Henley Fire Co Responder scheme went live on 23rd June.

Resilience and Specialist Operations (RSO) Update

20. We have received notice of this year’s emergency preparedness, resilience

and response (EPRR) Assurance which includes a deep dive into Business Continuity and Fuel. There is also a requirement to provide assurance on PTS and 111. We are still working to recruit a joint Business Continuity Manager for SCAS and Isle of Wight Ambulance Service.

21. Aircrew at Thruxton will be moving into new, charity funded accommodation

at the beginning of July. This is a fitted-out hangar which will include training facilities, staff welfare areas, offices and store rooms. The aircraft will also be housed within the same building.

22. The RSO Organisational Learning lead is working on setting up a Command

Academy with initial University Accreditation with Kingston University London. This project is in its early stages and of course will be worked-up on a cost-neutral basis with a potential for generating income from across Health.

NHS England (NHSE) - Ambulance Response Programme (ARP) 23. Dispatch on Disposition (DoD). The Trust has moved from 3 minutes to 4

minutes for Red 2 and Green Calls. For Red 2 DoD, this has changed from 2.25 mins between 7th and 30th April to 2.56 mins for May and June. The Trust has had no reported adverse or clinical incidents in relation to the ARP DoD move. The Business Intelligence Team has now completed an analysis of the effect of the 240 DoD change which will be presented to executives in early July.

24. ARP 2 Clinical Coding Trial. Trials of the revised clinical code set are now

well underway in South Western (SWAS), Yorkshire Ambulance Services (YAS) and West Midlands (WMAS), who joined the clinical code trial from early June. There is limited data available at present from these trial sites to determine the operational and clinical impact of the changes made; however the Health Research Unit at Sheffield University are undertaking a formal review and will be making recommendations to NHS England on code outcomes over the coming months. We are visiting YAS on 22 July to identify lessons.

25. The coding set report is due in August 2016; this will be presented by NHSE

in September 2016 to ministers for further consideration as to whether to extend the clinical code trial to other ambulance trusts, as part of a phased and agreed implementation.

Ambulance Review Modelling - Lightfoot Solutions

26. On 17 May, Section A Workshop 1 & 2 – SCAS Executive playback

t o o k p l a c e o n t h e modelling, resource and finance areas. Following

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this summary presentation, Lightfoot have now been asked to undertake further work to provide more explanation behind data variances over the last 3 years relating to SCAS operational performance.

27. This additional analytical work is being completed to ensure objectives and

deliverables of the review have been fully covered, in order that final conclusions and recommendations can be re-presented to the Trust Board, which is now expected to take place early in July.

28. There are a number of the key recommendations that are already being

progressed. They included introduction of auto dispatch CAD software for Red 1 calls with our CAD supplier, and reviewing job cycle times in the operations and improving urban drive zone management and green call queuing / stack management.

Automated Dispatch for Red 1 Calls Only 29. Work has progressed over June with our CAD supplier and we have agreed

the scope / specification, and determined the system configuration and our operating rules with auto dispatch processes for Red 1 Calls only. To support the software development work, preparation is underway on developing robust testing scripts for mid-July for site acceptance and user testing to occur. This will ensure SCAS operating rules and business intelligence reporting requirements have been fully tested before we can go live. The intention is to phase in auto dispatch at nodal level first; this will support users so we can manage and monitor impact and changes with this implementation. A revised go live has been agreed for the end of July / early August, which is subject to operational and technical readiness being completed.

30. One of the key dependencies before auto dispatch can go live is to fully test

on the latest version of NHS Pathways (version 11), which is due to be installed and operational, by late July.

Adastra Implementation 2016/17 31. Currently this project is on track with Advanced Ltd for go live transition to

begin during mid-September 2016. Technical work is well underway, with client set up and ICT infrastructure and all system interfaces in support of this hosted ICT service ready for end to end testing during July.

32. One of the key risks that will need to be mitigated will be to agree the training

programme, against the 111 staff abstraction rate to support delivery timelines and to minimise the day to day impact on NHS 111 service operational performance across both SCAS sites, this action is being worked through and will be reported back to the Project Board for sign off. In addition to the set up work, a unique staff engagement package for Adastra implementation is under development to support this rollout.

RECOMMENDATIONS TO THE BOARD 33. The Board is asked to note the contents of this report and the ongoing activity

to support operational output. Philip Astle, Chief Operating Officer, 28 June 2016

Agenda Item: 9b



Title Operational Performance Report – Patient Transport Services

Responsible Director James Underhay, Director of Strategy, Business Development Communications and Engagement










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


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


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

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

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

Other Previous considerations by the Board

Patient Transport Service performance is discussed at every meeting


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OPERATIONAL PERFORMANCE REPORT – PATIENT TRANSPORT SERVICES

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

Transport Services (PTS) contracts, activity and performance across the Trust’s Commercial Directorate.

EXECUTIVE SUMMARY 2 Performance across SCAS PTS has improved over the first quarter of 2016

against the majority of the key performance indicators (KPI’s) but all contracts continue to be challenging, specifically due to the increased distances and corresponding mileage of a significant number of patient journeys. This continued increase in mileage is down to various factors such as patient choice of treatment locations, and acutes and Health Care Professionals focussing on specialist clinics.

3 The majority of the activity for SCAS PTS is for outpatients appointments but

there continues to be an increase of request from acutes for focus to be on discharges to support system flow. This diversion of resources onto discharges affects the capacity for outpatient journeys. The SCAS management teams continue to work alongside commissioners on achieving best working practices and changes of KPI to meet system flow requirements.

4 Due to the variances in activity across all contracts with regards to mileage,

patient mobilities, and clinic times the management teams are conducting an overall rota review to ensure best efficiencies with shift times and right vehicle, right time, right place. Commissioners have recognised not all contract specifications meet patient requirements and contract negotiations are underway to address these issues.

5 A complete restructure of the Commercial Management team has

commenced with a full review of job descriptions, roles and accountabilities; once this part of the process is complete we will launch a full consultation across the commercial directorate.

6 Contracts

SCAS have mobilised two new contracts from the 1st April 2016 and have a mobilisation project in place to deliver a further phase of the Hampshire wide contract. As part of the final phase of the Hampshire contract, SCAS are currently preparing to mobilise the Winchester and Andover element of the contract taking over from the current provider on the 1st August 2016. This will then bring into one single consortium contract all Hampshire patient journeys.

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On the 1st April 2016, SCAS was awarded a Thames Valley wide contract which brings together patient journeys across 10 clinical commissioning groups (CCGs), a mental health trust and a hospital trust. The contract is significantly different from previously held contracts and softens the borders between each CCG boundary allowing better utilisation of resources. The contract is now a 24/7/365 day contract for both the contact centre and operational delivery. The first few months have allowed for new innovations to be developed like book ready, greater focus with on-line bookings with supported training to referrers, dynamic scheduling and introducing eligibility criteria of all patients travelling within the Thames Valley area. The contract has contract review meetings set on a monthly basis with a bi-monthly quality review meeting that will feed into and escalate to the CRMs. SCAS were also awarded a contract with Oxford Health Foundation Trust to deliver Non Emergency PTS and secure transport for Oxfordshire, Buckinghamshire and Wiltshire Mental Health patients. We are working closely with the commissioner to develop the contract review meeting format and information schedules based on the contract service specification.

CURRENT PERFORMANCE 7 PTS Contact Centre The PTS Contact Centres operate 24/7 and are based within the EOCs at

Bicester and Otterbourne. The call handling function operates on a virtual platform whereby the caller is routed to the first available call handler wherever they are based. The dispatch nodes are split into Hampshire, Berkshire, Oxfordshire and Buckinghamshire; from 0700 to 1900 they are run from both Contact Centres and from 1900 to 0700 operate from Otterbourne only covering the whole PTS area.

Key Performance Indicators (KPIs)

The following are the key performance indicators for the PTS contact centre.

This shows the calls answered (Fig 1) were slightly below budget in both April and May.

Fig 1

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Looking at the contact centre call answer performance there are two different targets based upon differing contracts (Fig 2) therefore we have shown the two targets against plan and for month to date and year to date. Currently we are not hitting the required performance; this is due to understaffing within the call handler workforce, creating gaps in the rota. There is currently a rota review underway looking to review call-handler available hours and call profiles to gain a closer match. As you can see from the graph (Fig 3) the performance across both measures has drastically improved month on month, this is vastly due to the increase in staffing which is still increasing.

Plan Actual Variance Plan Actual VarianceCall Answered 60 Sec 95% 87.55% (7.5%) 95% 86.09% (8.9%)Call Answered 30 Sec 95% 84.30% (10.7%) 95% 82.90% (12.1%)

MTD YTD

Call Answer Performance

Fig 2

75.00%

80.00%

85.00%

90.00%

95.00%

100.00%

Apr-16 May-16

CC Performance

Call Answered 60 Sec Call Answered 30 Sec

Fig 3 Performance against the call abandonment rate (Fig 4) is very good; this would normally go hand in hand with call answer performance. However call answer performance still has some improvement to make, it would appear that callers are content to hold on even when they are waiting more than the contract targets of 30 or 60 seconds.

Call Abandonment rate

MTD YTD

Plan Actual Variance Plan Actual Variance

Call Abandoned after 60 Sec 5% 1.60% 3.4% 5% 1.63% 3.4%

Fig 4

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When looking at the call volumes for April, part of the variance is due to a higher % of online bookings than forecast thus reducing the volume of calls coming through the contact centre (Fig 5). For May, the % of online bookings dropped slightly from the previous month and compared to budget, this did result in a small increase in calls. We are continuing to increase the % of online bookings, through further education and engagement with service users. We are also highlighting at Contract Review meetings the hospital and clinics where there is low or no use of the online booking and journey management facility.

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

% Online Bookings v Target

Budget Actual

Fig 5

With regards to the number of calls going to the voicemail, (Fig 6) this shows that performance has significantly improved, with a reduction of calls going to answerphone over the last two months. This is as a result of us answering a lot more calls earlier and thus stopping them reverting to the voicemail after 60 seconds. This results in us providing a better patient booking service to our customers and reduces the need to ring patients or Healthcare Professionals (HCP) back.

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Fig 6

Another factor that impacts on our performance is the call duration (Fig 7), because of the variety of type of calls we take in the PTS contact centre this can easily impact on the length of the call. For example, where we see higher volume of estimated time of arrival (ETA) calls this generally increases the call length as the call handler will usually have to liaise with the dispatchers when the patient or HCP can expect the transport to arrive. Also, due to a high number of new starters we would expect the call length to be slightly higher whilst they become increasingly familiar with the systems.

Fig 7

Key Performance Factors The graph below (Fig 9) shows the number of operational hours put out

against the planned number of hours required. We continue to be behind the plan due to vacancies within the call handler workforce which is slightly offset by bank usage and agency staff.

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2,8002,8502,9002,9503,0003,0503,1003,1503,2003,2503,3003,3503,4003,4503,500

Call Handler Resources v Baseline

Budget Hrs Actual Hrs

Fig 9 Abstractions for the contact centre (Fig 10) increased in May; a lot of the annual leave abstraction was due to the May bank holidays at the beginning and end of May. This is offset against the slightly lower call volumes on those days. Sickness has been consistent month on month and is static at 3%. We are in the process of changing the process to show new starters as on training and so this will increase the abstraction figure over the coming months. The ‘Other’ leave is for paid/authorised leave.

0.00%1.00%2.00%3.00%4.00%5.00%6.00%7.00%8.00%9.00%

10.00%11.00%12.00%

Apr-16 May-16

Abstractions

A/L Sickness Training Other

Fig 10

8 PTS Operations The PTS Operational team operate out of multiple locations across the SCAS

geography; there are two management teams covering the Hampshire and

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Thames Valley areas, the new interim structure has these teams led by two Business Managers supported by a commercial contracts manager.

Key Performance Indicators (KPIs)

These are the aggregate key performance indicators for the PTS Operations.

Fig 11 shows that the total number of journeys we undertook during April and May was lower vs the budgeted journeys. However, with most of the contracts we are paid on a mileage and mobility basis and therefore the volume of journeys is not a direct correlation to cost and income. The table below (Fig 12) shows there is very similar number of journeys month on month, the proportion of renal journeys has remained constant.

43,000

48,000

53,000

58,000

63,000

68,000

Demand v Budget

Budget Actual

Fig 11

Apr-16 May-16Total Journeys 43,438 43,698Renal Journeys 14,581 14,464

Fig 12 This graph below (Fig 13) shows the number of miles travelled per journey is significantly higher than originally budgeted. This is creating a cost pressure across the commercial operations, although the additional income against some contracts based on mileage is offsetting this slightly.

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6.006.507.007.508.008.509.009.50

10.0010.5011.00

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

Ave miles v Budget

Budget Actual

Fig 13

With regard to patient experience, one of the key performance indicators across PTS operations is the amount of time patients spend on the vehicle (Fig 14). As we are showing this for the whole of the PTS operations, this shows the variance to the targets specific to each contract. For both April and May we are ahead of target for this KPI across the total operation, with May seeing a further improvement on April.

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

Apr-16 May-16

Time on Vehicle Performance Variance %

Performance Variance +/-

Fig 14

The graph below (Fig 15) shows the inward and outward KPI for outpatient journeys (arrival at and collection from their appointments on time) showing the average variance for the two KPIs against their individual targets. This graph has taken the variance for each KPI by target and shown the average. For April we missed the outward performance by an average of 8% and 12% for inward performance. For May we missed performance by an average of 11% for outward journeys and 15% for inward. This shows our performance has slightly deteriorated between April and May. The reasons for this are linked to the extended journey length and thus the additional travelling time

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required to transport patients, and the significant vacancies we currently have partially due to the lack of TUPE staff we gained through recent mobilisations.

-16.00%

-14.00%

-12.00%

-10.00%

-8.00%

-6.00%

-4.00%

-2.00%

0.00%Apr-16 May-16

Outpatients Performance Variance %

Inward Performance Variance +/-

Outward Performance Variance +/-

Fig 15

Similarly to the above KPIs, the graph below (Fig 16) is for the inward and outward journey performance for renal patients. (i.e. patients arriving on time for their appointment, and being collected on time following their appointment) (N.B - Individual contracts having different KPIs). Both months have missed their performance standards with the inbound KPI deteriorating from April’s level but the outward journey KPI improving from April’s level. For April, the average variance against outward renal patients was 16% and 5% for inward. For May, performance was an average of 5% worse than target for outbound journeys, and 12% worse for the inbound. The reasons for the missed performance are consistent with those previously identified for the Outpatients KPIs.

-18.00%

-16.00%

-14.00%

-12.00%

-10.00%

-8.00%

-6.00%

-4.00%

-2.00%

0.00%Apr-16 May-16

Renal Performance Variance %

Inward Performance Variance +/- Outward Performance Variance +/-

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Fig 16 9 Workforce In May 54,000 Ambulance Care Assistant (ACA) hours were deployed,

compared with 50,000 during April. (Fig 17) Compared to the budget we have put out more ACA hours, this is partly due to a high bank usage along with lower abstractions than budgeted. It is also partly due to the higher than planned mileage per journey, as noted earlier. The consequence of the longer journey distances results in more ACA hours per patient.

44,000

46,000

48,000

50,000

52,000

54,000

56,000

SCAS ACA's hours Actual vs Budget

Budget Hrs Actual Hrs

Fig 17

Consistent with the contact centre hours above, annual leave increased in May (Fig 18) due to the dual bank holidays. Sickness has slightly increased between April and May and has just crept up to 6%. There has been a review of sickness across the service and more focus has been put on reviewing and actively managing the staff off on sickness. Like the contact Centre, we are reviewing the process of staff joining and going straight into training, this will start to show greater numbers of abstractions in future months as staff will show as being in training once they start with us, as recorded on our GRS scheduling system. The ‘Other’ includes leave which is low and captures suspensions, alternative duties and other authorised leave.

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0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

Apr-16 May-16

Abstractions

A/L Sickness Training Other

Fig 18

FUTURE PERFORMANCE 10 Plans for Sustaining/Improving Performance

Workforce

Recruitment continues to be behind plan (Fig 19) resulting in additional costs to backfill vacancies through a higher use of private providers. Investment has been made to advertise vacancies through different media and the initiative around the requirement for a C1 licence has been dropped from standards. New team members without C1 licences are being placed through C1 driving by SCAS through an agreed pay back process. This has opened up PTS to a wider volume recruitment market.

Fig 19

Other initiatives regarding improvements to recruitment and training include moving the driving element of the basic ACA course, which is being

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completed first as majority of course failures are from failing the driving requirement. In addition the job description for ACA’s is being reviewed to include some enhanced skills training e.g. Entonox administration. Currently for any patient requiring care above the skill set of an ACA a private provider has to be utilised at significant expense.

Contracts Milton Keynes contract negotiations for the second year is being worked through based on the significant over activity position from last year and we are working with the commissioners to deliver an action plan to reduce inappropriate activity and the significance of the activity changes. We continue to work with NENE CCG commissioners, to understand the PTS position with their current provider. The activity we are currently doing is part of a small contract covering patients who are mainly travelling into the Oxford area. We continue to work with commissioners and key stakeholders, as well as patient groups to deliver and provide excellent patient experience through service innovation and developments including;

• Eligibility criteria review ensuring equitable application and providing information of alternatives.

• Supporting CQUIN and QIPP schemes. One of which is a potential for a pilot scheme for patient led booking.

• Engagement with volunteer sector and social transport providers to look at closer working partnerships to efficiently use transport solutions.

• Reviewing patient flows to identify changing trends and the impact.

Reporting and Analysis Pre April 2016 we had a weekly private provider report that went through the approximate spend each week vs. budget and some of the reasons for the under/over spends including vacancies, under/over activity, bank usage. This was followed up by a weekly call to discuss the contents of the report and review and actions. Since April 2016 we have implemented an all-encompassing weekly report for each of the contract areas and contact centre. This looks at journeys, miles, hours, cost, abstractions, resources and KPIs etc, to better understand the performance and efficiency of the service. This is then discussed weekly with the management team by contract area, to identify areas for improvement and ensure we fully understand performance against plan. Innovation SCAS PTS have initiated a project plan to integrate the PTS telephony systems with the cleric booking and management software, the vision is that a caller will enter their booking reference or NHS number via their key-pad and the cleric system will auto populate with details. The call handlers can then simply clarify the information quickly and proceed with call; this will reduce call duration and enhance the caller’s experience of using the PTS services.

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OTHER KEY ISSUES 11 There is continued national scrutiny of Patient Transport services due to

contract failings resulting in very poor patient experience. SCAS PTS has formally had to respond to commissioners giving assurances on standards of private provider’s utilised and financial arrangements. SCAS continues to monitor the national situation and react accordingly.

RECOMMENDATIONS TO THE BOARD 12 To acknowledge the report and continue to support with actions which enable

the team to improve performance across all contract areas. Author Paul Stevens Title AD Commercial Services Date 30 June 2016

BOARD MEETING IN PUBLIC

13 JULY 2016

Agenda item: 9c


Title Finance and Estates Report for the month ended 31 May 2016

Responsible Director Charles Porter, Director of Finance

Recommendation (eg. note, approve, endorse)

To note the current financial position of the Trust.










Corporate Risk 17 – Non achievement of financial targets and CIPs

Implications

Regulatory and legal implications / impact (e.g. NHS Improvement provider licence and Continuity of Services risk ratings, CQC essential standards, competition law etc.) The paper covers our NHS Improvement financial risk rating – our current financial risk rating is a 2, which is in line with the plan.


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

Council of Governor implications / impact (e.g. links to governors statutory role, significant transactions etc.) The Public Finance Board papers are shared with the Council of Governors. In addition, periodic workshops for governors are held to develop their understanding of finance and the financial environment in which the Trust operates. Patient / staff implications (e.g. linked to NHS Constitution, equality and diversity)

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

Other

Previous considerations by the Board April 2016 and every bi-monthly Board meeting in public


This paper is presented as part of the process of the Board undertaking a continuous review of the Trust’s financial position.

Background reading can be found at:

NHS Improvement Risk Assessment Framework http://www.monitor.gov.uk/raf

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

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FINANCE AND ESTATES REPORT FOR THE MONTH TO 31 MAY 2016

PURPOSE 1 The purpose of the paper is to:

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

and expenditure; cash, capital and liquidity; NHS Improvement financial risk rating; and cost savings.

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

areas where the Trust’s financial performance is adversely behind plan at this stage of the financial year.

EXECUTIVE SUMMARY 2 Income and expenditure - the Trust shows a deficit of £588k for the month

which was £329k below the budget deficit for the month. The main driver behind the variance is the contract situation which accounts for £525k. The underlying operational position (excl. contract variance) was under budget along with corporate areas.

3 Cash and capital - The Trust’s cash balance at the end of May was £18.2m

which was £2.0m higher than the April forecast. Receipts were higher than the April forecast (£2m). The 90 day debtor figure increased in month and was £124k at end of May representing 2.33% of total sales debt.

4 NHS Improvement financial risk rating – the NHS Improvement Financial

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

5 Cost savings – overall the savings were £0.4m in the month £0.1m below

budget.

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CURRENT PERFORMANCE INCOME AND EXPENDITURE

6 As can be seen from the table below, the Trust made a deficit of £588k in the month which was £329k below budget.

Income was £33k lower than budget with £111k related to emergency services offset by £78k relating to commercial services. The emergency service income variance includes a £525k shortfall due ongoing emergency service contract negotiation offset by growth £520k and other related income £106k. Growth income is assumed at 70% marginal rates consistent with the 2015-16 emergency contract.

The Trust is currently going to arbitration on its emergency service contract. The current gap between the Trust and the commissioners is £6.3m. In the months accounts we have taken a prudent view and reduced our income by one twelfth of this figure £525k.

Overall costs were £296k above budget with £185k in emergency services and £174k non-emergency services offset by £63k in corporate. Non- emergency profitability was £96k below budget for the month.

Actual

Month Budget

Budget

Variance

Actual

Year to date Budget Budget

Variance

Full Year Forecast Budget

Profitability SCAS Income £k 14,384 14,416 (33) 28,543 28,700 (156) 175,975 175,961

SCAS Contribution £k 2,327 2,719 (392) 4,281 5,315 (1,035) 35,060 35,060 % Contribution % 16% 19% (3%) 15% 19% (4%) 20% 20%

Corporate overheads £k 2,915 2,978 63 5,765 5,944 179 36,959 36,960

EBITDA £k 196 523 (327) 83 937 (854) 7,489 7,489 EBITDA % % 1.4% 4% 0% 3% 4% 4%

Overall Surplus/(Deficit ) £k (588) (259) (329) (1,484) (628) (856) (1,900) (1,900) % Surplus/(Deficit) % (4%) (2%) (2%) (5%) (2%) (3%) (1%) (1%)

7 Further information can be seen in the following appendices:

• Appendix A1 – income and expenditure monthly position • Appendix A2 – income and expenditure quarterly position • Appendix B – analysis of income • Appendix C – key operational ratios for income and expenditure

CASH AND CAPITAL

8 The Trust’s cash balance at the end of May was £18.2m, which was £2m higher than the April forecast. Receipts from sales income were £2m higher due to quicker than expected settlement of new PTS contract income invoices.

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Actual Month Budget Variance

Year to dat Actual Budget

e Variance

Full Year Forecast Budget Prior Year Variance

to budget

Variance to Prior

Year

Cash and capital position EBITDA £k 196 523 (327) 83 937 (854) 7,489 7,489 8,569 (0) (1,080) Working capital mov't £k 1,662 321 1,341 (279) 59 (338) 1,327 1,327 (5,646) 0 6,973 Capital Expenditure £k (34) (1,026) 992 (769) (1,630) 861 (8,645) (8,645) (6,950) 0 (1,695) Disposals £k 0 0 0 0 0 0 0 0 14 0 (14) PDC paid £k 0 0 0 0 0 0 (1,613) (1,613) (1,360) 0 (253) Interest £k (42) (38) (4) (36) (32) (4) (62) (62) (65) 0 3 Repayments of loans £k (700) (700) 0 (700) (700) 0 (1,738) (1,738) (1,738) 0 0 Other £k 1 118 (117) 0 254 (254) (2) 0 2 (2) (4) PDC & DOH Loans £k 0 0 0 0 0 0 0 0 0 0 0 Cashflow £k 1,083 (802) 1,885 (1,701) (1,112) (589) (3,244) (3,242) (7,174) (2) 3,930

Cash balance £k 18,225 18,814 (589) 18,225 18,814 (589) 16,684 16,684 19,926 0 (3,242)

9 The 90 day debtor figure has decreased and now stands at £124k (down from

£63k in April). This represents 2.33% of debt, which is an increase in the April percentage (0.73%). The current balance of outstanding debt comprises £47k PTS ECRs, £35k PTS SLA and £42k CQUIN. There is a residual risk of debt moving to the 90 day category in June of £456k comprising £252k PTS activity for Oxon CCG and £204k disputed SHIP Risk Share charges.

10 Cash amounts paid out in May were line with the April forecast. Capital

expenditure has been slow in the first two months (£0.261m year to date) leading to a downward pressure of capital payments (£0.6m down on April forecast). Cash payments in relation to pay were slightly higher than April forecast due principally to redundancy payments. In addition revenue non pay payments were £0.5m higher than forecast arising from higher private provider expenditure.

11 Further information can be seen in the following appendices:

• Appendix D – key financial ratios, including liquidity • Appendix E1 & 2 – cash flow forecast and reconciliation to 31 March 2017 • Appendix F – capital expenditure 2016/17 • Appendix G – balance sheet and forecast to 31 March 2017

NHS IMPROVEMENT FINANCIAL RISK RATING

12 As can be seen from the table below, our rating is a 2 which is below plan due to the contract income situation.

Actual Month Budget Variance

Actual

Year to dat Budget

e Variance

Full Year Forecast Budget Prior Year Variance

to budget

Variance to Prior

Year

Financial Risk Rating

Overall Score 2.0 2.0 0.0 2.0 2.0 0.0 2.0 2.0 2.0 0.0 0.0

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COST SAVINGS

13 As can be seen from the table below, overall the savings were £374k which was £42k behind the in the month. There is an action to recover the savings in the coming months.

Project

Actual

Month Budget

Var

Actual

YTD Budget

Var

Forecast

Full Year Budget

Var

C

omm

erci

al D

ivis

ion

Com1. Auto Allocation Auto Plan 15 11 4 21 21 (0) 128 128 0

Com2. PP Rationalisation 26 15 11 54 30 24 78 42 36 Com3. Wokingham Rent 1 1 0 2 2 0 8 8 0 Com4. Reduce Training Time 0 0 0 0 0 0 63 80 (16) Com5. Reduce Missed Meal Breaks 1 2 (1) 3 3 (0) 36 36 0

Com6. Improve SCAS Efficiency 0 17 (17) 0 33 (33) 200 200 0

Com7. Rearrange Driver Training 0 0 0 0 0 0 4 4 0 Com8. Increase Online Booking 2 2 0 2 2 0 60 60 0 Com9. Replace Short Term Hire Vehicles 7 7 0 13 13 0 40 40 0 Com10. Improve PP Efficiency

0

20

(20)

0

41

(41)

243

243

0

Com30. Cease use of Ext Examiner 1 1 0 3 3 0 16 16 0 Com31. Increase VCD usage

0

32

(32)

13

64

(51)

384

384

0

Com32. Increased SCAS Staffing 14 52 (39) 43 105 (61) 608 628 (20) Subtotal Commercial Division 66 160 (93) 153 317 (163) 1,869 1,869 (0)

A

&E

A&E11. OT Incentive Reduction 44 53 (9) 198 211 (13) 1,047 1,056 (9) A&E12. OPS Sickness Reduction 55 0 55 105 0 105 341 335 6 A&E13. Annual Leave Reduction 42 42 0 84 84 0 503 503 0 A&E14. Reduce Cycle Time 0 0 0 0 0 0 1,236 1,236 0 A&E15. Increase See and Treat 0 0 0 0 0 0 496 496 0 A&E16. Reduce Response Ratio 17 17 0 34 34 0 201 201 0 A&E17. Reduce Staff Wastage 28 0 28 45 0 45 73 60 13 A&E18. Improving HCP Utilisation 13 13 0 26 26 (0) 296 296 (0) A&E19. A&E Recruitment Reprofile 35 45 (10) 60 105 (45) 277 287 (10) A&E33. 111 Reduce Sickness 0 10 (10) 0 21 (21) 129 124 5 A&E34. 111 Rota Redesign 0 0 0 0 0 0 153 153 0 A&E35. 111EOCShareClinicianHours 0 0 0 0 0 0 30 30 0 A&E36. 111 Reduce Attrition 0 0 0 0 0 0 45 45 (0) A&E37. BOC Cylinder Reductions 2 4 (2) 3 8 (5) 45 50 (5) A&E38. Fleet Cost Reductions 28 28 0 55 55 0 330 330 0 Subtotal Frontline Ops 262 212 50 609 543 66 5,202 5,202 (0)

Co

rpor

ate

Corp20. Estates CIPS 10 10 0 16 19 (3) 157 157 0 Corp21. Finance CIPS 9 8 1 10 17 (6) 163 163 0 Corp22. ICT Savings 9 8 1 9 16 (7) 213 213 0 Corp23. PIT Savings 2 2 0 2 3 (2) 20 20 0 Corp24. Serv Dev & Bids Savings 3 3 0 6 6 0 49 49 0 Corp25. HR CIPS 4 4 0 7 7 0 71 71 0 Corp26. Education CIPS 8 8 (0) 19 16 3 107 107 (0) Corp27. CEO CIPS 0 0 0 0 0 0 55 55 0 Corp28. Corp Affairs CIPS 0 0 0 1 1 0 5 5 0 Corp29. Technology Scheme 2 2 0 4 4 0 21 21 0 Subtotal Corporate 46 44 1 74 90 (15) 861 861 0

Target/(contingency) 0 0 0 0 0 0 0 Total 374 416 (42) 837 949 (113) 7,933 7,933 (0)

4.7% 5.2% 10.5% 12.0% FUTURE PERFORMANCE

14 The forecast for the year remains at the budget level of £1.9m. This will need to be review once the emergency service contract issues are resolved.

RECOMMENDATIONS TO THE BOARD 15 The Board is asked to note the current financial position of the Trust, and the

actions in place to address any areas where performance is behind plan. Charles Porter Director of Finance

Actual

Month Budget

Variance

Actual

Year to date Budget Variance

Forecast

Budget

Full Year Prior Year Variance to Variance to

budget Prior Year

14,384 14,416 (33) 28,543 28,700 (156) 175,975 175,961 174,986 14 989

12,111 12,222 (111) 24,145 24,310 (165) 150,076 150,076 147,365 0 2,712

9,934 9,749 (185) 20,052 19,273 (778) 117,790 117,790 119,490 (0) 1,700

2,177 2,473 (296) 4,093 5,037 (944) 32,287 32,287 27,875 (0) 4,412 18% 20% -2% 17% 21% -4% 22% 22% 19%

2,273 2,194 78 4,399 4,390 9 25,899 25,885 27,622 14 (1,723)

2,122 1,948 (174) 4,211 4,111 (100) 23,125 23,111 24,810 (14) 1,685

150 246 (96) 188 279 (91) 2,774 2,773 2,811 0 (38) 7% 11% -5% 4% 6% -2% 11% 11% 10%

2,327

2,719

(392)

4,281

5,315

(1,035)

35,060

35,060

30,686

(0)

4,374

25,899 0

23,125 0

2,774 0 11%

35,060 0

323 239 389 472 229 291 97 38 53 (0) 0

639 145

309 251 407 472 240 319 97 42 58 (0) 0

639 143

(14) 12 17 1 12 29 0 4 5 0

(0) (0) (2)

643 507 771 904 447 553 189 77 107 (0) (0)

1,278 288

615 499 813 945 477 636 194 84 116 (0) 0

1,278 286

(28) (8) 43 41 30 83 5 7 9 0 0

(0) (2)

3,755 3,143 4,863 5,669 2,893 4,035 1,274 531 701 707 0

7,670 1,719

3,755 3,141 4,863 5,669 2,893 4,035 1,274 531 702 707 0

7,670 1,719

3,234 3,135 4,714 5,112 2,555 3,931 1,126 492 659

(336) (14)

8,247 1,530

0 (1) 0 0 1 0 0 0 1 0 0 0 0

(521) (7)

(149) (557) (337) (104) (148) (39) (42)

(1,043) (14) 577

(189) 2,915 2,978 63 5,765 5,944 179 36,959 36,960 34,385 (1) (2,574)

(588) (259) (329) (1,484) (628) (856) (1,900) (1,900) (3,699) (0) 1,799

0 0 0 0 0 0 0 2,505 0 0

(588) (259) (329) (1,484) (628) (856) (1,900) (1,900) (1,194) (0) 1,799

639 639 (0) 1,278 1,278 (0) 7,670 7,670 8,247 0 577 138 138 (0) 276 276 (0) 1,655 1,655 1,465 0 (190) 7 5 (2) 12 11 (2) 64 64 67 0 3

(0) 0 0 0 0 (0) 0 0 14 0 (14)

196 523 (327) 83 937 (854) 7,489 7,489 8,571 (0) (1,082) 1.4% 3.6% 0.3% 3.3% 4.3% 4.3% 4.9%

South Central Ambulance Service NHS Foundation Trust (Appendix A1) Financial results for Month 2 ended 31 May 2016

Forecast May 2016

Variance to out-

turn

TOTAL SCAS INCOME

£000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's

175,975 0

Emergency Services (inc. 111)

Income

150,076 0

Direct costs 117,790 (0)

Gross contribution

Non-Emergency Services Income

Direct costs

Gross contribution

32,287 (0) 22%

Contribution Operational Activities

Central Costs Clinical Services Finance Estates IM&T Human Resources Education Services Service Development Communications & Public Engag't Corporate Other (contingency) Loss/(Profit) on disposal Depreciation Financing Costs Total overhead costs

3,755 0 3,140 (2) 4,863 (0) 5,671 2 2,893 0 4,034 (0) 1,274 0 531 0 702 1 707 0

0 0 7,670 0 1,719 0 36,959 (0)

Net surplus/(deficit) (1,900) (0)

Discontinued Operations 0 0

Surplus/(deficit) for the year Memo: Depreciation Public dividend capital Net interest payable Profit on disposal

EBITDA %

(1,900) (0)

43,091 43,719 (627) 43,990 43,776 214 44,929 44,716 214 43,965 43,751 214 175,975 175,961 14

36,497 37,140 (643) 37,587 37,381 206 38,479 38,273 206 37,513 37,307 206 150,076 150,101 (25)

29,824 29,596 (227) 29,165 29,245 80 29,863 29,949 85 28,937 29,000 63 117,789 117,790 1

6,673 7,543 (870) 8,423 8,137 286 8,616 8,324 291 8,576 8,308 268 32,287 32,312 (24) 18.3% 20.3% 22.4% 21.8% 22.4% 21.7% 22.9% 22.3% 21.5% 21.5%

6,595 6,579 16 6,402 6,394 8 6,450 6,443 8 6,452 6,444 8 25,899 25,860 39

6,111 6,015 (97) 5,645 5,668 23 5,685 5,715 30 5,683 5,713 30 23,125 23,111 (14)

483 564 (81) 757 726 31 765 727 38 768 731 38 2,774 2,748 25 7.3% 8.6% 11.8% 11.4% 11.9% 11.3% 11.9% 11.3% 10.7% 10.6%

7,156 8,108 (951) 9,179 8,863 317 9,381 9,052 329 9,345 9,038 306 35,061 35,060 1

951 714

1,181 1,380 1,889 122 166 (0) (0)

1,918 414 18 50

925 707

1,220 1,417 1,998 129 174 (0) (0)

1,918 414 16 50

(26) (7) 39 37 109 7 8 0

(0) (0) (0) (2) 0

936 740

1,232 1,428 2,101 135 180 (0) 0

1,918 414 16 50

943 742

1,220 1,417 2,072 134 178 (0) 0

1,918 414 16 50

7 2

(12) (11) (29) (1) (2) 0 0 0 0 0 0

936 745

1,232 1,428 2,100 135 179 207 0

1,918 414 16 50

943 747

1,220 1,417 2,070 134 177 207 0

1,918 414 16 50

7 2

(12) (11) (29) (1) (2) 0 0 0 0 0 0

937 741

1,218 1,434 2,111 140 176 500 0

1,917 414 14 50

943 746

1,204 1,417 2,062 134 174 500 0

1,918 414 16 50

7 5

(14) (16) (50) (6) (2) (0) 0 0 0 2 0

3,761 2,939 4,863 5,669 8,202 531 701 707 (0)

7,670 1,655

64 200

3,755 2,941 4,863 5,669 8,202 531 702 707 (0)

7,670 1,655

64 200

0 (5) 2 0

(0) 1

(0) 1

(0) (0) 0 0 0 0

8,803 8,967 164 9,149 9,104 (45) 9,358 9,312 (45) 9,652 9,577 (75) 36,962 36,960 (2)

(1,647) (859) (788) 30 (241) 271 23 (261) 284 (308) (539) 231 (1,900) (1,900) (0)

South Central Ambulance Service NHS Foundation Trust (Appendix A2) Financial results for Month 2 ended 31 May 2016

Actual Q1

Budget

Variance

Actual/ Q2

Budget

Variance Forecast

Q3 Budget

Variance

Forecast

Q4 Budget

Variance

Forecast

Full Year Budget

Variance

£000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's

TOTAL SCAS INCOME

Emergency Services Income

Direct costs

Gross contribution

Non-Emergency Services Income

Direct costs

Gross contribution

Contribution Operational Activities

Central Costs (inc op overheads)

Clinical Services Finance Estates IM&T Transformation & OD Communications & Public Engag't Corporate Contingency Loss/(Profit) on disposal Depreciation PDC Interest Injury benefit Total overhead costs

Net surplus

0

Actual

Month Budget

Variance

Actual

Year to date Budget Variance

Forecast

Budget

Full Year Prior Year

Variance to budget

Variance to Prior

Year

10,712 10,506 206 21,020 20,963 57 130,707 130,707 125,665 0 5,042 262 271 (9) 524 542 (18) 3,253 3,253 3,143 0 110

1,113 1,131 (18) 2,044 2,178 (134) 12,353 12,353 15,249 0 (2,896) 19 21 (2) 32 42 (10) 253 253 354 0 (102) 26 26 (0) 52 52 (0) 314 314 314 0 (0) 42 42 0 79 83 (4) 500 500 439 0 61 67 125 (58) 199 250 (51) 1,500 1,500 1,872 0 (372) 0 0 0 0 0 0 0 0 27 0 (27)

(127) 102 (229) 199 204 (5) 1,222 1,222 637 0 586 (2) (2) 0 (4) (4) 0 (25) (25) (336) 0 311

12,111 12,222 (111) 24,145 24,310 (165) 150,076 150,076 147,365 0 2,712

875 859 17 1,715 1,718 (2) 10,639 10,639 9,995 0 644 1,043 980 63 1,980 1,959 21 11,756 11,756 4,884 0 6,872

43 42 1 86 84 2 502 502 5,104 0 (4,602) 13 13 0 25 25 0 151 151 3,386 0 (3,235) 63 55 9 130 110 21 658 658 774 0 (115) 78 78 (0) 157 157 (0) 420 420 1,322 0 (901)

102 108 (6) 191 216 (25) 1,296 1,296 1,147 0 149 33 38 (5) 69 77 (7) 376 376 383 0 (7) 20 20 (0) 40 40 (0) 74 60 291 14 (217) 2 2 0 4 4 0 25 25 336 0 (311)

2,273 2,194 78 4,399 4,390 9 25,899 25,885 27,622 14 (1,723)

14,384 14,416 (33) 28,543 28,700 (156) 175,975 175,961 174,986 14 989

Appendix B

South Central Ambulance Service NHS Foundation Trust (Appendix B)

Financial results for Month 2 ended 31 May 2016

Income analysis

Emergency Services E&U Contract 2016/2017 HART income 111 Service Public Events CBRN/Flu funding RTA Recoveries Training funding from Health Education England Workshop Income Other Income AfC Transfer Total Emergency Services

£000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's

Non-Emergency Services PTS Hampshire PTS Thames Valley PTS OHFT PTS Others PTS MK Logistic Services - Berkshire Logistic Services - Ox & Bucks Commercial Training TVEA AfC Transfer Total Non-Emergency Services

Total income

Actual May-16

Budget May-16

Variance May-16

+/(-)

Actual YTD

Budget YTD

Variance YTD +/(-)

Forecast Full Yr

Budget Full Yr

Prior year Full Yr

10.7%

2.3%

8.5%

8.7%

2.3%

6.4%

2.3%

2.3%

3.8% 521 51 470 792 (185) 977 1,118 1,118 218

75 48 27 164 98 66 700 700 752

119 189 (69) 239 189 50 2,264 2,264 1,902 0 0

119 189 (69) 239 189 50 2,264 2,264 1,902

715 288 427 1,195 102 1,093 4,082 4,082 2,872

Actual May-16

Budget May-16

Variance May-16

+/(-)

Actual YTD

Budget YTD

Variance YTD +/(-)

Forecast Full Yr

Budget Full Yr

Prior year Full Yr

192

204

12

346

399

53

2,456

2,456

2,466

151 135 (16) 298 267 (31) 1,608 1,608 2,022 59 27 (31) 122 55 (68) 328 328 603 50 36 (14) 93 71 (22) 427 427 503 36 28 (8) 80 56 (24) 335 335 470 2 4 2 3 9 6 51 51 74

43 59 (2) 109 118 9 653 640 1,224 532 493 (57) 1,051 974 (77) 5,859 5,846 7,362

717

359

(358)

1,430

697

(733)

3,541

3,541

7,831

316 328 13 672 486 (186) 3,481 3,481 4,461 489 222 (267) 967 679 (288) 2,436 2,436 5,644

1,522 909 (613) 3,069 1,862 (1,207) 9,459 9,459 17,936

247

279

33

464

558

95

3,350

3,350

3,495

91 120 28 190 239 49 1,405 1,405 902 (0) 0 0 0 0 0 0 0 -2 14 28 15 35 56 21 210 335 368 351 427 75 689 854 165 4,965 5,090 4,764

South Central Ambulance Service NHS Foundation Trust Appendix C

Key Operational Ratios

Activity - % inc above prior year - income from growth (£k)

Delays at hospitals - income from delays (£k)

CQUINN (Clincal Quality Incentive) - Potential income - Contingency/Other Subtotal CQUINN

Total income from activity related measures

Key Operational Spend (£k)

Overtime - A&E - North - A&E - South - A&E - Control - A&E - Comm Resp/Emer Plan/Fleet - Commercial Division - PTS - Commercial Division - non-PTS - Other

Total Overtime

Private Providers - A&E - North - A&E - South - PTS

Total private providers

Fuel - A&E - Commercial Services - Fleet central - Other Total fuel

Actual

May-16 Budget

Variance

Actual

YTD Budget Variance

Forecast

Full Year Budget

Variance

1

1

0

2

2 1

3

3

0

4 4 0 4 4 0 4 4 0 1 1 0 1 1 0 1 1 0 1 1 0 1 1 0 1 1 0 2 2 0 2 2 0 2 2 0

May-16 YTD

Apr-16 YTD

Mar-16 YTD

Last Year Full year

Comments

84%

84%

83%

83%

90% 93% 91% 91% Nil of note 97% 87% 89% 89% 95% 85% 93% 93%

124 63 70 70 2.3% 0.7% 4.6% 4.6%

10.7% 5.8% 96.5% 96.5% 12.0% 6.7% 100.0% 100.0%

South Central Ambulance Service NHS Foundation Trust

NHS Improvement Financial Risk Rating

Appendix D

Capital Service Cover Liquidity I&E Margin I&E Margin Variance From Plan Overall (Financial Sustainability Risk Rating)

Better payment practice target - Non-NHS by number - Non-NHS by £ value - NHS by number - NHS by £ value

Debtors > 90 days (£k) As % of total debts

% cost improvements secured (actual) % cost improvements secured (plan)

South Central Ambulance Service NHS Foundation Trust

20/06/2016 10:01

Appendix E

CASHFLOW 2016-17

Apr-16 £000 Actl

May-16 £000 Actl

Jun-16 £000 Fcst

Q1 £000 Fcst

Q1 £000

Budget

Q1 £000

Variance

Q2 £000 Fcst

Q2 £000

Budget

Q2 £000

Variance

Q3 £000 Fcst

Q3 £000

Budget

Q3 £000

Variance

Q4 £000 Fcst

Q4 £000

Budget

Q4 £000

Variance Income

11,284

16,275

14,675

42,234

44,191

(1,957)

87,136

89,093

(1,957)

132,435 133,839

(1,404)

177,613

177,613

0 SL Receipts

Fixed Asset Receipts 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Interest 5 4 5 14 18 (4) 29 36 (7) 44 54 (10) 59 72 (13) Capital Loan From HA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Other Income/PDC/VAT/RTA 59 383 320 762 1,164 (402) 2,262 2,287 (25) 3,421 3,447 (26) 4,474 4,500 (26) Other 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Total Cash In 11,348 16,662 15,000 43,010 45,373 (2,363) 89,427 91,416 (1,989) 135,900 137,340 (1,440) 182,146 182,185 (39)

Expenditure

8,919

9,412

9,450

27,781

28,048

267

56,489

56,741

252

85,938

86,190

252

115,789

116,042

(253) Pay expenditure Non Pay expenditure 4,478 5,426 5,350 15,254 15,754 500 29,270 30,301 1,031 43,190 44,622 1,432 57,521 57,255 267 Capital expenditure 735 0 224 959 2,503 1,544 4,045 4,486 441 7,241 6,995 (246) 8,595 8,645 (50) Dividends on PDC 0 0 0 0 0 0 785 785 0 785 785 0 1,613 1,613 0 Loan Repayment 0 700 0 700 700 0 869 869 0 1,569 1,569 0 1,738 1,738 0 Working Capital Loan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Interest on DH Loans 0 41 0 41 44 3 63 66 3 110 113 3 131 134 (3) Other expenditure 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Total Cash Out 14,132 15,579 15,024 44,735 47,049 2,314 91,521 93,248 1,728 138,833 140,274 1,441 185,388 185,427 (39)

Net Cash In/(Out) (2,784) 1,083 (24) (1,725) (1,677) (48) (2,094) (1,832) (262) (2,933) (2,934) 1 (3,242) (3,242) 0

Balance B/fwd 19,926 17,142 18,225 19,926 19,926 0 19,926 19,926 0 19,926 19,926 0 19,926 19,926 0

Balance C/fwd 17,142 18,225 18,201 18,201 18,249 (48) 17,832 18,094 (262) 16,993 16,992 1 16,684 16,684 0

CASHFLOW RECONCILIATION

Apr-16 £000

May-16 £000

Jun-16 £000

Q1 Actl

Q1 Budget

Q1 Variance

Q2 Actl

Q2 Budget

Q2 Variance

Q3 Actl

Q3 Budget

Q3 Variance

Q4 Actl

Budget £000

Q4 Variance

EBIT Depreciation & Amortisation Other Gain/(Loss) NHSD EBITDA

(753) 639

(1,195) 1,278

(86) 1,918

(86) 1,918

(86) 1,918

0 0

45 3,834

45 3,834

0 0

(46) 5,751

(46) 5,751

0 0

(181) 7,670

0

(181) 7,670

0

0 0 0

(114) 83 1,832 1,832 1,832 0 3,879 3,879 0 5,705 5,705 0 7,489 7,489 0

0 (3,120) 1,203 (24) (735)

0

0

(821) 659

(151) (735)

0

0

(986) (769) (117) (959)

0

0

(986) (769) (117) (959)

0

0

597 (760) (117)

(2,503) 0

0

(1,583) (9) 0

1,544 0

0

(114) 103

(234) (4,045)

0

0

1,849 (1,157) (234)

(4,486) 0

0

(1,963) 1,260

0 441 0

0

215 1,152 (351)

(7,241) 0

2,004 (884) (351)

(6,995) 0 0

(2,004) 1,099 1,503 6,644

(7,241) 0

0

2,150 (355) (468)

(8,645) 0

0

2,150 (355) (468)

(8,645) 0

0 0 0 0 0 0

Stock (Inc)/dec Debtors (Inc)/dec Creditors Inc/(dec) Provisions Inc/(dec) Capital expenditure Capital disposals Free Cashflow pre finance Interest Dividends on PDC Free Cashflow PDC Payment/(Repayment) Loan repayments Lease Borrowings Capital Loan from DH

(2,790) (965) (999) (999) (951) (48) (411) (149) (262) (520) (521) 1 171 171 0

6 (36) (26) (26) (26) 0 (29) (29) 0 (59) (59) 0 (62) (62) 0 0 0 0 0 0 0 (785) (785) 0 (785) (785) 0 (1,613) (1,613) 0

(2,784) (1,001) (1,025) (1,025) (977) (48) (1,225) (963) (262) (1,364) (1,365) 1 (1,504) (1,504) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (700) (700) (700) (700) 0 (869) (869) 0 (1,569) (1,569) 0 (1,738) (1,738) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Net Cash In/(Out) (2,784) (1,701) (1,725) (1,725) (1,677) (48) (2,094) (1,832) (262) (2,933) (2,934) 1 (3,242) (3,242) 0

SOUTH CENTRAL AMBULANCE NHS FOUNDATION TRUST Appendix F

Capital resources available F1 Budget CAPITAL EXPENDITURE 2016/17 Core Depreciation 7,670 7,670

Disposal Receipts 0 For the period to Available Surplus 0 31 March 2017 Internal Sources 825 825

Total capital resources available 8,495 8,495

Shortfall to be financed 0 0

Exp summary F1 Budget Clinical Estates 3,806 3,785 Operations 90 90 Fleet 2,852 2,852 IT 1,768 1,768 Contingency (21) 0 Total 8,495 8,495

Actual/Forecast Spend Profile Scheme Description Budget

£000

April Actl

May Actl

June Fcst

July Fcst

August Fcst

September Fcst

October Fcst

November Fcst

December Fcst

January Fcst

February Fcst

March Fcst

Total Fcst

ESTATES

2,205

133

2

15

500

500

500

572

2

23

4

15

20

2,205 New Education Facility - Bone Lane

Basingstoke Additional Parking 40 20 20 40 SHIP PTS Phase 2 - New building 3 3 Bracknell Heating 10 10 10 High Wycombe Kitchen 12 12 12 Southern House Air Con Upgrade 70 35 35 70 HART Additional Car Parking 25 25 Hythe Internal Upgrade 6 6 6 Transcare Upgrade 12 8 12 Newbury Conversion of Locker Room 20 10 10 20 Nursling New Store 7 7 7 Nursling Station Upgrade 14 7 7 14 Hants all stations 40 chirs 11 11 11 NH EOC Chs 2 Eastern Road Heating Upgrade 15 15 NH Kitchen Upgrade 12 12 12 Maidenhead ASAP 25 12 13 25 NH AC Phase 3 60 17 14 29 60 Bletchley RC Crew Room Upgrade 30 15 15 30 Nursling Station Upgrade Lighting 25 13 12 25 Nursling New Office Fleet 15 1 14 15 Bracknell Crew Room Upgrade 30 30 30 Didcot Crew Room Upgrade 15 15 15 Portsmouth - Roof Upgrade/pigeon prevention 40 10 10 10 10 40 Ringwood External Upgrade 20 20 SEHRC Roof Improvements 236 90 60 86 236 High Wycombe Crew Room Upgrade 25 25 25 Newbury Upgrade Lighting 15 15 Oxford City Electrical Switchgear Upgrade 50 25 25 50 Oxford City Crew Room Upgrade 20 10 10 20 Oxford City ambirad 6 6 Oxford City wash bay upgrade 15 15 15 Oxford City Heating/Pipework 10 10 Reading Internal and External Dec 20 10 10 20 Sotoke Mandeville Crew Room Upgrade 30 10 10 10 30 Wexham Park Garage Doors Replacement 50 12 16 22 50 New ASAP - Slough 75 23 20 32 75 Cycle Racks 30 15 15 30 SH Accommodation 500 1 5 150 150 194 500

OPERATIONS Fuel Monitoring 50 5 5 5 10 5 5 5 10 50 Workshop Equipment 40 15 10 15 40

FLEET HY08 x 11 Assume Modular Build 1,496 46 508 395 437 110 1,496 HY08 x 7 Assume Conversions 791 226 339 226 791 RX 57 x 3 Van Conv 339 113 113 113 339 HX56 x 1 Van Conv 113 113 113 RX05 x 1 Van Conv 113 113 113

INFORMATION TECHNOLOGY DS2000 78 1 20 20 7 30 78 Blade Server replacement 59 19 5 35 59 Station Infrastructure - Hubs 300 1 49 50 50 50 50 50 300 Network Infrastructure - virtualisation 21 4 6 11 21 Replace Phones 137 57 50 30 137 Station Upgrades - Thin Client 133 36 20 30 27 20 133 Radio Site Strengthening 80 4 10 10 17 20 16 3 80 FAT Pipe Upgrade 20 10 10 20 Vehicle WIFI 98 5 6 8 8 2 14 21 18 16 98 Telemetry for vehicles 8 8 8 AW ICCs 15 15 15 Email 200 50 50 50 50 200 CAD - Adastra 111 379 129 150 100 379 GRS 50 28 22 50 Intergraph Development 100 21 12 5 8 8 9 8 8 9 8 4 100 Hardware/Software refresh 90 3 7 10 10 10 10 10 10 10 10 90 Contingency General -21 -21

TOTAL PROGRAMME 8,495 211 50 224 1,016 1,046 1,024 880 1,149 1,167 1,073 413 242 8,495

Quarter Actual / Forecast 485 3,086 3,196 1,728 8,495

22% 160% 125% 98% 100%

Monthly ( Monitor) Budget 437 956 848 857 869 207 243 1,149 1,167 1,073 417 272 8,495

Actual As at May 16

(£k)

65,053 3,372

68,425

1,031

2,950

4,829 5,347 2,054

12,230 18,225

34,436

(1,218) (10,091) (4,232) (289)

(1,738) (4,487) (22,055)

12,381

80,806

(4,178) (8,044)

(18) (12,240)

68,566

(57,874) (10,998)

350

(1,528) 1,484

(68,566)

Actual As at 31 Mch 16

(£k)

66,005 3,403

69,408

1,031

2,950

1,101 8,694 1,619 11,414 19,926

35,321

(1,323) (9,792) (3,487) (762)

(1,738) (4,637) (21,739)

13,582

82,990

(4,878) (8,044)

(18) (12,940)

70,050

(57,874) (10,998)

350

(1,528) 0

(70,050)

Forecast As at 31 Mch 17

(£k)

66,650 3,583

70,233

1,031

2,950

2,159 6,683 380

9,222 16,684

29,887

(1,100) (9,917) (3,233) (612)

(1,738) (3,223)

(19,823)

10,064

80,297

(3,140) (8,989)

(18) (12,147)

68,150

(57,874) (10,998)

350

(1,528) 1,900

(68,150)

South Central Ambulance Service NHS Foundation Trust Appendix G

BALANCE SHEET As at May 16

FIXED ASSETS

Property, Plan & Equipment Intangible assets

CURRENT ASSETS

Stocks & Work In Progress

Assets held for resale

Sales Ledger Debtors Prepayments & Accrued Income Other Debtors Trade & Other Receivables Cash and cash equivalents

TOTAL CURRENT ASSETS

CREDITORS Purchase Ledger Creditors Accruals & deferred income Other Creditors Incl Pensions, PAYE & NI Capital Accruals Borrowings < 1 year Provisions < 1 year CURRENT LIABILITIES

NET CURRENT ASSETS/(LIABILITIES)

TOTAL ASSETS LESS CURRENT LIABILITIES

Borrowings Provisions Other Financial Liabilities Non-Current Liabilities

TOTAL ASSETS EMPLOYED FINANCED BY:

TAXPAYER'S EQUITY Public Dividend Capital Revaluation Reserve Other Reserve Govt Grant Reserve- bfwd Retained Earnings I & E YTD

TOTAL TAXPAYERS EQUITY

Adjusted net current assets/liabilities for Liquidity 8,400 9,601 6,083

Agenda Item: 10



Title Integrated Performance Report (IPR)

Responsible Director Charles Porter, Director of Finance

Recommendation (eg. note, approve, endorse) To note performance in month 2 of 2016/17










The IPR is one such mechanism for monitoring risks to the Trust.


A number of the KPIs relate to performance on regulatory matters; for example, the NHS Improvement governance and financial sustainability risk ratings.


Financial performance on CIPs, I&E, and against the financial risk ratings are all reported.


The Council of Governors receive the IPR each month, and an update on performance at each Council of Governors meeting.


The IPR includes a range of metrics relating to patients and staff.


The Board receives and considers the IPR at each of its meetings.


Red > 30% Red scores, Green > 70% Green and <10% Reds (but no key indicators), Amber - rest

(Key indicators are: national standards, financial risk rating, overall FRR, SIRI's and Never Events).

RAG

Vs. last

monthR A G

999 Service

Clinical Performance A 28% 39% 33%

National Standards R 100% 0% 0%

Operational performance R 54% 15% 31%

Safety and risk management R 83% 0% 17%

111 Service A 6% 11% 83%

Corporate Areas

QIPP's (cost improvements) A 25% 10% 65%

QIPP's (quality impact) A 0% 58% 43%

Monitor - financial rating G n/a n/a n/a

Monitor - governance rating G n/a n/a n/a

Human Resources R 53% 22% 25%

Overall Commentary:

Safety and Risk Management

QIPP's - Cost Improvements

Human Resources:

Key workforce challenge remain recruitment to our vacancies across all core areas (999/CCC/PTS), competition remains high across all areas, coupled with high employment, in particular within the Thames Valley.

Integrated Workforce Planning (IWP) are now in situ for 999, CCC and PTS each provides focus on recruitment and localised initiatives to attract candidates into our Trust. Recruitment is below forecast and

continuing to be balanced with above forecast retention.

Sickness absence remains steady as an average, focused work on local outliners is taking place. Appraisal remain below target however above benchmark for the same period 2015/16.

S&M training continues to improve and is monitored on a weekly basis at Executive level.

May's activity was 10.7% higher than the same period last year . All three Red targets were missed in the month with Red 1 being 73.7%, Red 2 was 71.5% and Red 19 at 94.2%. The financial performance has

been impacted by the ongoing contract negotiation and CIPs were slightly lower than budget.

There has been a good start to this years CIP program however some projects are still to progress meaning the months results are £42k behind

There has been an increase in both CNST and Public Liability Claims in the month against the target set - This needs to be monitored to establish whether this is a true rising trend. The claims are historical and

there are no consistent themes. Staff continue to raise incidents relating to physical and non physical assaults and these are investigated and managed through the Head of Risk and Security and reported to the

Health and Safety Committee.

Integrated Performance ReportReport Period: May 2016

Red -rated areas are further commented on below:

Page 1 of 33

Integrated Performance Report - 999 SCAS

Commentary:

Commentary:

M2 Recruitment Actual 6 / forecast 10 FTE.

YTD Recruitment Actual 37 / forecast 46

FTE. Shortfall Balanced by improved

attrition rates and internal movement

M2 Attrition Actual 13/ Forecast 18 FTE.

YTD Attrition Actual 20 / Forecast 34 FTE

1,419.9 1,404.5

1,150.0

1,200.0

1,250.0

1,300.0

1,350.0

1,400.0

1,450.0

1,500.0

1,550.0

1,600.0

Total Frontline Workforce

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

31.0 37.0

0.0

50.0

100.0

150.0

200.0

250.0

300.0

350.0

400.0

Frontline Recruitment

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

7.3 20.3

0.0

50.0

100.0

150.0

200.0

250.0

Frontline Attrition

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

6.2%

8.6%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

Frontline Attrition %

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

Page 2 of 33


Commentary:

Activity remains significantly above budget for the second month in a row.

43,545

46,568

30,000

35,000

40,000

45,000

50,000

55,000

60,000

65,000

Activity (999 incidents)

2016-17Actuals2016-17 Plan

2015-16Actuals

24,466

26,416

15,000

17,000

19,000

21,000

23,000

25,000

27,000

29,000Activity North


2015-16Actuals

19,079 20,152

15,000

16,000

17,000

18,000

19,000

20,000

21,000

22,000Activity South

2016-17Actuals

2016-17 Plan

2015-16Actuals

Page 3 of 33


Commentary:

Commentary:

Many performance indicators are worse in the south than in the North and this is no exception. This will be further investigated at Level 2 meetings.

See above

11.2% 11.3%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

Hear & Treat

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

9.9% 10.1%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

Hear & Treat North

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

13.0% 12.8%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

Hear & Treat South

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

36.9% 36.3%

34.0%

36.0%

38.0%

40.0%

42.0%

44.0%

See & Treat 2016-17Actuals2016-17 Plan

2015-16Actuals

37.0%

36.8%

34.0%

36.0%

38.0%

40.0%

42.0%

44.0%

See & Treat North

2016-17Actuals

2016-17 Plan

2015-16Actuals

36.7%

35.7%

34.0%

36.0%

38.0%

40.0%

42.0%

44.0%

See & Treat South 2016-17Actuals

2016-17 Plan

2015-16Actuals

48.1%

47.6%

40.0%

42.0%

44.0%

46.0%

48.0%

50.0% Non Conveyance


2015-16Actuals

46.9%

46.9%

40.0%

42.0%

44.0%

46.0%

48.0%

50.0%Non Conveyance North


2015-16Actuals

49.6%

48.5%

40.0%

42.0%

44.0%

46.0%

48.0%

50.0%

52.0%Non Conveyance South


2015-16Actuals

Page 4 of 33


Commentary:

Commentary:

Commentary:

The high demand, coupled with the high levels of abstractions and high non availability of Private Providers has meant that this target has been missed across the board.

The effect of moving Milton Keynes from the south to the North for reporting means that it is now easier for the TV targets to be met but more difficult for the SHIP.

See above. Red 19 is particularly difficult to hit in the SHIP contract but the target was met for TV.

75.1% 73.5%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

Red 1 Performance


2015-16Actuals

75.5%

76.0%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%North Red 1 Performance


2015-16Actuals

74.7%

70.2%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

South Red 1 Performance

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

74.6% 71.5%

60.0%

62.0%

64.0%

66.0%

68.0%

70.0%

72.0%

74.0%

76.0%

78.0%

Red 2 Performance

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

76.2%

74.0%

60.0%

62.0%

64.0%

66.0%

68.0%

70.0%

72.0%

74.0%

76.0%

78.0%


2016-17 Actuals

2016-17 Plan

2015-16 Actuals

72.5%

68.2%

60.0%

62.0%

64.0%

66.0%

68.0%

70.0%

72.0%

74.0%

76.0%

78.0%

80.0% South Red 2 Performance


2014-15Actuals

95.6%

94.2%

90.0%

91.0%

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%

98.0% Red 19 Performance

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

96.1%

95.0%

90.0%

91.0%

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%


2016-17Actuals

2016-17 Plan

94.8%

93.0%

90.0%

91.0%

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%

98.0%South Red 19 Performance


2015-16Actuals

Page 5 of 33


Commentary:

Commentary:

Commentary:

See

The high utilisation of DCA has led to an increase in long waits across the board. Once again it is worse in the South and there needs to be some rebalancing of resource.

0.6%

1.2%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%Long waits Red 8

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

0.4% 0.6%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%Long waits Red 8 North

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

1.0%

2.1%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%Long waits Red 8 South

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

1.2%

1.9%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0% Long waits Red 19

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

0.9%

1.2%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00% Long waits Red 19 North

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

1.5%

2.7%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00% Long waits Red 19 South

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

14.7%

17.1%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Long waits Greens

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

11.6%

14.6%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

Long waits Greens North

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

18.9%

20.7%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

Long waits Greens South

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

Page 6 of 33


Commentary:

Commentary:

1,059 975

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

Hospital handover delays


2015-16Actuals

334 300

0

500

1,000

1,500

2,000

2,500

3,000North Hospital handover delays

2016-17Actuals

2016-17Plan

2015-16Actuals

725 675

0

500

1,000

1,500

2,000

2,500

3,000South Hospital handover delays

2016-17Actuals

2016-17Plan

2015-16Actuals

0.05%

0.07%

-0.01%

0.01%

0.03%

0.05%

0.07%

0.09%

0.11%

0.13%

0.15%

Complaints

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

0.04%

0.06%

-0.01%

0.01%

0.03%

0.05%

0.07%

0.09%

0.11%

0.13%

0.15% North Complaints 2016-17 Actuals

2016-17 Plan

2015-16 Actuals

0.05%

0.08%

-0.01%

0.01%

0.03%

0.05%

0.07%

0.09%

0.11%

0.13%

0.15% South Complaints

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

Page 7 of 33


Showing improvements and above same period 2015/16

Remains steady, welfare call handed back to Team Leaders to undertake at a local level. Weekly monitoring of absence continues at Executive level.

5.7% 5.1%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%North Sickness

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

6.5%

7.3%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%South Sickness

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

6.1%

6.0%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%Sickness

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

84.6% 85.8%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%North Appraisals

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

75.4% 75.8%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%South Appraisals

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

84.6% 85.8%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0% Appraisals

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

Page 8 of 33


Commentary:

Face to face training planned through Q1

and into July 2016, weekly monitoring of

attendance undertaken weekly at Executive

level, weekly attendance during M2

continued to improve on first few weeks of

M1.

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%Training Course Completion (1 of 2)

999 - Manual Handling

999 - Health & Safety

999 - Equality & Diversity

999 - Conflict Management

999 - Infection Control

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%


999 - Safeguarding Adults

999 - Safeguarding Children

999 - Fire Awareness

999 - Information Governance

Page 9 of 33


Commentary:

Commentary:

Stroke Care - This small drop was due to

Blood Glucose recording. This will be

monitored.

STEMI 150 - This is due to low numbers in

the MINAP database, this is due to Trusts

not entering data. The database closes on

the 31st May so the final figure will be

available by the end of June.

75.3% 73.6%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Dec Jan Feb March April May June July Augt Sept Oct Nov

STEMI - Care

2016-17 Actuals

2016-17 Plan

2015-16 Actuals (Dec '14 - Nov '15)Note: National CQI's are reported with a 4 month lag

99.1%

97.2%

94.0%

95.0%

96.0%

97.0%

98.0%

99.0%

100.0%

101.0%

102.0%


Stroke - Care 2016-17 Actuals

2016-17 Plan

2015-16 Actuals (Dec '14 - Nov '15)

Note: National CQI's are reported with a 4 month lag

91.2%

86.8%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%


STEMI - 150min to PPCI

2016-17 Actuals

2016-17 Plan

2015-16 Actuals (Dec '14 - Nov '15)Note: National CQI's are reported with a 4 month lag

60.0%

52.7%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

April May June July Augt Sept Oct Nov Dec Jan Feb March

Stroke - 60min to stroke centre

2016-17 Actuals

2016-17 Plan

2015-16 Actuals (Dec '14 - Nov '15)

Page 10 of 33


Commentary:

Cardiac Arrest survival - The sudden drop

this month cannot be explained but will be

monitored for a trend. The figures will be

discussed at the trust Clinical Review

Group.

36.4%

41.7%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%


ROSC (witnessed) 2016-17 Actuals

2016-17 Plan

2015-16 Actuals (Dec'14 - Nov '15)


34.3%

17.4%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%


Cardiac Arrest (witnessed) Survival 2016-17 Actuals

2016-17 Plan

2015-16 Actuals (Dec'14 - Nov '15)


Page 11 of 33

Integrated Performance Report

Operational Performance R Overall rating (other) R

Performance Pressures

National indicators

Incident Growth - SCAS 10.7% 2.5% n/a 8.7% 2.4% n/a 2.3% 2.3% n/a

Incident Growth - North 10.9% 2.1% n/a 8.5% 2.1% n/a 2.1% 2.1% n/a

Incident Growth - South 10.8% 3.0% n/a 8.9% 2.7% n/a 2.6% 2.6% n/a

999 % calls from frequent callers 3.1% 5.0% G 3.1% 5.0% G 5.0% 5.0% G

Other indicators

Actual Plan RAG Actual Plan RAG Forecast Plan RAG

Green 2 - response within 30 minutes 60.7% 88.0% R 64.0% 88.0% R 88.0% 88.0% G

Green 4 - telephone assessment within 60

minutes88.3% 90.0% A 89.4% 90.0% A 90.0% 90.0% G

Operations indicators

VOR - scheduled maintenance 4.0% 4.0% G 4.0% 3.2% G 4.0% 4.0% G

VOR - unscheduled 18.0% 18.0% G 18.0% 18.0% G 18.0% 18.0% G

A&E Performance by CCG Cluster


Green 2 - response within 30 minutes

North Cluster 62.5% 88.0% R 66.6% 88.0% R 66.6% 88.0% G

South Cluster 58.1% 88.0% R 60.5% 88.0% R 60.5% 88.0% G

Green 4 - telephone assessment within 60 minutes

North Cluster 87.9% 90.0% A 89.1% 90.0% A 89.1% 90.0% A

South Cluster 88.7% 90.0% A 89.7% 90.0% A 89.7% 90.0% A

Performance Measure May-16 Year to date Full year Commentary on exceptions

(Red - action to correct, Amber - action to reduce risk, Green - nil)

RAG

May-16 Year to date Full year Commentary on exceptions


An increase in resources will be required . PP are the only solution in the short term and they are

being offered the work but are enable to meet the demand at the moment.

Commentary on exceptions


Overall rating (national - Red 8 & Red 19)

Lead Director: Philip Astle

May-16Performance Measure Year to date Full year

Plan RAGForecastActual Plan RAG Actual Plan

Page 12 of 33


Clinical Performance Overall ratingA

2.00

Other clinical indicators

Hypoglycaemia care bundle 98.0% 98.2% A 99.0% 98.2% G 98.2% 98.2% G

Asthma care bundle 80.0% 82.2% A 76.0% 82.2% A 82.2% 82.2% G

Limb fractures care bundle 40.0% 45.8% R 64.6% 45.8% G 45.8% 45.8% G

Febrile convulsion care bundle 82.0% 87.5% A 88.3% 87.5% G 87.5% 87.5% G

Safeguarding

Number of adult referrals - this relates to vulnerable

adults who may be at risk from abuse or neglect1,465 460 n/a 2,879 920 n/a 11,040 5,520 n/a

Number of child referrals - this relates to children

who may be at risk of abuse or neglect336 130 n/a 656 260 n/a 1,560 1,560 n/a

Vehicle deep cleans - A&E 104 110 A 222 220 G 1,320 1,320 G

Vehicle routine cleans 4,718 5,300 R 9,670 10,666 A 68,429 68,429 G

Number of cleanliness compliance audits* 53 59 R 159 94 G 648 648 G

Medicines Management

Number of adverse events due to administration

errors* 0 1 G 0 2 G 12 12 G

Number of controlled drug incidents* 5 4 R 9 8 R 48 48 G

RAG Forecast

RAG Actual Plan

RAG Actual Plan

Plan RAG

Measure (care bundles are part of National Clinical

Performance Indicators data gathering) RAG Actual Plan

May-16

This drop is due to 1 incident where a blood glucose was not recorded or an exception recorded.

This drop is due to the recording of peak expiry flow rates this will be improved by the reminder page in the ePCR once

the testing has been completed due in November 16

This drop is due to the recording of two pain scores this will be improved by the reminder page in the ePCR once the

testing has been completed due in November 16

This drop is due to the recording of blood glucose monitoring this will be improved by the reminder page in the ePCR

once the testing has been completed due in November 16

Full year

RAG

Great improvements made in Deep clean figures this month, again, lack of vehicles being available due to work pressure meant target

was missed by 6 this month

Actual

Year to date Commentary on exceptions



(Red - action to correct, Amber - action to reduce risk, Green - nil)Measure



100% of vehicles available, were made ready - due to operational requirements the number of vehicles that were available was

reduced from the planned level

Year to date

Hygiene & infection prevention & control

May-16

Actual Plan

Actual Plan RAG

Plan RAG Actual Plan RAG

* These items are also reported in the quality accounts

Measure

Measure May-16 Full year

Red > 30% Red scores, Green > 70% Green and <10% Reds (but no key indicators),

Amber - rest


(Red - action to correct, Amber - action to reduce risk, Green - nil)Full yearYear to date

Lead Director: John Black

Actual Plan

May-16 Full yearYear to date

Plan RAG

RAG Forecast Plan

Forecast

Forecast Plan RAG

Page 13 of 33

Integrated Performance Report - National ACQI

Safety & risk managementOverall rating R

Red > 30% Red scores, Green > 70% Green and <10% Reds (but no key indicators), Amber - rest


Number of DATIX incidents - staff (this is the internal form

to report incidents in SCAS - this covers all types of incident

- accidents, injuries, missing equipment etc.)

154 119 n/a 304 245 n/a 1,798 1,798 n/a

Number of DATIX incidents - non staff (this is the internal

form to report incidents in SCAS - this covers all types of

incident - accidents, injuries, missing equipment etc.)

268 195 n/a 554 381 n/a 2,845 2,845 n/a

Number of incidents reported to the NRLS (CQC/NRLS

reportable)20 117 n/a 53 178 n/a 914 914 n/a

% of incidents reported to the NPSA within 30 days 1 1 G 2 1 R 1 1 G

Number of Serious Incidents Requiring Investigation (SIRI)

reported 2 1 R 3 2 R 12 12 G

Number of SIRI investigations outstanding after 60 days

(excluding events that are officially suspended)0 0 G 0 0 G 0 0 G

Number of Never Events (CQC/NPSA reportable) 0 0 G 0 0 G 0 0 G

Clinical negligent claims (CNST) 2 1 R 2 2 G 12 12 G

Public liability claims 3 1 R 3 2 R 12 12 G

Staff Safety Measure

Number of RIDDOR reports (HSE reportable) 6 8 G 10 16 G 96 96 G

Number of Physical Assaults (NHS Protect reportable) 16 12 R 30 23 R 140 140 GThe sustained increase in the number of incidents reported by staff has seen a corresponding

increase in the number of physical assault incidents reported.

Number of Non-Physical Assaults (NHS Protect reportable) 16 7 R 29 26 R 149 149 GThe sustained increase in the number of incidents reported by staff has seen a corresponding

increase in the number of non-physical assault incidents reported.

Number of Security Incidents (NHS Protect reportable) 6 4 R 9 8 A 48 48 GThe sustained increase in the number of incidents reported by staff has seen a corresponding increase in

the number of security incidents reported.

* These items are reported in the quality accounts as well

FOI (Freedom of Information Act) 78.0% 100.0% R 75.4% 100.0% R 98.0% 100.0% A

Data protection Act (DPA) - police, solicitor/medical,

subject access85.0% 100.0% R 84.0% 100.0% R 98.0% 100.0% A

Lead director: Deirdre Thompson

Full year

Patient Safety Measure

May-16 Year to date Commentary on exceptions


Page 14 of 33

Integrated Performance Report - Clinical Coordination Centre

Commentary:

Commentary:

in bound call volumes remain high for May

and above the plan. We recived 60,301 calls

in total.

111 call answer performance was on

trajectory at 95.33 with an abandonemtn

rate well below the 5% threshold. 999 call

anmswer performace impacted on

compared to April, this is due to demand

rise and recruitment chanllenges. To give

context the average call answer is between

3-4 seconds, indicating delays.

98,165

109,785

80,000

90,000

100,000

110,000

120,000

130,000

140,000Calls (111 incidents)

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

90.10%

84.60%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0% 999 Call answer time (95% percentile)

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

89.9% 95.3%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

110.0% 111 Call answer time (95% percentile)

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

54,976

60,301

40,000

45,000

50,000

55,000

60,000

65,000

70,000Calls (999 incidents)

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

Page 15 of 33


Commentary:

999 referrals remain within the national

average of between 9- 11%.although above

plan for SCAS.

9.84%

9.40%

6.0%

7.0%

8.0%

9.0%

10.0%

11.0%

12.0%

111 to 999 referrals (%) North

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

10.63%

10.15%

6.0%

7.0%

8.0%

9.0%

10.0%

11.0%

12.0%

111 to 999 referrals (%) South

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

7.82% 7.94%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

111 ED Referral (%) North

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

6.58% 6.76%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

111 ED Referral (%) South

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

Page 16 of 33


Commentary:

Commentary:

999 abandonment rate reflects the pressure

currently within the CCC. Abandonment rate

above the 1% standard but only marginally

indicating a safe service but with delays for

call answer within 5 seconds.

0.965 0.9571

0.9547 93.9% 0.9592 0.9578

0.9504 0.9468

0.9378

0.961

95.0%

0.9

0.91

0.92

0.93

0.94

0.95

0.96

0.97

0.98

0.99

1Red 19 Performance

2014-15 actual

2014-15 plan

2013-14 actual

Continuing improved performance in September and the Q2 targets has been

achieved

0.89 0.886

0.857

0.817

0.853

92.5%

0.7855

0.8591

0.8309

95.0%

0.7

0.75

0.8

0.85

0.9

0.95

1Call answer time (95% percentile)

2014-15 actual

2014-15 plan

2013-14 actual

Deterioration month on month due to staffing levels

- call answering still good

17.4% 18.1%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%111 Transfers to clinician (%)

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

30.6% 30.2%

95.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%111 Call back (% < 10 mins - target 95%)

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

1.57%

0.54%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

111 Calls Abandoned (target <5%)

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

0.65%

1.15%

0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

1.2%

1.4%

999 Calls Abandoned (target <5%)

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

Page 17 of 33


Commentary:

Commentary:

EOC continue to show good compliance

with appraisals, 111 improving on Month 1

figures.

Absence in both EOC and 111 continues to

be high, however EOC showing slight

improvement on forecast. Focus work on

111 absence will be considered.

0.01% 0.00%

0.00%

0.02%

0.04%

0.06%

0.08%

0.10%

0.12%

0.14%

111 Complaints 2016-17Actuals2016-17 Plan

2015-16Actuals

6.3%

5.3%

7.9%

7.6%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0% Sickness

EOC Actual

EOC Plan

111 Actual

111 Plan*The plan is 0.5% lower than last years actual

91.7% 89.6%

69.0% 72.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

April May June July Augt Sept Oct Nov Dec Jan Feb March

Appraisals

EOC appraisals

111 Service

Appraisal Target

Page 18 of 33


Commentary:

Commentary:

Following internal development EOC under

forecast in particular for call-takers. CCC

open recruitment events to take place

during July alongside continuing

recruitment.

243.6 243.7

230.0

235.0

240.0

245.0

250.0

255.0

260.0

265.0

EOC Workforce

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

184.7

188.0

0.0

50.0

100.0

150.0

200.0

250.0

300.0

111 Workforce

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Training Course Completion (1 of 2)

Manual Handling

Health & Safety

Equality & Diversity

Conflict Management

Infection Control

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Training Course Completion (2 of 2)

Safeguarding Adults

Safeguarding Children

Fire Awareness

Information Governance

Page 19 of 33


111 Service Overall rating A Red > 30% Red scores, Green > 70% Green and <10% Reds (but no key indicators), Amber - rest


Oxford :

Oxford Calls (no. answered) 17,731 17,822 n/a 32,811 34,212 n/a 197,459 197,459 n/a

Oxford Call Answering (% within 60

seconds) 95.0% 95.0% G 92.3% 95.0% A 95.0% 95.0% G 111 call answer on trajectory and stable

Oxford 999 referrals (%) 8.9% 10.0% G 9.2% 10.0% G 10.0% 10.0% G Below target

Oxford Calls Abandoned (target <5%) 0.5% 5.0% G 1.1% 5.0% G 5.0% 5.0% G below national target

Oxford Transfers to clinician (%) 17.8% 20.0% G 18.1% 20.0% G 20.0% 20.0% G this has shown some improvements although still below plan

Oxford Time taken for call back (% < 10

mins - target 95%)30.1% 95.0% R 30.4% 95.0% R 30.4% 95.0% R

Hampshire :Hants Calls (no. answered, 111 and

Dental)48,083 49,255 n/a 91,222 93,241 n/a 561,010 561,010 n/a

Hants Call Answering (% within 60

seconds, 111 only) 95.4% 95.0% G 92.8% 95.0% A 95.0% 95.0% G 11 call answer on trajectory and stable

Hants 999 referrals (%) 10.2% 10.0% A 10.4% 10.0% A 10.0% 10.0% G

Hants Calls Abandoned (target <5%, 111

only)0.6% 5.0% G 1.1% 5.0% G 5.0% 5.0% G

Hants Transfers to clinician (%) 17.0% 20.0% G 16.3% 20.0% G 20.0% 20.0% G

Hants Time taken for call back (% < 10

mins - target 95%)31.5% 95.0% R 31.4% 95.0% R 31.4% 95.0% R

improvement programme in place and some improvements being

delivered

Full yearYear to date

Lead Director: Philip Astle/Luci Stephens

Measure May-16



Page 20 of 33



Berkshire:

Berks Calls (no.) 20,259 20,372 n/a 38,050 39,010 n/a 233,438 233,438 n/a

Berks Call Answering (% within 60

seconds) 95.2% 95.0% G 92.3% 95.0% A 95.0% 95.0% G

Berks 999 referrals (%) 10.7% 10.0% A 11.0% 10.0% R 10.0% 10.0% G

Berks Calls Abandoned (target <5%) 0.5% 5.0% G 1.0% 5.0% G 5.0% 5.0% G

Berks Transfers to clinician (%) 19.0% 20.0% G 18.8% 20.0% G 20.0% 20.0% G

Berks Time taken for call back (% < 10

mins - target 95%)28.5% 95.0% R 28.7% 95.0% R 28.7% 95.0% R

Buckinghamshire:

Bucks Calls (no.) 13,226 13,611 n/a 25,277 26,215 n/a 154,458 154,458 n/a

Bucks Call Answering (% within 60

seconds) 95.4% 95.0% G 92.4% 95.0% A 95.0% 95.0% G

Bucks 999 referrals (%) 8.0% 10.0% G 8.0% 10.0% G 10.0% 10.0% G

Bucks Calls Abandoned (target <5%) 0.5% 5.0% G 1.0% 5.0% G 5.0% 5.0% G

Bucks Transfers to clinician (%) 19.1% 20.0% G 19.3% 20.0% G 20.8% 20.8% G

Bucks Time taken for call back (% < 10

mins - target 95%)27.7% 95.0% R 29.4% 95.0% R 29.4% 95.0% R


delivered

Luton & Beds:

Luton & Beds Calls (no.) 9,885 9,864 n/a 18,853 18,976 n/a 112,103 112,103 n/a

L&B Call Answering (% within 60

seconds) 95.5% 95.0% G 92.9% 95.0% A 95.0% 95.0% G

L&B 999 referrals (%) 11.2% 10.0% R 10.8% 10.0% A 10.0% 10.0% G

L&B Calls Abandoned (target <5%) 0.5% 5.0% G 1.1% 5.0% G 5.0% 5.0% G

L&B Transfers to clinician (%) 20.9% 20.0% A 19.9% 20.0% G 20.8% 20.8% G

L&B Time taken for call back (% < 10

mins - target 95%)30.9% 95.0% R 31.1% 95.0% R 31.1% 95.0% R


delivered

Full yearYear to dateMeasure May-16

Page 21 of 33


NHS Improvement rating

Actual Actual Actual Actual Forecast Plan Plan Plan

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Financial risk rating 3 2 2 2 2 2 2 2

Actual Actual Actual Actual Forecast Plan Plan Plan

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Red 1 75.1% 69.6% 72.3% 70.5% 75.0% 75.0% 75.0% 75.0%

Red 2 75.7% 71.3% 74.0% 69.4% 75.0% 75.0% 75.0% 75.0%

Red 19 95.1% 93.8% 95.1% 93.6% 95.0% 95.0% 95.0% 95.0%

Failure to comply with requirements regarding access to healthcare for people with a learning disability No No No No No No No No

Risk of, or actual, failure to deliver mandatory services No No No No No No No No

CQC compliance action outstanding 31 March 2015 No No No No No No No No

CQC enforcement action within last 12 months up to 31 March 2015 No No No No No No No No

CQC enforcement notice currently in effect as at 31 March 2015 No No No No No No No No

Moderate CQC concerns or impacts regarding the safety of healthcare provision as at 31 March 2015 No No No No No No No No

Major CQC concerns or impacts regarding the safety of healthcare provision as at 31 March 2015 No No No No No No No No

Trust unable to declare on-going compliance with minimum standards of CQC registration No No No No No No No No

Has the Trust has been inspected by CQC No No Yes No No No Yes No

If so, did the CQC inspection find non compliance with 1 or more essential standards No No No No No No No No

Other governance factors/risks (data breaches) Yes No No No No No No No

Overall governance rating Green Green Green Green Green Green Green Green

Commentary:

Forecast forward risks related to the financial position and the risk to performance and the potential impact of the overall governance rating

2015-16 - reported 2016-17 Plan

2015-16 Actual

Lead Director: Will Hancock

Governance Indicators

Financial Indicators2016-17 Plan

Page 22 of 33


Finance Finance rating A CIP rating A

Monitor Continuity of Service Risk Rating


Debt service cover rating (25%) 1 1 G 2 3 R 3 3 G

Liquidity Rating (25%) 4 4 G 4 4 G 4 4 G

I&E Margin (25%) 1 1 G 1 1 G 1 1 G

I&E Margin Variance From Plan (15%) 1 1 G 1 1 G 1 1 G

Continuity of Service Risk Rating (New) 2 2 G 2 2 G 2 2 G


Debtors > 90 days> 5% total balance No No G No No G No No G


(Red - action to correct, Amber - action to reduce risk, Green -

nil)

Measure May-16 Year to date Full year

Monitor Forward Financial Risk Ratings

Lead Director: Charles Porter

Measure: Financial sustainability risk rating May-16 Year to date Commentary on exceptions

(Red - action to correct, Amber - action to reduce risk, Green -

nil)

Full year

Page 23 of 33



£k £k £k £k £k £k

Commercial Division

Subtotal Commercial Division 66 160 R 153 317 R 1,869 1,869 A


£k £k £k £k £k £k

Operations

Eliminate overtime incentive scheme 44 53 A 198 211 A 1,047 1,056 A 9

Reduce sick absence by 0.5% to 6.2% (per mth) 55 0 G 105 0 G 341 335 G 9

Annual leave reduced by 0.5% due to new recruits 42 42 G 84 84 G 503 503 G 2

Reduce cycle time by 4 mins 0 0 G 0 0 G 1,236 1,236 G 12

Increase See and Treat by 1% 0 0 G 0 0 G 496 496 G 9

Reduce response ratio by 0.01 (1.12 ratio for full year) 17 17 G 34 34 G 201 201 G 9

Staff Attrition by .6% 28 0 G 45 0 G 73 60 G 8

Improve use of HCP tier - HCP dedicated desk 13 13 G 26 26 G 296 296 G 6

A&E Recruitment better profiling for year 35 45 A 60 105 R 277 287 A 12

Reduction is BOC cylinder hire 0 4 R 0 8 R 129 50 G 0

111 reduce sickness to 14/15 level of 6.48% vs 8.8% 0 10 R 0 21 R 153 124 G 12

111 Rota redesign to increase rota efficiency 0 0 G 0 0 G 30 153 R 4

Cost Improvement Plans (QIPP's)

Measure May-16 Year to date Full yearCommentary on exceptions (Red - action to correct, Amber -

action to reduce risk, Green - nil)

Quality Impact

Measure May-16 Year to date Full yearCommentary on exceptions (Red - action to correct, Amber -

action to reduce risk, Green - nil)

Quality Impact

Page 24 of 33


111/EOC share clinician hours to meet peaks 0 0 G 0 0 G 45 30 G 4

111 reduce attrition from 36% to 30% 2 0 G 3 0 G 45 45 A 6

Fleet Savings 28 28 G 55 55 G 330 330 G

Subtotal 999 Service 262 212 G 609 543 G 5,202 5,202 G

Corporate

Estates CIPs 10 10 G 16 19 A 157 157 G 2

Finance CIPs 9 8 G 10 17 R 163 163 G 2

ICT Savings 9 8 G 9 16 R 213 213 G 2

BI Savings 2 2 G 2 3 R 20 20 G 12

Service Development & Bids 3 3 G 6 6 G 49 49 G 4

HR 4 4 G 7 7 G 71 71 G 2

Education 8 8 A 19 16 G 107 107 G 1

Chief Executive 0 0 G 0 0 G 55 55 G 6

Corp Affairs 0 0 G 1 1 G 5 5 G 4

Technology Scheme 2 2 G 4 4 G 21 21 G 4

Subtotal Corporate 46 44 G 74 90 A 861 861 G

Contingency 0 0 G 0 0 G 0 G

Total 374 416 A 836 894 A 7,933 7,933 A

Page 25 of 33


Quality Impact Assessment of the Cost Improvement Programmes 2016-17

Auto Allocation Auto Plan 20

Auto Allocation is dispatching of a journey to a

resource on the day (i.e.. the current dispatchers

work).

Auto Plan is automatic allocation of journeys to a

resource in the pre plan state which is currently

24 hours in advance (i.e.. the current planners

work).

3 Q 3

This should not have any impact on the quality of

the service provided if implemented in a planned /

controlled approach9

Closely monitor impact on service through the quality

KPI's for the contracts during rollout of the project9

Rationalisation of private provider 42 Reduced prices from some private providers

(continuation from previous year)2 Q 2

Should not affect Quality rates are reduced in

agreement but SCAS continue to have the same

level of availability of staff from PP's4 Negotiation to ensure availability of correct skill sets 2

Removed Wokingham Rent 8 Stopped renting Wokingham for training manager

& admin, moved to Wexham ambulance station2 Q 3

Should not affect Quality if communicated and

implemented in a controlled way6 Planned change with good communication to staff 4

Reduce training time 80

Reduce training time from 4 weeks to 3 weeks,

this is by covering more elements on the

shadowing week.

3 Q 3 Possibility of risk to quality 9

Need to monitor the staff feedback from their training

and also need to monitor any complaints, concerns or

incidents and patient survey for any intelligence that

quality is being impacted

9

Reduce Missed Meal Breaks

Overruns 36

Reducing missed meal breaks & overruns by

better allocation of jobs/with help from Auto

Allocation/Auto Plan

3 Q 2

Ensuring staff wellbeing and reducing levels of

stress and tiredness should contribute to safe

patient care.6 monitor over-runs and missed meal breaks 4

Improve SCAS Efficiency 200

Improving patients moved per shift hour worked,

better allocation of resources to job to reduce

down time/travelling time

4 Q 3

Should enhance patient care and quality ensuring

that the right resource is allocated to the right

incident at the right time12 monitor through the turnaround KPI's 12

Rearrange Driver Training Course 4

Rearranging the training course so that the driver

training element is first as that has highest failure

rate, but currently they do it last & therefore

being paid for first 3 weeks of training to

potentially fail driver training

3 Q 3 Should not impact quality 9 2

Increase Online Booking 60

Increase online booking for patient journeys by

HCPs to reduce calls going through the contact

centre

4 Q 3Should not adversely impact on quality if

implemented correctly and communicate to HCP's12

monitor effectiveness of the bookings through the

contract KPIs9

Replace Short Term Hire Vehicles 40 Reducing cost of short term vehicle hire as taking

on 5 year leases, continuation from previous year2 Q 2 Should not impact quality 4 2

Commercial Division

Mitigated

Risk Level

Action to Mitigate Downside

Scenario

Risk

RatingMitigating ActionsPotential Impact to Quality/Delivery£000’s Source of Saving

Quality

/Deliver

Conse-

quenceLikely

Page 26 of 33


Improve Private Provider

Efficiency 243

Improving patients moved per shift hour worked,

better allocation of resources to job to reduce

down time/travelling time

4 Q 3

Should enhance patient care and quality ensuring

that the right resource is allocated to the right

incident at the right time12 monitor through the turnaround KPI's 12

Cease use of external examiners 16

Within the FACT team, no longer need external

examiners to pass or fail students, workbooks and

course have been adapted to ensure they are

examined through out the course

2 Q 2 Should not impact quality 4 2

Increased VCD usage 384 Increasing the use of volunteer car drivers to

reduce the private provider usage4 Q 2

may impact quality and will require close

monitoring8

Need to monitor any complaints, concerns or


quality is being impacted8

Increase SCAS Staffing 628 Increasing SCAS staffing to reduce the private

provider usage4 Q 2 should enhance patient care and quality e 8

Need to monitor any complaints, concerns or


quality is being impacted8

Eliminate overtime incentive

scheme 1,024

Cease payment of overtime incentive for frontline

staff and EOC3 Q 3 May impact on quality if shifts uncovered 9

Need to monitor the level of resources following

implementation and any adverse incidents or

concerns relating9

Reduce sick absence by 0.5% to

6.2% (per mth) 335

Manage staff sickness absence in order to reduce

sickness abstraction by 0.5% per month3 Q 3

Potential to improve return to work and staff

availability / resource9 Needs to be monitored 9

Annual leave reduced by 0.5%

due to new recruits 500

With a more recently recruited workforce the

overall average annual leave 2 Q 1

should not impact on quality and should improve

resourcing2 2

Reduce cycle time by 4 mins 1,236

Reduce cycle time elements which can be

specifically targeted by SCAS, eg overlaps and RRV

waiting times.

3 Q 4 should improve quality 12 difficult to achieve the change 12

Increase See and Treat by 1% 496

Trainee specialist paramedics are now nearing the

end of their training. They will be joining the team

Rotas and will be delivering more see and treat

3 Q 3 should improve quality 9 Need to monitor see and treat rates 9

Action to Mitigate Downside

Scenario£000’s Source of Saving

Conse-

quence

Quality

/Deliver

999 Service

Likely Potential Impact to Quality/DeliveryRisk

RatingMitigating Actions

Mitigated

Risk Level

Page 27 of 33


Reduce response ratio by 0.01

(1.12 ratio for full year) 200

Post NARP we have seen the response ratio

reduce. Our YTD is 1.13 and currently we have a

ratio on 1.11. A FY average of 1.12 is the new

target

3 Q 3Should enhance resources availability and improve

quality9 Need to monitor 9

Staff Attrition by .6% 60

Reduce staff attrition via "stay interviews"

enhanced team leader skills and improved internal

education offerings.

2 Q 4Should enhance resources availability and improve

quality8 Need to monitor 8

Improve use of HCP tier - HCP

dedicated desk 295

Increase the utilisation on the HCP tier by

manning the HCP desk during hours of operation,

re- deliver the Communications to GPs and own

paramedics

3 Q 5Should improve the quality if implemented

successfully15

Need to monitor impact on responsiveness and

waiting times6

A&E Recruitment better profiling

for year 350

Flow through from the recruitment profile of

15/163 Q 3

Should enhance resources availability and improve

quality9 Need to monitor delivery of the plan 12

111 reduce sickness to 14/15 level

of 6.48% vs 8.8% 165

Target 111 sickness through a sickness cell and

active management plus increased staffing3 Q 3


quality9 Need to monitor through KPI's and the IPR 12

111 Rota redesign to increase rota

efficiency 100

Following Process Evolution review redesign rota's

to offer better match against call profiles2 Q 2


quality4 4

111/EOC share clinician hours to

meet peaks 30

Flex clinicians between 111 and EOC to meet

peaks in each are. Eg 9-11 in 111, afternoons in

EOC.

2 Q 3Should improve quality but need to ensure there

are enough Clinicians available to do this safely6

Monitor effectiveness and ease of moving from each

area4

111 reduce attrition from 36% to

30% 37

Target attrition by increasing WTE, offering career

pathways and more steady Rotas'2 Q 3


quality6 Requires monitoring 6

Page 28 of 33


Estates CIPs 157

Non-renewal of lease car, exiting properties, re-

negotiated rent free periods in northern and

southern house & reduction in gas and elec prices.

3 Q 3 no impact on quality 9 2

Finance CIPs 188

Reductions in Agency fees, Recruitments Costs,

Consultancy, Internal Audit and A1 vehicle

parking.


ICT Savings 213

Review and consolidation of telephone lines,

photocopy re-tender and ortivus for 6 months

only,


BI Savings 20 Lower recruitment. 4 Q 3could impact on the quality of information and our

ability to analyse12 need to monitor impact on information 12

Service Development & Bids 49 Reduction in Agency fees, consultancy costs, bank

contracts & computer expenditure.4 Q 4

could impact on the quality of information and our

ability to analyse4 need to monitor impact on information 4

HR 71

Reduction in Agency spend, computer purchases

& telephone expenses. Also savings due to non-

renewal of lease car and HR Director 3 month

overlap in 15/16.

2 Q 1 should not impact on quality 2 2

Education 107

Nil ad hoc van hire and reduction of lease car

usage forecasted in 16/17. Also expecting a

reduction in refurb and consultancy costs. Further

savings expected due to cancellation of skid

course, HE team member not being replaced and

exiting Greenham Common part way through the

FY.


Chief Executive 55 Reduction in Consultancy & Recruitment Fees. 2 Q 4Need to ensure this does not impact on

recruitment numbers6 needs to be monitored 6

Corp Affairs 5 Reduction in recruitment & printing costs. 2 Q 2 should not impact on quality for patients 4 4

Technology Scheme 21

Opportunity for individuals to purchase

technology items with payments deducted

directly out of the employees salary. Savings

achieved by reducing SCAS's gross payroll liability

2 Q 4 Should not impact on quality for patients 4 4

Corporate Areas

Page 29 of 33

Integrated Performance Report - Trust HR

Commentary:

Commentary:

The success of the Health, Wellbeing and

Attendance project is reflected in the

decrease in absence. However, absence

rates are affected by the seasons and it is

likely that we will see a continued decrease

over the summer months. The HR

team continue to encourage the completion

of appraisals and local management

meetings. Appraisal skills training is still

available as part of the HR management

development programme.

5.9%

5.5%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

Trust Sickness

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

73.6% 75.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Trust Appraisals

2016-17 Actuals

2016-17 Plan

2015-16 Actuals

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%


Manual Handling

Health & Safety

Equality & Diversity

Conflict Management

Infection Control

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%


Safeguarding Adults

Safeguarding Children

Fire Awareness

Information Governance

Page 30 of 33


Cat Red 8

Cat Red 19

Cat Red 1

Cat Red 2

Abandoned calls

Recontact 24hrs Telephone

Recontact 24hrs On Scene

Frequent caller

Resolved by telephone

Non A&E

ROSC

ROSC - Utstein

STEMI - 60

STEMI - 150

STEMI - Care

Stroke - 60

Stroke - Care

The percentage of patients who have suffered an ST-elevation myocardial infarction (STEMI) – a type of heart attack – and who have received

thrombolysis (treatment with a clot-busting drug) within 60 minutes of the original 999 call to attend them.

The percentage of patients who have suffered an ST-elevation myocardial infarction (STEMI) - a type of heart attack - and who then been directly

transferred to a centre capable of delivering primary percutaneous coronary intervention (PPCI) and received angioplasty treatment within 150

minutes of the original 999 call to attend them.

The percentage of patients who have suffered a stroke, as confirmed by the face to face carrying out of a Face Arm Speech Test (FAST) and who

were potentially eligible for stroke thrombolysis (treatment with a clot-busting drug) and who arrived at a hyper acute stroke centre within 60

minutes of the original 999 call to treat them.

The percentage of suspected stroke patients who were assessed face to face and who received the correct treatment (appropriate care bundle) in

line with ambulance guidelines.

The percentage of patients who have suffered an ST-elevation myocardial infarction (STEMI) - a type of heart attack - and who have received the

correct treatment (appropriate care bundle) in line with ambulance guidelines.

Red 1 call are the most time critical of Red call and cover cardiac arrest patients who are not breathing and do not have a pulse and other severe

conditions such as airways obstruction.

Red 2 calls are serious but less immediately time critical and cover conditions such as stroke and fits.

The total number of patients who having had suffered a cardiac arrest and stopped breathing have then been recorded as having had a return of

spontaneous circulation (a pulse/heartbeat) at the time of their arrival at hospital.

The number of patients who have been witnessed suffering a cardiac arrest and stopped breathing, whose heart was then in a rhythm which

allowed it to be shocked with a defibrillator and have then been recorded as having had a return of spontaneous circulation (ROSC) at the time of

their arrival at hospital.

National Ambulance Clinical Quality Indicators (CQI's)

The number of patients who have been cared for and treated at the scene of the 999 call or taken to somewhere other than an A&E department

for treatment (for example, an NHS Walk-in Centre).

The percentage of Category Red (immediately life-threatening) calls reached within 8 minutes – the target is 75%.

The percentage of Category Red (immediately life-threatening) calls where a vehicle able to transport the patient has arrived within 19 minutes –

the target is 95%.

The percentage of 999 callers who have hung up before their call was answered in an emergency control room.

The number of patients who have re-contacted the ambulance trust within 24 hours of them having called 999 and been offered clinical advice

over the phone.

The number of patients who have re-contacted the ambulance trust within 24 hours of them having called 999 and then were discharged on scene

following face to face ambulance assessment.

The number of patients who have re-contacted the ambulance trust within 24 hours for whom a locally agreed frequent caller procedure is in

place. These patients are referred to as "patients at risk" in SCAS.

The proportion of 999 calls that have been resolved by providing telephone advice and no ambulance response.

Page 31 of 33


Cardiac - STD

Cardiac - STD Utstein

Time to Answer - 50%



Time to Treat - 50%

Time to Treat - 95%

Time to Treat - 99%

Handover improvement

Clear-up improvement

Turnaround improvement

CQC

HSE

NHS Protect

NPSA

REAP

RIDDOR

CCG Clinical Commissioning Group

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations

Care Quality Commission

Clear-up time is the time from clinical handover above to the time that the ambulance vehicle departs hospital. This had a target of 15 minutes.

Clear-up improvement is where the total clear-up time for all hospital visits has improved compared to the same period last year.

Turnaround time is the total of handover and clear-up time. This had a target of 30 minutes. Turnaround improvement is where the total

turnaround time for all hospital visits has improved compared to the same period last year.

The Health and Safety Executive

Resource Escalation Action Plan

Other terms and abbreviations

NHS Protect leads on work to identify and tackle crime across the health service.

National Patient Safety Agency

Hospital handover time is the time from hospital arrival by ambulance personnel to clinical handover to hospital clinical staff. This had a target of

15 minutes. Handover improvement is where the total handover time for all hospital arrivals has improved compared to the same period last year.

The time taken for a health professional working for the ambulance trust to arrive at the scene of a Category A (immediately life-threatening) call,

measured by the time below which 99% of patients were reached.

The time taken to answer 999 calls in an emergency control room measured by the time below which 50% of calls were answered.







The percentage of patients who have been witnessed suffering a cardiac arrest and stopped breathing, whose heart was then in a rhythm which

allowed it to be shocked with a defibrillator and were successfully resuscitated and survived to be discharged from hospital.

The overall percentage of patients who having suffered a cardiac arrest and stopped breathing were successfully resuscitated and survived to be

discharged from hospital.

Page 32 of 33

MM

Agenda Item: 11



Title Workforce Report

Responsible Director Melanie Saunders, Director of HR & OD


The Trust Board is asked to receive and note the report









Please provide details of the risks associated with the subject of this paper (x-reference to the corporate risk register / Board Assurance Framework) Corporate Risks 5.1 Failure to support staff and provide access to education and training to meet mandatory, clinical and organisational requirements 5.2 Failure to effectively manage sickness absence 5.3 Failure to recruit and retain staff


CQC Regulation 22. Outcome 13 - Staffing. CQC Regulation 23, Outcome 14 - Supporting Workers


There are financial implications associated with delivering the workforce action plan

Council of Governor implications / impact (e.g. links to governors statutory role, significant transactions etc) Council of Governors receive the monthly Integrated Performance Report containing information regarding workforce Patient / staff implications (e.g. linked to NHS Constitution, equality and diversity)

The workforce action plan supports the pledges to staff in the NHS Constitution, published March 2013

Other Previous considerations by the Board Board Seminars 2013, 2014, 2015, 2016


http://www.nhsemployers.org/your-workforce/retain-and-improve/raising-concerns-at-work-and-whistleblowing/information-for-employers/raising-concerns-policy-and-legislation https://improvement.nhs.uk/resources/freedom-to-speak-up-whistleblowing-policy-for-the-nhs/

http://www.nhsemployers.org/your-workforce/retain-and-improve/raising-concerns-at-work-and-whistleblowing/information-for-employers/raising-concerns-policy-and-legislation




https://improvement.nhs.uk/resources/freedom-to-speak-up-whistleblowing-policy-for-the-nhs/

https://improvement.nhs.uk/resources/freedom-to-speak-up-whistleblowing-policy-for-the-nhs/

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WORKFORCE REPORT

PURPOSE

1 The purpose of this report is to: • Provide a summary of achievements against our workforce plan for 2016/17; • Provide update on our readiness for the Agency Regulations, due to come

into force July 2016.

EXECUTIVE SUMMARY 2 Our 2016/17 workforce plans have been designed to deliver continuing workforce

improvements, thus supporting: • safe and effective patient care and key performance targets; • workforce sustainability and improving workforce numbers beyond 2016/17; • continue to improve on recruitment, attrition and workforce stability; • reduce reliance on agency workers and achieve reductions in agency spend;

and • support the delivery of system transformation plans

3 Against rising demands and the evident workforce challenges in our area the

impact of our focus on recruitment and development activities should not be under estimated. SCAS made significant improvements during 2015/16, however the challenges of rising demands on our services and on the skill set of our workforce remains.

4 Our workforce plans for 2016/17 aim to deliver the following:

• 999 recruitment of 346 wte, with attrition forecast at 14% we anticipate a net increase in staff of 123 (allowing for internal changes/movement) and vacancies reducing to c11%.

• 111 recruitment of 201 wte, with attrition forecast at 35% we anticipate a net increase in staff of 65 and vacancies reducing to c5%.

• PTS recruitment of 138 wte, with attrition forecast at 12% we anticipate a net increase in staff of 65 and thus vacancies reducing to c5%.

• Our workforce plan for EOC is still under development, scheduled for completion July 2016.

5 Performance against these plans during months 1 and months 2 has been

variable, whilst attrition in most areas has improved or a least remained on forecast, recruitment in all core areas remains a significant challenge with each IWP being under forecast at the end of both month 1 and month 2. A shortage in the labour market and increased competition across the range of skills we are seeking continues to challenge our recruitment performance.

6 Our marketing materials and advertisements are under continual review, with the

aim of attracting more candidates. Recruitment campaigns are being run more frequently and include a 3 month local radio campaign due to commence 1 July 2016.

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7 In light of the EU referendum, SCAS is actively supporting the NHS “#loveyourEUstaff” campaign, a range of communications from our CEO have been released including a personal message to our existing EU staff and a message to those candidates whom we are currently working with in Poland for employment during the Summer.

CURRENT PERFORMANCE 999 FRONT-LINE INTEGRATED WORKFORCE PLAN 8 Recruitment Activity

8.1 A shortage in the labour market and increased competition within the wider

healthcare community continues to challenge our recruitment performance. The biggest factor influencing the shortfall in recruitment has been our ability to recruit International Paramedics, where first mover advantage has now been lost, with 5 other Ambulance Trusts competing for the same Students. The Trust is now looking to expand our search within Poland and other countries for qualified clinical staff.

9 Attrition

9.1 Attrition in 999 continues to fall well below forecast. The cumulative total of

20.3 FTE leavers is 13.7 FTE ahead of target and this improvement is looking to continue to fall in M3 where 10 FTE have left the Trust against a

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999 VACANCIES Apr May

ACTUAL 1420 1404

PLAN 1424 1415

ROTA ESTABLISHMENT 1743 1743

VACANCY Vs. EST 323 339

VACANCY Vs. EST % 19% 19%

16 FTE. The Year End Turnover result is predicted to fall to 12.5% against a forecast of 14%

10 Workforce Vacancies

10.1 The overall performance against plan is 10FTE down and is likely to rise to

15 FTE down by the end of M3. Vacancies against rota establishment are now at 339FTE (19%). The impact of the shortages in recruitment, largely caused by the significant drop in International Paramedics, has been reduced by improvements in staff retention.

10.2 The overall Workforce Plan is forecast to make some recovery during Q2, as

early recruitment pipeline indicators are that we will be recruiting above plan and staff retention looks set to continue being below forecast.

10.3 During month 2 with the support of Health Education England, SCAS led our

first system-wide meeting to discuss the challenges with Paramedic recruitment, the increasing need for the Paramedic skill set within wider healthcare and the need for a system-wide workforce planning approach in the future. We continue to hold similar discussions at STP workforce meetings as we strive to ensure sustainability of this skill set not only within our Ambulance Service but within the wider health community.

111 SERVICE INTEGRATED WORKFORCE PLAN 11 Recruitment Activity

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111 VACANCIES Apr May

ACTUAL FTE 184 188

PLANNED FTE 186 198

ESTABLISHMENT 215 224



11.1 Recruitment for 111 is currently 8.6FTE down on plan. This is largely due to labour shortages and a reduction in applications through both Direct-Hire and Agency-Hire. In July 2016, the Recruitment Team are facilitating ‘Open Days’ for Direct-Hire into all SCAS Contact Centres (111, EOC and PTS), whilst August 2016 Recruitment will be working with our agency partners to promote improved recruitment pipelines. Adverts have again been reviewed, with the aim of attracting more candidates, campaigns are being run more frequently and include a 3 month local radio campaign due to commence 1 July 2016.

12 Attrition

12.1 After an excellent M1 period, M2 was above the Attrition forecast leaving the cumulative total on-track. Pressures on the labour market means that any shortfall in recruitment activity will need to be met by a combination of reduced demand and improved staff retention. M3 leavers is projected to be 5FTE, which is a significant improvement on the 8FTE forecast. At this stage, staff attrition in 111 is looking to at around 30% against a projected 35%.

13 Workforce Vacancies

13.1 Whilst staff attrition is looking set to be below forecast for Q1 and this has

helped reduced the overall pressure on the shortfall created from the below-forecast recruitment performance. The overall performance is 10FTE down on plan, leaving vacancies at 36FTE (16%).

PATIENT TRANSPORT SERVICE INTEGRATED WORKFORCE PLAN

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14. Recruitment Activity

14.1 Whilst recruitment activity in PTS has produced the highest direct-hire rate for two years, recruitment activity is 15FTE down on plan. It should be noted that at the same time PTS has recruitment significant numbers of Bank staff and PTS Management have been affected by C1 licence concerns and a below-expected application rate. Adverts are being redesigned and greater focus placed on the delivery of new starters within PTS for Q2.

15. Attrition

15.1. Attrition within the PTS Operations areas is on-track, but the overall

attrition result is above forecast due to a slight decrease in PTS Contact Centre retention.

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PTS VACANCIES Apr May

ACTUAL FTE 372 380

PLANNED FTE 415 429

ESTABLISHMENT 437 448



16. Workforce Vacancies

16.1 The overall performance against the PTS workforce plan is significantly down

on plan (49FTE). However, the uncertainty within the incoming TUPE staff numbers for both SHIP and TV contracts has had a huge impact on the overall performance, where only 10FTE joined against a forecast in excess of 40FTE. It should also be noted that 15 FTE of Bank staff were employed, meaning that the shortfall is 35FTE. PTS Management team are now working with Education and recruitment to ensure that this shortfall is made up in Q2.

17 EOC INTEGRATED WORKFORCE PLAN 17.1 The Integrated Workforce Planning (IWP) Process commenced 10th June

2016 and is subject to the standard IWP rigorous planning methodology. Data cleansing has now been completed and ESR/Kronos systems have been aligned. An interim demand profile has been agreed (using the existing Funded Establishment), although this will be reviewed during the year as improved telephony data and Unit Hourly Utilisation (UHU) calculations are made available.

17.2 Attrition and Internal Movement / Promotion are included within the plan EOC

experience ‘positive’ attrition as staff progress careers within SCAS. The IWP Template is nearing completion and the draft plan is expected to be presented to the WFDB in July 2016. During the M2 vacancies dropped from 20% to 18%, with 45 wte short-fall to establishment. The M3 Board report will include further details of the performance against plan.

FUTURE PERFORMANCE 18 A shortage in the labour market and continuing competition for workforce within

Thames Valley and Hampshire continues to challenge our recruitment performance. The Team have put into place a range of activities to attract candidates including:

• Three month radio campaign started 1 July 2016 • Exploring increased use of social media, included targeted campaign with 25

mile radius of key towns within our area.

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• Recruitment open day 2 July 2016, focussing on Contact Centres (PTS/111/EOC)

• Continue focused newspaper advertising • Direct contact with high street chain to offer recruitment work-shops for staff

facing redundancy. • Candidate focused videos to help improve application and interview

techniques • Review of assessment techniques, increasing use of technologies within the

assessment process • Direct mail-shots to previous staff and candidates

19 We will be closely monitoring the success of these activities through the

Integrated Workforce Planning meetings and Workforce Development Board. OTHER KEY ISSUES Agency Caps 20 Background

20.1 On 23 March 2016, NHS Improvement published new rules relating to the use of agency staff within the NHS. These came into effect for most parts of the NHS with effect from 1 April 2016 and for Ambulance services from 1 July 2016.

20.2 Within the guidance agency staff are defined as those who work for the NHS

but who, for the purposes of the transaction, are not on the payroll of the NHS organisation offering employment. Managed Service Providers are excluded from the Agency Rules.

20.3 The purpose of these rules is to drive a significant reduction in agency

expenditure across the NHS during 2016/17.

20.4 In summary, the rules require that:

• Employers work within a maximum ceiling for agency spend • Employers use only agencies who are on an accredited framework • Employers pay agency staff no more that the capped rates of pay • Employers comply with a series of governance requirements

20.5 Full details of the Agency Rules can be found at

https://improvement.nhs.uk/resources/reducing-expenditure-on-nhs-agency-staff-rules-and-price-caps/

21 Progress Update

21.1 In preparation for the introduction of Agency Rules for Ambulance Trusts, SCAS tasked a multi-disciplinary team to benchmark existing practices against the 4 key compliance areas and to initiate immediate remedial actions where necessary.



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22 Ceiling for Agency Spend

22.1 NHS Improvement notified SCAS of the agency expenditure ceiling for all staff groups during March 2016. The ceiling was calculated on our reported agency expenditure in M1-M9 of 2015/16, with a reduction then applied. The ceiling set for 2016/17 is £4,476,000.

22.2 In order to effectively monitor spend against our ceiling, our finance teams are

working to ensure that all expenditure is coded correctly and excludes any spend that falls outside of the scope of the rules (e.g. managed service provider spend).

22.3 A monthly spend profile is being created for ease of monitoring and reporting

purposes and consideration is being given to how the expenditure is to be monitored with budget managers.

23 Accredited Frameworks

23.1 A review of all the agencies we use has been completed and with the exception of two, all have been confirmed as being on an NHS accredited framework.

23.2 SCAS is working with both remaining providers to ensure their compliance

with the accredited framework rules; we await the outcomes of their applications to the accredited supplier list, which we expected to receive by the end of June 2016. One agency is a major supplier of 999 operational staff to SCAS, as such this item has been placed on our risk register (also see risks below)

24 Capped Rates of Pay

24.1 The rules outline hourly pay rates for agency workers to be capped at +55% of the Agenda for Change basic rates of pay. A check of our current agency staff revealed that we are paying above the capped rates for two agencies, one of which we have re-negotiated rates to bring them in-line with the rules. Positive discussions continue with the remaining supplier to also bring their rates in line with the capped rates.

25 Governance Arrangements

25.1 The rules require the following governance arrangements to be in place:

25.2 “We expect all trust boards, including the boards of all foundation trusts, to

ensure that they are following robust and effective processes for managing the implementation of the agency rules. We expect:

25.3 accurate and timely weekly override submissions to NHS Improvement: submitted weekly by Wednesday noon; submissions signed off by a board member”

25.4 Reports are being coordinated and submitted to NHSI weekly following sign-off by the Director of HR & OD, returns are also shared with the full Executive Team. Going forward agency shifts will be monitored on a

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weekly basis as part of our regular performance monitoring at Executive Team meetings.

25.5 board accountability: one accountable officer in place for agency expenditure and compliance to the agency rules”

25.6 The responsibility for compliance with agency rules has been assumed by the Director of HR & OD.

25.7 escalation process for sourcing agency staff which ensures: appropriate review of agency use taking into account safety, quality and finances

25.8 Procedures for the engagement of agency workers have been updated, our procurement system has also been amended to ensure orders cannot be made without compliance checks being undertaken by the manager requesting the order.

25.9 regular internal review panels for monitoring trust overrides and reviewing agency rules monitoring data; and regular board review of agency expenditure and overrides to ensure compliance with agency ceiling

25.10 Compliance with the agency rules will be a standard element of Executive monitoring and Board reporting from July 2016 onwards.

26 Identified Risks

26.1 During preparations for compliance several risks have been identified and added to our corporate risk register. In summary these are:

26.2 Compliance with the ceiling: Given the continuing workforce challenges

SCAS faces, our reliance on agency provision, in particular within the Thames Valley remains high. Our management and finance teams are continuing to review and thus identify how achievable the ceiling will be, spend against the ceiling will be reported monthly via standard Executive and Board performance reports.

26.3 Accredited Frameworks: One of our major suppliers of 999 agency workers

is not yet on an accredited framework; this poses a key risk to compliance against the agency rules. Their application to be included on an accredited framework is being processed and the outcome is expected shortly. In the event that they are unsuccessful there are a range of contingency plans which will require discussion, including the continued use of the agency and to declare an override to the rules on the basis of maintenance of staff staffing levels.

26.4 Capped rates: Negotiation with agencies to achieve the capped rates has

been positive. However we will need to monitor the supply of agency workers to be assured that supply it is not adversely affected as a result of re-negotiated rates.

26.5 One of our core suppliers also provide services to a number of NHS

Ambulance Services and other NHS organisations, as well as private Ambulance services and other private sector organisations. If other NHS organisations do not work to the pay caps there is a risk that agency

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workers will opt to work for NHS organisations offering rates above the cap or move to private sector employers. We will need to monitor this to ensure that the supply we require (c1000 hours per week) is maintained.

27 Conclusions

27.1 SCAS has made good progress with ensuring compliance with the new agency rules, however there is still some ongoing work, including the accreditation of one of our major 999 agency worker suppliers.

27.2 Going forward the Board will be updated on progress and compliance with the rules with the standard suite of reporting.

RECOMMENDATIONS TO THE BOARD 28 The Board are asked to note the progress made in respect of the workforce plans

each designed to support continued improvements in performance, quality of patient care, aid recruitment and retention and improve the working lives of our staff.

Melanie Saunders Executive Director of HR and OD July 2016

Agenda Item: 12



Title Sustainability and Transformation Plans (STPs)

Responsible Director James Underhay, Director of Strategy, Business Development, Communications and Engagement

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










The changes to services, system-wide funding and governance arrangements that are being developed through this planning process are likely to present both opportunities and risk to SCAS.


The STP process requires that system-wide compliance with clinical and quality standards, plus financial targets.


The changes to services, financial frameworks and governance arrangements that are being developed through this planning process are likely to present both opportunities and risks to SCAS.


So far, there has been minimal engagement of Governors in the process, due to the constraints of purdah in the run up to the EU referendum. There will be a session on STPs for Governors on 19 July to ensure that they are briefed on the process and engaged in the development of plans.


Patient experience, access to services and equality of outcomes has been a key factor in the case for change in local systems. Workforce challenges and plans to improve system-wide recruitment and retention has also featured strongly in the STPs.

Other Previous considerations by the Board 30 June 2016 Board Seminar


NHS Five Year Forward View, published by NHS England in October 2014 Delivering the Forward View: NHS Shared Planning Guidance 2016-2021, published by NHS England in December 2015

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SUSTAINABILITY AND TRANSFORMATION PLANS

PURPOSE 1 The purpose of this paper is to update the Board on the development of

Sustainability and Transformation Plans (STPs) in our four local systems. EXECUTIVE SUMMARY 2 Local health and care systems are required to develop joint STPs, in order to

deliver the national ambitions set out in the Five Year Forward View.

3 SCAS is a partner in four STPs:

• Bedfordshire, Luton and Milton Keynes • Frimley (NE Hampshire, Berkshire East and part of Surrey) • Hampshire and Isle of Wight • Buckinghamshire, Oxfordshire and Berkshire West

4 Engagement in these STPs is critical, as they represent the opportunity to

work with partners to address some key challenges (such as workforce), to seize the opportunity to transform care (for example using digital developments) and to secure funding that has been made available centrally.

KEY ISSUES National guidance 5 In December 2015, NHS England issued planning guidance on a new

approach for health and social care. Commissioners and providers were asked to group into locally-determined systems, in order to build health and care services around the needs of local populations. In January 2016, this resulted in the development of 44 ‘STP footprints’ across England.

6 Each system was required to produce a draft Sustainability and

Transformation Plan (STP) by 30 June 2016. These plans show how local services will evolve and become sustainable over the next five years – ultimately delivering the Five Year Forward View vision of better health, better patient care and improved NHS efficiency.

7 A credible STP is required before a system can access Sustainability and

Transformation Funds from NHS England. 8 SCAS is a partner in four STPs:

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Ref Name Population CCGs 24 Bedfordshire, Luton and Milton Keynes 0.9 m 3 34 Frimley (NE Hants, E Berks, part of Surrey) 0.7 m 5 42 Hampshire and Isle of Wight 1.8 m 7 44 Buckinghamshire, Oxfordshire, Berkshire West 1.7 m 7 Challenges faced by each system 9 Unsurprisingly, there are some common themes emerging in terms of the

challenges faced and the focus for improvement in each system:

• Reducing variation and inequalities in terms of access and outcomes across the population

• Improving well-being, prevention, early detection and self-care • Supporting people with long-term conditions, particularly in relation to

the growing population with multiple complex conditions • Workforce: recruitment, retention and new roles • Sustainability of services and the implications of 7-day services • Opportunities presented by digital and other technological

developments • Financial viability and scope to improve efficiency through joint-

working across each system Engagement activities 10 Each system has developed draft proposals to address the challenges faced

and to achieve the vision of the Five Year Forward View at local level. The timetable for engagement had to be revised due to the constraints of purdah in the run up to the EU Referendum. Therefore, engagement activities are now planned over the Summer, with a view to STPs finalising plans and commencing implementation in the Autumn 2016.

Potential implications for SCAS 11 Again, there are some emerging themes in relation to the potential

implications and opportunities for SCAS. 12 Many of the STPs have identified workforce challenges as a key area

requiring focus. SCAS needs to engage in this joint work as a way of helping to address our own challenges, particularly around the paramedic workforce.

13 Digital and other technological developments have also been identified as a

potential way of enabling care professionals to support more citizens in their own homes, to work more collaboratively and to link with other agencies. Building on our existing technical infrastructure for 999 and NHS111 services, SCAS is likely to be a key player in these developments.

14 Several STPs are exploring the development of multi-disciplinary multi-

agency hubs, to provide more integrated support to people in their own homes and community settings. This would offer a much wider range of expertise and direct access to support the assessment and referral of people

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who call SCAS. We need to be involved in the development of these hubs, so that 999 and 111 callers can benefit from these new models of care.

CONCLUSIONS 15 STPs represent a new way of planning care, with the potential to

transformation how health and social care is delivered to local citizens. They also offer a chance for SCAS to work with partners to address our workforce challenges and to seize the opportunities presented by digital and technological developments.

16 SCAS has been engaged in the development of the draft plans so far, and

needs to continue to work closely with partners as these a wider range of stakeholders are engaged, the plans are developed further and ultimately the changes agreed are implemented.

RECOMMENDATIONS TO THE BOARD 17 To note the new approach to planning across health and care. 18 To recognise the importance of SCAS’ engagement in the development of

detailed plans and subsequent implementation across our four local STPs. Isobel Wroe Assistant Director, Strategy & Service Development 3 July 2016

Agenda Item: 13



Title Accelerated Clinical Transformation Programme Update

Responsible Director Deirdre Thompson, Director of Patient Care











There is a potential risk that funding is not available to help support delivery of elements of the Accelerated Clinical Transformation Programme


No direct implications


Implementation of the Accelerated Clinical Transformation Programme will require appropriate investment but is, in turn, expected to increase efficiency within the organisation.

Council of Governor implications / impact (e.g. links to governors statutory role, significant transactions etc) We will be discussing the Accelerated Clinical Transformation Programme in greater detail at the Council of Governors meeting on 19 July 2016. Patient / staff implications (e.g. linked to NHS Constitution, equality and diversity)

The intended benefits of the Accelerated Clinical Transformation Programme include improved patient outcomes and clinical benefits, as well as increased efficiency and ways of working for staff.


Previous update on Accelerated Clinical Transformation Programme was at the February 2016 Board Seminar


Accelerated Clinical Transformation (ACT)

Update Achievements

September 2015 to June 2016

Purpose of ACT - Accelerated Clinical Transformation • To accelerate the pace of planned change • Add clinical benefits for patients • Improve patient outcomes • Increase SCAS and partner provider efficiency • Generate new ideas using modern technology and joint working with

our partners, to support people in their own homes • Test pilot concepts

ACT - Digital Enabling

Objective Provide the digital capability for the Clinical Transformation and Interoperability Workstreams Summary of Progress to date • LiveLink to Care Homes – Pilot Active • LiveLink to Front Line – Pilot Active • LiveLink to Air Ambulance to Emergency Dept – Pilot Active • Interoperability with Hampshire Health Record – Active Benefits • LiveLink supports Clinical decision making • Interoperability provides access to Special Patient Notes Any Future Funding requirements Funding would be needed through Commissioning to roll out Live Link to care Homes, after successful pilot evaluation, and incorporate into the Local Digital Roadmap programme.

ACT LiveLink – Care Home (Langford View, Bicester) Operational Change • Patient or PoA Consent Process • Call Flow process – CG sign off, CAD changes, EOC Directive • Staff (EOC & Care Home) training: 11 EOC and 6 Care Home staff • Training & Education package designed for Clinicians • Audit and storage of video calls

Active : 8 June 2106 • Evaluation of quality of imaging/process • Evaluation of outcomes • Accelerated roll out of pilot sites- x10 Care Homes, Frontline Crews, Air Ambulance to

OUH.

ACT – Live Link Front Line 999 & Air Ambulance Objective Provide the digital capability for the Clinical Transformation and Interoperability Workstreams Summary of Progress to date • LiveLink to Care Homes – Pilot Active • LiveLink to Front Line – Pilot Active Benefits • LiveLink supports Clinical decision making • Interoperability provides access to Special Patient Notes Any Future Funding requirements: Funding would be needed through Commissioning to roll out widespread LiveLink to Care Homes.

ACT- Hants Fire & Rescue: Non-Injury Falls Response Objective • Provide clinically appropriate, timely, low cost, non-injury Falls response • To reduce patient waiting times / Long Waits

Summary of Progress to date • Signed Memorandum of Understanding: SCAS & HFRS • Responder training developed - triage, dispatch, patient assessment algorithm, w frailty

and falls risk assessments and referral processes Pilot Go live: 1 July 2016 Benefits • Reduced 999 patient waits • Ambulance resources available for higher acuity patients • Cost effective, protected resource Any Future Funding requirements? • Funded from efficiency savings

ACT- End of Life support for people in their own/care home

Objective. A proof of concept to: • improve the individual needs of people on an End of Life (EoL) pathway • enable SCAS staff to make decisions to support people at home: • - reducing ‘inappropriate’ transportations to ED (50% die in hospital vs 70% who

want to die at home • reducing ‘on scene’ time by providing a structure to managing EoL patients. • reducing the 65% conveyance rate (we can reduce 59% of EoL admissions from

Care Home) • reducing impact and cost to the health economy – aim to convert convey to a

non-convey

• ACT EoL pilot benchmark data set (Aug 15 to Jan 16)

ACT- End of Life support for people in their own/care home

Summary of Progress to date.

• SCAS EoL Clinical Champions identified • End of Life ‘e-education’ module produced • Access to additional community services via DoS • Embedding SCAS into CCG EoL networks

Benefits.

• Improved patient End of Life care • Reducing inappropriate patient journeys to ED • Reducing on scene time for front line resources • Improved costs and benefit to the health economy • Benefits the wider health economy - every £1 spent on community EoL pathways generates

£2.23 of benefits • Links patient pathways to ACT pilots (Live link, SPNS,VHFU)

Any Future Funding requirements?

• End Of Life Clinical Lead Role at Band 7 - to pull together operational development,

pathways and CCG funding opportunities. • Education materials £800 • Staff training time (1hour)

ACT- Mental Health Practitioner (MHP) in EOC

Objective. • To increase access to Mental Health Practitioner in the EOC 999/111 to improve mental health pathways (in

line with National MH Crisis Care Concordat).

Summary of Progress to date. • Cover in place at NH 6 days a week (peak periods- eves/nts). • Direct access to Samaritan pathway Active January 2016 • MH training from Solent to all SH EOC/111 clinicians • Agreed direct referral pilot for Solent- Go live: 1 August 2016

Benefits.

• Positive impact on patient journey • Reduction in number of unnecessary journeys to ED. • Increased EOC clinical support • Piloting 2 new models of care- physical vs direct access • Good quality of service for patients.

Any Future Funding requirements

• NH MHP supplied by Ox Health and funded by OX CCG only. Additional costs to extend? • Additional hours/support would require funding or virtual links to service across the whole of SCAS.

57

36 37

20

0

10

20

30

40

50

60

APRIL MAY

Ambulances sent

Ambulances stood down

ED attendance/Ambulance utilisation.

NH MHP- Benefits Based on 254 calls over 40

operational shifts (approx. 400 hours).

26

15

6

10

0

5

10

15

20

25

30

APRIL MAY

No of times alternativepathway provided

Number of Hear and Treat

Alternatives to ambulance.

ACT- Samaritans Pathway

ACT – Management of High Intensity Users (VHIU) Objectives • Negotiate and align VHIU patients with the care that they need • Demand Practitioner writes a Patient / Premises Management Plan (PMP) • Reduce the number of ambulances sent to VHIU patients / premises • Patient / premises needs met appropriately

Summary of Progress to date • Trial with 2 additional Demand Practitioners • Patient Management Plans developed and trialled • Proven model and benefits achievable for patients, SCAS and wider health economy

Benefits • Patient’s care aligned to need • Reduction in missed Red calls & Reduction in Ambulances not required to patients Any Future Funding requirements? • Additional Band 6 Demand Practitioners

ACT- VHIU Activity (2015 – 2016) Activity (VHIU) • 2,200 known patients (999) 3,000 + known patients (111) • 45,000 – 999 incidents created • 33,722 ambulances sent • 500 x 999 calls from 1 patient in December Patient Case Study (VHIU) • 26 calls in 11 days from 57 yr old female • 19 ambulances sent in 11 days - 7 missed Reds • Patient Management Plan written and partner providers engaged. Intensive SCAS/

patient management • Patient Management Plan activated and ‘live’ on CAD • 38 calls received in next 4 days • 2 ambulances sent (appropriate providers involved)

ACT: Integrated Care w Providers Strategic Objective.

To increase joint working and interoperability with other providers to meet Commissioner Standards for Integrated Urgent Care (NHSE Sept 2015) and Thames Valley NHS Urgent Care Specification. Key Requirements: • Seamless referral from NHS 111 to primary, community, social and voluntary services using warm transfer,

electronic referral and direct booking. • Increased NHS 111 access to enhanced clinical support and specialist care including Acute Care. • Enhanced clinical triage of 999 Green and ED referrals from NHS 111 • Shared record keeping and use of Primary event messaging across services to prevent duplication.

Summary of ACT Progress to date.

Direct access • Increased access to community services now via DOS- MUDAS, BRAVA, • Direct access to Samaritans in place since January 16 (SH) - average 15-20 referrals per month • Direct referral pilot to MH teams pilot to Solent from August 16 • Direct warm transfer/referral pilot to BHT Acute Pharmacists for NHS111 clinicians and patients (4 Feb- March

16) Low referrals due to time of day. To review/extend • Actively developing access to urgent repeat prescriptions (PURM) across Thames Valley and Wessex (by Winter) Direct Booking • Agreement w East and West Berkshire Out of Hours to extend direct booking (post Adastra) • Agreement w Oxford Health, PHL and Berks UCC to pilot direct booking into MIU, PCC (in progress) • Agreement to pilot ‘In hours’ GP booking w Wokingham CCG (in progress)

Other • ‘Live Link ‘ now live in Bicester Care Home from 8 June- to roll out x10 care homes

ACT: Integrated Urgent Care Status to align with new requirements Achieved Ongoing Increased access to Mental Health teams in NH EOC and Samaritans via SH

Roll out Samaritans pathway to NH Direct access to Solent/Southern AHT

Increased access to Pharmacy from 111 via BHT Working with PURM – repeat PX workstreams for TV and Wessex

End of Life Pathway & training in place SCAS EOL clinical lead to work w CCGs to improve care pathway

Increased access to Community Services via DoS. Eg Brava, MUDAS

Increased access to records/interoperability eg Social,

Go live for Skype real time clinical assessment & referral.

Further Skype Roll out w Care Homes, 999 crews and Air Ambulance.

Development of TV Alliance Partnership Agreement to increase direct booking in/out of hours- UCC, MIU 2016/17

Hampshire Fire pathway developed support to Falls (G60).

Develop pathways to manage vulnerable patients eg Paediatrics, Frail Elderly

ACT- Integrated Urgent Care pilots Benefits

• TV 111 Alliance in place to positively support procurement and the implementation of TV 111/IUC specification and Commissioner Standards.

• Improved relationships now with local providers and access from NHS 111 to additional clinical support eg Pharmacist, MHP

• Improved direct patient referral into primary & community services to support admission avoidance w reduced referral to ED.

• Now using innovative digital technology to support clinical assessment, interoperability, efficiency and effectiveness across providers.eg Booking, Real time assessment ‘Live Link’, PEMS, shared records,

ACT – Vision of a Local Digital Roadmap

Objective Delivery of the Local Digital Roadmaps for the Sustainability & Transformation Plans as part of the NHS Five Year Forward View programme Summary of Progress to date • Regional Digital Footprint – Complete • SCAS Digital Maturity – Complete • SCAS Local Digital Roadmap - Complete Benefits Improving the Care and Quality gap, the Finance and Efficiency gap & the Health and Wellbeing gap Any Future Funding requirements All capability initiatives will require funding. Potential sources are from £4.2bn NHS technology fund, including £1.8bn to create a paper-free health and care system and the NHS England Estates and Technology Transformation Fund £1billion capital investment programme

Relationship Model

ACT – Digitally Enabling Clinical Capability Initiatives Records, Assessments and Plans • Interoperability - Access to Special Patient

Notes • Interoperability - Access to Integrated Patient

Record • Interoperability - End of Life - DNR - Paper

Form Removal Transfers of Care • Interoperability - Sharing SCAS Discharge

Summary • Transformation - Bookings for Emergency

GP Appointments • Transformation - Bookings for Minor Injuries

Unit Appointments • Interoperability - Non-Emergency Patient

Transport • Transformation - Inbound Patient Condition

Sharing • Transformation - Mental Health Pathway

Remote Care • Transformation - SCAS LiveLink to Care

Homes Decision Support • Transformation - SCAS LiveLink for Front

Line • Transformation - SCAS LiveLink to Patient /

Caller • Business Intelligence - Auto Reporting &

Alerting Medicines Management and Optimisation • Transformation - Emergency Prescriptions Asset and Resource Optimisation • Staff e-Rostering Orders and Results Management • Capability Review Programme

Agenda Item: 14



Title SCAS Charity Strategy and Governance

Responsible Director James Underhay, Director of Strategy and Business Development

Recommendation (eg. note, approve, endorse) The Board is asked to approve the Strategy for the charity









Please provide details of the risks associated with the subject of this paper (x-reference to the corporate risk register / Board Assurance Framework) The Charitable Funds Sub Committee is monitoring a detailed risk register, and an aggregate risk has been added to the corporate risk register as risk no 26, which has been pulled through onto the Board Assurance Framework as item 3.3.

Implications Regulatory and legal implications / impact (e.g. NHS Improvement provider licence and continuity of services risk ratings, CQC essential standards, competition law etc) This strategy, if adopted, should ensure the Trust is adequately prepared to meet the requirements of the proposed new Fundraising Preference Service and Charity Regulator, but as neither scheme is yet finalised at a national level, the Charitable Funds sub committee will need to maintain a watching brief and advise on any further development required to ensure compliance


The strategy anticipates an increase in charitable funds income from the estimated £240 k raised by the SCAS Charity and League of Friends in 2015/16 to c£440k in 2017/18 and £590k in 2018/19.


The Strategy anticipates an active role for Governors as ambassadors for the charity and potentially as active fundraisers.


The strategy is designed to ensure that SCAS can deliver more than the core services it is funded to provide by the NHS, in order that it can go further towards meeting its aspirations for developing staff and services and so improving its service to patients.

Other


The strategy was debated in a very early draft at the Board Seminar on April 28th. Charitable Funds considered an early draft in April, and looked in depth at further aspects such as communications at its meeting in June. A detailed discussion of the draft strategy took place at the Board Seminar on June 30th, and this paper incorporates the changes requested at that meeting.


Draft strategy presented to Charitable Funds and Board in April can be supplied on request, and includes the research and options considered in reaching the recommendations set out in this paper.

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SCAS CHARITY STRATEGY AND GOVERNANCE

PURPOSE 1 The purpose of the paper is to enable the Board to;

a. agree the strategy for development of the Trust’s charity b. approve the revised Terms of Reference (ToR) for the Charitable Funds

Sub Committee EXECUTIVE SUMMARY 2 The paper describes the current state of the Trust’s charity, proposes a vision

for what it might become and achieve, and sets out the actions required to start to deliver that vision over the next 12-24 months. The new ToR are attached as Appendix 1

KEY ISSUES The strategy document attached covers the following areas: 3 An assessment of the current state of the charity. 4 The causes the charity will fundraise for and its fundraising targets. 5 SMART objectives for the next 18 months against which progress and

success can be monitored. 6 The action needed to deliver these objectives. 7 A budget for the period 2016/17-2018/19. CONCLUSIONS 8 This strategy is not without risk and challenge, but if the Trust commits to

supporting and overseeing its delivery, it will deliver on the three principle intentions behind investing in development of the charity. It will:

• Ensure the Trust maximises the potential of its charity to raise funds that

can be invested in developing and providing services that are additional to the core NHS services the Trust is funded to provide.

• Mitigate against the risks to its reputation that could arise from

insufficiently pro-active management of its charitable activity.

• Improve the support and recognition provided to the volunteer fundraisers who have been, and will remain, the lifeblood of the charity.

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RECOMMENDATIONS TO THE BOARD 9 The Board is recommended to:

a. Approve this strategy b. Approve the revised ToR for the Charitable Funds Sub Committee

Author Rachel Coney Title CEO South Central Ambulance Charity Date 30/6/16

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A Strategy for the South Central Ambulance Charity 1. The starting point

1.1 Why the Board is investing in development of the charity The SCAS Board took a decision to invest in development of the SCAS Charity early in 2015. In appointing a CEO to drive development it sought to:

• Ensure the Trust maximises the potential of its charity to raise funds that can be invested in developing and providing services that are additional to the core NHS services the Trust is funded to provide.

• Mitigate against the risks to its reputation that could arise from

insufficiently pro-active management of its charitable activity.

• Improve the support and recognition provided to the volunteer CFR fundraisers who have been the lifeblood of the charity for several years.

This strategy sets out an approach to realising these three aims. 1.2 Charity objects and area of activity

The Charity’s objects, as defined with the Charity Commission, are that the Charity exists “for charitable purposes relating to the general, or any specific, purposes of the South Central Ambulance Service NHS Trust or to purposes relating to the health service”.

The area of benefit is not defined, but the charity is described as operating in the following areas:

• Bracknell Forest • Buckinghamshire • Hampshire • Oxfordshire • Reading • Slough • West Berkshire • Windsor and Maidenhead • Wokingham.

The Charity was formed in 2006 from the merger of charities linked to former ambulance trusts for Oxfordshire, Hampshire, Berkshire and Buckinghamshire. It was previously linked to a separate Community Responder Scheme Charity, but this was wound up, with assets transferred into the SCAS Charity in 2011.

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1.3 Financial performance The draft accounts for 2015/16 indicate that the charity raised £123k and spent £190k, reducing its balance by £67k. This compared to income of £237k and expenditure of £221k the previous year – when the charity benefitted from a small number of legacies. Income was almost exclusively generated in 2015/16 by local CFR schemes in Hampshire and Berkshire, who raise funds through a variety of community activities such as business donations, personal donations, small grants from other local charities, local events and collecting tins. The largest proportion of expenditure (108k) was on medical equipment, and further analysis is required to understand the split between provision of public access defibrillators and CFR kit bags. Further analysis is also needed of the expenditure coded “other” and the estimated figure to be recharged to the charity by the trust. Reserves held at the end of 2015/16 are £526k, of which £410k is ringfenced to the 112 local CFR schemes in Berkshire and Hampshire who raised that money. Approximately £125k is expected to be transferred into the charity from the League of Friends at the end of June. This will be held in individual funds ringfenced to each of the CFR schemes in Oxfordshire and Berkshire. We do not yet know what has been raised or spent in Oxfordshire and Buckinghamshire in the last year. In addition an estimated £400k a year is spent by partner organisations on purchasing and installing defibrillators in local communities as a result of Trust education and advocacy work. Despite the good reserves position, the very small amount of cash available to invest in development of the charity is a significant factor in the development strategy proposed in this paper – which focusses on activity that can be delivered with minimum investment of time and cash by the charity, and which minimises risk. The charity is reliant, at this stage, on the Trust’s willingness to invest time and expertise from other teams such as communications and finance, and on the provision of subsidy in the form of accommodation, IT support, telecoms services etc. The value of this support needs however to be viewed in the context of the value of the contribution the CFR service makes to the quality of patient experience, facilitated by the charity. This strategy sets out clear fundraising targets, and a costed plan for delivering on those. These figures are benchmarked against the average return on investment for charities of just over £3 income for every £1 invested1. Successful NHS charities raise approximately 1% of exchequer funds. This suggests that this charity could aspire, in time, to be generating £1.68m/year, but that it should expect to build investment to just under £0.5m per year to achieve this. This strategy suggests we can get about 1/3rd of the way to this target by the end of 2018/19.

1 http://www.institute-of-fundraising.org.uk/library/fundratios-summary-2013/

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1.4 Governance and risk management The Board agreed revised governance arrangements for the charity in January 2016. These clarify the roles and responsibilities of the CEO, the Charitable Funds Sub Committee and the full Board as Corporate Trustee. This can be summarised as follows:

• The Board will set strategy and agree an annual plan and budget, with advice from the Charity CEO, the Director of Strategy and Business Development and the Charitable Funds sub committee.

• The sub committee will be responsible for delivering effective and appropriate governance of the charity, and will provide assurance to the Board that the Charity is delivering in line with the Board’s instruction, and in compliance with relevant legislation and codes of best practice.

• The sub committee and the CEO will have delegated authority to make day to day decisions with regard to application of charitable funds, in line with limits agreed by the Board.

• The Audit committee will ensure appropriate governance, risk management and internal controls are in place.

New TOR for the sub committee and a new scheme of delegation now need to be agreed. These are attached at Appendix 1.

The charity’s governance and transactional processes were reviewed by the Trust’s internal auditors in the first week of June 2016. They wanted to assess whether:

• The strategy and vision in place is fit-for-purpose to support the aims and objects of the charity.

• The governance, representation, reporting to, and scrutiny at the Charitable Funds Committee is adequate and effective.

• Due diligence and transfer of assets from the South Central Ambulance Service League of Friends is adequate.

• Policies and procedures to support the operation of the charity are adequate and effective.

• Structure and support of the Charity to support volunteers is sufficient. • Procedures to approve budgets, collect income and authorise expenditure are

sufficient to allow accurate and complete transactions. The Auditors hope to be ready to report their findings and advice to the Audit committee on July 13th 2016, and this strategy will need to be reviewed to ensure all identified issues are addressed.

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1.5 Visibility and brand awareness The levels of awareness about the charity outside the CFR community in Hampshire and Berkshire is low, both inside and outside the Trust. The charity has no clearly identifiable brand, it is not clear to potential donors that it exists at all, and for those who are aware that it exists, it is very unclear what it exists to do. Local CFR schemes have, to differing degrees, raised awareness of their own scheme, and its dependence on public support in their own local areas. However CFR schemes often feel and behave like independent standalone charities, who all happen to share one charity number and one bank account. The local awareness raising they have achieved has been about their local scheme, and not about the charity through which they are supported. Making the charity visible, and creating a very clear understanding amongst fundraisers and potential donors of what it exists to do, and its relationship to local CFR schemes, are fundamental building blocks for successful development, and this strategy therefore includes a comprehensive marketing and communications plan. 1.6 Other charities operating in the area The development strategy for the South Central Ambulance Charity must take into account the other charities that are raising funds in our area in order to support our staff and/or to deliver a service in partnership with us. These are:

i. The two air ambulance charities. ii. The two local branches of BASICS - a charity which supports doctors who

wish to volunteer to respond to 999 calls. iii. The Ambulance Service Charity – a national charity providing individual staff

welfare , wellbeing and financial support to serving and retired personnel and their families in times of distress or hardship.

iv. West Berkshire Rapid Response Cars – a small Newbury based charity that has bought, and maintains, 5 vehicles that it makes available for staff responding in rural and semi rural areas in and around West Berkshire.

v. The South Central Ambulance Service Benevolent Fund – formerly the Hampshire staff benevolent fund.

vi. The South Central Ambulance Service League of Friends – which has supported CFR fundraising in Buckinghamshire and Oxfordshire, and which has raised money for community defibrillators and other community education initiatives.

This strategy therefore addresses issues exposed in an early analysis of the degree of alignment that exists and/or could be developed, between the remit and ambition of these charities, and the vision and aims proposed here for the South Central Ambulance Charity.

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1.7 Infrastructure and resources needed The mature and successful charities operating in our sector have built large staff teams and extensive volunteer networks. These teams are equipped with substantial fundraising materials and sophisticated information, data analysis and communication tools. At present the only resources and infrastructure the South Central Ambulance Charity has are a CEO, a commitment to appoint a Charity Officer and access to the time and expertise of the Trusts’ leadership, communication and finance teams. This strategy sets out proposals for the gradual development of infrastructure and for initial investment in fundraising materials

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2. The Vision 2.1 Our core message The South Central Ambulance Charity - Helping your local ambulance service to help you For the next three years we will be focussed on raising funds for three campaigns:

• To train and equip our volunteers • To train and equip communities to save lives • To enhance and develop the care we give

All the money the charity raises will be used to fund services that are additional to the core NHS services that SCAS provides. QUESTION: Does this core message need any further revision? 2.2 How the money we raise will be spent The money we raise to train and equip our volunteers will fund things like:

• Our Community First Responders, the voluntary “ambulance” at the end of your street.

• Our volunteer car drivers – the volunteers who help get frail patients to and from medical appointments at no cost to the patient.

The money we raise to train and equip local communities to save lives will fund things like:

• Public access defibrillators and awareness raising campaigns about how to use them.

• Use of our education ambulance in schools, and other training and education events and activities.

The money we raise to enhance and develop the care we give will fund investment in things like:

• State of the art equipment. • Research projects. • Pilots of ideas for clinical innovation. • Extra training and development. • Improvements to working environments.

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2.3 Our fundraising targets In 2017/18 we want to raise enough to be able to invest £290k through the charity:

• At least £250k to train and equip our volunteers. • At least £20k to train and equip communities to save lives by installing 1 more

public defibrillator every 6 weeks across our region and delivering 5 education events or projects2.

• At least £20k to invest in projects to enhance and develop care. .

In 2018/19 we want to raise enough to be able to invest £400k:

• At least £315k to train and equip our volunteers. • A further £45k to train and equip communities to save lives. • At least £45k to invest in projects to enhance and develop care.

2.4 Our development goals If we are going to succeed in meeting these targets then we will need to:

• Develop and promote the charity brand. • Develop appropriate partnership arrangements with the other charities that

support the trust. • Develop and roll out a suite of low cost/low risk fundraising activities. • Improve the support we give to our volunteers and the communication we

have with them. • Improve our governance and operational processes. • Engage our staff as fundraisers. • Embed the charity firmly and appropriately in the life of the Trust.

2.5 Measuring success The charity’s objectives for the period to March 2017 will be to:

i. Deliver a high profile internal and external PR campaign to run through late September and early October to publicise its new strategy.

ii. Over the next 12 months deliver a monthly cycle of news stories and PR opportunities and three big campaign stories, to maintain and build profile raising thereafter.

2 Further discussion is scheduled in late July with the Community Defibrillator team, to discuss in detail how we report the value of their work, and how the charity can augment that.

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iii. Roll out newly branded fundraising materials for use by all CFR and Co Responder schemes over the next 6-12 months in order to establish a consistent brand across all 4 counties.

iv. Launch a regular donor giving campaign, a lottery, a recycling programme, a challenge programme, a corporate partners programme, a fundraise for us campaign and a legacy campaign by the end of September 2016.

v. Re-launch collecting box fundraising under tighter governance and the new brand by October 2016.

vi. Have created, and be maintaining, a charity database by the end of October 2016.

vii. Engage staff as active fundraisers through delivery of a ‘keep what you raise’ campaign in June/July 2017 and a comprehensive ongoing internal comms campaign.

viii. Have attracted 25 regular monthly donors by the end of March 2017, at an average monthly donation of £10, creating a base from which to generate a net income of at least £3000 plus gift aid in 2017/18 and a target to raise £1,000 in 16/17.

ix. Have attracted 500 regular lottery players by the end of March 2017, creating a base from which to generate a net income of at least £13k in 2017/18.

x. Have signed a commercial partnership agreement with BIU limited by June 30th 2016, which will generate approximately £20k from recycling in 16/17 and £50k in 17/18.

xi. Sign up 5 participants to fundraising challenge events in time for them to raise a total of £5k in 17/18

xii. Sign up 4 corporate partners by the end of March 2017, and have agreed separate lottery, regular donor giving and challenge fundraising targets with them, with a target of each partner generating at least £10k in 2017/18.

xiii. Sign up 2 additional corporate partners during 17/18, allowing us to generate a further £20k from this source by the year end.

xiv. Meet our CFR fundraising targets of £200,000 in 2016/17 and £250,000 in 2017/18.

xv. Register 25 individual one off giving/fundraising activities during 2017/18, with a combined fundraising target of £15k. We will aim to generate 5k from one off activities in 16/17.

xvi. Ensure that the SCAS and FACT events programme are supporting fundraising from summer 2017, with a target of 10 major events attended, generating income of £6000.

xvii. Meet the volunteer recruitment needs of Patient Transport and Indirect Services ( targets to be agreed by October 2016)

xviii. Maintain costs at 35% or less of funds raised, from 2018/19.

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3. How we will achieve these targets

Delivering the vision and objectives described in section 2 will require:

• Delivery of a comprehensive communications and marketing plan. • Developing and delivering fundraising activities. • Improvements to the support we give to our volunteers and the

communication we have with them. • Building relationships with partner charities operating in the region. • Development of governance and operational processes through which the

Board can be assured of delivery, risk management and compliance. The action plans for each of these development areas are set out below, and if successfully delivered will embed the charity firmly and appropriately in the life of the Trust.

3.1 The communications and marketing plan 3.1.1 Objectives The charity marketing and communications campaign needs to result in increased giving to the charity.

It also needs to contribute to the wider SCAS objectives of:

• Developing the SCAS brand as one that is highly valued, respected and trusted by all its stakeholders.

• Improving public understanding of the breadth of services the Trust delivers.

• Reducing inappropriate demand on emergency care resources through public education about how to use existing services and the development of alternative pathways of care.

• Improving staff recruitment, retention and morale. • Increasing FT membership and ensuring representation.

3.1.2 Target audiences To achieve these objectives the charity marketing and communications campaign needs to reach:

• Service users and their families • Staff • Volunteers • FT Governors and members • Large employers across the region (public and private sector), our

suppliers and our commercial services customers • The general public (potential service users)

Campaign messages must be carefully differentiated to meet the needs of each of these audiences.

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3.1.3 What the campaign will comprise To raise awareness of the charity and the causes for which it is raising money, the communications and marketing campaign for 2016/17 and q1 of 17/18 will comprise: Press/PR

i. Launch of the new charity brand, strategy and website at the Trust AGM, with the support of Patron, Simon Weston.

ii. Internal and external press and PR campaign from Sept 28th for 2 weeks to generate as much coverage as possible of the charity re-launch.

iii. 1 large cold call email inviting people to opt into a charity mailing list to staff, suppliers, customers, volunteers, FT members and stakeholders in late September.

iv. Running regular articles on the charity in Staff Matters in the run up to the launch.

v. Generating monthly good news stories for release to the media and internal circulation.

vi. Scheduling three big communications campaigns during the first year – one for each of the three fundraising campaigns on which the charity is focussed.

vii. Identifying key speaking opportunities where we can raise awareness of the charity with local politicians, business people, educational institutions and grant giving charities.

Using SCAS activities/print to raise brand awareness viii. Introduction of a charity branded leaflet by September 28th, for use in all

engagement work undertaken by the Trust and including sections on “how you can support the charity”, “volunteering for SCAS”, “working for SCAS” and “using SCAS services appropriately”. This to be widely distributed at Governor led, HR and Patient engagement events; carried on all PTS vehicles and inserted into all postal responses to people contacting the trust with compliments.

ix. Adding the charity logo, text to give and web address to the vinyls on the outside of all trust response vehicles.

x. Adding the charity logo, web address, and postal address to the standard patient discharge information form left with every patient at their home.

xi. Replacing NHS lanyards with charity branded lanyards for all new staff. xii. Including a section on the charity in corporate induction. xiii. Widely promoting a “keep what you raise” competition across teams and sites

to be run in late June/early July 2017, with the top 3 teams having an additional £500, £250, £100 given to them by the charity. All funds raised to be spent by teams in line with the objectives of the transforming 999 care campaign.

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Increasing brand awareness through fundraising activities xiv. Contracting with BIU limited to get branded textile recycling bins in public

areas across Hampshire during July 2016. xv. Contracting with a lottery supplier who will help promote the charity. xvi. Recalling all collecting boxes and re-issuing under the new brand. xvii. Providing CFR schemes and other volunteer fundraisers with newly branded

templates for recruitment materials, poster templates, car stickers and gift aid forms.

xviii. Gradually replacing all banners, flags and gazebos already owned by CFR schemes with newly branded versions.

xix. Closing down all “independent” CFR websites (over time) and providing CFR schemes with a profile page on the charity website and a template for a facebook page.

3.2 Developing and delivering fundraising activities

Historically income to the charity has come from 3 sources: • CFR fundraising • Grateful patient donations • Legacies

With the exception of the activity undertaken by CFRs, fundraising has been passive, and in order to generate increases in income, the charity needs to engage in pro-active fundraising. However, the charity cannot yet afford the kind of team that can develop relationship based fundraising, manage large teams of volunteers or organise fundraising events. The start-up strategy is therefore focussed on:

i. Promoting the charity. As has already been stated, no-one gives to an invisible charity and if we achieve nothing else, then we must promote the charity much more widely to people who might be moved to give. ( see section 3.1)

ii. Contracting with third party fundraising service suppliers. The charity has limited time or money available to invest in fundraising activity. Initially it is envisaged that most new income will come from contracts with companies supplying lottery and recycling services. The fundraising budget assumes that we will join the Unity lottery service, as we were unable to conclude successful negotiations with our preferred supplier in the risk averse, post Brexit climate. Fundraising budgets have been adjusted to reflect this.

iii. Developing corporate partnership. The charity will provide a single point of oversight for the Trusts relationships with businesses from which it is seeking sponsorship or philanthropic support. A consistent corporate partnership offer will be developed, so that the value of business support is equitable across the Trust. The charity will build and maintain a database of corporate relationships, and will proactively seek up to 6 corporate partnerships in

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2017/18. This will be the major focus of the CEO’s time on direct fundraising activity.

iv. Giving the CFRs the resources they need to increase their fundraising. This

strand of activity is underway, and the first major step has been to bring all CFR schemes under the umbrella of the South Central Ambulance Charity, rather than having support split between the charity and the SCAS League of Friends. The CEO has spent a considerable amount of time meeting CFR fundraisers in order to identify the support and resources they need, and an audit of CFR fundraising techniques and the materials they need is underway. The focus now is on putting the “train and equip our volunteers” campaign front and centre in all the charity activity; improving the financial admin service we give CFRs; providing them with the branded resources they need and encouraging them to take up and use them; ensuring the corporate supporters they recruit benefit appropriately from the development of the charity and improving the governance of their fundraising activity.

v. Enabling individual giving by offering on line resources and support. The

charity will not have the capacity to focus on recruiting and supporting individual fundraisers and it is unlikely we will be able to afford to develop this aspect of what we do in the lifetime of this strategy. The strategy assumes that Governors and Board members will lead by example and consider setting up monthly direct debit donations to the charity. It also assumes that, initially, we focus on making sure our website supports and promotes individual fundraising efforts; that we have systems in place to look after the people who do fundraise on our behalf and that we encourage staff to signpost grateful patients to our website to see how they can support us.

vi. Promoting fundraising activities. The website and ongoing communications

campaign will actively promote fundraising activities which range in scale from hosting a collecting tin or holding a cake sale to in memoriam giving, legacies, runs, bike rides and challenge holidays. However there will be limitations to the number of individual fundraisers the charity can support.

vii. Actively encouraging staff fundraising. The charity is already working with the

communications team and operational managers to raise awareness of the charity with staff. This will continue and the internal comms campaign will focus on: promoting what is in it for them; creating in house teams for events, running an annual “keep what you raise” month in late June/early July – with the top fundraising teams having their funds topped up by the charity; including information on the charity in induction and supplying all staff with basic information on an ongoing basis about what to do if you are offered a donation.

viii. Longer term developments. As the charity matures focus will need to shift to encompass solicitation of gifts from major donors, active encouragement of legacy giving and trust and foundation fundraising. These activities will

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require at least one more member of staff in the team, and this is budgeted for in 2018/19.

3.3 Improving the support we give to volunteers. The Trust relies on volunteer car drivers to deliver its PTS targets, and on CFRs and Co Responders to deliver the quality of patient experience it aspires to in emergency service response. The charity will be reliant on volunteers to support its fundraising activity. Raising money to train and equip the volunteers who help the Trust deliver its services will be the central campaign of the charity, but the charity also needs to support and grow the volunteer led fundraising that is undertaken on its behalf. At the moment the Trust does not have a coherent trust wide strategy for recruiting, training, on-boarding and supporting its volunteers. Each operational division takes responsibility for its own volunteer teams and is very successful in doing that, but departments are not signposting volunteers to other opportunities in the Trust. There is no central volunteer database, the Trust is not signed up to on line volunteer recruitment services, does not have a strategic relationship with the councils for voluntary action in its patch, and does not have a senior leader who is accountable for taking decisions on partnership working to recruit volunteers with other public sector partners. The potential to volunteer with SCAS, the opportunities on offer and the reliance of the Trust on its volunteers are not widely known. CFRs are expertly supported and deployed by the team of Community Liaison and Training Officers (CLATOs) in their clinical volunteering roles. CFRs have also been the only active volunteer fundraisers to date, and whilst they have had support from CLATOs in this area as well, they have not received a good enough service from the Trust or its charity in terms of banking monies, meeting their spending requirements, giving them information on their fundraising activity, thanking them, providing them with basic fundraising materials, advising them on grant applications or training them. This service has not been good enough anywhere in the SCAS region, but has been particularly lacking in Oxfordshire and Buckinghamshire. Equally, the potential to grow the contribution CLATOs and CFRs can make to fundraising for other Trust campaigns has not been explored at all. Volunteer car drivers are expertly supported and deployed by the PTS service, but have not been made aware of the charity, and it has not played any role in supporting recruitment or retention of these volunteers, or encouraged them to become fundraisers. The internal audit process is expected to make clear recommendations about how process pathways need to be improved for volunteer fundraisers and communicated more effectively to them. It has already been agreed that the charity will recruit a Charity Officer, whose primary function will be to deliver the audit recommendations by providing CFR fundraisers with an improved financial admin, reporting and

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transaction service, and by providing a first point of enquiry and contact for volunteers on fundraising questions. It is proposed that the charity also:

• Becomes the front door for all volunteer recruitment, and the vehicle for promoting the contributions volunteers make to the life of the trust.

• Actively recruits its own volunteers to support delivery of this strategy. • Plays an active role in all volunteer training. • Takes the lead for the Trust on building strategic relationships with other

volunteering umbrella bodies active in the region. • Reviews and advises on the volunteer agreements in place across

operational departments.

3.4 Building relationships with other charities who support the Trust SCAS benefits to varying degrees from the work undertaken by several other charities, and managing and maintaining these relationships as it develops its own charity will be vital. The approach proposed with each of the main players is outlined below:

i. Air Ambulance Charities. The CEO should meet at least 1/4lly with the Heads of Fundraising, and should seek to ensure that the approach taken by all three charities towards working together is one of open, collaborative partnership and mutual support. This approach has been agreed in principle and firm foundations for supportive joint working have been laid.

ii. The Ambulance Service Charity. The CEO should maintain a dialogue with

The ASC, and the charity and HR department should actively promote the benefits and services it offers all staff, paid for by its LIBOR funds. HR should promote the potential benefit of becoming a regular donor to The ASC to any staff member who might also benefit from access to their physical rehab and PTSD services – both of which require you to be a monthly donor to access.

iii. BASICS Hampshire and Thames Valley. The CEO should encourage a

dialogue between BASICS and the Air Ambulances, in order to ensure synergy between the development of both approaches to Dr attendance at the scene of an accident or emergency.

iv. West Berkshire Rapid Response Cars. Having facilitated a discussion which

has led to the refresh of the SLA between the Trust and this charity, the CEO now needs to attend 6 monthly SLA review meetings, which will incorporate sharing of information on corporate fundraising strategies to ensure collaboration on donor approaches and management.

v. SCAS Benevolent Fund. The CEO has facilitated an awayday for the

Trustees, who have developed an action plan for development. They are developing a new, sustainable and more relevant business model and will

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spend a year actively trying to recruit new members. They have agreed, in principle, to sign a Memorandum of Understanding with the Charity that commits them to information sharing with the Trust, so that it can be assured about the activities being undertaken in its name. They will not be seeking any funding other than through staff subscription, and will not be promoting themselves outside the Trust.

vi. Hayling Island First Responder charity. This charity has agreed to work

towards folding up and transferring its activities and funds into the SCAS Charity within 12-18 months. In the meantime it has agreed to sign a Memorandum of Understanding setting out joint working arrangements.

vii. SCAS League of Friends. In accordance with the delegated powers granted on April 28th, the Charitable Funds committee has written to the League of Friends to inform them that the Trust wishes them to cease, immediately, using the SCAS name, or referencing any kind of relationship with the Trust in any activity they undertake or materials they publish. This decision means that they can no longer fulfil their objects as a charity, and discussions are ongoing about the appropriate use of the balance of the funds they hold, and any future role for their brand and their trustees in the work of the South Central Ambulance Charity. These discussions need to be concluded by the early autumn.

3.5 Development of appropriate governance and operational processes 3.5.1 What is in place Some steps have already been taken to build the operational infrastructure of the charity:

i. The ToR for the Charitable Funds subcommittee have been revised, are attached at Appendix One and will need formal Board approval on July 13th.

ii. A risk management framework has been developed and is in active use.

iii. The Internal Auditors are reporting with recommendations on financial

processes to Audit Committee on July 13th, and the actions they recommend will be reviewed and adopted. These will address current weaknesses in the ways in which money raised by volunteers is banked, and in how spending from charitable funds by CFRs is agreed and authorised.

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3.5.2 What is needed

In addition the Charity needs to develop:

i. A collection box management regime. ii. A fundraising event registration process. iii. A systematic approach for maximising gift aid. iv. The means to order and track use of promotional materials, to ensure they

deliver a fundraising return. v. A means to run costed fundraising promotional campaigns throughout the

year, and to measure the return. vi. A means to calculate and track the cost/benefit return of fundraising activities. vii. Clear processes for communicating with, and supporting fundraising teams,

individuals and corporate partners. viii. Clear processes for communicating with donors, and for recording individual

donor activity. ix. Thank you processes. x. Volunteer recruitment, retention and deployment policies and procedures. xi. A policy on receiving gifts in kind. xii. Criteria and a process for distributing funds to beneficiaries other than CFRs. xiii. Processes for updating its website and social media, and for monitoring CFR

promotional activity. And in due course: xiv. Processes for developing fundraising from major donors, legacies and trust

and foundation applications. 3.5.3 Making this happen i. Database. A specialist fundraising database would enable the first ten items on

this list to be efficiently and effectively managed – and would automate many of the required processes. It would lay the foundations to enable the charity to start to build the future fundraising activity anticipated for 2018/19 and 2019/20, and will meet the needs of Indirect Services for a system to manage CFR recruitment, training and communications. Standard packages cost between 8 and 12k to set up, with ongoing licence/support costs of about £1-1.5k per year. Demonstrations have been booked for potential end users in the charity, CFR and finance teams with 3 leading suppliers, following which a procurement exercise will need to be run with appropriate input from procurement and IT. The costs of such a database have been factored into the budget, the Charity Officer has been recruited in part on her ability to develop and manage this, and it needs to be up and running by the end of September.

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ii. Other systems and processes. Development of criteria and processes for

distributing funds will be complete in time for the Charitable funds committee to approve proposals on September 5th, and the other policies and procedures will be on the agenda for review by that committee in October.

iii. Human resources. This strategy can be delivered by the CEO and Charity Officer, as long as the database is purchased and the charity has the active support of the communications, finance, IT, procurement and leadership teams. It cannot afford to be re-charged for those services for the foreseeable future. The strategy envisages needing and being able to take on a third member of staff in 2018/19. This will be a fundraiser role, and will enable development of a wider range of fundraising activities.

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3.6 Budget for 2016/17-18/19

ACTIVITYhow many

individual target total gift aid total

how many


how many


monthly donors 15 £10/month 900 225 1125 25 £10/month 3000 750 3750 50 £10/month 6000 1500 7500

lottery players 25050p/week to us 2500 0 2500 500

50p/week to us x52 weeks 13000 0 13000 1000

50p/week to us for 52 weeks 26000 0 26000

recycling (tonnes donated) 200 £100/tonne 20000 0 20000 500 £100/tonne 50000 0 50000 600 £100/tonne 60000 0 60000individual challenges 0 0 0 0 5 £1,000 5000 625 5625 5 £2,000 10000 1250 11250Corporate partners 0 0 0 0 0 6 £10,000 60000 0 60000 10 £10,000 100000 0 100000one off/community activities 10 £500 5000 625 5625 25 £500 12500 3125 15625 35 £500 17500 4375 21875individual donations 10 £50 500 125 625 25 £50 1250.0 313 1563 50 £50 2500 625 3125major events 0 0 0 0 0 10 £500 5000 1250 6250 10 £500 5000 1250 6250CFR fundraising 200000 5000 205000 250000 12500 262500 300000 15000 315000

TOTAL 234875 418312.5 551000

Expendituretrain and equip volunteers 205000 250000 315000Train and equip communities 0 20000 45000Transform 999 care 0 20000 45000CEO 78750 78750 80325Charity officer(s) 35000 35000 70000Promotional materials 10000 10000 12000travelling and other expenses 6000 6000 8000database installment payments 6000 6000 1200memberships 1500 1500 1500legal fees 2000 2000 2000trust recharges 0 0 0

total fundraising costs 139250 139250 175025

TOTAL expenditure 344250 429250 580025

costs as % of funds raised % 59 % 33 % 32

Impact on balance sheet

Balance in reserves at start of year 526000 541625 530688League of Friends transfer 125000needed from reserves 109375 10938 29025balance to c/f 541625 530688 501663

2018/192017/182016/17

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ACTION PLAN

ACTION PLAN ACTION When WHO AGREE STRATEGY FOR CHARITY

Exec Committee consider first draft complete JU/RC CoG consulted on first draft complete RC CF Sub committee consider second draft complete JU/RC Board approve creation of b5 post to facilitate transfer of LOF funds and improved support to CFR fundraisers

complete JU

Board discuss and approve strategy 30/6/16 & 13/7/16

JU/RC

IMPROVE GOVERNANCE, RISK MANAGEMENT & OPERATIONAL PROCESSES

Board agree CF Committee ToR 13/7/16 RC/JU Internal audit identify inadequate controls 13/7/16 RC/JU Risk register considered by CF committee on an ongoing basis and incorporated into Corporate Risk Register

8/6/16 RC

Develop and agree an MoU with other charities using the SCAS logo and name that provides assurance to SCAS board

By end July 2016

RC

Review and revise arrangements in light of audit findings By end October 2016

RC

Join IoF and Assocn of NHS Charities to access up to date information and advice complete RC Agree process and criteria for fund distribution By launch in

Sep 2016 RC

Specialist fundraising database live By end Sept 2016

RC

Remaining policies and procedures approved by CF Committee 20/10/16 RC RAISE THE PROFILE OF THE CHARITY

Patron secured 8/6/16 GH/RC Website ready to test and finalise 22/8 AH Name , logo and strapline to Board for approval 30/6 BH/ RC Vehicle branding with charity brand to be incorporated in NHSE funded re-livery of all trust vehicles tbc RC How You Can Help Us engagement /awareness raising leaflet ready to go to print 30/8 RC

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ACTION PLAN ACTION When WHO Branded fundraising materials ordered 5/9 MA Costed implementation plan agreed with comms for redesign and reprint of any SCAS print that is going to incorporate the charity brand

25/7 BH/RC

Internal re-launch comms and PR plan finalised 25/7 GH/RC External re-launch comms and PR plan finalised 25/7 GH/RC Initial opt in mailing sent 30/9 Ch. Off Induction, badges, lanyards etc featuring charity Jan 2017 RC/MS Fundraising campaign 1 launched March 2017 RC Fundraising campaign 2 launched Sept 2017 RC Fundraising campaign 3 launched Dec 2017 RC

BUILD RELATIONSHIP WITH OTHER CHARITIES

CFR and co responder funds transferred from LOF 1/8 RC/ND Agreement reached on future of other LoF funds 4/9/16 RC 1/4lly meetings taking place with Air Ambulances From 8/6/16 RC WBRRC new SLA signed 30/7/16 NM/RC MoU signed with Hayling Island Responders 30/10/16 RC Benevolent Fund Trustee awayday facilitated 27/5/16 RC MoU signed with Benevolent Fund 30/8/16 RC

LAUNCH FUNDRAISING ACTIVITIES

Lottery partner signed up 15/8/16 RC Charity Challenge partner signed up 15/8/16 RC Agreement confirmed with Bag it Up 30/6/16 RC Scheme to enable all CFRs to provide first aid cover at events in return for donations in place 1/7/16 RC CFR fundraising event registration process up and running 30/10/16 RC Resources required for: fundraise for us; regular donor giving; corporate partnership; text to give; and legacy giving campaigns completed on website ready for launch

5/9/16 RC/GH

Amnesty on collecting boxes and re-issue under new governance Oct 2016 RC 4 corporate partners signed up March 2017 RC Staff keep what you raise competition June/July

2017 RC

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ACTION PLAN ACTION When WHO IMPROVE SUPPORT TO VOLUNTEERS

Recruit Charity Officer as single point of contact for CFR fundraisers 21/6/16 RC/ND Review systems and processes in light of audit feedback and set up new ones 31/8/16 ND/Ch. Off. Move all financial transactions to Charity Officer 31/8/16 ND Communicate changes to CFRs 15/9/16 Ch. Off. Purchase and install database 20/9/16 Ch.Off. Co-ordinate volunteer recruitment through charity website and print From 30/9 RC Review and harmonise policies and procedures across departments & start building strategic relationships From Jan

2017 RC

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4. Conclusion

This strategy is not without risk and challenge, but if the Trust commits to supporting and overseeing its delivery, it will deliver on the three principle intentions behind investing in development of the charity. It will:

• Ensure the Trust maximises the potential of its charity to raise funds that can be invested in developing and providing services that are additional to the core NHS services the Trust is funded to provide.

• Mitigate against the risks to its reputation that could arise from insufficiently pro-active management of its charitable activity.

• Improve the support and recognition provided to the volunteer CFR fundraisers who have been the lifeblood of the charity for several years.

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Appendix 1: SCAS CHARITABLE FUNDS COMMITTEE TERMS OF REFERENCE 1. Reason for updating

1.1 The TOR for this committee need to be updated following a review of charity governance arrangements conducted by the Board at its seminar of February 25th 2015.

1.2 This set of TOR, once agreed, will replace those agreed on April 2nd 2015.

2. The remit of the Trust Board

2.1 The Trust Board is responsible for all the affairs and activities of the SCAS Charitable Trust (reg’d charity no 1049778), in its role as Corporate Trustee.

2.2 The Board has responsibility for setting the strategic direction of the SCAS Charitable Trust. This will include establishing and agreeing an annual plan and budget for the charity (ensuring that there are clear aims and activities), and determining the spending priorities and criteria for the application of charitable funds.

2.3 The Board will receive and approve the Annual Financial Statements of the Charity and will authorize them for submission to the Charity Commission.

2.4 The Director of Strategy and Business Development and the SCAS Charity Chief Executive will provide support and advice to the Board in developing the strategy, and the Board may request that the Charitable Funds Committee has some earlier input to, and oversight, of the emerging strategy and plans.

3. The remit of the Charitable Trust Funds Committee

3.1 The primary purpose of the Charitable Funds Committee will be to ensure that there is appropriate governance over the activities of the charity. The committee will be responsible, with delegated authority from the Board, for:

3.1.1 Seeking assurance that the application and investment of funds is in accordance with the spending priorities, criteria and scheme of delegation set by the Board.

3.1.2 Confirming that the charity acts in compliance with relevant legislation.

3.1.3 Ensuring that appropriate arrangements are maintained in respect of financial reporting, accounting and audit, and internal control systems.

3.1.4 Monitoring and reviewing the integrity of the SCAS Charity Annual Financial Statements, including having them independently audited; recommending the Annual Financial Statements to the Board of Directors for approval and ensuring their subsequent submission to the Charity Commission in the required format and in the required timescale.

3.1.5 Taking some day-to-day decisions regarding application and investment of charitable funds, in accordance with the framework set by the Board (a delegated authority limit for expenditure will be set by the Board and all spending decisions taken by the Charitable Funds Committee should be reported back to the Board as part of an assurance report).

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4. Membership/Attendance 4.1 Membership of the Committee shall consist of a minimum of three Non

Executive Members of the Board. 4.2 The Chair of the Committee will be a Non-Executive Director, appointed

by the Board of Directors of the Trust. 4.3 The committee will be attended by The Director of Business and Strategy

and/or the Director of Finance; the SCAS Charity Chief Executive and the Assistant Director of Finance, Financial Control, or an appropriate deputy.

4.4 Other officers of the Trust and/or Non Executive Directors will be invited to attend for specific agenda items as required.

5. Quorum

5.1 The Committee shall be quorate if two of the three NEDs who make up the committee are present.

5.2 The Chairman has the casting vote.

6. Frequency of Meeting

6.1 The Charitable Trust Funds Committee will normally meet not less than three times in each financial year.

7. Reporting Arrangements

7.1 The Committee’s prime purpose will be to ensure effective governance of the charity and to oversee delivery of the strategy agreed for the Charity by the Trust Board.

7.2 Within agreed areas of delegated authority the Committee will report to the Trust Board on matters arising from its meetings. At a minimum the Committee will provide reports to the Board after each meeting of the Committee. These regular reports will cover:

7.2.1 Progress on delivery of the agreed strategy. 7.2.2 Report on funds raised and disbursed within agreed levels of

delegation. 7.2.3 Risks to the delivery of the agreed strategy, and mitigating

actions proposed to address these. 7.2.4 New opportunities arising for development of the Charity that

the Board may wish to act on. 7.3 The Committee will bring requests to approve disbursements from the

Charity’s funds that exceed agreed levels of delegation to the Board at the first opportunity after such applications have been received.

7.4 The Committee will assure the Trust Audit Committee, as required and requested, that an effective system of governance, risk management and internal control is established and maintained for the SCAS Charitable Trust.

8. Other Matters

8.1 In accordance with all other Committees of the Board, the Committee will review its own effectiveness on an annual basis.

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9. Scheme of delegation

Charity funds can be distributed according to the following scheme of delegation: Over £10k Charitable funds committee Up to £10k Director of Finance or Director of Strategy and Business Up to £5k CEO of Charity Up to £2.5k Lead Community Response Officer Up to £250 CLATOs Up to £50 CFR scheme leaders

Review date June 2016.

Next review date May 2017.

This version incorporates final edits requested by CF Sub Committee on June 8th 2016.

0

Agenda Item: 15



Title NHS Improvement 2016/17 Quarter 1 Return

Lead Director Charles Porter, Director of Finance

Purpose of the paper To update the Board on the quarterly performance to enable the Board to sign the quarterly self-assessment return

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

The Board is asked to review the report and agree the four declarations that should be made.








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

Please provide details of the risks associated with the subject of this paper Risks are outlined in the detail of the paper.

Implications Regulatory and legal implications / impact (e.g. Monitor provider licence and continuity of services risk ratings, CQC essential standards) NHS Improvement – our current financial risk rating is a 2, which is in line with the plans that we submitted to NHSI. CQC – N/A

Financial implications / impact (e.g. CIPs, FRR, year-end outturn) The quarterly NHS Improvement return includes details of our financial risk rating.

Council of Governor implications / impact (e.g. links to governors statutory role) All public Board papers are shared with the Council of Governors.


The paper should be read in conjunction with a number of other Board papers (e.g. Quality and Patient Safety Report, Integrated Performance Report, and Finance Report), recognising that the Trust’s objective is to ensure clinical quality whilst maintaining a sound financial and governance environment.

Other Supporting information, including background papers and previous considerations by the Board

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

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

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NHS IMPROVEMENT 2016/17 QUARTER 1 RETURN Executive Summary

The Board is asked to discuss and agree what declarations should be reported as part of the 2016/17 Quarter 1 Compliance Declaration and what the final sign off process should be. The Trust is required to make four declarations as follows: “The board anticipates that the trust will continue to maintain a financial sustainability risk rating of at least 3 over the next 12 months.” On the basis of the latest financial reports it is recommended that the Board of Directors is unable to make this declaration. It is expected that the risk rating will be a 2. “The board anticipates that the trust’s capital expenditure for the remainder of the financial year will not materially differ from the amended forecast in this financial return.” The Board confirms that it is able to make this declaration. “The board is satisfied that plans in place are sufficient to ensure: on-going compliance with all existing targets (after the application of thresholds) and a commitment to comply with all known targets going forwards.” Whilst the Trust successfully hit Red 19 in Q1, it missed all the targets in Q4. This is for the following reasons:

a. Exceptionally high demand. b. The introduction of amended definitions for the Red targets.

Given the record of performance over the last few quarters, it is recommended that the Board declares a risk to hitting Red 1, Red 2 and Red 19 in quarter 2. The reasons for this vary but are largely due to a combination of:

• recent difficulty in achieving consistency of the targets

• high and unpredictable demand

A range of mitigating and recovery actions are in place as part of the continued turnaround plan to ensure the best possible performance is achieved. These include but are not limited to:

• increasing planned resource (SCAS and private provision)

• robust action plan and engagement with acutes on hospital delays

• resource escalation plan to improve performance as demand fluctuates

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“The board confirms that there are no matters arising in the quarter requiring an exception report to Monitor which have not already been reported.” It is recommended that the Board confirms that it is not able to make this declaration due to the fact that although we are close to having a 999 contract signed for 2016/17, the Trust will need to revisit its budget in light of the funding gap. We have undertaken a process of mediation, and are fully committed to ensuring a satisfactory outcome for the Trust. Board of Directors There were no changes to the composition of the Board in quarter 1. The Board ended quarter 1 with an equal number of voting Non Executive and Executive Directors. Provision had been made for the Chair to have a second/casting vote should a voting decision be required. Following a recruitment process in late 2015, one new Non-Executive Director, Sumit Biswas, joined the Board on 1 July 2016. NED succession planning arrangements to appoint a new Chair, and additional Non Executive Director(s) during the course of 2016/17 are in place. Council of Governors One governor resigned during quarter 1 – a public governor for Berkshire. There are currently five public governor vacancies and elections will be held later in 2016. Governance Rating The Trust expects to achieve the red 19 target in Q1 but miss red 1 and red 2, as follows: Indicator Target Achieved/Not

met Explanation (if failed to meet)

Actual

Ambulance Category Red 1 minute response time

>75% Not met See above 74.0% (est)


>75% Not met See above 73.1% (est)


>95% Achieved 95.1% (est)

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Finance: Quarter 1 / quarter to June 2016 Commentary The financial section will be completed once the period 3 financial result has been finalised. I can update the Board on this at the Board meeting. 1. The cumulative position for the year to date is that the Trust achieved an EBITDA of £xm against the target of £xm and a deficit of £xm which was in line with the budgeted £xm deficit. 2. Under the Financial Services Risk Rating, the Trust achieved a ratio of 4 for liquidity, 2 for capital servicing, 1 for financial margin and 1 for financial margin variance giving an overall FSRR of 2. 3. Total operating income for Q1 was £xm which was £xm below plan. 4. Total operating expenses for Q1 were £xm which was £xm above planned expenditure. 5. Savings performance for the quarter was £xm, which compares to a plan of £xm. 6. Capital expenditure additions in Q1 were £xm, which was £xm below the budget level. 7. The cash position at £xm was £xm above plan. 8. The position on 90 day debtors at Q1 was £xk outstanding which represented x% of sales ledger debt. Summary and Conclusion The Income and Expenditure results at the end of Q1 were in line with the revised plan. The Trust's financial service risk rating in 2016/17 was a 2. Charles Porter Director of Finance July 2016

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MONITOR 2016/17 QUARTER 1 RETURN

APPENDIX 1: Financial Summary

To be circulated once financial results for Q1 are known.

APPENDIX 2: Cashflow To be circulated once financial results for Q1 are known.

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Appendix 3


Agenda Item: 16


Title

Board Assurance Framework (BAF)

Responsible Director

Deirdre Thompson, Director of Quality and Patient Care


To note the risk scores and assurances, controls and actions









Please provide details of the risks associated with the subject of this paper Risks in delivering key corporate objectives and strategic aims. Ensure mitigating actions in place.

Implications

Regulatory and legal implications / impact (e.g. NHS Improvement terms of authorisation and risk ratings, CQC essential standards, competition law etc)

Risks associated with response times or delays to patients to a HASU as outlined in risk 1.2 can impact on compliance with CQC outcomes 1 and 4 (Dignity, respect and welfare of patients). Risk of receiving inadequate rating following the CQC inspection as outlined in risk 4.3

Financial implications / impact (e.g. CIPs, FRR, year-end outturn) Financial risks may affect compliance with the NHS Improvement Framework. Risks associated with objective 6 (Commercial Viability) may have implications for Opportunity Pipeline and financial risks, 4.1 and 4.2 may impact on NHSI (Monitor) Compliance.

Council of Governor implications / impact (e.g. links to governors statutory role) Assurance from Council of Governors that risks identified have action plans in place.


Links to the NHS Constitution – principle 7 – NHS is accountable to the public and should therefore transparently take responsibilities for services. The NHS also commits to ensure continuous improvement of services.

Other


BAF presented to the Board at every public meeting. Corporate risks evaluated in the risk register by Executive Committee in the Risk and Compliance Group meeting March 2016 and in the Executive Committee. Corporate Risk Register considered in Audit Committee in April 2016


SCAS NHS FT Corporate Risk Register Department of Health (2003) gate ref: 1054 Building the assurance framework. A practical guide for NHS Boards.

Good Governance Institute (2009) version 2.1 Board Assurance Frameworks: a simple rules guide for the NHS.

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BOARD ASSURANCE FRAMEWORK (BAF)

PURPOSE 1 To highlight to the Board the principal risks to the successful delivery of

the Trust’s strategic objectives and the controls and assurances in place to mitigate these.

2 The report sets out an updated BAF for July 2016. In addition a

monthly risk profile is included which gives a summary view of the mitigated scores of identified risks.

3 The Board are asked to note the risk scores, assurances, controls and

actions in place.

EXECUTIVE SUMMARY 4 The BAF is presented to include monthly risk profiles for 2016 / 2017

year to ensure Board visibility.

5 There are currently 6 red risks and 9 amber rated risks on the BAF as reviewed by the Executive Directors on a monthly basis and by the Audit Committee in Apri l 2016.

6 Risk 1.1 – Risk relating to Long Waits for patients remains red at 16.

7 Risk 1.3 - Consequences of missing red targets remains red at 15.

8 Risk 1.6 – Risk to patient safety, patient confidence and Trust reputation

due to issues with Portsmouth Hospitals NHS Trust and the upward trend in handover delays remains at 16. There has been some improvement since the May Trust Board. If the improvement continues then a reassessment of the risk will be presented at the next Trust Board meeting.

9 Risk 4.1 - The risks around the Cost Improvement Plan delivery and

achieving financial targets remains red at 16 due to the forecast deficit. 10 Risk 5.2 - Effectively managing sickness and absence remains red at 16

although there are signs of improvement using the new processes.

of 2

11 Risk 5.3 – The ability to recruit and retain staff remains red at 20 as the

benefits of all the plans currently being implemented need to be realised with an improved trajectory through the year ahead. It is worth noting that within the Corporate Risk Register this risk has been divided into three risks aligned to the three service area plans.

12 Risk 2.2 – Inability to deliver benefits from the newly implemented 999

NHS Pathways has been removed from the Corporate Risk Register as this is now business as usual and delivering.

13 New risk added in June 2016 - Risk 3.3 – Growth of SCAS charity may

increase Trust exposure to financial and reputational risk during start-up phase.

14 New risk added in June 2016 – Risk 5.4 – Agency cap regulations.

15 Risks on the BAF have been reviewed in full to ensure that

appropriate controls and assurances have been identified, and that any action plans have agreed timescales allocated and necessary updates are provided. They have also been reviewed in terms of their alignment with the Trust’s Corporate Risk Register. The BAF is a key mechanism used to reinforce strategic focus and improved management of risk.

NEXT STEPS

16 The BAF will continue to be reviewed by the Executive Directors at their

meetings with an updated report being presented to the Board of Directors meeting.

CONCLUSION

17 The BAF has been further reviewed and updated since the last report to

the Board in May 2016 and reflects the risks for the current year.

RECOMMENDATIONS TO THE BOARD

18 The Board are asked to confirm that the principal risks have been

identified and are being adequately mitigated. Deirdre Thompson Director of Patient Care

RAG

Strategic Objective Risk Principal Risks Date Co Lik Tot Current Control Measures Gaps in Controls Current Assurance Gaps in Assurance Action to be taken Respons. Timing / Co Li Tot

6 1.4 Private providers not consistently meeting required standards resulting in poor patient outcomes and experience

5 4 20 Bi monthly quality assurance monitoring and checks of all PP's used by SCAS. Liaison with CQC when PP's are inspected. Revise list of approved PP's and policy to ensure assurance. SIRI investigations where required and learning applied.Using a limited number of companies Tender process to reduce number of providers

Learning from SIRI's ongoing. Monitoring of all PP's used if a company outside of agreement used National tender to be agreed Local contract to be agreed Vehicle communication infrastructure (not standardised)

Bimonthly quality assurance monitoring. Weekly reviews of PP's used. Strengtened template of assurance process. Heightened awareness for SLT of approved PP's. SCAS liaison with CQC inspections of PP's. Redefining service specification.Clinical Governance framework developed - awaiting ratification Clinical governance framework for PP’s approved by Q&S committee Sept 13 Agreed a zero tolerance approach when staff have not administered the “basic” level of care & assessment

Use of non approved PP's when demand is high Contract in negotiation Clinical Governance framework to be developed.

November 2015 situation remains unchanged with PPs still regularly checked and no SIRI's. Additional PP's are being brought on stream so continue with current processes. Conduit has been reviewed by NHS Pathways and SCAS Head of NHS 111 governance followed up with further review and agreed actions on the number of compliance audits by call handlers Feb 2016: Monthly governance reviewes continue with no significant concerns raised. APRIL 2016: No concerns raised JUNE 2016: Continue with monthly reviews and unannounced inspections of provider sites.

Philip Astel COO

Weekly review with formal bi-monthly monitoring

3 2 6 6

21 1.5 Non compliance with timescales for complaint acknowledgement and responses

3 3 9 Recruitment under way for Head of Patient experience. Process mapping exercise completed and identified changes are being planned - for implementation in January 2016. Review of complaints team structure currently being undertaken. Agency staff being employed whilst permanent recruitment is ongoing. Reports of current caseload have been reviewed and will be completed weekly so that the situation can be closely monitored. Clinical Governance leads will be involved in process.

Poor experience for complainants, potential increase in complaints relating to process issues. Non compliance with national targets/ contract quality schedules leading to increased external scrutiny. Reputational risk

Action Plan for recovery New processes yet to be embedded January 2016: New Manager appointed to start mid January. Assistant Director of Quality managing the department and focusing and responding to the backlog. Feb 2016:Actions on track, Head of Complaints and Complaints Officer now in post. Redsign of processes having a very positive impact hence reduction in risk to 6.APRIL 2016: Actions continue to improve the responsiveness for complaints June 2016: Our SCAS Acknowledgement within our target of 3 days has improved to 86%. Further work to improve the final resolution responsiveness is progressing with formal reporting by service to the Trust Board from September onwards.

Deirdre Thompson Director of Quality and Patient Care

Weekly review with formal bi-monthly monitoring

3 2 6 6

22 1.6 Risk to patient safety, patient confidence and Trust reputation due to issues with Portsmouth Hopsitals NHS Trust and PHL. Lack of assurance for patient safety in ED and ED queue at Portsmouth Hospitals NHS Trust, associated impact on PTS due to late planning of discharges. PHL s inability to deal with demand in this locality.

4 3 12 Risk summit attended by stakeholders with 30 day action plan agreed. Trust will attend further risk summit in January. Local metrics identified for weekly monitoring . These include impact on emergency and 111 services. Queues being managed and permanent deployment of Jumbalance at Portsmouth hospital site. Regular calls with PHL

Poor patient experience and potential for adverse clinical outcomes. Poor reputation and risk to performance

Reviews of patient incidents demonstrating poor patient experience and minimal evidence of patient harm

Delays continuing at high levels February 2016: Performance in the SE Hampshire area continues to result in very lengthy delays at ED and also resultimg in significant delays in all categories of patinets. Senior Management Team engaged on a daily basis and all efforts being made to resource up to mitigate the risk when possible. Concersns escalated to Commissioners, CQC, NHSE and TDA. CSD continue to support patients who are waiting and the clinical team continue to audit incidents following delays. Continue to have significant media interest which is being managed through the Comms Teams.APRIL 2016: The OPs and Clinical Team are reviewing further actions to further mitigate the impact on long waits: • To have further clinical assessment at key points in their wait (Luci Stephens lead)• A protected ‘Green’ response that would focus on the longest, most vulnerable patient (Mark Ainsworth Lead)• It was also agreed that a ‘Perfect Week’ be planned internally and in collaboration with other stakeholders / providers in the area and tested the w/c 3rd May 2016 to ensure that the Trust better understand future resource requirements (Rob Kemp and Mark Ainsworth-Smith Leads)• There was some discussion on the use of indirect resources to manage the long wait patients and the operational team will be exploring this further (Mark Ainsworth Lead)• It was also agreed that our current escalation policies and procedure are reviewed and streamlined to ensure that senior decision makers have the resources and support in times of increased demand and hospital handover delays (Mark Ainsworth Lead)• Alongside the policy review it was also agreed to add in guidance for staff on how to manage / care for patients within a queue in an ED department or when waiting for periods of time in an ambulance (Jane Campbell Lead) June 2016: Extended Ambulance Handover Patient Care Standard Operating Procedure finalised to further support patient care. Improvements have been seen in handover delays over the past 4 weeks and SCAS continue to monitor this.

DT Weekly review with formal bi-monthly monitoring

4 4 16 16

7 2.1 Poor IT Resilience 4 4 16 Programme of resilience improvements approved by the Board Nov 12 following peer review of resilience Virtual telephony business case approved for implemenation Aug 14 Back up procedures strengthened.Replacement of the UPS at Northern House Mch 14.

January 2016: ICAD report identified just minor items from a detailed audit of processes Feb 16: Review of ICT Security went to Dec 15 Board. Review of ICAD upgrade whent to Jan 16 Board.APRIL 2016:Update to telephony action plan and external penetration testing reviewed at Exec in March. Internal audit being carried out in March reviewing success in covering resilience actions. June 2016: This risk has been downgraded as there has been a consistent performancve in terms of IT over through Q4 and in the fist 2 months of Q! 2016/2017

Charles Porter Director of Finance

Weekly review

4 3 12 12

3

November 2015 The trust has moved into turnaround mode with significant focus on performance and additional reporting of kpi's and accompanying actions Feb 2016: This continues to be a rising challenge since Jan and is being managed by areas and up to the Board level. Immediate Handover policy is being implemented when possible albeit a challemge due to space and trolley issues at the ED's. PHCP is also supporting crews in the ambulance crews to further support patinet safety alongside the Team Leaders. APRIL 2016: Handover delays have continued to impact on our ability to respond to patients. The main impact has been in SE Hampshire, although other acute trusts have seen an increase in attendances affecting their turnaorund times. The ops teams have been focusing on the clear up times to improve our vehicle availability. June 2016. The fundamental of this risk remain the same although performance has picked up in April. The trust's funding position may increase this risk.

June 2014: Some early evidence of improvement

1520

9Deirdre Thompson Director of Patient Care

Monthly review

3

2. Emergency Performance

22/06/16

1.2 Failure to convey patients to HASU in a timely manner and failure to provide adequate pain relief to STEMI patients

1. Clinical Excellence: Quality of care, patient safety and experience

22/06/16

3 12

1,2

4,5

22/06/16

51.3 Availability of resources (fleet and staff) and turnaround times at hospitals, resulting in delays to patients and inability to meet targets - red and green calls consistently

16

204

Action plan in place for STEMI and stroke (in IPR) rate SCAS performance mid table

22/06/16

Deirdre Thompson Director of Patient Care John Black, Medical Director Philip Astel COO

Improved CQC QRP Patient satisfaction surveys Staff satisfaction surveys/ staff safety culture audit increase in reported compliments CQC compliance with Outcomes 1,4 and 7 Quality Accounts and national ambulance benchmarking Audits of patient care records and delays to care Information on complaints and incidents shared with staff Production of ‘you said we did ‘ news letters Trust lead human factors work stream across south central –conference March 2012 with LD Patient Champion New Appraisal system implemented Random reviews / audits of delays provided assurance of quality of care, but also identified learning or improvement areas – (key priorities for quality accounts) CSD governance framework reviewed Jan 13. Compassion element applied to appraisals May 2013. Team leader training in patient experience in June 2013. Time critical transfer policy reviewed. Penalties in new acute trust contracts for A&E delays. Double verification now live across SCAS focusing A&E departments on timely handover Weekly deep clean performance data in line with vehicle availability being monitored KPI performance management meeting with MAKE READY Directors monthly Pilot of 9 week deep clean schedule commenced 4th Nov September 2014: Add in Indirect Resources actions and also North Hampsire CQUIN pilot and also the winter resilence plans

1.1 Inconsistency in providing clinically excellent, evidence based and safe patient care as outlined in national quality measures / indicators .(Long Waits, Non-Conveyance and availability of equipment)

Board Assurance FrameworkRaw Risk

RatingMitigated

Risk

44

34

3 9

16

CRG monitor network developments - stroke, ppci and trauma. IPR data set reported to board Clinical audit programme Clinical memos and directives to staff SIRI review group minutes and lessons learned incident reporting April 2014: Stroke and STEMI interogation and campaign with senior OPs and Clinical Team members driving changes - Sept-14 Stroke interogation and campaign with senior OPs and Clinical Team members driving changes. Robust action plan and trajectory in place and being monitored. Robust action plan and trajectory in place

Safety Peer reviews Consistent data quality/thematic HCP feedback collation for 111 services further development required Organisational learning from incidents, complaints and SIRI’s and patient experience data. Learning triangulation from legal claims/complaints/incidents. Need for Qlikview to have consistency in all its reporting. need a safety culture audit planned for Q2 2013. CQUIN plans for ACP's and GP triage and Non Conveyance. Timeliness of clinical data. Consistency of clinical data.

November 2015 ACQI report guideline re-issued to staff on how to gain compliance. ePR configuration change control notice has been sent for evaluation and pricing with a view to it being in the November update. When ePR dataset included in the dataset this shows an improvement in complianceJanuary 2016: No further update - monitoring performance .On improvement trajectory for the April reported percentage Feb 2016: STEMI Performance on trajectory 76.7% - Medical Director continues to engage with Acute providers and the Stroke Networks regarding location of HASU's. Stroke 60 performance improved from same period last year folowing Campaign 'Fast Means Fast' APRIL 2016: The peformance for March 2016 is 59%. The Medical Director continues working with Wycombe HASU and the Stroke Network to ensure that SCAS are engaged with any future decisions on the location of this centre; The performance for the March is 76.1% hence the improvement has been maintained following the campaign and ensuring the inclusion in the EPR datasets. JUNE 2016: Recent review demonstrates that patients are receiving analgesia however there are incidents when patients do not record the patients pain score. This is being reinforced with clinical staff to ensure that this is recorded going forward. Recent improvements continue with the April performance at 60%.

November 2015 Monitoring continues. Long wait continues to be higher than target Implementation of NARP should improve resource utilisation, early indications look positive. Implemented revised CSD protocols to enable clinicians to intervene in incidents to assist with alternative pathwyas suitable for patients. January 2016: Some improvement seen through the latter part of December with NATP and CSD interventions / chnage of focus February 2016:Long Waits remains a concern and is being impacted by increases to hospital handovers and demand, long waits impacted aso by the focus to ensure that all Red (life threatening calls) are responded to. Welfare checks continue by CSD clinicuans for Long Wait patients. APRIL 2016: The performance for the March is 56% hence the improvement has been maintained following the campaign and ensuring the inclusion in the EPR datasets. June 2016. The fundamental of this risk remain the same although performance has picked up in April. The trust's funding position may increase this risk. June 2016. In April the long waits reduced significantly because demand and red acuity dropped but the fundamental issue remains. The ARP code changes are the long term solution in part and we have done a limitied trial on a Green tail vehicle to judge the effect.

4Monthly review

4DH quality indicators and measures for 111 and 999 services JRCALC guidelines/Pathways for 111 audit process 1% of calls Trust Board and Quality and Safety Committee assures clinical and quality governance processes Audit committee reviews and cross references quality domain Executive Team monitors all quality and clinical processes and policies and performance Performance, complaints and incidents reviewed by the PERG and Quality and Safety Committee Clinical Review Group reviews Processes and education for all staff to raise awareness Monitoring of clinical work streams through clinical committee and governance structure Quality and clinical metrics embedded in Integrated Performance Report CQC Quality Risk Profiles New evidence supporting new care pathways (STEMI, stroke and trauma) . Planned programme of equipment maintenance in place monitored through H&S committee. Internal audititors report Feb 13 of equipment.

Need to ensure that the trajectory for improvement is achieved through monthly monitoring of performance

All front line staff have JRCALC manuals and pocket books PCI indicators benchmarked nationally Individual scorecard for staff through the CARS system Quality Report Account KPMG audit of quality account SCAS clinical strategy/CAG meetings 111/ Quality Contract reports 111 CQC compliance with Essential Standards Green 4 action plan to increase hear and treat Research and development strategy in place with research resource developing Clinical Audit plan in place and agreed by CRG and Q&S April 2013 Internal audit provided substantial assurance against CQC standards New pathways of care in place for PCI. And Stroke with demonstrated outcome benefits. CRM monitoring of stroke improvement plan. Patient survey plan agreed at PERG June 2013 /111 satisfaction surveys Internal audit of medicines management – substantive assurance of safety of medicines storage and administration processes . Contract Performance reports and scruitiny. Performance on national quality indicators improving from previous months (Oct data) SCASCADE launched to share learning

Patient outcomes and experience due to delays through whole organisational learning from SIRI’s and complaints. Action required to address complaints pertaining to attitude of staff. Analysis of National Ambulance benchmarks (Sept 2012)Staff training requires an element of customer services as a thread running through all programmes of education. Review Francis report findings and apply robust learning programme and assurance.

Stroke data for CTD times being audited.Stroke data for CTD times being audited Negative media stories Increase in complaints and incidents in 2012- drill down to reasons staff attitude, delay and not sending an ambulance remain the main reasons Risk identified with non conveyance current theme for experience - learning identified with CSD surveys Numbers of incidents reported as a delay. CSD peer reviews to be routine. Fleet improvement plan not yet implemented fully.

8

5Deirdre Thompson Director of Patient Care Philip Astel COO

Monthly review and daily analysis

DH quality indicators and measures Patient Experience Group scrutinising data and developing actions Executive Team monitors all quality and clinical processes and policies and performance Complaints, concerns, comments and compliments monitored through the PERG. Delay to backup audit commenced. Fleet review 2013. Increased workshop hours for fleet. Contracts in hospitals to apply penalities for delays. UHU project to meet supply and demand needs. Daily monitoring, Resources adjusted as per demand, Roster management, UHU project and modelling, REAP escalation plans and CSD reviews

RAG



RatingMitigated

Risk

9 2.3 Inability to deliver the ePR deployment programme & realise the benefits

3 4 12 Financial Pressures Will lead to competitive disadvantage Poor reputation

Early project phase Membership Engagement Strategy Membership and Engagement Committee Support for governors e.g. engagement toolkit Charter of Expectations inc no. of engagement events Programme of Engagement events inc. constituency meetings and patient forums Training commenced in the pilot areas

Early project phase November 2015 software updates implemented for clinical reporting. January 2016 EPR now rolled out for Portsmouth conveyance. Summary Care record now live. Mobile directory (mobile DOS) now live and being rolled out in Hampshire. Feb 16: Final area (Oxford) now completed. Mobile directory now rolled out to Berkshire. APRIL 2016: Benefits review to be presented to June 2016 Board JUNE 2016: review of benefits carried out which shows numerous benefits in excess of the business case, but financially some areas not delivering - E - learning, and with non conveyance it is difficult to establish how much is to due EPR, although total non conveyance has improved more than the target.

Charles Porter, Director of Finance

Monthly review

3 3 9 9

11 3.1 Risk of Information Governance Breach

4 5 20 June 2014: The process for loading files on to the website has been modified. The controls have been enhanced to ensure Senior manager sign off publishing rights to the Web manager alone, pending a review and retraining of all editors, Controls have been enhanced in the HR team for handling sensitive data

Outlined in the BDO Audits of the Information toolkit

Through rapid response to the incident led by FD Communicating to staff regarding the extent of the issue Full Co-operation with the ICO Improvement programme to significantly reduce the likelihood of a similar incident happening again Managers are ensuring that their staff have completed the online IG refresher training. Additional IG steering group meetings to monitor. Sept 2014: Wider review of IG commissioned with BDO

percentage of staff completing IG online refresher training uptake throughout the trust

August 2015: Continued progress on improvements. Awareness training planned in conjunction with ICO and other Ambulance Trusts Feb 16 Awareness training w/c 22 Feb.APRIL 2016: JUNE 2016:Continued improvement in IG processes and culture

Charles Porter Director of Finance

Bi-monthly review

3 2 6 6

26 3.3 Growth of charity may increase Trust exposure to financial and reputational risk during start up phase

22/06/16 2 3 6 Higher than anticipated cross subsidy may be required in start up phase. Increased profile of charity may bring challenge about charity governance & compliance.

Early in start up Internal audit advising on governance issues; joined expert membership bodies to access advice; full board reviewing development strategy; CF sub committee monitoring delivery.

Early in start up Minutes of Cf Committee meetings; Audit report. James Underhay, Executive Director of Strategy

Quarterly 2 2 4 4

13 4.1 Risk to achieving financial targets and realise CIP’s.

5 5 25 Cost improvement plans agreed and monitored Board approved budget & performance management of budget LTFM aligned to Monitor framework Monthly financial monitoring by Board and Executive Team. Board agreement in Sept 12 to spend additional monies at operational level. Challenge by Audit committee Internal Audit reviews or accounts Local Counter Fraud work External Audit & SIC . Cashflow reporting and analysis. Performance management of CIP'sCIPs reported monthly to the board. Strengthened CIP governance tracking process implemented. Increased performance management of late payments and debtors Review forecast risks at Board which are then mitigated. Internal audit report with substantial assurance.

Austerity measures to be identified and agreed. Ensuring end of year position with CIP's identified.

History of good financial management Board approved budget on 25th March 2012 CIP meetings Internal and external audits inc. year end audit reports Minutes of Board, audit committee and executive committee. 6 monthly budget reviews External Review Boards each month with commissioners Benchmarking against peers Improved SLR Performance management of CIP’s through business programme board and executive team Clean audit report and value for money conclusion

Forecast readjusted therefore increased risk. Demand continues at a high level. Period 7 surplus and cost savings behind budget

November 2015 updated financial position approved by the Board. Internal turnaround in place. Framework in place to find £1m of improvement to the position. January 2016 To date tracking slightly ahead of the agreed forecast position Feb 16: Surplus continues to be ahead of position. June 2016 Still in dispute with contracts for the 999 service. CIP target behind plan and being monitored via Turnaround

Charles Porter, Director of Finance

Monthly review

4 5 20 20

14 4.2 Cost of delivering performance levels in 111 higher than assumption

5 4 20 Monthly reporting to the board.Monthly Performance Review meetings.Detailed improvement plan

111 business is new so control measures need to be adapted.

Track record of delivery of budgeted financial surplus Track record of financial recovery programmes National acceptance that the 111 service is different to originally envisaged (giving opportunity for variations)

No Track record of 111 business controlling cost or delivering the of budgeted financial surplus Service is still new so cost may vary for reasons which are not known. High sickness and attrition affects cost.

November 2015 Service is running well with focus this quarter on service delivery. Expected to deliver improved efficiency during the next quarter due to economies of scale but will continue to monitor Feb 16 Improved financial position in 15/16 due to One Call, but not at budget level. Vacancies affecting call answer and therefore penalties.APRIL 2016: Significant volume increase in March compounded by the low staff numbers and lower provision of service from Conduit lead to poor performance and high sanctions. Growth in March was 21% higher than prior year, however Easter fell in April. Overall growth in 111 was 2.7% on prior year. The year did have two Easters and an extra day being a leap year. JUNE 2016 : This risk is being contained by controlling overtime, Bank Staff and allowing the PP to under deliver and therefore under pay. However the fundamental issue remains that the cost of delivering 95% is significant. Efforts to reduce call times will help.

Charles Porter, Director of Finance. Chief Operating Officer

Monthly review

4 2 8 8

15 5.1 All staff access not met for education and training to meet mandatory, clinical and organisational requirements

4 4 16 Education training programme Statutory and mandatory training Training needs analysis Integrated workforce plan Appraisals and training monitored through scorecard by Exec Committee and Board

Operational pressures Northern cluster rota not yet operational undermines ability to deliver against the trajectorySustainability of provision of training CQC outcome 14 compliant but requires an outcome lead. Appraisal data not yet available for 12/13. Compliance with elearning for IG and Fire not yet achieved.

Training remains on trajectory adhering to programme Staff feel valued and have received training applicable to role – as reviewed by SHA and CQC visit Recruitment plan trajectory aligned to integrated workforce plan. Training needs analysis and review of needs for commercial sector. Staff survey results. Elearning programme to be introduced making learning more accessible. Monitoring of uptake to be done.Face to face training commenced May 13

Loss of hours due to recovery action plans. TNA to be reviewed and developed.Plans in place to deliver statutory and mandatory training Rostering system will ensure correct availability of staff Potential breach of H&S legislation not actioned in a timely manner. Review of reasons for absence with personal accident data.

May 2015 - Training plan for 2015/16 agreed by Workforce Board and due to REAP 2 plan being implemented. PTS training plan commenced with good abstraction and attendance to date. August 2015 low demand levels have led to reduced income and pressure on costs vs income. This is being mitigated by endeavouring to reduce resource in line with income wherever possible without impacting service APRIL 2016: S&M Training attendance to be monitored weekly by Executives during Q1 2016/17.

Will Hancock, CEO. Melanie Saunders Acting Director of HR

Monthly review

4 3 12 12

Action plans agreed with the key leads and in progress and await completion and evidence of completion

November 2015: CQC inspection preparations are on track, action from DT report on track January 2016: NHS 111 CQC focused inspection draft report received for factual accuracy checking. Report findings are positive and support the completion and effectiveness of the actions resulting from the DT SIRI investigation Feb 2016: CQC report published and the one 'Should' action in progress APRIL 2016: A technical solutions now sourced to ensure that going forward the Trust will be able to track that staff have viewed clinical memos or information relating to changes to standard operational procedures.. This will close the one should action from the Nov 2015 NHS 111 focused inspection.JUNE 2016:all actions completed and CQC have inspected the service as part of the Trustwide rated inspection in May 2016. Early feedback from the inspectors was in the main positive but we await the final report.

Bi-weekly updates EMG and final SIRI report to Trust

Board and Commissioner

s

2

882

2 4 4

3.2 Risk to patient safety, patient confidence and Trust reputation in the NHS 111 service if recommendations and actions are not implemented in a timely manner following the investigation into the Daily Telegragh publication / incident / concerns

22/06/16

3. Stakeholder preception and Trust

reputation

12 4

4.3 The risk of of not being rated 'outstanding' or 'good' following the May 2016 rated comprehensive inspection

Inspection methodology is still new and untested. No ratings given as a pilot inspection. Awaiting report

4

Actions to be identified and implemented in a timely manner

Through a rapid response to the publication and allegations within, led by the Director of Strategy, Communications and communicating openly and transparently with Commissioners, Stakeholders and Regulators and through the very early involvement of staff and patients potentially affected significantly reduced the risk to reputation. The declaration of a SIRI and launching of a comprehansive investiagtion, agreeing ToR with key stakeholders, further reduces the impact. Bi-weekly progress updates to EMG and early identification and implementation of actions will further reduce the risk.

164

Track record of delivering projects Track record of positive judgements of compliance following previous CQC inspections Leadership drive and focus to receive outstanding rating and focus in all areas by the Exec and SLT

Deirdre Thompson, Director of Quality and Patient Care

Deidre Thompson Director of Quality and Patient Care

Monthly reporting to the board. Bi- Weekly Plan to Executive meetings. 3) Detailed project and readiness / compliance plan . Comprehensive Action Plan being implemented post inspection and monitored via Executive management Group

Weekly Review

Through rapid response and launch of a comprehensive SIRI investigation and the responsiveness from all parties involved ensures that the investigation progresses and meets the ToR set.

November 2015: CQC Action plan on track and reviewed by Execs every 2 weeks January 2016: Action plan on track. CQC rated inspection planned for the 3 - 6th May 2016. Readiness plan presented to the Executive Management Committee and being implemented through Q4. Feb 2016: Data being submitted on 3rd March. Previous action plan on track. Liaising with the CQC regarding forthcoming inspection May 2016.APRIL 2016: Plan on track and working very closely with the CQC Logistics Team and also their Analysts. Plans are now in place for the formal interviews and staff supported by the Trust Compliance team. COG and Trust Board updated on progress. JUNE 2016: CQC inspection completed along with the submission of all data requests. The Trust awaits the draft report and continues to monitor compliance and act on areas for improvement e.g. Meds management processes.

3

22/06/16

412 Pilot inspection - first wave with unclear methodolgy for the sector

22/06/16

4. Sound Governance

5. Leadership and Culture

10

RAG



RatingMitigated

Risk

16 5.2 Effectively managing sickness absence and staff absences

4 4 16 Area Managers action plans to reduce sickness absence. Monitoring at Workforce Board.

All ops managers to be trained to use Kronos absence module.

Team leaders trainined in absence management and use of policy. Joint working with Occupational Health to rehabilitate staff back to work. Slight decrease in absence showing.

Figures not showing consistent month on month reduction in all areas.

November 2015: Health, Wellbeing and Attendance project mobilised in 3 phases incorporating U&E Care, CCC. Aim of the project to reduce absence in order to add more resilience ahead of winter pressures. Will also focus on ensuring that the reduction achieved is sustainable by equipping managers with a 'tool kit' of health and welbeing tools in order to assist management of attendance in future. APRIL 2016: H&WB strategy in draft, focused work for CCCs to take place during Q1 2016/17. Absence monitor daily by line managers and weekly at Exec level.

Will Hancock, CEO. Melanie Saunders Acting Director of HR

Monthly review

4 4 16 16

5.4 Agency Caps/Regulations 5 4 20 Being managed and monitored by NHSI weekly on the level of activity and breaches of regs - equating to possible fine and sanctions

New Project Agency task and finish group established weekly actions taken. Working with all agencies and providers to engage with the regulations and adherance to the guidance

New Project The outstanding agency is Medic now who whodul be on the correct framework by the 9th July 2106 - this is late so we will be reporting a breach.

Melanie Saunders

Exec and Board review bi monthly

3 3 9 9

November 2015 Project teams mobilised for both SHIP 2 and TV PTS contracts. Governance structure agreed and in place. Steering group meeting regularly to oversee key workstreams Feb 2016: Implemenation on track and reviewed by the Executive Management Team in Feb. Engagement with Acute providers proactive and positiveAPRIL 2016: SHIP Phase 2 and the TV mobilisation have been implemented successfully. We continue to monitor feedback from patients and providers and also KPI's to ensure that the service is safe, effective and responsive.JUNE 2016: TV and OHFT Contracts launched successfully and now being operationalised. Excellent feedback from commissioners and service users in relation to mobilisation effort. SHIP2.2 due for launch in August 2016. Project on track with Executive scrutiny of project on bi-weekly basis

Continued recruitment programme Increase GP use in CSD Monitor at WFDB Attrition data further analysis increase CPD opportunities Monitor at WFDB

James Underhay Executive Director

Will Hancock, CEO. Melanie Saunders Director of HR

Exec and Board review bi monthly

November 2015 Health, wellbeing and attendance project implemented. In addition to plans for a "we're listening" action plan, focusing on improving day to day issues that staff indicate are an factor in retention.February 2016: Recruitment trajectories continue to achieve above forecast, activities monitored via Exec at Turnaround meetings. Integrated workforce plans for PTS and CCC now complete, PTS agreed via WFDB, CCC due at WFDB in March 2016. Attrition showing improvements, you said we did action plan in place and monitoried via staff forums and JNCC. Band 6 and APP role launched, work on rotas, mealbreaks and overruns continues to be monitored at turnaround meetings. APRIL 2016: RISK 17 (Recruit to 999) Integrated workforce plans for 2016/17 complete and scheduled for approval at April 2016 WFDB, 999 plan subject to outcome of commissioning for 2016/17. Action plan for improved retention needs further development. RISK 18 (Inability to RETAIN) : Attrition showing signs of improvement, Band 6 and AAP role providing a positive impact, high demand for Paramedic skill set within the wider health ecomony remains biggest challenge to retaining staff, along with work life balance - overruns and missed meal breaks, short notice shift change. You said we did plan to be refined during 2016/17 to include suite of workforce measures to be monitored/improved. RISK 23 (Recruit to NHS111) Integrated workforce plans for 2016/17 complete and scheduled for approval at April 2016 WFDB, plan needs clarity around demand assumptions and ability to train numbers required (seating/trainer capacity). Action plan for improved retention needs further development: RISK 24 (Recruit to PTS) Integrated workforce plans for 2016/17 complete approved during January 2016, Managers need to be focused on delivery of plan as approach is new to PTS management team, recruitment teams to help ensure this focus is provided and deadlines are not missed.

James Underhay Executive Director

20 6.2 Retendering of 111 contracts for Thames Valley and risk of no retaining

4 November 2015 NHS England have published the revised commissioning standards during October 2015. Review is underway to compare current service capabilities against new service and clarify the gaps. Work is well advanced as part of the transformation programme to introduce new innovations within the current service in line with emergency thinking, SCAS working closely with NHS England and is well regarded as a leading provider of 111 services. CQC inspection will be critical to mental perception of the service following the DT undercover investigation. CG been developing a comprehensive plan to address issues identifed as a consequence of internal/external review. Performance of service remain high, meeting most current service KPIs'. Feb 2016: Market warming event attended by SCAS w/c 22nd Feb. Acclerated Clinical Transformation pilots in progress to link with Pharmacy, Mental Health Practititioners and other key practitioners in preparation for intergrated care and assessment going forward. APRIL 2016:SCAS PQQ response developed and submitted in partnership with key TV sub-contractors, (OHFT / BHT / Bucks-HT) Agreement in place to work collaboratively with partner organisations to deliver a compelling and integrated service model. Performance issues still a risk to reputation, which is now being scrutinised through the Turnaround process by Exec. Signs of performance improving as activity volume reducing. Work underway with partners to co-design innovative service model. JUNE 2016:SCAS and TV NHS111 partners working collaberatively to produce a quality submission in response to the MCP procurement process. Extensive partner involvement and Executive scrutiny of the service model and bid submission

22/06/16 124

8None at present

SCAS performance with 111 services has continued to improve, and SCAS is now generally regarded as a strong provider. Issues still remain with key relationships at commissioning bodies, which may have an influence upon future successes at retender.

NHS 111 continues to have a key focus within the organisation to ensure that we are delivering consistently strong performance, at optimal cost to SCAS. Service improvements are routinely being implemented, and outstanding backlogs of QA are being addressed with a formal planned approach

None at present

Both Hampshire and Ox/Bucks PTS contracts may be retendered during 2013/14. Currently it is unclear as to the exact timetable when this may occur, or the likely content of the retendered services. The outcome of these will largely depend on the content and weighting of the ITT requirements

12

8

Reduced performance Poor outcome for patients Hear and treat not improved Poor staff morale Increased use of temporary staff

Monthly review

Creation of a pipe line of opportunities monitored through the Trust Board

4 2

3

Significant engagement ongoing with key stakeholders, scenario analysis developed re potential outcomes and discussed at Trust Board Level. Mitigating actions re service and service performance are underway

Contract performance is routinely monitored and reviewed with Commercial Management team. In addition this is reported to and discussed with commissioners, which may include actions for service or performance improvements and innovations. Performance issues identified are addressed as part of ongoing action planning with clear responsibility for rectification as apporpriate.

Increasing competition for staff from neighbouring trusts

204Conitued recruitment programme and CPD 20Monthly review

82

4

4 53

123

12

RAG Key:Green - Risk is low and or is being adequately mitigated (<8)Amber - Risk is high and is being adequately mitigated (equal to or more than 8 but less than 15)

22/06/166.1 Final mobilisation of SHiP2 and Thames Valley PTS contracts (Potential loss of PTS & logistics contracts along with mobilisation of phase II SHiP PTS contract and ensuring contract KPI's met)

19

6. Commercial Viability

17,18, 23,24

5.3 Ability to recruit Ability to retain staff

Board Assurance Framework 2016/17

PROFILE OF RISK RATINGS 2016/17 (JUNE 2016 Updated BAF)

RISK REG REF

JAN FEB MAR 15/16 APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR

1.1 Inconsistency in providing clinically excellent, evidence based and safe patient care as outlined in national quality measures / indicators (long waits, non-conveyance and equipment availability)

3 16 16 16 16 16 16

1.2 Failure to convey patients to HASU in a timely manner and failure to provide adequate pain relief to STEMI patients 1,2 12 9 9 9 9 9

1.3 Availibility of resources (fleet and staff) and turnaround times resulting in delays and inability to meet targets - red and green calls consistently

4, 5 15 15 15 15 15 15

1.4 Private Providers not consistently meeting required standards resulting in poor outcomes and experience for patients 6 6 6 6 6 6 6

1.5 Non compliance with timescales for complaint acknowledgement and responses 21 9 6 6 6 6 6

1.6 Risk to patient safety, patient confidence and Trust reputation due to issues with Portsmouth Hopsitals NHS Trust and PHL. Lack of assurance for patient safety in ED and ED queue at Portsmouth Hospitals NHS Trust, associated impact on PTS due to late planning of discharges. PHL s inability to deal with demand in this locality.

22 12 16 16 16 16 16

2.1 Poor IT Resilience 7 16 16 16 16 16 12

2.2 Inability to deliver all the benefits from the newly implemented 999 NHS Pathways 8 4 4 4

2.3 Inability to deliver the ePR deployement programme and to realise the benefits 9 9 9 9 9 9 9

3.1 Risk of Information Governance Breach 11 9 6 6 6 6 63.2 Risk to patient safety, patient confidence and Trust reputation in the NHS 111 service if recommendations and actions are not implemented in a timely manner following the investigation into the Daily Telegragh publication / incident / concerns

12 6 6 6 6 6 43.3 Growth of charity may increase Trust exposure to financial and reputational risk during start up phase 26 4

4.1 Failure to achieve financial targets and realise CIP’s. 13 20 20 20 20 20 204.2 Cost of delivering performance levels in 111 significantly higher than assumptions 14 8 8 8 8 8 8

4.3 The risk of of not being rated 'outstanding' or 'good' following the May 2016 rated comprehensive inspection 10 8 8 8 8 8 8

5.1 All staff access not met for education and training to meet mandatory, clinical and organisational requirements 15 12 12 12 12 12 12

5.2 Effectively managing sickness absence and staff absences 16 16 16 16 16 16 16

5.3 Ability to recruit and retain staff 17,18,23,24 20 20 20 20 20 20

5.4 Agency Caps/Regulations 25 9

6.1. Final mobilisation of SHiP2 and Thames Valley PTS contracts (Potential loss of PTS & logistics contracts along with mobilisation of phase II SHiP PTS contract and ensuring contract KPI's met)

19 12 12 12 8 8 8

6.2 Retendering of 111 contracts for Thames Valley and risk of not retaining 20 9 9 9 12 12 12

OBJECTIVE 5: LEADERSHIP AND CULTURE

OBJECTIVE 6: COMMERCIAL VIABILITY

OBJECTIVE 1: CLINICAL EXCELLENCE QUALITY OF CARE, PATIENT SAFETY AND EXPERIENCE

OBJECTIVE 2: EMERGENCY PERFORMANCE

OBJECTIVE 3: STAKEHOLDER PRECEPTIONS AND TRUST REPUTATION

OBJECTIVE 4: SOUND GOVERNANCE

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ITEM 17 – BOARD COMMITTEE UPWARD REPORTS Summary Upward Report Upward reporting from the Quality & Safety Committee to the July 2016 Public Trust Board Issues identified by the Quality & Safety Committee on 2nd June 2016

Topic Issue Action Taken

Items with issues not achieved/ compliant

1. Serious Incident Requiring Investigation report

Report needs further development. In particular it was requested that this should seek to identify trends and cross cutting themes, and identify actions and learning to address these.

Incorporate SIRI learning into the Aggregated quarterly report. Jane Campbell to action

Areas of Concern/ Risk

2. Staff communications briefing strategy

Nigel Chapman raised an issue regarding the comprehensiveness and effectiveness of the staff engagement strategy

For Action – James Underhay to outline the current strategy directly with Nigel Chapman

Items for awareness / assurance/noting

3. CFRs and Co-Responders Scoping the future role / deployment model of CFRs and Co-Responders

Nic Morecroft supported by Philip Astle (SRO) to progress with involvement from NEDs

4. ARP update Safely moved to 240 seconds Next phase – The introduction of Clinical code set will be a significant change for the Trust

For Noting and to remain as an agenda item for future Q&S Committee meetings – Rob Ellery

5. Long Wait review and update Detailed operational action plan shared with the Committee. Committee noted the ongoing work that is being done but lacked assurance that the issue

Noting by the Trust Board

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would improve with the level of resource available.

6. Leadership Walkabout A number of common issues were identified in reports, indicating the importance of continuing to undertake walkabouts. Also suggested that NEDs engage with more staff through the level 2 meetings

Recommendation to Board – Dates of the level 2 meetings to be shared with invites to the NEDS

board of directors meeting · 2017-03-01 · board of directors meeting meeting in public . date:...

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