east of england ambulance service nhs trust · 1. recruit 400 student paramedics in 2015/16 2. up...

East of England Ambulance Service NHS Trust: Annual Report 2014 - 15

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East of England Ambulance Service NHS Trust

Annual Report 2014/15


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CONTENTS

Welcome by the Chair, Sarah Boulton 3 Foreword by the Chief Executive, Dr Anthony Marsh 3 Introducing the East of England Ambulance Service NHS Trust 4 Review of the year…..and the year ahead 5 Emergency Operations 5 Patient Transport Service 9 Primary Care 11 Commercial Services 13 Resilience and Special Operations 15 Fleet, Estates and Equipment 17 Research and Development 19 Financial Performance 19 Sustainability Report 20 Caring for Patients 22 Serious Incidents Annual Report 29 Our People 36 Risk Management and Information Governance 38 The Trust Board 48 Declarations of Interest 60 Financial Report 62 Appendix A – Annual Governance Statement Appendix B – Annual Report


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Welcome by the Chair, Sarah Boulton I joined the Trust in March 2014 and my primary aim was to work with the Board to make sure we deliver improved services to patients and better support our staff. During this year, I have been impressed by the dedication of our managers, staff and volunteers to help us meet six very clear priorities, which have laid the foundations of our turnaround. It‟s because we‟ve been able to get to the root of the challenges we face - not enough front line staff and not enough ambulances, amongst other issues – that we‟ve been able to do this and I thank everyone involved in helping us to reap benefits for patient care within one year. As a Board, and because the Trust‟s recovery is underway, we are now developing a new strategy, vision, values and culture to take the next steps towards becoming a top performing ambulance service. Getting the culture right within our service is inherent in allowing us to keep moving forward at pace to build on the significant developments we‟ve seen – it helps individuals flourish, and it has a direct influence on patient care. By working towards these common goals together, regardless of where we work or volunteer in and around the region, we know that we can evolve the East of England Ambulance Service into one that we can all be proud of. Foreword by the Chief Executive, Anthony Marsh I became Chief Executive in January 2014, a time when the Trust was extremely challenged with poor performance and delays in responding to patients, to lead the turnaround and improve our service to patients. I immediately set six clear priorities for everyone in the service to focus on to build a sustainable and high performing ambulance Trust. These were:

1. Recruit 400 student paramedics in 2014/15 2. Up skill emergency care assistants (ECA) to emergency medical technicians (EMT)

and EMTs to paramedics 3. Maximise clinical staff on frontline vehicles 4. Reduce response cars and increase ambulances 5. Accelerate fleet and equipment replacement programme 6. Reinvest corporate spend in frontline delivery

I am pleased that we have delivered all of those priorities – resulting in the recruitment of over 500 front line staff, a modern and well equipped ambulance fleet and the reduction of £14 million in management and support service costs – and as a consequence we have seen our service to patients improve, despite a 6% rise in demand and increased levels of hospital handover delays. As a result of this hard work, there have been significant improvements to our performance and the service we provide to patients. In particular we have seen a reduction in delays responding to patients and a fall in back up delays, something that was all too common when I first joined the Trust. Over the year we have also seen substantial improvements to our 999 call answering standards, and we are now one of the best performing ambulance services in the country on two of the four national ambulance targets.


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I, and the Board, recognise there is much more work to be done. This is why we will continue to recruit and train hundreds of new Paramedics over the coming year, up skill our existing emergency care assistants to emergency medical technicians (EMT) and EMTs to paramedics, maintain the most modern ambulance fleets in the country and identify more efficient ways of working in our management and support functions. Our six priorities for 2015/16 are:

1. Recruit 400 student paramedics in 2015/16 2. Up skill 60 Emergency Care Assistants to Emergency Medical Technicians

(EMT) and 40 EMTs to paramedics 3. Continue fleet replacement programme to maintain all frontline vehicles less

than five years old 4. Reinvest corporate spend in frontline delivery through robust benchmarking 5. Implement an organisational development programme 6. Secure the purchase and implementation of the new Computer Aided

Dispatch system Having put the foundations of recovery in place we will also be focusing on delivering an organisational development programme to change the culture of the Trust and further improve staff morale. This work has already started as we work with our staff and volunteers to establish a new set of vision and values for the organisation. Over the coming year, as we continue to build on the turnaround we have put in place, we will see our service to patients continue to improve and at the same time make this an even better place to work. Please accept my many thanks for everything you, our staff and volunteers, have done to achieve these improvements. I am very proud of you all. Well done.

Introducing the East of England Ambulance Service NHS Trust The East of England Ambulance Service NHS Trust (EEAST), established on the 1st July 2006, provides emergency and urgent care services throughout Bedfordshire, Cambridgeshire, Hertfordshire, Essex, Norfolk and Suffolk. Our dedicated and skilled staff work 365 days a year, 24 hours a day to make sure patients receive the best possible care. We have more than 4,000 staff operating from more than 130 sites and a fleet of 1,000 vehicles. We are supported by more than 1,500 volunteers who provide community first responder and volunteer ambulance car services. The eastern region is made up of both urban and rural areas with a population of nearly six million, as well as the many tourists who enjoy visiting the area in holiday seasons. It includes major airports and docks which increase the number of people in our region on a daily basis. The emergency 999 service About 2,400 emergency 999 calls come into the ambulance service every day and are answered and managed in our emergency operations centres at Bedford, Chelmsford and Norwich. The call handler records information about the nature of the patient‟s illness or injury to make sure they get the right kind of medical help. Our call handlers use sophisticated software to put the patient‟s condition into a particular category, depending on how urgent it is. This is known as triaging, and allows us to make sure the most seriously ill patients can be prioritised and get the fastest response.


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Once this key information is established, the response will be either an emergency ambulance dispatched on blue lights, through to further clinical assessment over the phone for patients with minor conditions which could be advice over the phone from a paramedic or a referral to their GP, pharmacist or local walk-in center. Not just an emergency service As well as providing the 999 emergency ambulance service, we also provide a range of other services including: Patient transport services and primary care We provide non-emergency patient transport services around the region to help people who need assistance because of their medical condition or age, from home to outpatient appointments at hospitals or other care centres. This service also provides specialist neonatal transfers between hospitals for babies in need of special care. In 2014/15 we also ran the 111 non-emergency health service number in Norfolk but unfortunately we were not awarded the contract for the next five years and will handover operations in September to another provider. Special and partnership operations The Trust operates two hazardous area response teams (HART) and has a resilience and emergency planning department who work closely with critical care charities and community volunteers to respond to a variety of emergency situations. Commercial services We operate a number of services which generate income for the Trust. These include training for blue-light drivers and first aid at work. In addition there is a contact centre and a medical service which cover events, festivals and medical repatriation.

Review of the year…..and the year ahead Emergency Operations When someone calls 999 the first person they will speak to is a call handler in one of our emergency operations centres. The call handler asks a number of questions to ascertain as much information about the patient‟s illness or injury to ensure that the right type of medical help is arranged. Given the high volume of 999 calls received, the Trust has to prioritise each patient according to the seriousness and nature of the problem. This is to ensure those with the greatest need get help first. This is done through a sophisticated software system which categorises the severity of each patient‟s condition. There are six nationally agreed categories each with a nationally agreed response target for the Red categories and local commissioner agreed Green and Urgent targets as detailed in the table below.

Category Description Response time and target

Red 1 Patients with potentially life threatening conditions; for example a cardiac arrest

An eight-minute response 75% of the time

Red 2 Patients with potentially life threatening conditions; for example a suspected stroke

An eight-minute response 75% of the time

Red 19 Patients requiring transport to hospital receive a vehicle able to transport them in a clinically safe manner.

A nineteen minute response 95% of the time.


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Green 1 Patients with serious, but not life threatening, conditions; for example a diabetic condition

An emergency response within 20 minutes, 75% of the time

Green 2 Patients with serious, but not life threatening, conditions; for example a suspected fractured arm

An emergency response within 30 minutes, 75% of the time

Green 3 Patients with non-emergency conditions; for example an overdose with no symptoms

A response within 50 minutes or a phone assessment from a clinician within 20 minutes, 75% of the time

Green 4 Patients with non-emergency conditions; for example someone who has fallen with no apparent injuries

A response within 90 minutes or a phone assessment from a clinician within 60 minutes, 75% of the time

For some patients with minor conditions a paramedic or nurse may treat them over the phone, completing a more in-depth assessment to understand what the patient really needs. This may be advice to see their own GP, visiting a pharmacy, or speaking to an out of hour‟s service. This means that those patients get the right care for their needs locally rather than being taken to hospital and potentially very busy A&E departments. Crucially this also frees up ambulances for those in the greatest need, giving them a faster and potentially lifesaving response. Performance Over 2014/15 we have seen significant improvements to our performance. The improvements in performance were, as is documented throughout this report, due to:

hundreds of frontline staff recruited and major up skill training introduced place for emergency care assistants and emergency medical technicians

hundreds of new ambulances delivered with new and upgraded equipment

increased ambulance cover

ambulances back on road faster after handing over patients at hospital

999 calls being picked up more quickly

£14m efficiency savings made in management and support functions since January 2014, money that is being reinvested in the frontline.

These performance improvements have been against a backdrop of increased demand on the 999 service – nearly a 6% increase in 999 calls - and ongoing issues of ambulance crews having to wait extended times at hospitals to hand over patients. In 2014/15, the Trust lost approximately 42,000 hours due to these delays. Thanks to the actions put in place, the Trust is no longer the worst performing ambulance service. Indeed since late 2014, we are reaching the potentially most life threatened patients faster than the majority of other ambulance services. In addition, there have been improvements in the Trust‟s response for Red 2 calls, the second most serious type of emergencies, and the Red 19 target. The plans put in place for 2015/16 will build further improvements to our performance and services to patients Table 1 shows the Trust time response performance for 2014/15 across all categories. For greater transparency, this year we have split out the Trust‟s performance in the green 3 and 4 categories into telephone and face to face responses. We have also split out the Trust‟s performance against different categories of urgent requests – requests made by healthcare professionals for an ambulance to take a patient to a hospital or clinic.


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Table 1

Category/Measure 2013/14 Activity

2013/14 Performance

2014/15 Activity

2014/15 Performance

999 Calls 912,474 964,917

Red 1 13,093 73.57% 15,734 70.99

Red 2 250,695 69.42% 289,264 62.79

Red 19 262,270 92.92% 303,702 91.22

Green 1 46,954 79.12% 36,770 78.67

Green 2 218,592 82.97% 238,306 79.08

Green 3 31,372 90.72%

Green 3 (telephone) 10,016 85.54

Green 3 (face to face)

19,113 92.12

Green 4 95,628 92.99%

Green 4 (telephone) 41,659 93.40

Green 4 (face to face)

59,065 90.59

Urgent 60,242 75.14%

Urgent (1 hour) 19,162 58.90

Urgent (2 hours) 17,559 76.85

Urgent (4 hours) 17,287 86.45

This shows that we have not met national performance targets for the year (Red 1, Red 2 and Red 19). However, as we have seen more staff joining the frontline and ambulance cover increase we have seen continued and sustained improvements across all national targets in the last half of the year. The graph below shows the improvements made, month on month to Red 1 performance.

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Recruitment In 2014/15 we recruited 400 student paramedics to help increase our frontline staffing numbers, increase ambulance cover and work towards our aim of having a paramedic on every ambulance and rapid response car. This is helping to improve our performance and response times to patients. In 2015/16 we will continue to build frontline staffing for the benefit of patients by recruiting another 400 student paramedics. All of EEAST‟s student paramedics go through eight weeks of initial training in the classroom and three weeks of blue light driver training before starting on the front-line. They will receive three more weeks of classroom training in their first nine months as students, before going onto the second year of their paramedic pathway. It takes between two and two and a half years for a student paramedic to become fully qualified and registered. We also put in new career development opportunities for our existing staff. We introduced a pathway for our emergency care assistants (ECA) to train to become emergency medical technicians (EMT) and our EMTs to train to be paramedics. In 2014/15 we trained 60 ECAs to EMTs, and will up skill more than 60 ECAs in 2015/16. We have more than 50 EMTs currently on their paramedic pathway and will continue to offer these opportunities to our EMTs in 2015/16. Modernising the emergency fleet The Trust put in place a massive vehicle replacement programme which saw 267 emergency ambulances replaced– including 27 additional ambulances for the fleet. By the end of March there were no emergency ambulances older than five years. Every new ambulance comes with a full set of brand new medical devices and equipment which altogether means a better experience and more reliable transport for staff and patients. Last year, the Trust also:

replaced 45 Patient Transport Service (PTS) ambulances, five of which have specialised bariatric capability/equipment

introduced four specialist Hazardous Area Response Team-type vehicles to supplement this specialist capability

introduced 68 all-wheel drive Skoda Scout response cars to replace two-wheel drive vehicles, bolstering the Trust‟s all-wheel drive capability in the event of adverse weather.

We are moving ahead with the next ambulance and response car replacement requirements for 2015/16 and 2016/17 to ensure that we maintain an emergency fleet that has no ambulance older than 5 years. Reinvesting in frontline services Since January 2014 the Trust has made savings with a full year effect of £14m. This was achieved through a combination of reducing the spend on agency and interim staff, restructuring back office and management and ending a number of secondments. Community first responders (CFR) A responder is a volunteer trained by the ambulance service to attend emergency calls in the area where they live or work. Their aim is to reach a potentially life-threatening emergency in the first vital minutes before the ambulance crew arrives. We have around 1,400 CFRs and they play a vital role in saving lives in their community. They are an addition to the ambulance service response and often reach a patient in


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minutes to start life-saving treatment whilst the ambulance is on its way. Over the last year the East of England Ambulance Service‟s Community Responders have attended 25,542 calls. On 15,855 of those occasions they arrived prior to the arrival of an ambulance crew and on 9,009 occasions they were within 8 minutes of the call being answered in the Emergency Operations Centre. The volunteer‟s dedication contributes 2.95% towards meeting our Red 1 and 2, 8 minute standard. Led by the community partnership team, the volunteers also promote the role of the CFR and have attended many events in their communities, to inform and educate people on the importance of basic life support and defibrillation and also the role of CFRs in the community. Many support the service and partner charities with training in life-support too. In addition, working with local businesses, sports facilities, community groups, Parish councils and others the community partnership team has delivered 1000 Automatic External Defibrillators (AED‟s) into their local communities. These vital pieces of equipment assist in saving lives of people who go into cardiac arrest, the delivery of these AED‟s and the training of people to use them will help deliver a better service to our patients. We are extremely proud of our CFRs and would like to thank them for their dedication and commitment to the ambulance service and saving lives of patients within our communities. Patient Transport Service The patient transport service (PTS) is used by people who have scheduled appointments at hospitals or clinics but are unable to make their own way there. The criteria for eligibility to use this service are set by the clinical commissioning groups, rather than the ambulance service. During 2014/15 we made 464,194 contracted journeys, equivalent to more than 1,200 journeys every day across Cambridgeshire, Essex, Great Yarmouth and Waveney, Norfolk and Suffolk. We also delivered 20,915 non contracted journeys. At the beginning of 2015 we won the PTS contract for West Essex, covering the Harlow, Waltham Abbey, Epping, Ongar, Saffron Walden and Stansted areas and this commenced on the 1 May 2015. Contracts for patient transport services are tendered by the local clinical commissioning group and patient transport services operate in a very competitive market with many private companies bidding aggressively for the business. The contracted activity has reduced during 2014/15 due to the loss of two PTS contracts: the mid Essex and Norfolk contracts were both awarded to private providers. However; we do believe the Trust is best placed to deliver patient transport services, with dedicated, committed and passionate staff. The PTS service also complements our 999 emergency services. To deliver our services we use specialist vehicles to transport patients who are elderly, disabled, frail or with mobility or medical needs. Those who are mobile and able to sit comfortably in a standard saloon car may be taken to hospital by one of our volunteer drivers, known as the Ambulance Car Service (ACS). The ACS is a group of dedicated volunteers whose role is to support walking patients travel to their appointments. The volunteers play an essential role in helping us to provide better patient care. Each journey can be stressful for the patient, irrespective of the number of times they visit hospital, so a friendly face and understanding attitude will always put them at their ease.


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This year has seen investment in a number of new vehicles and the fleet has been enhanced with bariatric resources. The number of bariatric journey requests has increased significantly over the last few years and this investment will improve the quality of service to this patient group. Our PTS service also provides resilience to the ambulance service and supports the healthcare response during peak periods (such as winter time), or if a major incident occurs. An example of this was an incident at Southend Hospital in February 2015. PTS staff stayed on duty to help in evacuating patients and move them to places of safety. Such incidents demonstrate the added value which PTS provide to our commissioners and local communities. In addition we have worked with our call centre to enhance the eligibility screening process. This ensures the correct patients receive patient transport and those not eligible can be supported through other community transport services. The value we place on patient‟s views about the services mean we have regular patient satisfaction surveys. Satisfaction with our patient transport service is extremely high, ranging between 87% and 98%. The staff also pride themselves on providing quality care for patients and the cleanliness of vehicles is an important factor in the patient‟s experience. Vehicles are audited monthly and high standards are consistently achieved. Random audits of volunteer car drivers‟ cars also take place. The infection, prevention and control (IPC) target is set nationally at 85% and these figures of the overall percentage of PTS vehicles meeting IPC standards show how well we perform against such national standards:

Cambridgeshire 97.3%

Essex 99.5%

Suffolk 98.8%

PTS as a whole 98.4%

In 2014/15, we maintained ISO 9001 standards in all areas. This is an auditable quality management system and is very valuable as a demonstration of the quality standards that we set for ourselves. Looking ahead, we will continue to bid for PTS contracts which are tendered whilst developing PTS services further. Some of the highlights of our innovative plans for 2014/15 include:

rolling out new bariatric vehicles in Cambridgeshire, Essex, Suffolk and Great Yarmouth and Waveney, adding to our flexibility around patient mobility and safety,

improving our communications with patients through the introduction of improved technology and updating our systems,

care bundles developed giving consideration to the conditions of those patients most frequently transported, so we provide the best possible care as well as giving staff increased skills and training,


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Primary Care The Trust ran the Norfolk 111 non-emergency service and the GP out of hours (OOH) care during 2014/15 but did not win the bid to retain this service and will cease running this service on 1st September. NHS 111 NHS 111 is a telephone triage service that makes it easier for the public to access health care and information 24/7. It is designed for those people who need medical help when it is not an emergency. Patients receive health advice over the phone, or are directed to the right local service for their needs, which could be an OOH doctor, walk-in centre or urgent care centre, community nurse, emergency dentist or late opening chemist. The GP OOH care in Norfolk operates when GP surgeries are closed and provides access to a GP in convenient local bases and over the telephone. Callers are assessed on the telephone by a doctor, and then receive one of the following:

Telephone advice

An invitation to attend a primary care centre

A visit from an emergency care practitioner or nurse

A visit from a GP The Norfolk 111 service has been one of the best performing services in the country. Performance dipped after June whilst we recruited and trained new call handlers to improve staffing levels. Performance was not achieved in December due to high spikes in demand; we experienced an almost 30% increase in calls from the previous December. Thanks to a reduction in these spikes in demand and the extra staff we have recruited and trained performance has returned to its highest standards.

Figure 1: 111 answered within 60 seconds performance.

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Norfolk out of hours (OOH) GP service The Norfolk OOH service has continued to operate successfully, and this is reflected in a low proportion of upheld complaints (figure 2) and a continuing reduction in staff sickness levels. Performance against all standards remained strong throughout the year, with a dip in performance in December due to the exceptionally high demand on the service – a 17% increase in demand from December 2013.

Figure 2: 111/OOH combined complaints as a percentage of total calls answered. Training has been a focus through the year, with drivers getting skid-pan and dispatch training to develop their skills. Communication between the teams has also been improved, thanks to a focus on this area. The high point of the year came during the Easter 2014 period where performance targets were exceeded. This despite an increase in calls compared to the same period in 2013, yet we were still able to provide the fast, efficient service that Norfolk people have come to expect. We were also able to roll out the regional telephony project, which enables the 111 service to allow calls to be presented in either of our call centres and improves performance and enhances resilience.

Commercial Services Medical Care Service (MCS) The Medical Care Service provides dedicated medical event cover across Norfolk and Suffolk, as well as critical care support to the Great Yarmouth and Waveney PTS team. The ambition is to replicate this model, where viable, across the region and the MCS team are also looking at how support for the 999 emergency service can be extended and enhanced. The service has retained and won a number of contracts such as Huntingdon race course cover. Whilst this year has led to a reduction in activity due to the loss of the PTS contract in Norfolk, it enabled additional capacity to further support emergency operations in the delivery of the 999 service. The MCS has developed an excellent relationship with commissioners and continues to support commissioners enhance their PTS contracts. The success of the Great Yarmouth and Waveney Critical Care Service has encouraged other commissioners to review their

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services with potential opportunities for MCS in the coming year. The MCS business model has proven to be a success within Norfolk. In 2014/15, the Board agreed investment in new vehicles to support further development of the team and the service it provides; MCS aims to increase its capacity further and reduce the pressure on emergency operations through delivery of frontline emergency care. Commercial Contact Centre This Norwich-based centre offers 24/7/365 services to a large number of NHS and private sector customers. The management team is focused on exceeding customer expectations which has contributed to the very high level of customer retention and new business development in 2014/15. The team has developed excellent working relationships with customers and especially commissioners who recognise the high quality service provided. In July 2014, the call centre launched a new service providing a message handling and referral service for Birmingham Community Health Care NHS Trust and the patient transport booking service was expanded in November to include the Essex area. The call centre team have responded to patient feedback and worked closely with patient transport service (PTS) managers to develop a new eligibility algorithm aimed at improving the patient experience. This was successfully launched in March. Following our successful tender for West Essex PTS, the call centre has been selected to provide the call handling for the service when it launches. National Performance Advisory Group for the NHS (NPAG) NPAG is a national NHS organisation operating on a self-funding basis. The service is hosted by the trust but NPAG operates at arm‟s length providing clients with an objective and independent service. This group offer a range of management services to the NHS and the wider public sector. NPAG‟s products and services can be grouped into the following four key areas:

National best value and benchmarking groups

Training workshops and courses

Management consultancy services

Conference organisation and event management It has clients across Britain in a wide range of NHS organisations including large teaching hospitals, community organisations, clinical commissioning groups and ambulance trusts. Almost 20 best value groups (BVGs) cover a broad spectrum of interest areas to NHS managers, ranging from sterile services to telecoms. Each BVG provides a national forum for managers and their peers to meet, network, critically compare and review services, and seek continuous improvement in terms of quality, fitness-for-purpose, performance and value for money. In 2014/15 NPAG diversified its training workshop portfolio which included „Putting the Patient First‟ workshops, which was developed in light of the Francis Report. A bariatric patient care workshop was launched in June 2014. A major consultancy project was the provision of management support to Oxleas NHS Foundation Trust in Kent in the market testing and contracting out of all the soft FM services on a newly-acquired hospital site.


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In addition to running the largest ever government finance event for HM Treasury in November for more than 800 people, NPAG also promoted its own clinical engineering (CE) conference in September which, with 16 sponsors, was its biggest CE conference to date. In 2015/16, NPAG has plans to grow existing BVGs and introduce two new ones; promote workshops in new areas and develop the conference service. Driver Training Unit For the fifth year running, the Trust‟s Driver Training Unit (DTU) has been awarded an „A‟ star rating from the accreditation awarding body Edexcel for both the Ambulance Driving (D1) and Ambulance Emergency Response Driving (D2) qualifications. In 2014/15 the DTU trained 43 new staff for the Patient Transport Service and 438 candidates in emergency response driver training. All of the DTU instructional team are qualified 4x4 off-road instructors, Driving Standards Agency-approved driving instructors, and highly-qualified emergency response driver trainers. Commercial first aid training The Commercial Services Team has been running for 14 years in Bedfordshire and Hertfordshire and during the past 12 months, the work within Norfolk and Suffolk has increased significantly. Both the clinical D13 Police Firearms Training and the ILS course with Norfolk and Suffolk Foundation Trust and other work (GP surgery training, dentist‟s courses, school sessions, etc.) has given valuable training to non-ambulance staff who can help in an emergency. The positive feedback we receive is testament to the knowledge and quality of the staff who have delivered the many sessions. There are many staff who continue to give their time freely to visit schools (and other groups) to teach courses across our region. We are keen to support voluntary work like this in the community. Raising awareness of our training is on-going and through the National Ambulance Association of First Aid Training (NASFAT) and its website. As a result we are doing more training. We receive enquiries from colleagues across the Trust, many of whom are front line staff keen to learn about our work. They are our voice and the quality of their front-line work and their enthusiasm for the care of their patients; allow us to reach many more groups of people keen to be trained by us. We continue to alter and improve our existing courses in keeping with the latest guidelines. We are also in the process of developing new courses and revising current ones. We work with our community partnership team, automated external defibrillator (AED) manufacturers, the charity SADs UK and other interested parties. We are passionate about the provision of PADs in schools, other areas of high footfall and rural locations, etc. Work in this field includes training those who may need to use the machines and during the past 12 months we have supplied 40 AEDs to local communities. We have had two External Quality Assurance visits to ensure our first aid courses are of the required standard. Our training staff are qualified in Internal Quality Assurance as well. Our plans for the future include:

restructuring the team to support growing training opportunities

increasing the number of staff


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rolling out more courses across the region and expanding our client-base

developing teaching materials

Resilience and Special Operations The Civil Contingencies Act 2004 (CCA) has been in place for more 10 years and has had a significant impact on the UK‟s resilience arrangements, including NHS ambulance services. The key duties that we have to comply with under the legislation are:

assess and evaluate the risks

compile plans to deal with risks

work with our partner agencies

warn, inform and advise the public

share information between agencies

joint exercise multi agency plans

promote business continuity. The Trust‟s compliance is discharged as a Statuary Ambulance Service; this happens through multi-agency work (national, supra- regional and local resilience fora), and a clear audit trail of appropriate decisions and actions is held and regularly updated. We also comply with the legislation through our resilience arrangements which manages these processes and which are internally scrutinised by the Executive Team. The major incident, business continuity and pandemic influenza plans are revised, scrutinised and tested and are reviewed and approved by the Trust Board every year. The Board also receive an update on the Trust‟s compliance with the CCA and NHS England Framework for Emergency Preparedness Resilience and Response (EPRR) (2013). Under the CCA and NHS EPRR Framework, the Trust completes a three-yearly multi-agency live exercise which will be due in 2016. We also take part in local multi-agency exercises and regularly test our communication processes. Major incidents In 2014/15, the Trust managed and coordinated the response to one major incident and a number of significant incidents. The major incident occurred in August 2014 when a number of illegal immigrants were found in a container in Tilbury, Essex. The Trust response to chemical, biological, radiological and nuclear (CBRNE) incidents The UK faces a sustained period of significant terrorist threat and we actively ensure that the service can respond to any such emergency. Our specialist staff and vehicles mean we can provide national mutual aid support if required whilst maintaining a response within the region. Air operations and charity partners The Trust uses five air ambulances thanks to its charity partners – the East Anglian Air Ambulance, the Essex and Herts Air Ambulance charities, and Magpas Helimedix. The East Anglian Air Ambulance has one helicopter flying into the early hours of the morning and MAGPAS provide a doctor/paramedic rapid response vehicle (RRV) throughout the night twice a week giving the Trust 24/7 critical care for part of the week. Three volunteer doctor-led support teams provide expert care and treatment to patients who are suffering extreme trauma or who have challenging conditions and require stabilisation


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prior to being transported to hospital. These are the Suffolk Accident Rescue Service, Norfolk Accident Rescue Service and Basics Essex Accident Rescue Scheme. The Trust has a 24/7 critical care desk which manages the deployment of specialist response units such as air ambulances, HART and BASICs teams and the air operations team work with the charity partners to promote the value of immediate and specialist care support at incidents within the region. Hazardous area response teams (HART) The HART programme was launched in 2007 to enable ambulance staff to treat patients in the most difficult circumstances, such as a collapsed building, at height, in or near water or at major incidents Specialist training and equipment has given HART staff the ability to work alongside fire and police colleagues to reach patients who are in hazardous environments, confined spaces or trapped at height to give life-saving treatment and care at the point of harm. The Trust now has two HART teams, located in Cambridgeshire and Essex, which are sent to specialist incidents allowing regular ambulance crews to be released from protracted calls, as well as ensuring medical care can be delivered to those in need within a hazardous environment. Business continuity The purchase of Continuity2 software in April 2014 enabled us to start a restructure of business continuity processes. Rather than organise around directorates and departments, which are subject to change, there is now a business continuity process based around localities. Each locality has a named manager who has to complete the Business Continuity Plan and associated Business Impact Analysis. During Business Continuity Awareness week in March, 22 managers attended workshops about exercising and testing of plans. A comprehensive programme of awareness is taking place around the software and business continuity processes. Engaging with other agencies The Resilience and Specialist Operations Unit works closely with a range of stakeholders to ensure a joined up approach to emergency planning and resilience. We also work closely with voluntary aid agencies and host regular networking events for them. We also completed an innovative project with the British Red Cross which will provide additional support to our Special Operations Response Team. Training and exercising The Specialist Operations Response Team (SORT), made up of volunteer staff, provides a specialised emergency response to major incidents involving hazardous materials. To ensure the team is prepared for any eventuality, they receive monthly training. The Resilience and Special Operations teams provide a range of specialist training in command and control, major incidents, and continuing professional development (CPD). All competency-based training courses align with the national occupational standards, and ensure staff have demonstrated competency around their specific roles. The Professional Update (PU) training programme for operational staff has included elements of CBRNE and a personal workbook looking at all aspects of resilience. We pioneered the use of video for the PU session ensuring consistency of delivery and have


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also launched e-learning via the Trust intranet. Debriefing The Trust has a fully-integrated system of debriefing following major incidents and exercises which leads to a report and a subsequent action plan to form any learning points.

Fleet, estates and equipment The Operations Support team have been part of an ambitious programme to modernise vehicles and medical devices ensuring that no ambulance or response car would be older than five years by the end of March 2015. The replacement plans which commenced early in 2014 delivered 267 new ambulances and 68 all-wheel drive response cars, each with the latest life-saving medical equipment. Emergency ambulances One of the six Trust priorities was to accelerate fleet and equipment replacement programme and increase the size of the ambulance fleet. By May 2014, we had delivered 147 new ambulances into service of which 27 were additional to the existing fleet bringing the total ambulance fleet size to 323 emergency ambulances. In the summer of 2014, the Board approved the replacement of a further 120 emergency ambulances, all of which are now in service. By investing in the modern and larger ambulance fleet we have been able to help increase ambulance availability with the latest medical equipment for our staff and patients. The newer fleet predictably has a low failure rate compared to the aged vehicles we replaced and provide the best patient environment available. Rapid response cars By June 2014, we brought into service 68 new all-wheel drive response cars which replaced older two wheel drive cars. This new cohort of response cars greatly reinforces the Trust‟s operational resilience and ability to provide an emergency response to patients in adverse weather or difficult terrain. We are currently concluding the planning and procurement process for the next batch of response cars scheduled to come into service, which will provide a mix of the current Skoda Estate all-wheel drive car and a larger SUV 4 x 4 with a higher ride height which will be of particular benefit within our more rural areas. Patient Transport Service We commissioned 45 brand new vehicles for use by our Patient Transport Service (PTS) teams which have been designed to meet the specific requirements of the patient groups they serve and also meet the latest requirements in terms of specification and build quality. Five of these vehicles have been designed by PTS staff to include specialised equipment and vehicle design to support the care of bariatric patients, now ensuring the Trust has a specific capability to respond to the special needs of this patient group. Healthcare Referral Team This important team manages patients with lower acuity conditions; we rapidly assessed and provided the vehicle and equipment required to enable this team to support A&E services. We provided 27 vehicles equipped to HCRT-approved standards to enable this service to go live in October. We are reviewing HCRT vehicle requirements with a view to providing them with modern, coach-built ambulances consistent with existing designs for an emergency ambulance. Medical devices Alongside our plans to deliver a modern fleet, we have also significantly invested in providing


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new medical devices and new types of equipment to support improvements to patient care. Last year, we completed a full review and procurement process to ensure every spare ambulance and response car was fully equipped. The objective was to ensure all vehicles could respond without the inefficient and frustrating process of moving equipment. All 120 emergency ambulances coming into service by the end of March arrived with a full complement of medical devices and equipment, eliminating the previous practice of putting old equipment on new vehicles. This investment of around £1.8m assures us that we have equipment of sufficient quantity and quality and removes variability in the standard of response we are now able to provide. The Trust is investing more than £12m in new, state-of-the-art 12-lead monitor defibrillators. With 160 having been purchased and in the process of operational roll-out, another 223 were ordered for delivery by the end of March 2015. A further 277 of these will be bought in 2015/16 completing the Trust‟s ambitious and much-accelerated defibrillator replacement plan. This initiative will see the whole emergency response fleet equipped with this latest medical technology. We have also introduced new types of equipment to improve the care that paramedics can offer patients, including the EZIO infusion system used to help access for rapid infusion of fluids and drugs, new traction splinting, specialised trauma „battle‟ dressings to assist in the management of most extreme haemorrhage, and specialised equipment to assist bariatric patients with complex needs. The collective investment is around £2.8m but offers patients much improved care. To support the now well known “chain of survival”, our teams commissioned 1,000 automated external defibrillators (AEDs) worth more than £800,000 which were placed across the six counties in locations such as sports centres, village halls, and libraries saving more lives. Estates In 2014/15 we have improved space utilisation within the estate to reflect the changes arising from the restructure and the increased requirement for training facilities. As a result the trust HQ was moved to our existing ambulance station in Melbourn, Cambridgeshire. The vacated Cambourne premises were adapted to provide a central hub for student paramedic recruitment and training for the remainder of its lease. A new training facility was also established at our Norwich office. This complements the existing clinical training centres at Melbourn and Chelmsford. The Trust has also invested in its Barton Mills site to increase the capacity of the Driver Training school and enhance the Fleet/Clinical Engineering/Frontline T&T throughput of operational vehicles, enabling the commissioning of the additional ambulance fleet. We have acquired new premises in Hemel and St Albans to facilitate the remodelling of the operational estate in West Hertfordshire following the Board‟s acceptance of an offer from Hertfordshire County Council for its leasehold interest in the current St Albans site. The Trust has continued negotiations to relocate its ambulance station at Chelmsford, giving staff a better facility to work in and a more optimum point to deploy ambulances from. It is now anticipated this will be operational in 2016. Discussions with other public sector partners with regard to co-location opportunities have continued. In 2014/15 we signed a generic occupancy licence with Suffolk Fire and Rescue Service and have established response posts in North and South Lowestoft to replace poor


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quality and poorly located premises. We have also established a new operational facility at Bury St Edmunds, to take pressure off the existing overcrowded ambulance station and accommodate some of the additional vehicles and staff working in this area. Based on a 2013 conditional appraisal, we estimated that 40% of our estate was below an acceptable condition. To address this, we are continuing to invest in a backlog maintenance programme which will run over the next five years. We have undertaken major station refurbishments at Clacton, Witham, Royston and Fakenham and this work will increase the functional suitability of the retained estate. Going forward, we will continue to review our estate and develop an estates strategy. This will involve on-going review of our space utilisation and investing in energy conservation technologies as part of our wider carbon reduction plan. Research and Development Research helps us to improve the current and future health of the people we serve. It is essential in successfully promoting health and plays a major part in continuing to improve services and supporting safe and effective care. Research identifies and evidences new ways of preventing, diagnosing and treating conditions. During 2014/15 we enrolled 538 patients and five staff into research approved by a Research Ethics Committee; this activity was for participation in three projects on the National Institute for Health Research (NIHR) Portfolio:

Epidemiology and outcome from out of hospital cardiac arrest registry study.

Early evaluation of the integrated care and support „Pioneers‟ in the context of the Better Care Fund and the Integrated Care Policy Programme,

Variation in rates of ambulance service non-conveyance of patients to an emergency department. The Trust also participated in Collaborations for Leadership in Applied Health Research and Care (CLAHRC) project looking in more detail at use of the emergency ambulance services by people with dementia. Research Support Services (RSS) supported a number of smaller-scale student-level projects by internal and external members of staff. Continued participation in such clinical research activity has demonstrated our on-going commitment to improving the quality of care offered, and to making a contribution to better health outcomes. Relevant emerging research evidence was made available to all staff on a regular basis through dissemination on the Trust‟s intranet. More than 90 staff have also received introductory training about research in the NHS and completed the Good Clinical Practice (GCP) e-learning course. The RSS activity was supported by funding from the new Local Clinical Research Network (Eastern), and through recruitment of subjects to Portfolio studies where applicable. In 2015/16 we will participate in a number of large-scale research projects, one of which will entail the Trust sponsoring research for the first time.


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Financial performance This annual report has been prepared to reflect the activities and financial position of the

East of England Ambulance Service NHS Trust for the year ending 31 March 2015.

For the 2014-15 financial year the Trust met the three important financial targets: Breakeven,

External Financing Limit and Capital Resource Limit. As in the previous year, plans

submitted to the NHS Trust Development Authority (TDA) were used for monitoring our

financial performance during the year.

For the year ending 31 March 2015, the Trust is reporting a retained surplus of £998,000

after impairments of £253,000 which gives rise to an adjusted retained surplus of

£1,251,000. This was ahead of the planned surplus for the year of £75,000.

The surplus is an increase on the reported adjusted surplus of £379,000 for the previous

financial year and is a considerable achievement given the transformation work the Trust

undertook in the year.

Looking at the financial statements for 2014-15, the Trust was able to maintain its operating

expenses at approximately the same levels as the previous financial year, despite a

considerable increase in activity. This together with an increase in revenue for the year has

resulted in the improved surplus position.

One of the principle factors behind the Trust‟s financial performance was the achievement of

our £10.4m cost improvement plan that ensured resource was directed to front-line

operations from support areas, in line with the six priorities.

The Trust was also able to make over £6.4m in capital investments during the year. This

enabled the purchase of 223 new defibrillators to modernise equipment on our vehicles,

together with investment in IM&T and Estate projects to support front-line operations.

The Trust has agreed all our principal contracts and therefore our revenue for 2015-16 and

our budgets for the year have been agreed by the Board. Included in these budgets is a

challenging savings target which will need to be achieved whilst maintaining our quality

standards. The Trust Board will continue to monitor our financial position and key risks; the

most significant financial risk being the delivery of the savings plans.

The full financial statements for the year ending 31 March 2015 are presented within the

Annual Accounts.

Sustainability Report During 2014/15, the Trust‟s focus has been on improving performance and the six priorities set to achieve that. Fleet One of the key priorities for 2014/15 was the fleet and equipment replacement programme. During the year, the Trust replaced 120 emergency ambulances with Euro 6 engines; the emissions for this engine, compared to the Euro 5, are shown below per engine:


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Euro 6 engine Euro 5 engine

CO 1.50 1.50

HC 0.13 0.46

NOx 0.40 2.00

PM 0.01 0.02

This has resulted in the following emissions reduction by the 120 replacement vehicles this year:

Emission reduction

CO 0.00

HC 39.6

NOx 192.00

PM 1.20

In addition the new ambulances come fitted with telematics. This allow us to profile the driving style via speed and fuel consumption and also has a speed limiter capability limiting speed to 70 mph when being driving under non-emergency conditions. The replacement vehicles are fitted with a pre-setting temperature setting within the patient saloon that comes on when the vehicle is shore-lined, thereby eliminating the need to keep the engine and primary heaters running when the ambulance is parked/at station. Other initiatives this year include promoting Trust bulk fuel sites rather than crews buying fuel for ambulances at retail fuel sites. In April 2014, bulk fuel accounted for 36.1% of all litres used, which has increased to 52%, representing 66,000 additional litres being drawn from bulk fuel sites. Also this year, the number of personal lease cars has reduced from 131 to 89 vehicles. Information Technology One project that has been rolled out this year is the withdrawal of printers across sites, and connecting to network photocopiers instead. This has resulted in a decrease in the number of toners being bought and ensures that the Trust is maximising the use of environmentally efficient photocopiers. The Trust has also increased the usage of conference calling during the year (see table below), helping to reduce staff travelling to meetings.

2013/14 2014/15

Number of conference calls

3,338 3,812

Number of participants

15,673 20,112

Number of minutes

302,404 410,490

Estates This year saw the successful rollout of automatic meter readings at 31 of the Trust‟s largest sites. This provides data on annual energy consumption, annual C02 emissions, annual kWh and Kg C02 used. The table below shows the actual consumption for this year compared to previous years.


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Actual Change on

2013/14

Actual

2014/15 2013/14 2012/13 2011/12

tCO2 tCO2 % tCO2 tCO2 tCO2

Stationary Energy 4,455 -761

14.5

5,216 5,223 4,909

This reduction in tonnes of carbon dioxide is due to capital carbon reduction schemes completed during 2013/14 and the installation of solar photovoltaic panels at Cromer completed during 2013/14, in addition to five other sites completed at the end of 2012/13, as well as a milder winter. This year has also seen two new contract providers appointed for waste and cleaning contracts. The new waste contract provider has waste segregation procedures being developed in line with latest legislation, enabling waste management in the most environmentally friendly way. Our new cleaning provider has its own environmental policy covering vehicle emissions and monitors environment performance when procuring equipment and materials. Communicating with staff and our communities Successful sustainable communications is, in the main, reliant on digital and other on-line formats. In April last year, a new communications rolling news site was launched for staff as an alternative to the Trust producing a long-form, hard-copy newsletter. We have also continued to use digital communications to enhance how we engage with the public and stakeholders. The use of Twitter and Facebook has increased this year and as the annual report goes to press, we will be around the 12,000 followers mark on Twitter. The big digital success of the year was the student paramedic recruitment, which allowed us to reach thousands of people online as well as promote the programme as new groups were starting their careers with us. As well as promoting the role of community first responders through social medial channels, and public engagement days with the Patient and Public Involvement team, they allow us to effectively share our news and responses to a very wide audience without the reliance on traditional print-form channels such as newsletters. Patient Transport Service CQUIN schemes There are two Commissioning for Quality and Innovation (CQUIN) schemes this year that drove the sustainability agenda forward for this team:

The introduction of a text messaging reminder service to patients to reduce the number of

abortive calls

Educating discharge co-ordinators in booking the most appropriate for patient

requirements, in order to avoid the need to dispatch additional resources.

Initiatives for 2015/16 The fleet team will continue the rollout of the vehicle replacement programme and an estates strategy will be developed. This will include a review of further solar 5PV installations and further investment in replacing external metal halide/low pressure sodium flood lighting with LED equivalents dependent on capital resourcing being available. We will continue to introduce energy efficient elements into backlog maintenance schemes and PTS will continue to look at ways to reduce the number of abortive calls.


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Caring for patients Patients are at the heart of the ambulance service‟s purpose. Our standards are set to ensure high clinical quality, care given to a patient that we would want for our own family and friends, and positive patient outcomes so that person goes on to recover well. To help support this, every NHS trust has a Quality Account which reflects on the progress made during the previous year and identifies priorities for the coming year. Our priorities for 2014/15 were set to help us reach the clinical quality standard we want, reach patients promptly, and treat them effectively so they are satisfied with the service that they receive from staff. The full quality account for this year will be published at the end of June. Priorities for 2014/15 In 2014/15, seven priorities were identified and we are pleased to report there has been improvement across a wide range of these. In particular, significant clinical improvements were made which have had a positive impact on both patients and staff, including the focus on those patients who use the service frequently and for patients who meet the screening tool criteria for red-flag sepsis. Ambitious strides have been made in the drive to recruit more paramedics and put more ambulances on the road; this supports an improved response time to patients, but also places more significance on the clinical skills set of staff to improve patient outcomes. There are areas in which the service failed to make the improvements it wanted, most notably in meeting time performance standards. For 2015/16, these seven priorities are remaining in order to fully concentrate on the core aspects of patient safety and focus on meeting these targets, and improving both the quality of care and speed of response to patients. Core priorities for 2015/16 The Trust has seen significant changes within the last year. To reflect the work the Trust needs to do in the coming year to stabilise and meet the needs of patients we will be remaining focused on a number of core priorities which match the mandatory indicators for ambulance Trusts set by the Department of Health. The areas covered will include:

Category „A‟ ambulance response times: preventing people from dying prematurely (domain 1)

Patients with a pre-hospital diagnosis of suspected ST elevation myocardial infarction who received an appropriate care bundle: preventing people from dying prematurely (domain 1), helping people to recover from episodes of ill health or following injury (domain 3)

Suspected stroke patients assessed face to face who received the appropriate care bundle: preventing people from dying prematurely (domain 1), helping people to recover from episodes of ill health or following injury (domain 3)

Percentage of staff who would recommend the provider to friends or family needing care: ensuring people have a positive experience of care (domain 4)

Rate of patient safety incidents and percentage resulting in severe harm or death: treating and caring for people in a safe environment and protecting them from avoidable harm (domain 5)

The seven priorities set in 2014/15, which will remain for 2015/16 and include the treatment of sepsis patients for which the Trust is involved in national improvement work, were:


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timely response

stroke care

friends and family

Frequent callers

cardiac arrest care

sepsis care

heart attack care

Timely response Rationale: Ambulance services are required to meet response time standards for 999 calls coded as life-threatening. Faster response times improve health outcomes and experience for patients with immediately life-threatening conditions. Improvements have been made in 2014/15 with a greater focus on recruitment of staff and new and replacement ambulances. Through feedback and complaints about patients who were non-life-threatening, we recognise some people still have prolonged waiting times for an ambulance but this continues to decrease. Improvement: We wanted to see a specific improvement in the longest waiting time for these indicators, hence the introduction of maximum response times. This meant fewer patients waiting longer for an ambulance response than in the previous year, and improving the time taken to get patients with life threatening conditions to hospital. Benefits for non-life threatening patients include less time spent on the floor if they have fallen, thus reducing the potential for avoidable pressure ulcers. Baseline: The 2014/15 end of year performance for Red 1 was 70.99% and for Red 2 was 62.79%. Based on provisional data for 2014/15 of the nine performance (time-based)


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indicators for green and urgent calls, the Trust has met eight of the required standards. All of the Green indicators were met and these included emergency responses within 20 or 30 minutes, and phone-based assessment for those patients not requiring an ambulance response. The six trust priorities set in 2014/15 included increasing ambulances and ambulance cover and reducing rapid response vehicles. Whilst performance has not been achieved against all the national standards, this action resulted in reduced waiting time for ambulances and an improvement in performance for reaching Red 1 calls and therefore is a key element of patient safety. In 2015/16 the focus will be on sustaining the reduction in ambulance waiting times and a continual improvement against the national standards from the last quarter 2014/15 baseline. Goal: To improve the response times to patients in the most life-threatening call categories. We are committed to improving performance against national targets and to meeting local quality indicators for non-life threatening calls; as part of the commitment to improving performance against national standards, we will continue a series of maximum response standards for 2015/16. Sepsis care Rationale: Sepsis claims the lives of more than 37,000 people in the UK, which is more than lung cancer and more than breast and bowel cancer combined. The estimated cost to the NHS for sepsis is around £2 billion annually for treatment. It is shown in recent research that early recognition of the signs and symptoms of sepsis will save lives, possibly as many as 12,500 per year in the UK. By using the screening tool developed by the UK Sepsis Trust in 2014/15, staff could recognise red-flag sepsis and septic shock in adults, and the need for urgent and timely interventions and transportation to hospital. Neutropenic sepsis is a significant cause of death in cancer patients receiving chemotherapy, and causes delays and changes to planned treatments. In England and Wales, relative to the increasing number of cancer diagnoses, the proportion of deaths due to neutropenic sepsis continued to rise for all age groups between 2001 and 2010. Recent National Institute for Health and Care Excellence (NICE) guidance recognises neutropenic sepsis is a medical emergency requiring immediate hospital investigation and treatment, and recommends improving the clinical care pathways of cancer patients undergoing chemotherapy, immediate access to antibiotics and appropriate healthcare staff training. Baseline: For 2014/15 the Trust intended to increase the target number of sepsis cases our crews recognised and recorded to 85%. The audit for this year was confined to one month (October) but the target was exceeded with the crews correctly identifying 93% patients with sepsis. Goal: We intend to set a target above 90% for the number of sepsis cases the clinicians recognise and record, and expand the audit to include care bundles given. Improvement: We will continue to increase the awareness and delivery of the sepsis care bundle and neutropenic sepsis to provide our patients the very highest standards of pre hospital care.


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Frequent callers Rationale: A frequent caller aged over 18 is defined as someone who calls more than five times in one month, 12 calls in a three-month period, or 15 calls in a one-month period from a communal address. A frequent caller under 18 is someone who calls two or more times in a six-month rolling period. A frequent caller should not necessarily be considered a nuisance caller as many suffer from long-term conditions which may need more regular contact with the service. These calls only represent a small number of our overall call volume but can make it more challenging to deal with those patients who have serious, life-threatening emergencies. An alternative way to manage this situation for patients who will invariably have complex health and social care needs is required which means we work closely with health care organisations. Baseline: The Ambulance Quality Indicator (AQI) linked to this priority measures the number of frequent callers as a percentage of all calls received. Each ambulance service has its own definition of a frequent caller and can manage them as they see fit, although a great deal of national work is on-going through the Association of Ambulance Chief Executives to standardise this. The Frequent Caller AQI guidance is under review and it is expected to recommend and introduce improved and comparable frequent caller national reporting parameters. The baseline will be defined during the coming year when these new reporting processes are in place. Goal: To increase the number of patients with a locally-agreed frequent caller procedure in place by working in partnership with the patient‟s other health and social care providers. Improvement: If patients are identified, their GP details will be obtained and call volume details recorded via an established format and made available to the patient‟s GP. If they are not registered with a GP, the local commissioning group or other relevant organisation will be approached. We aim to provide quarterly analysis relating to management plans in place for patients identified as frequent callers. Heart attack care Rationale: Most deaths in the UK from heart disease are caused by a heart attack. Around 103,000 heart attacks happen each year, with some people having more than one. Approximately 50,000 of those heart attacks are suffered by men, and around 32,000 by women. The British Heart Foundation estimates that one in three people die of a heart attack in the UK. This is why the care in the pre-hospital arena is vital. Most heart attacks are caused by coronary heart disease which is when the coronary arteries narrow due to a gradual build-up of atheroma (fatty material) within their walls and a piece breaks off leading to a blood clot. Because of the life-threatening risk with a heart attack, providing patients with a pre-hospital assessment for a STEMI and administering an appropriate care bundle means a significant improvement on patient outcomes, thereby supporting the NHS to reduce the number of patients dying prematurely and to help people to recover from episodes of ill health or injury. Baseline: We measure the AQIs for the percentage of patients suffering a STEMI who are directly transferred to a centre capable of delivering PPCI and angioplasty within 150 minutes of call, and the percentage of patients suffering a STEMI who receive an appropriate care bundle. The baseline figure for STEMI 150 in February 2015 was 94.9% and the care bundle was 84.1%. Goal: The Trust intends to achieve 95% PPCI within 150 minutes and 80% STEMI care bundle compliance.


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Improvement: To reduce the on scene times for those patients who are having confirmed STEMI and to continue to give high standards of care to those patients experiencing cardiac chest pain. Cardiac arrest care Rationale: Around 30,000 people each year in the UK suffer cardiac arrests in the pre-hospital environment – less than 10 per cent will survive to be discharged from hospital, according to data from the Resuscitation Council UK. Evidence shows that around two thirds of cardiac arrests outside of hospital are in the home, and that nearly half in a public place are witnessed by bystanders. With each minute that passes in cardiac arrest before defibrillation, chances of survival are reduced by about 10 per cent. Immediate cardiopulmonary resuscitation (CPR) in a shockable pre-hospital cardiac arrest can improve the chances of survival by up to a factor of three. The British Heart Foundation campaigns to train the public in emergency life support, and in an attempt to train young people to deal with cardiac arrests, want to get it on the National Curriculum in England and for it to include skills training as part of the National Citizen Service. This year, we installed 1,000 public defibrillators (AEDs) across the entire region to support a successful resuscitation campaign in line with the British Heart Foundation. Baseline: The table below shows the baselines achieved within this category. Return of Spontaneous Circulation (ROSC) refers to the point at which a pulse is regained following life-saving techniques

Category Baseline end of February 2015

Target for 2015/16

ROSC – all patients 26.2% 25%

ROSC – Utstein patients 50% 51%

Survival to discharge – all patients

3.1% 7%

Survival to discharge – Utstein patients

19.4% 25%

Goal: To improve our outcomes from cardiac arrest and work towards an increase in our ROSC and survival to discharge figures. Improvement: We aim to see improvements in both types of ROSC and survival to discharge figures on a consistent basis. Baseline: The baseline figures for 2015/16 will be taken from the latest year to date available at time of printing. Stroke care Rationale: Each year more than 110,000 people in England will have a stroke; it is the third biggest cause of death in the UK and the largest single cause of severe disability. Face-Arm-Speech-Time (FAST) is a simple test to help people recognise the signs of stroke and understand the importance of emergency treatment. The faster a stroke patient receives treatment, the better their chances are of surviving and reducing long-term disability.


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Baseline: We measure the percentage of FAST- positive stroke patients (assessed face-to-face) potentially eligible for stroke thrombolysis who arrive at a hyper-acute stroke centre within 60 minutes. The baseline figure for year to date February 2015 is 53.7% for stroke 60 and 94.9% for the care bundle. Goal: We aim to achieve continuous improvement in stroke 60 see continually high care bundle compliance. Improvement: To reduce on-scene times to patients who are having a stroke, and continue to give high quality care. Friends and Family Rationale: The NHS introduced a way of getting feedback from patients and staff about whether they would want a friend or relative to be treated at that service in their hour of need. The results are made public to drive continuous improvement, and to support this, we have been capturing this data for the last year. Whilst not a sophisticated measure of quality, it captures what patients think of our services and encourages us to focus on what matters to patients. Baseline: (friends and family test) Friends and Family (net promoter) scores ranged as follows (year-to-date February 2015): Emergency Service: +82 Primary Care service: +69 Patient transport services: +72 Goal: Once the national average is known, we will aim to maintain the friends and family score at the national level for those patients who agree or strongly agree that they would recommend the service to a friend or relative across all service lines which will capture the experience of the patients served by the Trust. Improvement: To see a rise in the Friends and Family Score which will give a simple indication of how our patients view the service. Baseline (Staff): During the previous year the Trust had a score of 40 when staff responded to the statement “If a friend or relative needed treatment, I would be happy with the standard of care provided by the organisation”. That was lower than the average median score (50) for other ambulance services. Goal: To increase the number of positive responses received to Question 12d in the annual staff survey to meet the average median for ambulance Trusts recorded in 2013. Improvement: To see a rise in the score for Question 12d of the annual staff survey which will provide an indication of how our staff view the Trust and the care that we provide. Public and Patient Engagement The public and patient involvement and engagement team (PPI) are responsible for getting feedback from the public and patients and taking these views back into the Trust to help aid service developments. Last year, the team attended 20 events to speak with public and patients about the


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ambulance service, promote the service‟s messages, provide health care advice particularly around stroke awareness, blood pressure checks, and using a „dispatch dilemma‟ game to demonstrate how we prioritise 999 calls. The team aim to reach the widest possible audience and so activity focussed around visiting shopping centres and events such as Ely Aquafest, the Multicultural Festival in Suffolk, older people‟s warm home events and seniors fayre and emergency services open days. The team runs a children‟s drawing competition giving out entry forms at events. Children draw pictures relating to the ambulance service and 12 winning pictures were selected and made into a calendar. The drawing competition has also proved a useful tool for staff visiting schools and groups to encourage children to get involved and learn about how and when to call for an ambulance.

Trust User Group These volunteers are the organisation‟s critical friend. Their work is supported by the PPI team and together they carried out more than 70 patient story discovery interviews. These interviews give us an opportunity to learn - the feedback and actions identified are reported internally, shared with operational managers and staff, used for training, and a video of an interview is shown at every Trust Board meeting. The group also assist with station cleanliness audits, review Trust documents and surveys, and have taken on the role of community ambassadors. Our volunteers continue to play a vital role in community engagement with our ambassadors taking part in more than 30 different activities over the last year. These included distributing leaflets about the appropriate use of the service, running stalls at various events, and giving talks to community groups.

Serious Incidents – 2014/15 Annual Review There have been no Never Events within the 2014/15 financial year. Summary In 2014/15, the Trust reported 92 Serious Incidents which compares to 54 in the previous financial year. This demonstrates an increase of 70% and is reflective of the following factors:

Specific analysis of 9,000 emergency calls where there had been a delay

Improved analysis of complaints for consideration as potential Serious Incidents

The recognised shortfall in paramedics and frontline staff within the organisation

Development of internal Never Events for inclusion as Serious Incidents, regardless of harm levels The following chart show the Serious Incidents by both reported and incident date, and includes the number of adverse incidents reported for comparison. It also shows that Serious Incidents reported have reduced in the last two months of the financial year thanks to the actions the Trust has put in place.


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When reviewing the financial year, there are peaks in reporting Serious Incidents in June and September with these two months resulting in a total of 33 reported. The increase included a number of complaints being reported as Serious Incidents – therefore retrospective reporting of an incident from a previous month – which resulted in these peaks. Adverse Incident reporting has seen a gradual increase, resulting in a return to the levels of reporting experienced in 2013/14. It is felt that the reason for this reduction was due to staff being aware that the patient safety team was conducting a case-by-case review of delay incidents, and as such staff felt there was no need for the incident to be reported. This theory is supported by the increase in incidents reported since October, when the Trust focussed upon ensuring staff knew they still had to report any incidents. Trends and themes The overarching trends in the Serious Incidents reported in the 2014/15 financial year have been:

taking longer to attend a patient

clinical assessment

allegations of abuse

data protection

Responding to patients Long waits for patients has been the most common theme seen within Serious Incidents by the Trust for the last two financial years; however, in 2014/15 the proportion of SIs relating to delays has reduced and is more consistent with the number of clinical SIs reported. These SIs have been attributed to the following common factors:

Increase in 999 calls and activity

Insufficient staffing and vehicle numbers

Increasing hospital delays in patient handovers

Incorrect coding during the 999 triage stage The Trust has focussed upon resolving long waits for patients in a number of ways:

Recruitment of 400 student paramedics in year, with a further 400 planned for

2015/16


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Fleet replacement programme and increased number of ambulances, all under five

years old

Hospital ambulance liaison officers at key hospitals to ensure early resolution of

hospital delays

Review and amendment of the Resource Allocation Guidelines

Increased numbers of call handlers and call handler team leaders to reduce

pressure in the control rooms

Regional telephony to improve responsiveness to 999 calls.

Clinical decision making The significant theme within the clinical Serious Incidents in this financial year has been non-conveyance. These SIs are because of the following common factors:

Cardiac care and associated pathways e.g. ECG recognition

Incomplete assessment or recognition of red flags and the need for conveyance

Recognition of sepsis markers

Application and understanding of capacity to consent (Mental Capacity) and appropriate safety netting. Actions taken to date have been wide-ranging and will continue with increased focus in 2015/16 through the launch of our Quality and Safety Strategy. They will include:

a non-conveyance checklist

capacity forms renewed with aide memoire cards

a Serious Incident session on the clinical Professional Update (PU) programme

including Clinical Assessment on the clinical PU programme

a relaunch of Clinical Quality Matters newsletter for staff with a focus on cardiac care

clinical bulletins relating to each condition seen within Serious Incidents, including sepsis, cardiac care, non-conveyance, fractured neck of femur, etc. Allegations of abuse Allegations of abuse is a new theme in 2014/15 with there being two substantiated cases which have been referred to court; both cases related to historical issues not identified through the adverse incident reporting system at the time. They relate to abuse of staff, by staff. There were another three incidents immediately reported as SIs; it should be noted that following investigation the police took the decision not to prosecute in those cases. Investigations have shown that DBS checking processes have been followed in all instances. In the case of the two substantiated allegations, the Trust‟s mechanisms for management of such incidents require careful review and amendment, in order to ensure high quality and timely investigations and sufficient support to those involved. As a result, we are completing a formal review of processes against the Lampard Report and actions will then be taken. Data Protection Four data protection SIs were reported, all occurring within one department. It is important to note that none of these met the threshold of a Serious Incident under the Information Commissioner‟s Office definition; however due to the nature of these incidents and the


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number seen, the Trust took the decision to report these as SIs and complete an aggregated investigation. All cases related to the release of staff personal and/or sensitive information and causes identified included:

inappropriate checking mechanisms prior to information release

increased workload and reduced capacity within the team

lack of clarity in the policy relating to staff information. Immediate actions at the time of the SIs being reported resulted in a „second check‟ mechanism being implemented prior to release of information, as well as immediate completion of mandatory Information Governance training. To date there have been no further breaches identified and additional actions relating to policy amendment will strengthen the systems further. Changes to the SI process We did see a backlog of SI investigations, due to the increase in numbers and reduction in capacity, but there have been focussed efforts in turning this around since February, with 60 Serious Incident investigations completed. This has been done by establishing a specific investigations team, dedicated to the completion of Serious Incident investigations. This team is now a permanent component of the Risk and Safety Team and so it is anticipated that there will be no further delays in finishing investigations. Compliments and complaints The Patient Services team coordinates all complaints, concerns and compliments, as well as legal claims against the Trust, inquests involving Trust staff, and requests for information, such as those received from coroners, police or subject access requests under the Data Protection Act 1998. In 2014/15 more than 1,538 compliments were made about the service, an average of 128 a month. Compliments are reported to the Trust Board and the staff names are published internally. Local management teams are informed of all compliments so they can be passed onto the staff and an acknowledgement letter from the Chief Executive is sent to the person making the compliment. Patient Services processes all complaints and concerns raised by patients and members of the public to ensure their concerns are heard, investigated and action is taken to put things right. The feedback, both positive and negative, is managed by the team and enquirers are kept informed throughout the process and informed of the outcome of their feedback. People who wish to provide feedback about the Trust can do so through a dedicated complaints email address [email protected], by phone 0800 028 3382 or in writing to Patient Services Department, East of England Ambulance Service NHS Trust, Hammond Road, Bedford, MK41 0RG. An „easy read‟ poster about how to provide feedback to the Trust has been sent to community hubs such as libraries and religious centres across the region to help improve accessibility. The team logs complaints on a risk management system and liaises with the complainant to


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ensure the correct information has been captured and all issues have been identified. They then work with the investigating manager to ensure a thorough and objective investigation has been completed. In 2014/15, the Trust received 974 complaints, which is a 22% increase compared to 2013/14. Of those, 77% related to emergency care, 14% to patient transport services, 7% to primary care services, and 2% to commercial and corporate services. The Trust‟s Complaints Policy was reviewed in 2014 to include information about the risk grading of complaints and the development of peer review panels.

Complaints are acknowledged as quickly as possible. Of the complaints received in the year, 98.5% were acknowledged within three working days in line with the Local Authority Social Services and National Health Service Complaints Regulations (2009). Working with other NHS organisations is also embedded within the department and we worked on 114 joint complaints this year. As with Serious Incident themes, the main theme from the complaints was around ambulance response times. The Trust‟s priority has been to increase the number of qualified staff and to ensure we have more ambulances available to respond to calls. This is helping to reduce complaints because patients are receiving a quicker and better service. The other two main themes were staff attitude and clinical care. Customer care was included in the Professional Update (PU) programme for this year and a new „Customer Care‟ programme is being developed. The Clinical Manual was republished this year and a non-conveyance checklist was produced for staff to complete for patients they are not taking to hospital. The importance of clinical reasoning behind patient assessment was included on the PU programme. Although most complaints are resolved through our complaints process, complainants can refer their complaint to the Parliamentary and Health Services Ombudsman (PHSO) if they feel it has not been resolved. We received 20 referrals, which is a decrease compared to the 21 referrals we received in 2013/14. Where complaints were upheld, appropriate action was taken in response to the Ombudsman‟s recommendations. For example, the guidance for emergency operation centre staff using the Healthcare Professional algorithm has been reviewed.

0

20

40

60

80

100

120

140

160

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

Total complaints received

2012-13 2013-14 2014-15


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The graph above shows the number of referrals the Trust has received from the PHSO per quarter. There was a significant increase in the number of referrals in the last quarter of 2013/14 due to the change in the PHSO‟s procedures, but the volume has decreased throughout 2014/15. Of those investigated and closed by the PHSO, four cases were partially upheld i.e. some aspects of the complaint were upheld by the PHSO and one case was fully upheld. The table below shows the types of cases which were partially or fully upheld.

Learning for Trust

Partially upheld The investigation should have included evidence from the third party independent witnesses that were on scene.

Partially upheld The paramedic should have conveyed the patient to hospital.

Partially upheld The crew should have conveyed the patient to hospital and the attitude of one staff member during the second attendance was inappropriate, although the Trust had addressed this as part of the complaint investigation.

Partially upheld The complainant was not kept updated throughout her complaint.

Partially upheld The policy for escalating calls to the Duty Manager in the EOC was not followed.

Fully upheld The crew inappropriately transferred the patient without using a hoist causing patient injury and the investigation into the complaint was not comprehensive.

Patient Advice and Liaison Service (PALS) The PALS service is integrated into the patient services team to simplify the procedure for someone to either log a PALS enquiry or to escalate their issues to a complaint, if appropriate. It also enables us to signpost people to the correct services, answer queries, deal with lost property and advise on the complaints process. A total of 540 PALS contacts related to negative concerns or feedback, and another 416 included enquiries about lost property or comments about the Trust. This makes a total of 956 PALS concerns received, a decrease of 41% compared to 2013/14. The significant

0

2

4

6

8

10

12

14

Q1 Q2 Q3 Q4

Nu

mb

er

of

refe

rral

s

Quarterly breakdown

PHSO referrals by quarter

2010-11

2011-12

2012-13

2013-14

2014-15


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reduction in the number of PALS concerns reported is due to a change in the reporting of concerns raised by healthcare professionals. These are now reported via the Trust‟s incident reporting system.

The team is committed to using the feedback we receive through compliments, complaints and PALS to help improve the service. The themes and trends identified are linked with learning from other sources; such as clinical audits, staff reported incidents, claims made by staff and patients, and health and safety issues. Examples include:

a notice disseminated to all ambulance stations about the importance of appropriate parking and ensuring that other road users are not obstructed

Staff attending refresher training focussing on trauma-related injuries to the neck, spine and pelvis, including spinal immobilisation. Looking forward The teams will be holding quarterly peer review panels in order to critically evaluate the current complaints process and will be working with the Patient‟s Association to develop these panels further. The current complaints survey will be reviewed to ensure the new Parliamentary and Health Service Ombudsman‟s framework (known as „My expectations when raising a complaint or concern)‟ is embedded within both the patient services department and the organisation. Inquests The department co-ordinated work contributing to 58 inquests this year and worked with the operational management team to support staff in attendance, as well as the Trust‟s solicitors where required. Inquest training for managers is arranged for 2015/16 to ensure our senior managers feel empowered to support staff attending these inquests. Safeguarding There is a high focus on safeguarding and the Trust strives to improve the referral process. A recent review of the questions set for referrals and update training for Single Point of Contact (SPOC) call handlers has led to a continual increase in the quality of information being sent to partner agencies. There has been a steady increase in the use of SPOC to refer for Safeguarding and vulnerable persons reaching 13,273 year to date with a peak of referrals in May of more than 1,400 referrals. This made up just over 36% of all referrals to

0

50

100

150

200

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

Total PALS enquiries

2012-13 2013-14 2014-15


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the SPOC service. Feedback from referrals has fluctuated during the year, mostly due to the capacity of the Safeguarding team during the restructure of the organisation. The feedback is received from either the GP or the Local Authority and is normally given when requested by the Safeguarding team. The Trust finds this level of feedback is invaluable to crews due to the positive impact this has on the staff who refer their concerns. We aim to provide staff with a greater understanding of their referrals and the impact on their patients, and endeavour to ensure they remain supported and engaged in the protection of the most vulnerable members of communities and to ensure information gets to the right agency for the most appropriate support. There is a continued focus on the quality assurance of the referrals through evolution of the referral form and review of the quality assurance process which is in place in the Safeguarding Team and at SPOC level. Operational staff will gain a greater understanding of the Mental Health and Mental Capacity acts and we will ensure compliance to legislation requirements, particularly with the introduction of the Mental Health Crisis Care Concordat published earlier this year. This will be in line with the launch of a newly agreed Capacity to Consent form which is easier to use and makes the complex decisions easier to relate to the particular incident. The safeguarding team will evaluate pathway options for domestic abuse cases and scope partnership working with the six police forces to send information directly to them. The Trust is also exploring the elements of child sexual exploitation and its remit within this emerging field of abuse.

Our People The Trust employs more than 4,000 staff and has around 1,500 volunteers. It is thanks to the hard work, dedication and commitment of staff and volunteers that services are improving. The table below shows the breakdown of staff at the end of February 2015.


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The Trust takes an inclusive approach to employee relations and benefits from effective partnership working with its recognised trade union, UNISON. Consultative mechanisms were developed in partnership and exist at local, regional and Trust-wide level and we have embedded within the organisation proactive consultation and engagement on all matters, either through our trade union partners or directly with staff. Health & wellbeing and investing in staff The East of England Ambulance Trust cannot deliver care without our staff and depends on having a healthy and productive workforce. Managers are key to facilitating open communication with their staff and this can play a huge role in keeping staff well, motivated, feeling valued and empowering employees to perform to their full potential to provide high quality patient care. Stress is believed to account for over 30 per cent of sickness absence in the NHS, costing the service £300-400 million per year. The latest NHS annual survey found that 30 per cent of NHS staff reported that they had suffered from work related stress. The Health and Safety Executive (HSE) defines stress as an adverse reaction that people have to excessive pressures or other types of demands placed on them. Some NHS staff have to deal with violent and unpredictable patients, others deal with traumatic and harrowing circumstances, and others have a lack of support or are not receiving enough communication about changes affecting them. The most important fact is the impact on the individual and how they feel able to manage those feelings. Health and wellbeing is a continuous exercise in our organisational development. The health of the workforce is determined by multiple factors and in turn health influences multiple outcomes. Health and wellbeing is an integral part of the Trust‟s agenda as a healthy workforce is a workforce that can offer more and deliver more. We aim is to work with Occupational Health, HR and managers to design health and wellbeing interventions that address issues raised through staff survey and other information such as sickness absence reasons, to support staff working in the most supportive environment.

As at 30 April

2015 of the 615

student

Paramedics in

post 86 were

undertaking

their initial

training


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Staff survey The 2014 NHS Staff Survey saw a response rate of 27% for the Trust down from 34% in the 2013 NHS Staff Survey, from an official sample size of 4,048. 1,078 completed questionnaires were returned from this sample. The key findings showed that the Trust has improved in 5 areas, stayed the same in 20 areas and declined in 4 areas. Overall EEAST improved on results compared to all of the ambulance trusts in England with eight lower than national ambulance average scores, compared to 13 in 2013. It is encouraging that the overall staff engagement score has increased to 3.16% an increase of 0.09%. In addition EEAST scored 3.04, an increase of 0.26 on staff recommendation of the Trust as a place of work or to receive treatment. The top 3 improved key findings were the percentage of staff feeling satisfied with the quality of work and patient care they are able to deliver; percentage of staff suffering work related stress in last 12 months has reduced by 7%; percentage of staff receiving job-relevant training, learning or development in last 12 months has increased by 6%. To ensure staff engagement improves the Trust Board will be reviewing an action plan at Trust Board on 25 March 2015 and locality Directors have been asked to develop local plans focussing on two to three key areas for improvement.

Risk Management and Information Governance Our risk management process has remained in situ with significant work undertaken to maintain the recognition and documentation of new risks, as well as the on-going mitigation of existing risks. Working towards achieving the six priorities has meant significant action to mitigate the key risks around workforce and the ability to deliver the service to patients. In the final quarter, the Trust refocused on embedding risk management into core business. This work will continue into 2015/16 through an approved training and development plan. The BAF is established and discussed regularly. Each Trust Board sub-committee review each of its relevant risks. This enables wider discussion to take place for each area of expertise and details to be reviewed or escalated, depending on the nature of the issues raised. The Trust has a well-established risk management and Board assurance process that is both top-down and bottom-up: The Board will identify the strategic risks being faced by the Trust

Operational risks will be flagged up through operations and activities of the Trust in

going about the achievement of the Trust‟s objectives

An electronic system of incident reporting is in place to make it easier for staff to

report incidents

Production of the Complaints, Litigation, Incidents and PALS (CLIP) report which

triangulates information from the incident reporting system and has become highly

effective in drawing to the attention of the Risk Management Group (RMG) (which

reports in to Patient Safety and Care Standards Committee) any potential or actual

risks.


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Continual review of the Trust‟s performance in relation to external assessors and

regulators i.e. internal and external audit, CQC, NICE etc.

Compliance with Statutory Requirements – e.g. Health and Social Care Act 2008

(Code of Practice, December 2009), Equality Act 2010 public sector duties.

Reviews of the external environment – i.e. publication of the Hard Truths report has

led to focussed action plans in relation to areas requiring improvement.

A risk assessment is done using standard risk management principles, focusing upon causes and effects and assessing the risk against impact and likelihood. Controls are then implemented and mitigating actions established to reduce the risk. The major risks identified within 2014/15 have been monitored and acted upon by the Board and committees regularly through scrutiny of the BAF. The risks identified can be split into the strategic risks agreed by the Board at the beginning of the financial year and the principal risks (those escalated to the Board from operational risk registers). A summary of the strategic risks is as follows:

Failure to consistently deliver key performance targets. Focus on recruitment has

greatly improved this risk; however issues with significantly increased 999 activity and

extended hospital handover delays across the region has negated some of the positive

impact of the recruitment undertaken

Ability to ensure compliance with all regulatory and legal requirements, in recognition of

the challenges faced during the restructure and transition, coupled with the new

requirements for the Care Quality Commission (CQC)

Failure to form strategic alliances with national and local partners due to the challenges

in stakeholder engagement and the level of scrutiny afforded to the Trust over the

course of the year. Successful mitigation has been undertaken

Failure to create and embed a culture of performance and accountability. Positive steps

in relation to this risk have been undertaken, and the Board are developing an

Organisational Development programme to further mitigate this risk in 2015/16.

Insufficient recruitment, training and development in line with the skills and values in our

strategy. This risk recognised the challenges faced when there are insufficient numbers

of clinicians, and the risks and challenges whilst the extensive recruitment programme is

underway. The risk has evolved over the financial year to be more focussed upon

mentorship and development, as the recruitment trajectory has been met

The lack of a stable and effective Trust Board was recognised as a strategic risk and

positive steps have been taken in the financial year, through the successful recruitment

of both the Interim Medical Director and the Director of Nursing and Clinical Quality

Failure to ensure a well governed and accountable Trust also relates to the challenges

faced during the restructure and the move to a leaner and more efficient organisation.

Improvements have been made in the latter part of 2015/16 following the operational

restructure and reinstatement of key groups, with policy review and approval underway.

Short term in-year ability to deliver key financial targets, as well as a longer term risk

relating to the ability to deliver a lean and financially viable organisation. Positive

mitigation of the in year risk has taken place and preparatory steps have been taken in

relation to the longer term sustainability of the organisation

Five operational risks were escalated to the BAF for Board oversight and scrutiny, all of


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which have the potential to impact on delivery of the Trust‟s key objectives. Significant work is being done in relation to each of these risks and a summary of each is as follows:

Failure to provide appropriate clinical documentation; this relates to the use of electronic patient care records and system issues associated with this, as well as the policies in place for clinical documentation

Ability to deliver a safe service during periods of industrial action. This was escalated in

October and robust planning resulted in successful mitigation through two periods of

action. This risk has now been de-escalated and returned to the operational risk register

Failure to provide consistently safe and high quality care was identified due to trends

and themes within Serious Incidents and through staff surveys

Impact from the CAD on service delivery has been identified as an area requiring Board

scrutiny, due to the need for a fully-functional software system within the control

rooms

Risks associated with storing, monitoring and usage of medicines have been escalated

to the BAF following limited assurance from the Internal Audit. A robust action plan and

project team are in place.

Lapses in data security and information governance compliance In 2014/15 the following five potentially serious information-related incidents were recorded with two reported to the Information Commissioner‟s Office (ICO) whom did not take any action:

Staff information contained in a disciplinary hearing statement, which was unrelated

to the subject of the hearing; this was repeated at the appeal hearing

Two occupational health reports released in error to the subject of a capability

hearing and the subject‟s solicitor; these reports were unrelated to the subject

Personal data emailed to wrong recipient via non-Trust email address

Personal data concerning an unrelated staff member with the same name shared

with sickness absence panel

Private and confidential information relating to a staff member following a Data

Protection Act request.

Information Governance Compliance In our annual self-assessment against the Information Governance Toolkit, we declared an overall „satisfactory‟ rating, having achieved level 2 on all applicable Toolkit standards. Compliance with NHS Pension Scheme regulations The scheme is an unfunded, defined benefit scheme that covers NHS employers, general practices and other bodies, allowed under the direction of the Secretary of State in England and Wales. The scheme is not designed to enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period. For more details see note 6.6 in the Annual Accounts on page 106.


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As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer‟s contributions and payments in to the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations. Counter fraud The Trust places high importance upon the identification, deterrence and detection of fraud within the NHS and takes a positive stance in countering fraud and bribery within the organisation. We are fully compliant with the directions issued by the Secretary of State in 2004, the NHS Counter Fraud and Corruption Manual, and the Standards for Providers: Fraud, Corruption and Bribery as set out by NHS Protect. The Local Counter Fraud Specialist (LCFS) reports to the Acting Director of Finance and attends Audit Committee meetings to report on the work achieved through a work programme of proactive assignments. The LCFS ensures that counter fraud is integrated into all Trust activity in a positive way. In addition to proactive work, the Trust supplements the work programme with resource for investigative activities so that an appropriate, proportionate response is taken to allegations of fraud and bribery. In 2014/15, the counter fraud culture has continued to be embedded and work has been done against each of the four areas of action set out in the Standards for Providers: Fraud and Bribery, as set out by NHS Protect (namely Inform and Involve, Prevent and Deter, Hold to Account and Strategic Governance). NHS Litigation Authority (NHSLA) The NHSLA remains the Trust‟s indemnifiers for both clinical negligence and employees claims. It has also introduced a number of actions that focus on improved outcomes, learning from claims, reducing harm and improving patient and staff safety. We continued to improve reporting and learning processes as well as introducing a new Patient Safety Strategy. A number of other actions, with the aim of reducing the number of claims received from both staff and patients include the procurement of improved tracked chairs for moving patients, implementation of bariatric equipment and vehicles, new vehicles, major recruitment, and up skilling of clinicians. Care Quality Commission (CQC) registration The Trust was registered with the CQC under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2009 on 1st April, 2010, without conditions or restrictions and to provide services under three of the regulated activities to cover the services agreed under contract and service level agreements. As a registered healthcare provider, the Trust has to demonstrate continuous compliance to these regulations and uses electronic software to upload evidence and monitor each outcome. So that we continue to work towards full compliance for all regulations, a new robust monitoring tool was implemented which provides the Board a dashboard to all regulations and any associated action plans. We are currently working with the providers to ensure this meets the revised regulations as well as the new Key Lines of Enquiry implemented on 1st April, 2015. An unannounced routine inspection in December 2013 reported that the Trust remained non-compliant with Regulation 9 Outcome 4 (Care and Welfare of People who use services).


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However, the CQC acknowledged that there have been significant improvements in a number of areas since then: decrease in staff sickness absence rates, complaints relating to ambulance response times, the number of Serious Incidents, long waits more than 25 minutes) for ambulances to take patients to hospital in life-threatening instances in some areas, and spending on private ambulance services. The CQC also concluded at the time that the Trust was also non-compliant with Regulation 22 Outcome 13 (Staffing) and did not have the numbers of suitably qualified staff it required to ensure that national ambulance response times were met and people received the care they needed in a timely way. After careful consideration, the CQC found that the Trust was taking reasonable steps to address the breaches in regulations and that it would not be appropriate to take further enforcement action at that point. To address this, the Trust set an ambitious six point priority plan for 2014/15 which included recruiting 400 student paramedics and up skilling current staff as well as the accelerated purchase of new ambulances and equipment.

Clinical Audit and Patient Experience Programme The clinical audit and patient experience programme forms part of the quality governance framework and provides an assurance that services for patients are at the required standard in order to meet the dimensions of quality: patient safety, patient experience and clinical effectiveness. It provides an essential view of the care we deliver in terms of the patient experience and the clinical outcome of the care that we provide to them. Where audit and experience reports highlight that standards are being delivered below those expected, it also serves as an early warning indicator so corrective action can be agreed and taken in a responsive way. The results enable us to share good practice with staff and with viewing us against other ambulance trusts. The results of audits and experience audits are used to review and develop training for our staff. The examples, themes or trends have enabled us to identify areas that draw out the quality measures. All audits are presented to the Clinical Audit and Patient Experience (CAPE) Group which reports directly into the Clinical Quality and Safety Group. The CAPE approves recommendations for actions to improve the quality of service provision and patient outcomes. The audit and patient experience programme for 2014/15 focused on national, strategic and regulatory driven audit projects which related to the priorities set within the Quality Account agenda. It is important to continue to link clinical development with audit and experience measures, as a result, the CAPE group will be disbanded, with clinical audit outcomes being discussed at the Clinical Development and Effectiveness Group. This group will report directly to the Clinical Quality and Safety group where trends will be aligned with those identified through the Trust‟s Learning Group (which determines trends and themes from patient experience including, complaints, patient surveys and discovery interviews). Being able to gather this wide range of information ensures a focus on the key priorities, or to identify areas to discuss with commissioners and other providers of care. The link with research produces an evidence base of patient need that allows a continued search for the delivery of clinical excellence. Compliance with the NHS Constitution The Trust‟s vision and values are in line with the NHS constitution. The Board is currently consulting with staff and volunteers over a new vision and values for the Trust which will be a major part of the Trust‟s organisational development programme.


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Significant issues Under achievement of ambulance response times At the beginning of 2014/15 the Trust was still experiencing significant challenges preventing us reaching national standards for response times to patients. These challenges also caused longer response times to patients with lower category medical problems, particularly in rural areas. A number of factors have caused these issues, including:

significantly rising demand for the ambulance service across the region. The number

of calls within the Red categories (immediately life-threatening requiring a response

within eight minutes) rose by 15% compared to 2013/14

hospital turnaround delays which have increased with 40,000 hours lost for crews

handing patients over to hospitals. This equates to nearly 3,500 12-hour shifts where

crews have been waiting at hospital and not able to respond to patients in the

community

frontline vacancies

a poor staff skill mix with not enough paramedics, resulting in high levels of several

people being dispatched to patients, and back-up requirements

high sickness rates in frontline and emergency operations centre staff

A lack of fleet and equipment to provide the core resourcing requirements. In

addition, a number of ambulances and RRVs which have significant mileage and

some over 10 years old.

The Trust Performance Improvement Action Plan was focussed and monitored at weekly Operational Management Board meetings, Executive Management meetings and Board meetings, the outcomes of which have significantly improved performance. The Board agreed six new priorities for 2015/16 to build on the improvements made in 2014/15. These priorities are:

recruit and train another 400 student paramedics

up-skill 60 emergency care assistants (ECAs) to emergency medical technician (EMT) and 40 technicians to paramedic

continue the fleet replacement programme to maintain all frontline vehicles less than five years old

undertake robust benchmarking of our costs to identify savings for reinvestment in frontline delivery

implement an Organisational Development Programme

secure the CAD system.

The Trust Board Directors’ responsibilities The Trust Board comprises the non-executive directors and executive directors that form a unitary body. The Board functions as a corporate decision-making body and should consist of six non-executive directors (including the Chair) and five executive directors. The Board now consists of a Chair, five non-executive directors, Chief Executive Officer, an Acting Director of Finance, three locality directors (having one vote between them) and a Director of Nursing and Clinical Quality, a part time Medical Director. One of the non-executive directors (NED) resigned in September and a new NED with clinical expertise and experience was appointed. An associate non-executive director is also appointed to provide further expertise and advice to the Trust Board


44

Appointment of Board directors Due consideration is given to the composition of the Board in terms of the protected characteristic groups in the Equality Act 2010. Each Board member is appointed for their experience, their business acumen and their links with the local community. The Secretary of State for Health has the power to make the appointments of the Chair and Non-Executive Directors but has delegated this role to the NHS Trust Development Authority (TDA). As a result the TDA is responsible on behalf of the Secretary of State for their appointment and removal, on-going support through appraisal, mentoring and training. All appointments are made by a public advertisement. Terms of appointment are normally for periods of four years with members eligible to be re-appointed or to re-apply up to a maximum of 10 years. The non-executive directors‟ responsibilities include:

helping to plan for the future growth and success of the organisation.

making sure that the management team meets its performance targets.

ensuring that finances are properly managed with accurate information.

helping the Board ensure it is working in the public interest. The Chief Executive and the Trust Board Executive Directors are appointed, via public advertisement, by members of the Remuneration Committee. The Remuneration Committee is composed of four non-executive directors including the Chair of the Trust. Sarah Boulton, Chair Sarah has worked at NHS Board level for many years, chairing a number of NHS organisations, most recently as chair of NHS Midlands and East Strategic Health Authority. Sarah has a background in business and finance having worked as a business and management lecturer and more recently as a management consultant advising on strategy, change and Board development. She is an associate for Capsticks Solicitors, a member of the Octopus Advisory Health Board and a Director of Healthy Board Services Ltd. Appointed to the Trust Board form March 10, 2014 to March 31, 2016 Sheila Childerhouse, Non-Executive Director Sheila has a wide breadth of experience within the public and voluntary/community sector. She brings an extensive network in the Health Service and has served for various local and regional Health bodies since 1984 in non-executive and chair roles. She led PCTs from 2000 and latterly she chaired the NHS Norfolk & Waveney cluster. She has also chaired provider trusts including an acute hospital through turnaround, mental health and community services. Sheila‟s original background was in education and she was a local authority member for over 20 years, chairing major committees including holding the portfolio for Social Well-Being. She has led rural and urban regeneration organisations, most significantly Keystone Development Trust, one of the largest trusts of its kind in the country. Sheila was a member of the board of the East of England Development Agency, and deputy chair from 2009, leading on economic participation and social inclusion. Sheila is a trustee of East Anglia‟s Children‟s Hospices and a heritage museum trust. She is also a partner in a farming business. Appointed to the Trust Board for an interim term: July 15, 2013 to January 14, 2014 Appointed to the Trust Board for first term: January 15, 2014 to January 14, 2018


45

Dean Parker – Non Executive Director, Chair of Audit Committee Dean lives in Welwyn Garden City, Hertfordshire, and is a member of the Chartered Institute of Public Finance and Accountancy. Dean has more than 20 years‟ professional experience and expertise in audit, financial reporting, risk management and corporate governance. For five years he was a Financial Audit Director at the National Audit Office, leading audits at firstly the Department of Health including Monitor and the National Institute for Health and Care Excellence, and then the Department for Business Innovation and Skills. Dean is also the Independent Chair of the Electoral Commission's Audit Committee and is an Independent Member on the Audit and Risk Committee of the Equality and Human Rights Commission. Appointed to the Trust Board for first term: December 2, 2013 to December 1, 2016 Valerie Morton – Non Executive Director, Chair of Remuneration and Terms of Service Committee Valerie has more than 35 years‟ experience in the voluntary sector specifically in governance, fundraising and management. She has held senior positions at Help the Aged, NSPCC and RNIB. Valerie set up her own third sector consultancy business 15 years ago and is a trustee of the Julia Norris Almshouse Trust She was a non-executive Director at Bedfordshire Heartlands Primary Care Trust from 2001 -2006, East of England Strategic Health Authority from 2006-2011, and Midland and East Cluster SHA from 2011- 2013. She has been awarded the honour of Fellow of the Institute of Fundraising, is the author of the bestselling fundraising textbook Corporate Fundraising, a regular commentator in the press, and seasoned conference presenter. Appointed to the Trust Board for Associate term: December 2, 2013 to January 14, 2014. Appointed to the Trust Board: January 15, 2014 to January 14, 2018 Peter Kara – Non-Executive Director, Chair of Performance and Finance Committee Peter is a Fellow of the Chartered Association of Certified Accountants. He is a director of two private companies and runs a consultancy providing financial and strategic planning help to small and medium-sized companies. He has had a wide range of involvement in the voluntary sector in Milton Keynes since 1991 and with a national charity in London. He was non-executive director to the Milton Keynes Community NHS Trust from October 1993 until its dissolution in October 2000. Peter was previously a non-executive director of the Milton Keynes Primary Care Trust before its dissolution in 2013. He has lived in Milton Keynes since 1980 and remains a trustee of the Milton Keynes Community Foundation and a director of its subsidiary, MK Community Properties Limited, having served terms as chairman of both organisations. Appointed to the Trust Board for first term: December 2, 2013 to January 6, 2017 Andrew Egerton-Smith MBE - Associate Non-Executive Director Andrew qualified as a chartered surveyor in the 1960s and spent 30 years practising in the eastern counties until his retirement in 1994. During the 1980s, he was closely involved as a Trustee of Garden House Hospice in Letchworth which was established in 1985 as one of the first hospice charities working in partnership with the NHS, and he remained a Trustee until 1998 when he was appointed Chairman of East Anglian Ambulance NHS Trust, a position which he held until 2006.


46

In 2000 he was one of the trustees involved in establishing the East Anglian Air Ambulance charity of which he remains Chairman – a position which he has held since the inception of the charity. He is much involved in his own property activities and has been a Board member of various organisations including Flagship Housing from which he retired in 2013 and as deputy chairman of NHS Norfolk from 2006 -2012. Andrew was awarded the MBE in the 2013 Queen‟s Birthday Honours. Appointed to the Trust Board for Associate term: October 7, 2013 to October 6, 2015 (subject to annual review) Judith Lancaster – Non-Executive Director Appointed to the Trust Board on September 9th 2013 and stepped down when she left the Trust on the 30 September 2014. Executive Voting Directors Dr Anthony Marsh QAM SBStJ DSci (Hon) MBA MSc FASI Chief Executive Officer Starting his ambulance service career in Essex in 1987, Anthony held a number of senior posts with services in Hampshire, Lancashire and Greater Manchester, before returning to Essex as Chief Executive in 2003. Relocating to the West Midlands, he became the Chief Executive Officer of the West Midlands Ambulance Service in 2006. In 2011, Dr Marsh was decorated with the Order of St John. In addition to his responsibilities as Chief Executive he was appointed Chair of the Association of Ambulance Chief Executives and is the lead for the National Ambulance Resilience Unit. He also holds the national portfolio for Emergency Planning, Response and Resilience. Anthony is a regional and national Cadre Major Incident Gold Commander. Anthony holds a Master of Science Degree in Strategic Leadership as well as a Master in Business Administration (MBA) and has been awarded a Doctorate with the University of Wolverhampton. Anthony was awarded Queens Ambulance Service Medal in the 2014 New Year‟s Honours. Appointed to the Trust Board: January 1, 2014. Rob Ashford Locality Director – Essex Rob has 25 years‟ ambulance experience, and joined EEAST in 2013 as Sector Leader for Essex. He began his career in Patient Transport Services in London, progressing on to front line and through operational managerial positions. In 2005 he joined Essex Ambulance Service as General Manager for west Essex. Following the merger of ambulance services, Rob was Locality Chief Operating Officer for the Bedfordshire and Hertfordshire area before moving to West Midlands Ambulance Service as Chief Operating Officer in 2008. Appointed to the Trust Board: October 2013 to March 31, 2014 as Director of Service Delivery and subsequently as Locality Director for Essex to present. Matthew Broad Locality Director – Norfolk, Suffolk and Cambridgeshire Matt joined the NHS Ambulance Service in 1997, working in London for the first 2 years of his career. He then moved to Suffolk in 1999 where he continued his operational


47

development becoming a Paramedic in 2000. Matt continued to undertake development over the following years which included attaining training qualifications that led him into delivering Student Ambulance Paramedic and Paramedic training. After spending 18 months as the Clinical General Manager in Essex, Matt was appointed to the General Manager post in Norfolk until his appointment to the Trust Board in May 2014. Appointed to the Trust Board: May 2014 to present Dave Fountain Locality Director – Bedfordshire and Hertfordshire Dave has 27 years‟ experience with the Ambulance Service originally joining Hertfordshire Ambulance in 1996 as an ambulance technician. Dave progressed through all levels of management including achieving his Clinical Education training qualification as an instructor and holds a registered Paramedics qualification. Dave stayed with the Hertfordshire Ambulance Service and latterly with Bedfordshire and Hertfordshire Ambulance Service before the amalgamation into the East of England Service in 2006. Dave was appointed to the Trust Board on his appointment as Locality Director in May 2014. Appointed to the Trust Board: May 2014 to present Kevin Smith Acting Director of Finance Kevin has over 20 years‟ experience in NHS Finance, working in the acute, community, mental health and ambulance sectors as well as experience in the construction industry. He began his career at Great Yarmouth and Waveney Health Authority, progressing through finance roles at the James Paget Hospital and Norfolk Mental Health, before joining the East Anglian Ambulance Trust in 2005. Following the merger of ambulance services in 2006, Kevin was appointed as Deputy Director of Finance for East of England Ambulance Service, continuing in this role until appointed as Acting Director of Finance in June 2014. Appointed to the Trust Board: 1st June 2014 to present Sandy Brown Director of Nursing and Clinical Quality Sandy has worked within NHS Boards in Scotland and England in a career spanning over 25 years, including a foundation trust. He has experience at executive level with the acute and ambulance sector, and worked within an integrated Board covering a wide range of services including mental health. Sandy‟s roles have included general management, Director of Nursing, and Nurse Director incorporating the Director of Operations duties. He has also developed clinical pathways, working with clinical teams to improve patient care and experiences. Sandy was one of the first Nurse Consultants in the country and specialised in critical care. He has a degree in Clinical Practice (nursing) and an MA in Health Research. He has completed a Florence Nightingale Institute Scholarship and the Kings Fund Leadership Programme. Appointed to the Trust Board: February 2015 Dr Andy Carson Medical Director Andy has worked as an inner city General Practitioner in Birmingham for over thirty years. Throughout his career he has been involved in medical education and research, which culminated in his spending ten years as Associate Dean for GP Training for Birmingham and Solihull, where he was responsible for the educational provision and progress of around 300 GP Trainees at any one time, spread over three years of training. He was supported by over


48

two hundred accredited GP Trainers, based in more than a hundred Training Practices across the city. Four separate half day release courses were run across the city by sixteen Programme Directors. Andy and his administrative team ran annual educational updates for the teams of educators involved in GP Training. Over the last four years, Andy has worked as Medical Director of West Midlands Ambulance Service. He chairs a number of internal committees and also oversees the governance of responders working with partner organizations, such as local BASICS schemes, Air Ambulance Services and the MERIT response. He is currently heading up a project developing a new, clinically focused digital patient record for use by front-line crews. This should enable staff to deliver the best possible care to patients in a pre-hospital environment, also allowing electronic connection into the wider NHS. Andy is a Fellow of the Royal College of General Practitioners Appointed to the Trust Board: February 2015 Ruth McAll, MBA, MA, FCIPD, MCIM, ACC Interim Director of Human Resources Ruth has more than 20 years‟ experience as an HR Director and has also worked nationally on NHS wide projects. Ruth is a qualified coach and mediator with a particular interest in organisational development. Appointed to the Trust Board: March 2015 Register of Interests At the time of their appointment, all directors are asked to declare any interests on the Register of Directors‟ Interests. Board members are asked at each formal Board meeting to register any changes to their declarations and to confirm, in writing, on an annual basis, that the declarations are accurate. The Register is maintained by the Trust Secretary and is available to anyone who wishes to see it. Enquiries should be made to the Trust Secretary at the following address: Trust Secretary, East of England Ambulance Service NHS Trust, Whiting Way, Melbourn, Cambridgeshire, SG8 6EN Trust Board and Subcommittee Meetings and their Evaluation Processes The Trust Board, in accordance with the Public Bodies (Admission to Meetings) Act 1960, holds its meetings in public. The Trust Board has powers to delegate and make arrangements to exercise any of its functions through a committee, sub-committee or joint committee. The inter-relationship of these is shown in the diagram below:


49

The Trust Board has four sub-committees: Audit Committee (AC), Remunerations & Terms of Service Committee (RemCom), Patient Safety and Care Standards Committee (PSCSC) and Performance and Finance Committee (P&FC). How we conduct Board meetings The Trust has maintained its support of the Nolan principles for public life and has continued to make the majority of decisions at Board meetings held in public. In 2014/15 the Trust Board met each month, conducting a series of different meetings throughout the day. These included eight meetings in public, one of which was the Annual Public Meeting which was held on 30th July. Eleven private sessions of the Board were held; eight prior to the public meetings. Seven workshop sessions were held to allow the Board to forward plan and implement its Board development plan. These workshops included risk management and developing vision, values and strategic goals for the Trust. Membership attendance at Trust Board and sub-committee meetings is monitored throughout the year and is reported in the Trust‟s Annual Report and Accounts. There is a formal schedule of matters reserved for the Board and a Scheme of Delegation detail the types of decisions that are to be taken by the Board and which decisions are to be delegated to management by the Trust Board.


50

Attendance Membership attendance at Trust Board and sub-committee meetings for 2014/15 is summarised in the tables below:

Trust Board Public and Private Meeting Attendance

2014 2015

25 04 14 28 05 14 25 06 14 30 07 14 24 09 14 30/31 10 14 26 11 14 10 12 14 27 01 15 25 02 15 25 03 15

Members Private P&P Private P&P P&P Private P&P Private P&P Private P&P

Total

Sarah Boulton (Trust Board Chair, NED) x x x x x x x x x x x

11/11

Sheila Childerhouse (NED) x x x x x x x x x Apologies x

10/11

Valerie Morton (NED) x x x x x x x x x x x

11/11

Dean Parker (NED) x x x x x x x x x x x

11/11

Peter Kara (NED) x x x x x x x x x x x

11/11

Andrew Egerton-Smith (ANED) x x x x Apologies Apologies Apologies x x x x

8/11

Anthony Marsh (CEO) x x x x x x x x x x x

11/11

Rob Ashford (Executive Director) x x Apologies x Apologies x Apologies x x Apologies

6/10

Dave Fountain (Executive Director) x x x x Apologies x x x x x

9/10

Matt Broad (Executive Director) x x x x x x Apologies x x x

9/10

Kevin Smith (Executive Director) x x x x x x x x x

9/9

Sandy Brown (Executive Director) x x

2/2

Ruth McAll (Interim Director) x

1/1

Andy Carson (Executive Director) x

1/1

Ex-members

John Martin (Executive Director) x x

2/2

Judith Lancaster x x x x x x / / / /

6/6

Tracy Nicholls x x x Apologies Apologies X x x /

6/8

Francesca Okosi Apologies

0/1

Stephen Day x x

2/2

(i) – Judith Lancaster left the Trust on the 30 September 2014 (ii) – Tracy Nicholls returned to her substantive role on the 25 February 2015 (iii) – John Martin left the Trust on the 30 June 2014 (iv) – Francesca Okosi left the Trust on the 9 May 2014 (v) – Scott Turner left the Trust on the 10 September 2014 (vi) – Stephen Day left the Trust on the 30 May 2014


51

REMUNERATION COMMITTEE ATTENDANCE 2014/15

MEMBERS

25/0

4/2

014

28/0

5/2

014

13/0

6/2

014

25/0

6/2

014

21/0

7/2

014

22/0

8/2

014

02/0

9/2

014

24/0

9/2

014

31/1

0/2

014

26/1

1/2

014

10/1

2/2

014

25/0

2/2

015

Total

Valerie Morton 12/12

Sheila Childerhouse ap

11/12

Peter Kara ap n/a n/a n/a n/a n/a n/a n/a 4/5

Judith Lancaster n/a n/a n/a N/a n/a n/a n/a n/a 4/5

Sarah Boulton n/a

11/12

Dean Parker n/a n/a n/a n/a ap

7/8

***The committee structure changed in September 2014 therefore these members no longer attended the meetings / No longer a non-executive director

AUDIT COMMITTEE MEETING ATTENDANCE 2014/15

2014 2015

MEMBERS 06.05.14 16.05.14 28.05.14 12.09.14 12.11.14

22.01.15 Total

Dean Parker (NED) Appointed Committee Chair from 31.01.14

6/6

Sheila Childerhouse *** *** 4/4

Sarah Bolton

6/6

Andrew Egerton-Smith (Associate NED) Apologies

5/6

Peter Kara (NED)

6/6

Valerie Morton (NED) *** *** 4/4

EX-MEMBERS

Total

Judith Lancaster Apologies *** / 3/4


PATIENT SAFETY & CARE STANDARDS COMMITTEE 2014/15

2014 2015

MEMBERS 05.05.2

014 01.07.2

014 O2.09.2

014 17.11.2

014 06.01.2

015 03.03.2

015 Total

Sheila Childerhouse (NED) Appointed Committee Chair 31.01.14

6/6

Sarah Bolton (Trust Board Chair, NED) 5/6

Valerie Morton (NED) 6/6

Rob Ashford Locality Director Essex

Apologies

Apologies

Apologies

Apologies

Apologies

1/6

Dave Fountain Locality Director Beds and Herts

Apologies

Apologies

Apologies

1/4

Matt Broad Locality Director Norfolk, Suffolk, Cambridgeshire

Apologies

Apologies

Apologies

Apologies

1/5

Tracy Nicholls Interim Director of Clinical Quality

5/5

John Martin (Executive Director) / / / / / 1/1

Judith Lancaster (Executive Director) / / / / / 1/1

Peter Kara (NED) Apologies

*** *** *** *** 1/2

Andrew Egerton-Smith Associate NED

*** *** *** 2/3


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PERFORMANCE AND FINANCE COMMITTEE ATTENDANCE 2014/15

2014 2015 Total

Members 22 07 14 12 09 14 21 11 14 22 01 15 18 02 15 18 03 15

Peter Kara (NED) appointed Chair 6/6

Sarah Boulton (Trust Board Chair, NED)

6/6

Dean Parker (NED) 6/6

Andrew Egerton-Smith (ANED) Apologies

5/6

Kevin Smith (Executive Director) 6/6

Dave Fountain (Executive Director)

Apologies Apologies Apologies Apologies Apologies 1/6

Rob Ashford (Executive Director)

Apologies Apologies Apologies Apologies Apologies Apologies 0/6

Matt Broad (Executive Director)

Apologies

Apologies Apologies 3/6

Ex-Members

Judith Lancaster

*** *** *** *** 2/2


The values shown are number of attendances against number of meetings held during the year. Where there is no entry this means the director is not a member of that committee

Review of Effectiveness of the Trust Board and Sub-Committees The Board and the sub-committees review their effectiveness informally on a regular basis and formally once a year through the Board‟s approved evaluation process. The Audit Committee utilises the self-assessment questionnaire available from the Audit Committee Handbook 2011 and provides an annual report to the Trust Board. The current Board has been in place for a year now and reviews of the effectiveness of the Board and its committees will be done by September 2015. A review of the subcommittees was carried out by the Chair and Trust Secretary in April/May 2014, resulting in the establishment of the four board committees as set out above. Revised Terms of Reference for each of these Committees have been approved by the Trust Board. Board Effectiveness Moving forward into 2015/16 the Board will review and build its effectiveness, particularly via the newly developed set of vision and values, an organisational culture that values empowerment, collaboration, innovation and a greater patient focus.

Remuneration Report Trust Board Remuneration Committee The Remuneration Committee is responsible for advising on the appointment and/or dismissal of executive directors and directors. The committee is also responsible for the approval of their remuneration and terms of service and for the monitoring of their performance against delivery of organisational objectives. Membership is drawn from the non-executive directors of the Trust Board and has 4 members including the Chair. The Chief Executive is entitled to attend the committee and be consulted with when the appointment and remuneration of the executive directors is being considered. He is


53

excluded from meetings on his own position. All appointments are by public advertisement, and external assessors are part of the recruitment process. Remuneration and performance conditions The remuneration of the Chair and the Non-Executive Directors is decided by the Secretary of State. The time commitment required is approximately three days per week for Chairs and two and a half days per month for non-executive directors. To determine an Executive Director‟s salary level, the Remuneration Committee used one or more of the following independent benchmarking comparative data during 2013/14:

Hay Group

NHS Foundation Trust Network

NHS ambulance services The policy of the Trust on remuneration of senior managers fully reflects the national guidance issued by the Department of Health. The performance of senior managers is assessed by performance against objectives. Executive directors have permanent employment contracts with termination periods of six months. The exception to this policy is by agreement of the Remuneration Committee. Reporting of other compensation schemes – exit packages There are no special contractual compensation provisions for early termination of Executive Director‟s contracts. Early termination by reason of redundancy is subject to normal NHS terms and conditions of service handbook or, for those above the minimum retirement age, early termination by reason of redundancy or „in the interests of the efficiency of the service‟ is in accordance with the NHS Pension Scheme. Employees above the minimum retirement age who themselves request termination by reason of early retirement are subject to the normal provisions of the NHS Pension Scheme. Detailed below are the remuneration, salary and pension entitlements of the senior managers. These disclosures have been audited. Salary and pension entitlement of the Trust Board The Chief Executive has determined that senior managers are those persons in senior positions having authority or responsibility for directing or controlling the major activities of the Trust. This means those who influence the decisions of the entity as a whole rather that the decisions of the individual directorates or departments. Detailed below are the remuneration, salary and pension entitlements of the senior managers. These disclosures have been audited.

East of England Ambulance Service NHS Trust: Annual Report 2014 - 15 54

Salary and allowances

Name Title

2014-15 2013-14

(a) (b) (c) (d) (e) (f) (a) (b) (c) (d) (e) (f)

Salary (bands

of £5,000)

Expense

payments

(taxable) total

to nearest

£100

Performance pay

and bonuses (bands of £5,000)

Long term

performance pay


All pensio

n-related benefit

s (bands

of £2,500)

TOTAL (a to e) (bands

of £5.000)

Salary (bands

of £5,000)

Expense

payments

(taxable) total

to nearest

£100

Performance pay


Long term

performance pay


All pensio

n-related benefit

s (bands

of £2,500)

TOTAL (a to e) (bands of £5.00

0)

Senior Managers in post at 31 March 2015

Sarah Boulton Interim Chair 35-40 Nil Nil Nil Nil 35-40 0-5 Nil Nil Nil Nil 0-5

Sheila Childerhouse NED 5-10 Nil Nil Nil Nil 5-10 0-5 Nil Nil Nil Nil 0-5

Judith Lancaster NED 0-5 Nil Nil Nil Nil 0-5 0-5 Nil Nil Nil Nil 0-5

Peter Kara NED 5-10 Nil Nil Nil Nil 5-10 0-5 Nil Nil Nil Nil 0-5

Valerie Morton NED 5-10 Nil Nil Nil Nil 5-10 0-5 Nil Nil Nil Nil 0-5

Dean Parker NED 5-10 Nil Nil Nil Nil 5-10 0-5 Nil Nil Nil Nil 0-5

Andrew Egerton-Smith

Associate NED 5-10 Nil Nil Nil Nil 5-10 0-5 Nil Nil Nil Nil 0-5

Anthony Marsh Interim Chief Executive 135-140

Nil Nil Nil Nil 135-140

45-50 Nil Nil Nil Nil 45-50

Rob Ashford Locality Director 90-95 5000 Nil Nil Nil 95-100

40-45 3000 Nil Nil 80-82.5

125-130

David Fountain Locality Director 90-95 9100 Nil Nil 57.5-

60 160-165

Nil Nil Nil Nil Nil Nil

Matthew Broad Locality Director 75-80 8900 Nil Nil 72.5-

75 160-165


Alexander Brown Director of Nursing 10-15 Nil Nil Nil 32.5-

35 40-45 Nil Nil Nil Nil Nil Nil

Ruth McAll Interim Director of HR 0-5 Nil Nil Nil Nil 0-5 Nil Nil Nil Nil Nil Nil

Dr Andrew Carson Medical Director 0-5 Nil Nil Nil 22.5-

25 25-30 Nil Nil Nil Nil Nil Nil

Tracy Nicholls Acting Director of Quality and Patient Safety 65-70 7000 Nil Nil 70-72.5

145-150


Kevin Smith Acting Director of Finance 80-85 5100 Nil Nil 127.5-130

215-220



Senior Managers who left the Trust Board in 2014/15

Ngozika (Francesca) Okosi

Director of Workforce, Engagement & Organisational Development

35-40 1200 Nil Nil 27.5-

30 65-70 85-90 1400 Nil Nil

15-17.5

100-105

Dr Scott Turner Interim Medical Director 25-30 2200 Nil Nil Nil 25-30 35-40 1800 Nil Nil 57.5-

60 95-100

John Martin Interim Director of Patient Safety and Clinical Standards

20-25 1200 Nil Nil 15-17.5

35-40 85-90 900 Nil Nil 45-47.5

130-135

Stephen Day Interim Director of Finance & Commercial Service Director

25-30 Nil Nil Nil Nil 25-30 245-250

Nil Nil Nil Nil 245-250

The Benefit in kind relates to car benefit charge.

The costs to the Trust in respect of Stephen Day, Interim Director of Finance & Commercial Services, for fees and expenses total £27,776 for the period. These costs were charged by Cadence Partners.

The total cost to the Trust in respect of Anthony Marsh (Interim Chief Executive) from West Midlands Ambulance Service NHS Foundation Trust (WMAS) was £175,054 for the period. This includes National Insurance and Pension which are reported by WMAS, so not included in this statement.

The costs to the Trust in respect of Ruth McAll, Interim Director of HR, for fees and expenses total £4650 for the period. These costs were charged by Fine Green Associates

The 2013/14 All Pension Related Benefits have been restated in line with the calculation for 2014/15 as per the Disclosure of Senior Managers Remuneration (Greenbury) 2015 & 2014 guidance.

The following senior managers served for part of the financial year 2014/15:

David Fountain Appointed to Trust Board 1st April 2014 Stephen Day Left the Trust Board on 30th May 2014

Matthew Broad Appointed to Trust Board 23rd May 2014 John Martin Left the Trust Board on 30th June 2014

Alexander Brown Appointed to Trust Board 23rd February 2015 Ngozika(Francesca) Okosi Left the Trust Board on 9th May 2014

Tracy Nicholls Appointed to Trust Board 9th July 2014 Dr Scott Turner

Left the Trust Board on 30th June 2014

Kevin Smith Appointed to Trust Board 1st June 2014

Dr Andrew Carson Appointed to Trust Board 9th February 2015

Ruth McAll Appointed to Trust Board 25th March 2015

Signed on behalf of East of England Ambulance Service NHS Trust on 28th May 2015:

Sarah Boulton Anthony Marsh

Interim Chair Interim Chief Executive


Senior managers’ pension benefits 2014/15 The following pension benefits have accrued for those senior managers directly employed by the Trust

Title Name

Real increase in pension at

age 60 (bands of £2,500)

Real increase in pension

lump sum at aged 60

(bands of £2,500)

Total accrued

pension at age 60 at 31 March 2015

(bands of £5,000)

Lump sum at age 60 related to accrued

pension at 31 March

2015 (bands of £5,000)

Cash Equivalent

Transfer Value at

31 March 2015 £'000

Cash Equivalent

Transfer Value at

31 March 2014 £'000

Real increase in

Cash Equivalent

Transfer Value £'000

Employer’s contribution

to stakeholder

pension £'000

Locality Director David Fountain 2.5-5 10-12.5 35-40 105-110 696 600 95 Nil

Acting Director of Finance Kevin Smith 5-7.5 10-12.5 35-40 70-75 476 371 104 Nil

Acting Medical Director Dr Scott Turner 0-2.5 0-2.5 15-20 55-60 356 340 16 Nil

Medical Director Dr Andrew Carson 0-2.5 0 0-5 0 35 16 19 Nil

Acting Director of Quality and Patient Safety Tracy Nicholls 2.5-5 10-12.5 20-25 60-65 377 297 79 Nil

Locality Director Robert Ashford 0-2.5 2-2.5 25-30 75-80 417 396 21 Nil

Locality Director Matthew Broad 2.5-5 10-12.5 15-20 50-55 259 195 63 Nil

Director of Workforce, Engagement & Organisational Development / Deputy Chief Executive

Ngozika (Francesca) Okosi

0-2.5 0 0-5 0 35 15 20 Nil

Director of Nursing Alexander Brown 0-2.5 5-7.5 30-35 95-100 604 543 61 Nil

Interim Director of Patient Safety and Clinical Quality

John Martin

0-2.5 2.5-5 10-15 40-45 167 148 18 Nil

As Non-Executive members do not receive pensionable remuneration, there are no entries in respect of pensions for Non-Executive members.

Cash Equivalent Transfer Values A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member‟s accrued benefits and any contingent spouse‟s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. Real Increase in CETV

This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee


(including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.

Median Remuneration

2014-15 2013-14

Band of Highest Paid Director’s Total Remuneration (Bands of £5,000) £'000 135-140 245-250

Median Total Remuneration £'s 26,186 27,007

Ratio 5.28 9.16 NHS Trusts are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisations' workforce. Due to changes in the Board personnel during the year, and interim positions, there is a change to the highest paid director compared to 2013/14. The banded remuneration of the highest-paid director in the organisation in the financial year 2014-15 was £135k-140k. This banding is 5.28 times the median remuneration of the workforce, which was £26,186. The large decrease in the ratio is due to the highest paid Director post being held by a Consultant in 2013/14 rather than a substantive employee in 2014/15. If the 2013/14 ratio is recalculated using the Chief Executive at the time as the highest paid Director, would show the banding as 5.32 times higher than the median remuneration of the workforce at £27,007, this is in line with the 2014/15 calculation and over the long term. The slight decrease in Median remuneration is due to the effect of management redundancies and recruitment of student paramedics. Agency and Consultancy staff are included on the basis of those occupying a vacant post as at 31st March 2015. These agency costs are annualised based on the expenditure on that individual in the week ending 31st March 2015, less an agency commission fee of between 7.25% and 9%. Locum GP's and Nurses are included using their actual income earned from the Trust in year. They are not annualised on the basis that they are not contracted to specific shifts throughout the year, but collectively they cover the sessional shifts of the GP out of hours service. Annualising GP and Nurse remuneration in this position would distort employee remuneration.

Reporting of other compensation schemes – exit packages – 2014/15 The Trust has no declarations to make in respect of compensation schemes or exit packages in the reporting period.


Off-payroll engagements note An off-payroll arrangement is where contracted individuals are paid directly or through their own companies (and so are responsible for their own tax and NI arrangements) and not being classed as employees.

Off-Payroll Engagements Table 1 For all off-payroll engagements as of 31 March 2015, for more than £220 per day and that

last longer than six months:

Number

Number of existing engagements as of 31 March 2015 127

Of which, the number that have existed:

for less than one year at the time of reporting 25

for between one and two years at the time of reporting 10

for between 2 and 3 years at the time of reporting 7

for between 3 and 4 years at the time of reporting 4

for 4 or more years at the time of reporting 81

All existing off-payroll engagements have at some point been subject to a risk based assessment as to whether assurance is required that the individual is paying the right amount of tax and, where necessary, that assurance has been sought. Prior to service commencement, each engagement must have signed a contract stating that they are responsible for accounting to the relevant taxes, national insurance, liabilities, charges, and duties. All engagements listed in Table 1 are with General Practitioner's or Nurse Practitioners, contracted to deliver the Primary Care Out of Hours service.


Off-Payroll Engagements Table 2 For all new off-payroll engagements between 1 April 2014 and 31 March 2015, for more than £220 per day and that last longer than six months:

Number

Number of new engagements, or those that reached six months in duration, between 1 April 2014 and 31 March 2015. 25

Number of new engagements which include contractual clauses giving the East of England Ambulance Service NHS Trust the right to request assurance in relation to income tax and National Insurance obligations.

25

Number for whom assurance has been requested 25

Of which:

assurance has been received 25

assurance has not been received 0

engagements terminated as a result of assurance not being received 0

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

2

Number of individuals that have been deemed “board members, and/or senior officers with significant financial responsibility” during the financial year. This figure includes both off-payroll and on-payroll engagements*

20

*All individuals who occupied a Board member position, for a period of time in the financial year, have been included in this figure.


60

Declaration of Interests

Name and Position Declaration of Interest

Sarah Boulton Chair, Non-executive Director

Director – Healthy Board Services Ltd Associate – Capsticks Solicitors LLP Member – Octopus Advisory Health Board

Sheila Childerhouse Non-executive Director

Partner – T&D Childerhouse Self-employed as partner in T&D Childerhouse Self-employed executive coach Trustee – Keystone – Keystone Development Trust Trustee – Burrell Museum Trustee – East Anglian Children‟s Hospice Associate – Capsticks Associate – Julie Oliver Associates

Andrew Egerton-Smith Associate Non-executive Director

Chairman – East Anglian Air Ambulance

Peter Kara Non-executive Director

Mental Health Act Manager – Central & North West London NHS Foundation Trust

Judith Lancaster Non-executive Director

Judge in First Tier Property Tribunal

Valerie Morton Non-executive Director

Proprietor of Valerie Morton Fundraising & Consultancy – some clients may be health related charities. Currently no conflicts to disclose. Associate Capsticks Solicitors LLP

Dean Parker Non-executive Director

Wife is the Chief Officer at the following Clinical Commissioning Groups – Westminster, Ealing, Hounslow, Kensington and Chelsea, Hammersmith and Fulham and was previously the Chief Finance Officer of the same groups. Independent Member of Audit & Risk Assurance Committee – Equalities & Human Rights Commission Chair of the Electoral Commission Audit Committee.

Dr Anthony Marsh Chief Executive Officer

Trustee of West Midlands Ambulance Service NHS Foundation Trust General Charity IMAS Partner IMAS Board member Major Incident Regional Commander National Major Incident Commander (Management in Crisis Cadre) Chair of the Association of Ambulance Chief Executives Ambulance Advisor Health Education England NHS Trust Development Authority National Ambulance Advisor Accountable Officer West Midlands Ambulance Service NHS Foundation Trust

Stephen Day Interim Director of Finance & Commercial Services

Director/owner – Entrusted Group Limited


61

Name and Position Declaration of Interest

John Martin Acting Director of Patient Safety and Clinical Standards

Director: College of Paramedics. Director: British Paramedic Association. Director: Challenge Your Thinking Limited. Self-employed consultant. Vice Chair: College of Paramedics. Chair: National Ambulance Lead Paramedic Group (Part of Association of Ambulance Chief Executives). Advisory Board member: Paramedic Education Evidence-based Project. Committee Member: Joint Royal Colleges Ambulance Liaison Committee. Committee Member: Allied Health Professions Federation. Health and Care Professions Council: Registration Partner & Education Partner. Jones & Bartlett Section Editor: Emergency Care in the Streets. NHSLA approved expert witness. Council member: East of England Clinical Senate (NHS England).

Scott Turner Acting Medical Director

GP: Part-time partner in general practice, including shareholding in Norwich Practices Ltd (NPL). Executive member of Norfolk Accident Rescue Service. Race-course medical officer.


Director: Elite Advanced Driver Training Ltd.

Matt Broad Locality Director Norfolk, Suffolk, Cambridgeshire

Nil

Dave Fountain Locality Director Bedfordshire and Hertfordshire

Nil

Tracy Nicholls Interim Director of Nursing and Clinical Quality

Nil

Kevin Smith Acting Finance Director

Nil

Alexander Brown Director of Nursing and Clinical Quality

Nil

Andy Carson Medical Director

Partner at Bellevue Medical Centre Medical Director – West Midlands Ambulance Service NHS Foundation Trust


62

Financial Report This annual report has been prepared to reflect the activities and financial position of the

East of England Ambulance Service NHS Trust for the year ending 31 March 2015.

For the 2014-15 financial year the Trust met the three important financial targets: Breakeven,

External Financing Limit and Capital Resource Limit. As in the previous year, plans

submitted to the NHS Trust Development Authority (TDA) were used for monitoring our

financial performance during the year.

For the year ending 31 March 2015, the Trust is reporting a retained surplus of £998,000

after impairments of £253,000 which gives rise to an adjusted retained surplus of

£1,251,000. This was ahead of the planned surplus for the year of £75,000.

The surplus is an increase on the reported adjusted surplus of £379,000 for the previous

financial year and is a considerable achievement given the transformation work the Trust

undertook in the year.

Looking at the financial statements for 2014-15, the Trust was able to maintain its operating

expenses at approximately the same levels as the previous financial year, despite a

considerable increase in activity. This together with an increase in revenue for the year has

resulted in the improved surplus position.

One of the principle factors behind the Trust‟s financial performance was the achievement of

our £10.4m cost improvement plan that ensured resource was directed to front-line

operations from support areas, in line with the six priorities.

The Trust was also able to make over £6.4m in capital investments during the year. This

enabled the purchase of 223 new defibrillators to modernise equipment on our vehicles,

together with investment in IM&T and Estate projects to support front-line operations.

The Trust has agreed all our principal contracts and therefore our revenue for 2015-16 and

our budgets for the year have been agreed by the Board. Included in these budgets is a

challenging savings target which will need to be achieved whilst maintaining our quality

standards. The Trust Board will continue to monitor our financial position and key risks; the

most significant financial risk being the delivery of the savings plans.

The full financial statements for the year ending 31 March 2015 are presented within this

Annual Report.

Kevin Smith

Acting Director of Finance



Annual Governance Statement Appendix A

Year Ended 31 March 2015

East of England Ambulance Service NHS Trust Trust Headquarters Whiting Way Melbourn Cambridgeshire SG8 6NA


East of England Ambulance Service NHS Trust Organisation Code: RYC Annual Governance Statement Scope of Responsibility As Accountable Officer and as set out in the Accountable Officer Memorandum, the Chief Executive has responsibility for maintaining a sound system of internal control that supports the achievement of the Trust‟s policies, aims and objectives, whilst safeguarding public funds and departmental assets for which he is personally responsible, in accordance with the responsibilities assigned to him. The Accountable Officer is also responsible for ensuring that the Trust is administered prudently and economically and that resources are applied efficiently and effectively. The Chief Executive has responsibility for ensuring that there is effective liaison with the NHS Trust Development Authority (TDA), the NHS England Local Area Teams (LAT), and the commissioners in the development of strategic priorities for the organisation through the Trust‟s Integrated Business Plan (IBP). The Chief Executive ensures both national and local targets are met and risks are mitigated to acceptable levels. The NHS TDA monitors the achievement of key priorities on an on-going basis. In addition, senior managers participate fully across the region in all strategic and operational planning, preparation and commissioning issues. The Governance Framework of the Organisation The Trust Board continues to adopt the National Leadership Council‟s principles as defined within The Healthy NHS Board Principles of Good Governance (2013). These are:

Formulate strategy for the organisation.

Ensure accountability by holding the organisation to account for the delivery of strategy and through seeking assurance that all systems of control are robust and reliable.

Shape a positive culture for the Board and the organisation. The Board recognises the importance of the principles of good corporate governance and is committed to ensuring these are effective and efficient. This is implemented through key governance documents, policies and procedures of the Trust, including:

The Trust‟s Standing Orders.

The Reservation of Powers to the Trust Board and Scheme of Delegation.

The Standing Financial Instructions.

The Annual Plan.

Terms of reference of the sub-committees of the Trust Board. The Trust has applied the principles of the relevant codes of corporate governance in the following manner:

The Trust is led by a Board comprising non-executive and executive directors which provides leadership within a framework of internal control whilst promoting innovation and vision, and challenge to any performance issues. The Trust Board monitors the effectiveness of the internal control systems and processes through clear accountability arrangements.


Each executive director provides an account of control systems and processes, monitoring methods and weaknesses within their Directorates during the year; cross checking evidence of compliance with statutory functions to ensure that the Trust remains legally compliant.

Delegation of authority for executive management to the Chief Executive, subject to monitoring and limitations as defined within the policies and procedures of the Trust, including Standing Financial Instructions and the Scheme of Delegation. The limitations require that any executive action taken in the course of business does not compromise the integrity and reputation of the Trust and takes account of any potential risks, health and safety, patient experience and finance issues, and also working with partner organisations.

The Audit Committee is fully functioning with a Chair of Audit with the requisite financial qualifications and experience.

The Trust Board Directors’ Responsibilities The Trust Board comprises the non-executive directors and executive directors that form a unitary body. The Board functions as a corporate decision-making body and should consist of six non-executive directors (including the Chair) and five executive directors. The Board now consists of a Chair, five non-executive directors, Chief Executive Officer, an Acting Director of Finance, three locality directors (having one vote between them), a Director of Nursing and Clinical Quality and a part time Medical Director. One of the non- executive Directors (NED) resigned in September 2014 and a new NED with clinical expertise and experience was appointed who will start with the Trust in April 2015. An associate non-executive director is also appointed to provide further expertise and advice to the Trust Board Appointment of Board Directors Due consideration is given to the composition of the Board in terms of the protected characteristic groups in the Equality Act 2010. Each Board member is appointed for their experience, their business acumen and their links with the local community. The Secretary of State for Health has the power to make the appointments of the Chair and Non-Executive Directors but has delegated this role to the NHS TDA. As a result the NHS TDA is responsible on behalf of the Secretary of State for their appointment and removal, on-going support through appraisal, mentoring and training. All appointments are made by a public advertisement. Terms of appointment are normally for periods of four years with members eligible to be re-appointed or to re-apply up to a maximum of ten years. The Non-Executive Directors‟ responsibilities include:

Helping to plan for the future growth and success of the organisation.

Making sure that the management team meets its performance targets.

Ensuring that finances are properly managed with accurate information.

Helping the Board ensure it is working in the public interest. The Chief Executive and the Trust Board Executive Directors are appointed, via public advertisement, by members of the Remuneration Committee. The Remuneration Committee is composed of four Non-Executive Directors including the Chair of the Trust. Register of Interests At the time of their appointment, all directors are asked to declare any interests on the Register of Directors‟ Interests. Board members are asked at each formal Board meeting to register any changes to their declarations and to confirm, in writing on an annual basis, that


the declarations are accurate. The Register is maintained by the Trust Secretary and is available to anyone who wishes to see it. This information is also published in the Annual Report and Accounts. Trust Board and Sub-Committee Meetings and Their Evaluation Processes The Trust Board, in accordance with the Public Bodies (Admission to Meetings) Act 1960, holds its meetings in public. The Trust Board has powers to delegate and make arrangements to exercise any of its functions through a committee, sub-committee or joint committee. Following a review of its committee structure during the year the Trust Board increased the number of committees from three to four, namely, the Audit Committee, Remuneration & Terms of Service Committee, Patient Safety & Care Standards Committee (PS&CS) and Performance and Finance Committee (P&FC) How the Trust Conducts its Board Meetings The Trust has maintained its support of the Nolan principles for public life and has continued to make the majority of decisions at Board meetings held in public. During 2014/15 the Trust Board met each month, conducting a series of different meetings throughout the day. These included eight meetings in public, one of which was the Annual Public Meeting which was held on 30 July 2014. Eleven private sessions of the Board were held; eight prior to the public meetings. Seven workshop sessions were held during 2014/15 to allow the Board to forward plan and implement its Board development plan. These workshops included risk management and developing vision, values and strategic goals for the Trust. Membership attendance at Trust Board and sub-committee meetings is monitored throughout the year and is reported in the Trust‟s Annual Report and Accounts (Appendix 1) Review of Effectiveness of the Trust Board and Sub-Committees The Board and the sub-committees review their effectiveness informally on a regular basis and formally once a year through the Board‟s approved evaluation process. The Audit Committee utilises the self-assessment questionnaire available from the Audit Committee Handbook 2011 and provides an annual report to the Trust Board. The current Board has been in place for a year now and reviews of the effectiveness of the Board and its committees will be done by September 2015. A review of the subcommittees was carried out by the Chair and Trust Secretary resulting in the establishment of the four Board committees as set out above. Revised Terms of Reference for each of these Committees have been approved by the Trust Board. Board Effectiveness Moving forward into 2015/16 the Board will review and build its effectiveness, particularly via the newly developed set of vision and values, an organisational culture that values empowerment, collaboration, innovation and a greater patient focus. Audit Committee The Board now has a fully established Audit Committee comprising two non-executive directors and an associate non-executive director. The Chair has recent and relevant financial experience and is a qualified accountant. The Trust Chair usually attends the Audit Committee meetings. The Audit Committee‟s primary role is to review the adequacy and effective operation of the organisation‟s overall internal control system. In performing that role, the Committee‟s work predominantly focuses upon the framework of risks, controls and related assurances that underpin the delivery of the organisation‟s objectives (the Board Assurance Framework). As a result, the Committee has a pivotal role


to play in reviewing the Board‟s disclosure statements that flow from the organisation‟s assurance processes. These declarations are independently assessed by the Committee as part of the annual report and accounts sign-off process and action recommended to the Trust Board. During 2014/15 the committee took on responsibility for the review of the corporate risk register as well as oversight of the systems and processes in place to manage risk. The committee undertook a review of the effectiveness of the corporate risk register and the Board Assurance Framework (BAF) and developed a new process and format for BAF enabling better management of corporate risks and associated action plans The Committee also provides assurance to the Board on compliance with relevant regulatory, legal and code of conduct requirements. The Committee reviews the arrangement by which the Trust‟s staff may raise, in confidence, concerns about possible improprieties in matters of financial reporting and control. The Committee‟s aim is to ensure that arrangements are in place for an independent investigation of such matters and for appropriate follow-up action through Internal Audit or the Counter Fraud Service. It maintains appropriate relationships with the organisation‟s auditors, both internal and external, as well as the Local Counter Fraud Specialist and Security Management. Key activities during the course of 2014/15 included:

Reviewing in detail the Annual Accounts 2014/15 for the Trust and its Charitable Fund, and considering the Annual Governance Report from External Audit for 2014/15.

Monitoring the delivery of an agreed programme of internal audit reviews, considering the findings of those reviews and monitoring the timely and effective implementation of agreed recommendations.

Monitoring of internal financial control matters, such as safeguarding of assets, the maintenance of proper accounting records and the reliability of financial information.

Reviewing the assurances as detailed in the Board Assurance Framework.

Reviewing the adequacy of relevant policies, legality issues and the Codes of Conduct.

Reviewing the policies and procedures related to fraud and corruption.

Reviewing the audit recommendations and the action plans on the audits with Limited Assurance

The Audit Committee, with the exception of the review of effectiveness, completed all items included in the plan for 2014/15. The Committee agreed that it could report to the Trust Board that:

In its view and taking into account the impact on Board composition and Board committee functions, the Trust had maintained an adequate system of governance, risk management and internal control across the whole of the Trust‟s activities (clinical and non-clinical), that supported the achievement of the Trust‟s objectives.

There was an effective internal audit function, including counter fraud services, established by management that met mandatory NHS Internal Audit standards and provided appropriate independent assurance.

Financial reports were complete and accurate, as reflected in the External Auditor‟s report to those charged with Governance. The audit opinion confirms that the accounts give a „true and fair view‟ of the state of the Trust‟s income and expenditure for the year and that they were properly prepared in accordance with the accounting policies relevant to the NHS in England An independent assessment Quality Account will be carried out by PS&CS Committee before submission to check whether this represented a balanced picture of the Trust‟s performance during 2014/15 and that the information reported therein was reliable and accurate, there were proper internal controls over the collection and reporting of the


measures of performance included in the Quality Account, and these controls were subject to review to confirm that they were working effectively in practice; the data underpinning the measures of performance reported in the Quality Account was robust and reliable, conformed to specified data quality standards and prescribed definitions, and was subject to appropriate scrutiny and review; and the Quality Account had been prepared in accordance with Department of Health guidance. Ernst and Young LLP are appointed as the Trust‟s external auditor to independently audit the financial statements and the part of the remuneration report to be audited in accordance with relevant legal and regulatory requirements, i.e. the International Financial Reporting Standards (IFRS). The Trust ensures that the external auditors‟ independence is not compromised by work outside the audit code by having an agreed protocol for non-audit work. Non-audit work may be performed by the Trust‟s external auditors where the Audit Committee‟s approved procedure is followed. This ensures that all such work is properly considered and the auditors‟ objectivity and independence is safeguarded. The statutory audit fee for 2013/14 audit work is estimated to be £91,313. No non-audit services were undertaken during the reporting period. Patient Safety & Care Standards (PS&CS) Committee The PS&CS is accountable to the Trust Board for assurance on quality, clinical governance frameworks, internal controls and related assurances which underpin the Trust achieving its strategic objectives. It plays a pivotal role in the assurance processes linked to the Quality Account and the CQC Registration Quality Risk Profile (QRP) and clinical risks. The PS&CS sets out to scrutinise patient safety performance, clinical performance, agree the clinical audit programme, review clinical audit findings and monitor plans to address deviation from expected clinical performance. It is also required to review patient experience feedback (e.g. complaints, surveys, etc.) and seek assurance on plans to address shortcomings. The PS&CS work plan also includes scrutiny of the CQC standards, principally on patient safety and clinical performance and a review of the performance of the Trust‟s clinical risk management, health and safety regimes and the Equality Delivery System (EDS). The Committee also had training on the Health Assure system which will enable the members to review the key lines of enquiries associated with the CQC standards and evidence independently Key activities during the course of 2014/15 include

Establishing the revised terms of reference for the PS&CS Committee and clear criteria for reporting

Reviewing the level of compliance with CQC essential standards and action plans related to CQC inspection reports

Reviewing the Clinical Audit Plan for 2014/15, the Health and Safety Strategy 2014/15 and the Annual Safeguarding Report 2014/15.

Reviewing the action plans resulting from the Information Commissioners Audit on Patient Care Records and Data Protection limited assurance report

Formulating and reviewing the action plans from the Francis Report and Lampard Report

Reviewing the SIs reports resulting from delayed responses, subsequent action plans and monitoring of progress of these action plans

Assurance on the Quality Impact assessments for the cost improvement programme for 2014-15

Reviewing Medicines Management including stock control of controlled drugs and security of drugs cupboards and The Medicine Management Annual report and recommendations.


Performance and Finance Committee (P&FC) The new performance and finance committee was established with the first meeting being held on the 22 July 2014 comprising two non-executive directors and an associate non-executive director. The Chair of the Trust Board also attends the meetings. The purpose of the Committee is to help the Board seek assurance that the Trust is running to plan in relation to operational and financial performance The Committee met on six occasions during the 2014/15 financial year, two of which were extraordinary meetings to discuss the 2015/16 budget and planning. Key activities during the course of 2014/15 include

Review of the Cost Improvement Programme

Review of the Ambulance replacement programme, objectives, cost, ramifications, procurement and timeframe

Review of operational performance against national targets, performance recovery plans and trajectories

Review of the capital programme, capital spend on defibrillators and estates

Review of the Commissioning strategy and Budget and planning for 2015/16

Progress on Training and Education programmes, progress, concerns on the lack of PU for frontline staff and the number of PDRs undertaken

Review of the workforce, information dashboard, attrition, HR compliance against mandatory/legal requirements

Remuneration & Terms of Service Committee The Remuneration & Terms of Service Committee is responsible for advising on the appointment and/or dismissal of the executive directors and directors. The committee is also responsible for the approval of their remuneration and terms of service and for the monitoring of their performance against delivery of organisational objectives. Membership is from the non-executive directors of the Trust Board. The Chief Executive is entitled to attend the committee and be consulted upon when the appointment and remuneration of the executive directors is being considered. The Chief Executive is excluded from meetings on his own position. An appointments panel of the Remuneration Committee is convened when appointments are to be made. All substantive, permanent appointments are by public advertisement, and external assessors are part of the recruitment process. The Committee has met twelve times during the year and has been actively involved in the following:

Reviewing, scrutinising and approving business cases and suitable alternative employment searches submitted under the Trust‟s Voluntary and Compulsory Redundancy Scheme

Appointment of Director of Clinical Quality, Medical Director and HR Director to interim positions during the year.

Appointment of a substantive Director of Nursing and Clinical Quality

Approval of the Business Travel Policy with a greater focus on sustainability


The Risk and Control Framework The Trust‟s Risk Management Strategy and Procedure describe the risk management process to identify potential risks that exist within the Trust. The Strategy outlines the principles that are applied to all Trust activities and services to ensure that any risks identified and analysed are suitably evaluated and treated, thereby mitigating any risks which could prevent the Trust from achieving its strategic objectives. Both the Risk Management Strategy and Procedure have been reviewed and updated in 2014/15, following the Trust restructure and the need to ensure on-going appropriateness and effectiveness. All risk registers for the Trust are managed via an electronic database. The system for escalation of principal risks is supported through monthly Director risk review processes led by the Risk Manager; risk register reports are scrutinised at both the Risk Management Group (RMG) and the Audit Committee. The Executive Management Board (EMB) has delegated responsibility for the implementation of risk management systems and processes to the RMG, which is Director-led; its terms of reference are reviewed and updated annually and attendance of members is proactively monitored. There is detailed scrutiny of the Trust‟s principal risks at the RMG to monitor progress against actions, consistency of scoring and identification of controls. A detailed review of at least one directorate risk register is undertaken at each meeting for the purposes of gaining assurance that risk is being managed effectively at a local level. This ensures that all levels of risk are being considered during the year and that focus does not only rest with the highest scoring risks. It is important to note that the first two quarters of the financial year were challenging for ensuring compliance with the Business as Usual elements of risk management, due to the transition between two Trust structures and the changes to management levels across the organisation. This resulted in the following issues:

Risk Management Group was unable to meet for a prolonged period of time

o This was mitigated in part through Audit Committee reviewing team risk registers at each meeting

o The BAF has been reviewed at the Executive Management Board o 1:1 Director risk meetings have continued

Restructure of the risk register has been required to ensure alignment with the new structure, which has caused a delay in some areas being able to document risk management processes

o Operational risk registers now fully aligned with areas

New managers in post o This has resulted in a need for training in risk management, which will take

place in quarter one 2015/16


Risk Assessment Prior to the restructure, identification of risk was considered to form a business as usual component throughout the organisation‟s practices, with directorates and teams responsible for management of their own risk registers which in turn, feed principal risks into the BAF. There is clear evidence that escalation from operational level to the BAF has continued in spite of the challenges faced; however there have been instances where there has been a delay in escalation through the BAF. A Risk Management Board workshop took place in quarter four to discuss risk management and the issues seen in the financial year, where assurances were provided in relation to the processes. The workshop reiterated the need to focus upon training for managers now in post following the restructure. The Trust has a well-established risk management and Board Assurance process that is both top-down and bottom-up:

The Board will identify the strategic risks being faced by the Trust

Operational risks will be identified through operations and activities of the Trust in going about the achievement of the Trust‟s objectives.

Electronic system of incident reporting – web-based incident reporting system in place so that staff can now report incidents by telephone.

Learning Group – production of the Complaints, Litigation, Incidents and PALS (CLIP) report which triangulates information held on the incident reporting system and has become highly effective in drawing to the attention of the Risk Management Group (RMG) which reports in to Patient Safety and Care Standards Committee, any potential or actual risks.

Continual review of the Trust‟s performance in relation to external assessors and regulators - i.e. internal and external audit, CQC, NICE etc.

Compliance with Statutory Requirements – e.g. Health and Social Care Act 2008 (Code of Practice, December 2009), Equality Act 2010 public sector duties.

Reviews of the external environment – i.e. publication of the Hard Truths report has led to focussed action plans in relation to areas requiring improvement.

Once identified, a risk assessment is undertaken using standard risk management principles, focusing upon causes and effects and assessing the risk against impact and likelihood using the internationally recognised 5x5 matrix. Controls are then implemented and mitigating actions established to reduce the risk. The major risks identified within the 2014/15 financial year have been monitored and acted upon by the Board and committees regularly through scrutiny of the BAF. The risks identified can be split into the Strategic Risks agreed by the Board at the beginning of the financial year and the Principal Risks (those escalated to the Board from operational risk registers). A summary of the Strategic Risks is as follows:

Failure to consistently deliver key performance targets is on-going. Focus on recruitment has greatly improved this risk; however issues with significantly increased 999 activity and extended hospital handover delays across the region has negated the positive impact of the recruitment undertaken.

Ability to ensure compliance with all regulatory and legal requirements was a new


strategic risk for this financial year, in recognition of the challenges faced during the restructure and transition, coupled with the new requirements for the Care Quality Commission

Failure to form strategic alliances with national and local partners has been identified as a strategic risk due to the challenges in stakeholder engagement and the level of scrutiny afforded to the Trust over the course of the year. Successful mitigation has been undertaken.

Failure to create and embed a culture of performance and accountability was identified by the Board as a new Strategic risk as an essential component to ensuring the success of the organisational restructure. Positive steps in relation to this risk have been undertaken, and the Board are currently considering development of an Organisational Development programme to further mitigate this risk in the coming year.

Insufficient recruitment, training and development in line with the skills and values in our strategy. This strategic risk recognised the challenges faced due to insufficient numbers of clinicians, and the risks and challenges faced whilst the extensive recruitment programme is underway. The risk has evolved over the financial year to be more focussed upon mentorship and development, as the recruitment trajectory has been met.

The lack of stable and effective Trust Board was recognised as a strategic risk and positive steps have been taken in the financial year, through the successful recruitment of both the Medical Director and the Director of Nursing and Clinical Quality

Failure to ensure a well governed and accountable Trust also relates to the challenges faced during the restructure and the move to a leaner and more efficient organisation. Improvements have been made in the latter part of the financial year following the operational restructure and reinstatement of key groups, with policy review and approval underway.

Two strategic risks were determined by the Board relating to finance; short term in-year ability to deliver key financial targets, as well as a longer term risk relating to the ability to deliver a lean and financially viable organisation. Positive mitigation of the in year risk has taken place and preparatory steps have been taken in relation to the longer term sustainability of the organisation

Over the course of the year, five operational risks have been escalated to the BAF for Board oversight and scrutiny, all of which have the potential to impact on delivery of the Trust‟s key objectives. Significant work is being undertaken in relation to each of these risks and a summary of each is as follows:

Failure to provide appropriate clinical documentation relates to the usage of electronic patient care records, and system issues associated with this, as well as the policies in place for clinical documentation

Ability to deliver a safe service during periods of Industrial Action was escalated in October and robust planning resulted in successful mitigation through two periods of action. This risk has now been de-escalated and returned to the operational risk register

Failure to provide consistently safe and high quality care has been identified due to trends and themes within Serious Incidents and issues identified through staff surveys

Impact from the CAD on service delivery has been identified as an areas requiring Board scrutiny due to the need to ensure a fully functional software system within the control rooms

Risks associated with storing, monitoring and usage of medicines have been


escalated to the BAF following limited assurance from the Internal Audit. A robust action plan and project team are in place.

Risk Management Overall, the Trust‟s risk management process has remained in situ with significant work being undertaken to maintain the recognition and documentation of new risks, as well as the on-going mitigation of existing risks. Challenges as a result of the restructure of management functions has impacted the timeliness of this process at times; although risk management can be clearly evidenced through the actions taken through the groups and committees, such as the Operational Management Board and Executive Management Board. Development of the Trust‟s six key priorities has seen significant action to mitigate the key risks around workforce and the ability to deliver the service which has undoubtedly had to take priority in this financial year. Quarter four has seen a refocusing of efforts on embedding risk management into core business, now that managers are predominantly in place following the restructure. This work will continue into the 2015/16 financial year through an approved training and development plan. It is relevant now the BAF is established and discussed regularly to have each Trust board sub-committee to review each of its relevant risks. This will enable wider discussion to take place for each area of expertise and details to be reviewed or escalated, depending on the nature of the issues raised. Data Security Incidents During 2014/15 the following five potentially serious information-related incidents were recorded by the Trust and reported two of them to the Information Commissioner‟s Office (ICO) who did not take any action on the reported incidents

Information (name and address of member of staff) contained in disciplinary hearing statement of case, which was unrelated to the subject of the hearing; this was repeated at the appeal hearing.

Two occupational health reports were released in error to the subject of a capability hearing and the subject‟s solicitor; these reports were unrelated to the subject.

Personal data emailed to wrong recipient via non Trust email address.

Personal data concerning an unrelated staff member with the same name shared with sickness absence panel.

Staff member received private and confidential information relating to another staff member following a Data Protection Act request.

Information Governance Compliance The Trust has completed its annual self-assessment against the Information Governance Toolkit at the end of March 2015. For 2014/15 the Trust has declared an overall „satisfactory‟


rating, having achieved level 2 on all applicable Toolkit standards. Compliance with NHS Pension Scheme regulations As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer‟s contributions and payments in to the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations. Compliance with Equality, Diversity and Human Rights Legislation

Control measures are in place to ensure that all the Trust‟s obligations under equality, diversity and human rights legislation are complied with. The Trust has a Steering Group whose purpose is to provide support, advice, assurance and governance for the Trust Board in relation to Equalities and Human Rights. The focus of this group is to maintain and monitor the execution of the general and public sector duties. This takes into account the NHS Constitution and guidance from the Equalities and Human Rights Commission. The Equality, Diversity and Human Rights policy was revised in line with the Equality Act 2010 and public duties. During 2014/15 some activities were undertaken to improve the Trust‟s evidence based data about the people who used the service so that a better understanding of how the service impacts upon them can be developed. The active engagement and involvement within the community has been maintained and developed, specifically with regard to the views of groups that represent people with disabilities. The Trust has an Equality Diversity and Human Rights Group which is chaired by the Chair of the Trust Board. The Trust has also developed a disability Policy this year to supporting all staff and recognising that staff with disabilities, or those who may be developing a disability, may require additional support to enable them to remain in the workplace. Counter Fraud

The Trust is fully committed to preventing fraud or bribery within the organisation and will take action against those identified to have committed fraud against the East of England Ambulance Service NHS Trust. The Local Counter Fraud Specialist (LCFS) reports to the Acting Director of Finance and attends Audit Committee meetings to report on the work achieved. The LCFS has during the past year undertaken specific bespoke workshops with Local Managers in the various Regions of the Trust ensuring that counter fraud is integrated at station level and cascaded by managers to local staff. The LCFS has also undertaken Fraud awareness and Security awareness in conjunction with the Trusts Local Security Management Specialist (LSMS) Throughout the past financial year the counter fraud culture has continued to be embedded into the Trust and work has been undertaken against each of the four areas of action set out in the Standards for Providers: Fraud and Bribery as set out by NHS Protect, namely Inform and Involve, Prevent and Deter, Hold to Account and Strategic Governance. Proactive reviews have been undertaken by the LCFS in the areas of Fleet management and Procurement during the year The Trust complies with the directions issued by the Secretary of State in 2004 and the NHS


Counter Fraud and Corruption Manual, and the Standards for Providers: Fraud, Corruption and Bribery as set out by NHS Protect. The Trust takes a positive stance in countering fraud against the organisation and the NHS in general and actively seeks to ensure that an appropriate, yet proportionate response is taken to allegations of fraud and bribery. Where appropriate sanctions and redress are sought. Review of the Effectiveness of Risk Management and Internal Control Reviewing the effectiveness of the risk and control framework is a continual process during the year, informed by individual performance reports, clinical audits, by evidence gathered in support of the NHS Litigation Authority assessment process, the registration process with the CQC and with the independent assurance from the Trust internal and external auditors. NHS Litigation Authority (NHSLA) Until April 2014 organisations were assessed against organisation type specific risk

management standards levels by the NHSLA. Although the NHSLA no longer carries out

these assessments, they remain the Trust‟s indemnifiers for both clinical negligence and

employees claims. It has also introduced a number of actions that focus on improved

outcomes, learning from claims, reducing harm and improving patient and staff safety.

During 2014/15, the Trust has continued to improve its reporting and learning processes as

well as introducing a new Patient Safety Strategy. A number of other actions have also been

implemented with the aim of reducing the number of claims received from both staff and

patients, these include; the procurement of improved tracked chairs for the movement of

patients, implementation of bariatric equipment and vehicles, purchase of new vehicles,

major recruitment and up skilling of clinicians.

Care Quality Commission (CQC) registration The Trust was registered with the CQC under the Health and Social Care Act 2008

(Regulated Activities) Regulations 2009 on 1 April 2010. The Trust was registered without

conditions or restrictions and is registered to provide services under three of the regulated

activities to cover the services agreed under contract and service level agreements. As a

registered healthcare provider the Trust has to demonstrate continuous compliance to these

regulations and uses electronic software to upload evidence and monitor each outcome.

To ensure that the Trust continues to work towards full compliance for all regulations, in

2014/15 it invested in a new robust monitoring tool which provides members of the Trust

Board, including Non-Executive Directors, a dashboard to all regulations and any associated

action plans. The Trust is currently working with the providers to ensure this meets the

revised regulations as well as the new Key Lines of Enquiry implemented on 01 April 2015.

Following an unannounced routine inspection in December 2013, it was reported that the

Trust remained non-compliant with Regulation 9 Outcome 4 (Care and Welfare of People

who use services). However, the CQC acknowledged that since that time the Trust had

made significant improvements in a number of areas; decrease in staff sickness absence


rates, complaints relating to ambulance delays, the number of Serious Incidents, long waits

(over 25 minutes) for back up vehicles to transport people to hospital in life threatening

instances in some areas. In addition, the CQC concluded that the Trust were also non-

compliant with Regulation 22 Outcome 13 (Staffing). The CQC found that the Trust did not

have the numbers of suitably qualified staff it required to ensure that national ambulance

response times were met and people received the care they needed in a timely way.

After careful consideration, the CQC found that the Trust was taking reasonable steps to

address the breaches in regulations and that it would not be appropriate to take further

enforcement action at that point.

To address this, the Trust‟s new Chief Executive, Dr Anthony Marsh set an ambitious six

point priority plan for 2014/15 which included recruiting over 400 more student paramedics

and up skilling current staff as well as the accelerated purchase of new ambulances and

equipment.

Clinical Audit and Patient Experience Programme The clinical audit and patient experience programme forms part of the quality governance

framework and provides the Trust with assurance that services are being delivered to

patients at the required standard in order to meet the dimensions of quality: patient safety,

patient experience and clinical effectiveness. It provides an essential view of the care we

deliver in terms of the patient experience and the clinical outcome of the care that we

provide to them. Where audit and experience reports highlight standards are being delivered

below those expected it also serves as an early warning indicator so that corrective action

can be agreed and taken in a responsive way. The results enable us to share good practice

across the Trust along with viewing us against other ambulance trusts. The results of audits

and experience audits are used to review and develop training for our staff. The examples,

themes or trends have enabled us to identify areas that draw out the quality measures.

All audits are presented to the Clinical Audit and Patient Experience (CAPE) Group who

report directly into the Clinical Quality and Safety Group. CAPE approves recommendations

for actions to improve the quality of service provision and patient outcomes. The audit and

patient experience programme for 2014/15 focused on national, strategic and regulatory

driven audit projects which related to the priorities set within the Quality Account agenda.

Moving forward it is important to continue to link clinical development with audit and

experience measures. As a result, the CAPE group will be disbanded, with clinical audit

outcomes being discussed at the Clinical Development and Effectiveness Group. This group

will report directly to the Clinical Quality and Safety group where trends will be aligned with

those identified through the Trust‟s Learning Group, a group which determines trends and

themes from patient experience including, complaints, patient surveys and discovery

interviews.

Being able to gather a wide range of information ensures a focus on the key priorities or to

identify areas to discuss with commissioners and other providers of care. The link with

research produces an evidence base of patient need that allows a continued search for the


delivery of clinical excellence.

The Head of Internal Audit Opinion and Annual Internal Audit Programme The Head of Internal Audit provides an opinion on the overall arrangements for gaining assurance through the BAF and on the controls reviewed as part of the internal audit work. In addition, the Board is advised by auditor and assessors providing an opinion on the adequacy and effectiveness of risk management, governance and control processes, service delivery, financial management and control, human resources, operational and other reviews levels.

The overall Head of Internal Audit has concluded that Limited assurance can be given in respect of the system of internal controls. This is because weaknesses in the system of internal controls are such as to put the client‟s objectives at risk. The level of non-compliance puts the client‟s objectives at risk. During 2014/15 the following eleven internal audits were awarded an assurance rating of limited assurance: Commercial Services Workforce Planning and Capacity Fleet Management Corporate Governance Medicines Management Mandatory Training Patient Transport Services Quality Accounts Station Visits Assurance Framework and Risk Management Disaster Recovery and IT Backup Actions have been agreed based on the recommendations from these audit reports and the implementation of these actions will be followed up by the Audit Committee Significant Issues Under achievement of ambulance response times At the beginning of 2014/15 the Trust was still experiencing significant challenges which

were preventing achievement of national standards for response times to patients. These

challenges were also causing extended response times to patients with lower category

medical problems, particularly in rural areas. A number of factors have caused these issues

including;

Significant rise in demand for ambulance services across the region. The number of calls within the Red categories (immediately life-threatening requiring a response within 8 minutes) rose by 15% compared to 2013/14.

Hospital turnaround delays have increased continuously over the year with 40,000 hours lost in delays for crews handing patients over to hospitals. This equates to 3,333 12 hours double staffed ambulance shifts where crews have been waiting at hospital and not able to respond to other emergency patients in the community.

High vacancy numbers with elevated levels of abstractions (staff undertaking alternative duties to their normal roles on the front line). Poor staff skill mix, not enough paramedics, resulting in high levels of multiple deployments and back up requirements

High sickness rates in frontline and emergency operations centre staff.


Lack of fleet and equipment to provide the core resourcing requirements

During the 2014/15 year, the Trust Performance Improvement Action Plan was focussed to

address these issues and was monitored at weekly Operational Management Board,

Executive Management Board and Trust Board meetings, which in turn significantly

improved performance

The Trust Board also agreed the following six new priorities for 2015/16

Recruit and train 400 Student Paramedics in 2015/16

Up-skill 60 Emergency Care Assistants to Technician and 40 Technicians to Paramedic

Continue the fleet replacement programme to maintain all frontline vehicles less than five years old

Undertake robust benchmarking of our costs to identify savings for reinvestment in frontline delivery

Implement an Organisational Development Programme

Secure a new CAD system

Risk Summits

The Trust was placed at an elevated Risk Summit status in December 2013 due to concerns relating to the following areas:

1. Inability to meet performance targets and respond in a timely manner to patients 2. Insufficient numbers of Paramedics to meet the needs of the community 3. Patient safety issues

Risk Summit meetings were held monthly in order to monitor progress against actions put in place in order to resolve the points above. Extensive work was undertaken in order to mitigate these issues and include:

Recruitment of over 400 Student Paramedics in 204/15, with on-going recruitment through 2015/16

Focus on reducing delays to patients through increasing numbers of ambulances

Return of all clinical staff to frontline services from secondment

Recruitment of substantive Director of Nursing and Quality and Interim Medical and HR Directors

Focus on delay analysis to ensure any harm to patients was identified and investigated in full

Completing the SI investigation backlogs The Trust was de-escalated from Risk Summit status to a stage of „enhanced monitoring‟ in February 2015, in light of the significant progress made and the assurances commissioners have received in relation to the longer term transition plan for the organisation. Accountable Officer: Dr Anthony Marsh, Chief Executive Officer Organisation: East of England Ambulance Service NHS Trust Signature: Date: 28th May 2015


Membership attendance at Trust Board and sub-committee meetings for 2014-2015 is summarised in the tables below:

APPENDIX 1

Trust Board Formal Meetings Private/Public/

Workshop

Audit Committee

Performance & Finance Committee

Patient Safety & Care

Standards Committee

Remuneration Committee

BOARD DIRECTORS Chair – Sarah

Boulton Chair – Dean

Parker Chair – Peter

Kara Chair – Sheila Childerhouse

Chair – Valerie Morton

Sarah Boulton Chair

11/11 8/8 7/7 6/6 6/6

5/6 11/12

Sheila Childerhouse Non-executive Director

10/11 8/8 6/7 4/4

6/6 11/12

Andrew Egerton-Smith (viii) Associate Non-executive Director

8/11 7/8 5/7 5/6 5/6

2/3

Peter Kara Non-executive Director

10/10 6/6 7/7 6/6 6/6

1/3 4/5

Judith Lancaster Ex-Non-executive Director (i)

6/6 3/3 4/4 3/4 2/2

3/3 4/5

Dean Parker Non-executive Director

11/11 8/8 7/7 6/6 6/6

7/8

Valerie Morton Non-executive Director

11/11 8/8 7/7 4/4

6/6 12/12

Dr Anthony Marsh Chief Executive Officer: on Secondment

11/11 8/8 7/7


6/10 4/8 4/7 1/6 1/5

Dave Fountain Locality Director Bedfordshire and Hertfordshire

9/10 8/8 5/7 1/6

2/5

Matt Broad Locality Director Norfolk, Suffolk and Cambridgeshire

9/10 8/8 6/7 3/6

1/5

Kevin Smith Acting Director of Finance

9/9 5/5 4/4 6/6

Sandy Brown Director of Nursing and Clinical Quality

2/2 1/1 N/A

Andy Carson Medical Director

1/1 1/1 N/A

Ruth McAll Interim HR Director

1/1 1/1 N/A

Tracy Nicholls Interim Director of Quality and Patient Safety (ii)

6/8 4/5 2/3 5/5

John Martin Ex-Executive Director (iii)

2/2 1/1 1/1

Francesca Okosi Ex- Director of HR (iv)

A* A*

Scott Turner Ex-Medical Director (v)

A* A*

Stephen Day Ex-Interim Director of Finance (vi)

2/2 1/1 1/1

A* – apologies recorded for the April 14 meeting with the Director stated then leaving the Trust. (i) – Judith Lancaster left the Trust on the 30 September 2014 (ii) – Tracy Nicholls returned to her substantive role on the 25 February 2015 (iii) – John Martin left the Trust on the 30 June 2014 (iv) – Francesca Okosi left the Trust on the 9 May 2014 (v) – Scott Turner left the Trust on the 10 September 2014 (vi) – Stephen Day left the Trust on the 30 May 2014 (viii) – Andrew Egerton-Smith was absent on three occasions due to surgery and post-operative care

Values shown are number of attendances against number of meetings during the year. Where there is no entry this means the director is not a member of that committee.



Annual Accounts Appendix B

Year Ended 31 March 2015

East of England Ambulance Service NHS Trust Trust Headquarters Whiting Way Melbourn Cambridgeshire SG8 6NA


Annual accounts Summary financial report

Statement of the Chief Executive's Responsibilities as the Accountable Officer of the Trust

The Chief Executive of the NHS Trust Development Authority has designated that the Chief Executive should be the Accountable Officer to the trust. The relevant responsibilities of Accountable Officers are set out in the Accountable Officers Memorandum issued by the Chief Executive of the NHS Trust Development Authority. These include ensuring that:

- there are effective management systems in place to safeguard public funds and assets and assist in the implementation of corporate governance;

- value for money is achieved from the resources available to the trust;

- the expenditure and income of the trust has been applied to the purposes intended by Parliament and conform to the authorities which govern them;

- effective and sound financial management systems are in place; and

- annual statutory accounts are prepared in a format directed by the Secretary of State with the approval of the Treasury to give a true and fair view of the state of affairs as at the end of the financial year and the income and expenditure, recognised gains and losses and cash flows for the year.

To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as an Accountable Officer.

Dr Anthony Marsh

28th May 2015


Statement of Directors' Responsibilities in respect of the Accounts

The directors are required under the National Health Service Act 2006 to prepare accounts for each financial year. The Secretary of State, with the approval of the Treasury, directs that these accounts give a true and fair view of the state of affairs of the trust and of the income and expenditure, recognised gains and losses and cash flows for the year. In preparing those accounts, directors are required to:

- apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the Treasury;

- make judgements and estimates which are reasonable and prudent;

- state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the accounts.

The directors are responsible for keeping proper accounting records which disclose with

reasonable accuracy at any time the financial position of the trust and to enable them to ensure that the accounts comply with requirements outlined in the above mentioned direction of the Secretary of State. They are also responsible for safeguarding the assets of the trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

The directors confirm to the best of their knowledge and belief they have complied with the

above requirements in preparing the accounts.

By order of the Board

Dr Anthony Marsh Kevin Smith Chief Executive Acting Director of Finance 28th May 2015 28th May 2015


Independent Auditor’s Report to the Directors of East of England Ambulance Service NHS Trust.

We have audited the financial statements of East of England Ambulance Service NHS Trust for the year ended 31 March 2015 under the Audit Commission Act 1998 (as saved transitionally for the purposes of the 2014/15 audit of accounts). The financial statements comprise the Trust‟s Statement of Comprehensive Income, the Statement of Financial Position, the Statement of Changes in Taxpayers‟ Equity, the Statement of Cash Flows and the related notes 1 to 28. The financial reporting framework that has been applied in their preparation is applicable law and the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England.

We have also audited the information in the Remuneration Report that is subject to audit, being:

•

the table of salaries and allowances of senior managers and related narrative notes on pages 54 to 55 in the Annual Report;

•

the table of pension benefits of senior managers and related narrative notes on pages 56 to 56 in the Annual Report; and

•

the table of pay multiples and related narrative notes on pages 58 to 59 in the Annual Report.

This report is made solely to the Board of Directors of East of England Ambulance Service NHS Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 44 of the Statement of Responsibilities of Auditors and Audited Bodies published by the Audit Commission in March 2014. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Directors, for our audit work, for this report, or for the opinions we have formed.

Respective responsibilities of Directors and auditor

As explained more fully in the Statement of Directors‟ Responsibilities in respect of the Accounts, set out on page 65, the Directors are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards also require us to comply with the Auditing Practices Board‟s Ethical Standards for Auditors.

Scope of the audit of the financial statements

An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of:

•

whether the accounting policies are appropriate to the Trust's circumstances and have been consistently applied and adequately disclosed:

• the reasonableness of significant accounting estimates made by the directors: and


• the overall presentation of the financial statements.

In addition we read all the financial and non-financial information in the annual report to

identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report.

Opinion on the financial statements

In our opinion the financial statements:

•

give a true and fair view of the financial position of East of England Ambulance Service NHS Trust as at 31 March 2015 and of its expenditure and income for the year then ended; and

•

have been prepared properly in accordance with the accounting policies directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England.

Opinion on other matters

Respective responsibilities of Directors and auditor

In our opinion:

•

the part of the Remuneration Report subject to audit has been prepared properly in accordance with the requirements directed by the Secretary of State with the consent of the Treasury as relevant to the National Health Service in England; and

•

the information given in the annual report for the financial year for which the financial statements are prepared is consistent with the financial statements.

Matters on which we report by exception

We report to you if:

• in our opinion the governance statement does not comply with the NHS Trust Development Authority‟s Guidance;

•

we refer the matter to the Secretary of State under section 19 of the Audit Commission Act 1998 because we have reason to believe that the Trust, or an officer of the Trust, is about to make, or has made, a decision involving unlawful expenditure, or is about to take, or has taken, unlawful action likely to cause a loss or deficiency; or


• we issue a report in the public interest under section 8 of the Audit Commission Act 1998

We have nothing to report in these respects

Conclusion on the Trust’s arrangements for securing economy, efficiency and effectiveness in the use of resources

Respective responsibilities of the Trust and auditors

The Trust is responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources, to ensure proper stewardship and governance, and to review regularly the adequacy and effectiveness of these arrangements.

We are required under Section 5 of the Audit Commission Act 1998 to satisfy ourselves that the Trust has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. The Code of Audit Practice issued by the Audit Commission requires us to report to you our conclusion relating to proper arrangements, having regard to relevant criteria specified by the Audit Commission in October 2014.

Respective responsibilities of the Trust and auditors (continued)

We report if significant matters have come to our attention which prevent us from concluding that the Trust has put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources. We are not required to consider, nor have we considered, whether all aspects of the Trust‟s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively.

Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources

We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criteria, published by the Audit Commission in October 2014, as to whether the Trust has proper arrangements for:

• securing financial resilience; and

• challenging how it secures economy, efficiency and effectiveness.

The Audit Commission determined these two criteria as those necessary for us to consider under its Code of Audit Practice in satisfying ourselves whether the Trust put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2015.

We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all significant respects, the Trust had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources.


Basis for a qualified conclusion

In response to a declining performance in ambulance response times and critical reports from the Care Quality Commission the Trust developed a two year performance improvement plan during 2014 which required significant investment in 2014/15 and 2015/16. Since 2014, the Trust has not been able to agree a longer term strategy, and as a result has not agreed a medium-term financial plan extending beyond 2015/16.

The trust has reported an adjusted retained surplus for 2014/15 of £1.25 million and is forecasting to breakeven in 2015/16. However, the scale of cost improvement plans assumed within the forecast increases the risk of financial deficit in 2015/16.

Conclusion

On the basis of our work, having regard to the guidance on the specified criteria published by the Audit Commission in October 2014, with the exception of the matters reported in the basis for a qualified conclusion paragraph above, we are satisfied that, in all significant respects, East of England Ambulance Service NHS Trust put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ending 31 March 2015.

Rob Murray

for and on behalf of Ernst & Young LLP

One Cambridge Business Park, Cambridge, CB4 0WZ, United Kingdom

02 June 2015


Statement of Comprehensive Income for year ended 31 March 2015.

2014-15

2013-14

NOTE £000s

£000s

Gross employee benefits 6.1 (160,591)

(160,213)

Other operating costs 4 (83,092)

(79,096)

Revenue from patient care activities 2 235,946

235,194

Other operating revenue 3 10,036

2,531

Operating surplus/(deficit)

2,299

(1,584)

Investment revenue 8 52

61

Other (losses) and gains 9 (282)

25

Finance costs 10 (64)

(81)

Surplus/(deficit) for the financial year

2,005

(1,579)

Public dividend capital dividends payable

(1,007)

(946)

Retained surplus/(deficit) for the year

998

(2,525)

Other Comprehensive Income

2014-15

2013-14

£000s

£000s

Impairments and reversals taken to the revaluation reserve

(39)

(600)

Net gain on revaluation of property, plant & equipment

0

1,115

Total comprehensive income/(expenditure) for the year

959

(2,010)

Financial performance for the year Retained surplus/(deficit) for the year

998

(2,525)

Impairments (excluding IFRIC 12 impairments)

253

2,904

Adjusted retained surplus

1,251

379

The notes on pages 10 to 42 form part of this account.


Statement of Financial Position as at 31 March 2015

31 March 2015

31 March 2014

NOTE £000s

£000s

Non-current assets: Property, plant and equipment 11 42,976

43,102

Intangible assets 12 0

0

Investment property 14 880

880

Total non-current assets

43,856

43,982

Current assets: Inventories 17 1,899

1,627

Trade and other receivables 18.1 18,683

21,555

Cash and cash equivalents 19 17,008

18,048

Total current assets

37,590

41,230

Total assets

81,446

85,212

Current liabilities Trade and other payables 20 (24,298)

(27,810)

Provisions 22 (1,990)

(3,389)

Total current liabilities

(26,288)

(31,199)

Total assets less current liabilities

55,158

54,013

Non-current liabilities Provisions 22 (5,247)

(5,061)

Total assets employed:

49,911

48,952

FINANCED BY: Public Dividend Capital

66,091

66,091

Retained earnings

(16,659)

(17,679)

Revaluation reserve

1,892

1,953

Other reserves

(1,413)

(1,413)

Total Taxpayers' Equity:

49,911

48,952

The notes on pages 10 to 42 form part of this account. The financial statements on pages 6 to 42 were approved by the Trust board on the 28 May 2015 and signed on its behalf by Dr Anthony Marsh Chief Executive Officer 28th May 2015


Statement of Changes in Taxpayers' Equity For the year ending 31 March 2015 Public

Dividend capital

Retained earnings

Revaluation reserve

Other reserves

Total reserves

£000s £000s £000s £000s £000s

Balance at 1 April 2014 66,091 (17,679) 1,953 (1,413) 48,952

Changes in taxpayers’ equity for 2014-15

Retained surplus/(deficit) for the year 0 998 0 0 998

Impairments and reversals 0 0 (39) 0 (39)

Transfers between reserves 0 22 (22) 0 0

Net recognised (revenue)/expense for the year 0 1,020 (61) 0 959

Balance at 31 March 2015 66,091 (16,659) 1,892 (1,413) 49,911

Balance at 1 April 2013 66,091 (15,160) 1,443 (1,413) 50,961

Changes in taxpayers’ equity for the year ended 31 March 2014

Retained deficit for the year 0 (2,525) 0 0 (2,525)

Net gain on revaluation of property, plant, equipment 0 0 1,115 0 1,115

Impairments and reversals 0 0 (600) 0 (600)

Transfers between reserves 0 5 (5) 0 0

Transfers under Modified Absorption Accounting - PCTs & SHAs 0 1 0 0 1

Net recognised (revenue)/expense for the year 0 (2,519) 510 0 (2,009)

Balance at 31 March 2014 66,091 (17,679) 1,953 (1,413) 48,952

The Trust's originating capital on 1 July 2006 was set equal to the aggregate of the predecessor Trusts closing net assets as at 30 June 2006. However, the calculation of the originating capital included predecessor Trusts' donated assets and government grant reserves. The 'other reserves' of £1,413,000 has been established at 31 July 2008 to account for this omission.


Statement of Cash Flows for the Year ended 31 March 2015

2014-15

2013-14

NOTE £000s

£000s

Cash Flows from Operating Activities Operating surplus/(deficit)

2,299

(1,584)

Depreciation and amortisation

5,930

5,189

Impairments and reversals

253

2,904

Dividend paid

(946)

(993)

(Increase)/Decrease in Inventories

(272)

12

Decrease/(Increase) in Trade and Other Receivables

2,812

(7,559)

(Decrease)/Increase in Trade and Other Payables

(147)

1,489

Provisions utilised

(4,434)

(1,001)

Increase in movement in non-cash provisions

3,157

3,582

Net Cash Inflow from Operating Activities

8,652

2,039

Cash Flows from Investing Activities Interest Received

51

62

Payments for Property, Plant and Equipment

(9,773)

(5,263)

Proceeds of disposal of assets held for sale (PPE)

30

25

Net Cash Outflow from Investing Activities

(9,692)

(5,176)

NET DECREASE IN CASH AND CASH EQUIVALENTS

(1,040)

(3,137)

Cash and Cash Equivalents at Beginning of the Period

18,048

21,185

Cash and Cash Equivalents at year end 19 17,008

18,048


NOTES TO THE ACCOUNTS

1. Accounting Policies The Secretary of State for Health has directed that the financial statements of NHS

trusts shall meet the accounting requirements of the Department of Health Group Manual for Accounts, which shall be agreed with HM Treasury. Consequently, the following financial statements have been prepared in accordance with the DH Group Manual for Accounts 2014-15 issued by the Department of Health. The accounting policies contained in that manual follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to the NHS, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Manual for Accounts permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the trust for the purpose of giving a true and fair view has been selected. The particular policies adopted by the trust are described below. They have been applied consistently in dealing with items considered material in relation to the accounts.

1.1 Accounting convention

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

1.2 Acquisitions and discontinued operations Activities are considered to be „acquired‟ only if they are taken on from outside the

public sector. Activities are considered to be „discontinued‟ only if they cease entirely. They are not considered to be „discontinued‟ if they transfer from one public sector body to another.

1.3 Movement of assets within the DH Group Transfers as part of reorganisation fall to be accounted for by use of absorption

accounting in line with the Treasury FReM. The FReM does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the SOCNE/SOCNI, and is disclosed separately from operating costs. Other transfers of assets and liabilities within the Group are accounted for in line with IAS20 and similarly give rise to income and expenditure entries. For transfers of assets and liabilities from those NHS bodies that closed on 1 April 2013, Treasury agreed that a modified absorption approach should be applied. For these transactions and only in the prior-period, gains and losses are recognised in reserves rather than the SOCNE/SOCNI.

1.4 Charitable Funds Under the provisions of IFRS10 Consolidated Financial Statements, those Charitable

Funds that fall under common control with NHS bodies are consolidated within the entity's financial statements. In accordance with IAS 1 Presentation of Financial Statements, restated prior period accounts are presented where the adoption of the new policy has a material impact.


The Trust does not consider that the East of England Ambulance Service NHS Charitable Funds is material therefore this has not been consolidated in the results of the Trust.

1.5 Revenue

Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable. The main source of revenue for the trust is from commissioners for healthcare services.

Where income is received for a specific activity that is to be delivered in the following year, that income is deferred.

The Trust receives income under the NHS Injury Cost Recovery Scheme, designed to

reclaim the cost of treating injured individuals to whom personal injury compensation has subsequently been paid e.g. by an insurer. The Trust recognises the income when it receives notification from the Department of Work and Pension's Compensation Recovery Unit. The income is measured at the agreed tariff for the treatments provided to the injured individual.

1.6 Employee Benefits Short-term employee benefits Salaries, wages and employment-related payments are recognised in the period in

which the service is received from employees. The cost of leave earned but not taken by employees at the end of the period is

recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period.

Retirement benefit costs Past and present employees are covered by the provisions of the NHS Pensions

Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.

For early retirements other than those due to ill health the additional pension liabilities

are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the NHS body commits itself to the retirement, regardless of the method of payment.

1.7 Other expenses Other operating expenses are recognised when, and to the extent that, the goods or

services have been received. They are measured at the fair value of the consideration payable.


1.8 Property, plant and equipment Recognition Property, plant and equipment is capitalised if: ● it is held for use in delivering services or for administrative purposes; ● it is probable that future economic benefits will flow to, or service potential will be

supplied to the Trust; ● it is expected to be used for more than one financial year; ● the cost of the item can be measured reliably; and ● the item has cost of at least £5,000; or ● Collectively, a number of items have a cost of at least £5,000 and individually have a

cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or

● Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost.

Valuation

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

All property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at fair value.

Land and buildings used for the Trusts services or for administrative purposes are stated in the statement of financial position at their revalued amounts, being the fair value at the date of revaluation less any impairment.

Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Fair values are determined as follows:

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

● Specialised buildings – depreciated replacement cost

HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets and, where it would meet the location requirements of the service being provided, an alternative site can be valued.

Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are revalued and depreciation commences when they are brought into use.


Fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from fair value.

An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged there. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit should be taken to expenditure. Gains and losses recognised in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Income.

Subsequent expenditure

Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is written-out and charged to operating expenses.

1.9 Intangible assets

Recognition

Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the trust‟s business or which arise from contractual or other legal rights. They are recognised only when it is probable that future economic benefits will flow to, or service potential be provided to, the trust; where the cost of the asset can be measured reliably, and where the cost is at least £5000.

Intangible assets acquired separately are initially recognised at fair value. Software that is integral to the operating of hardware, for example an operating system is capitalised as part of the relevant item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application software, is capitalised as an intangible asset.

Measurement

The amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred.


1.10 Depreciation, amortisation and impairments

Freehold land, properties under construction, and assets held for sale are not depreciated.

Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the NHS trust expects to obtain economic benefits or service potential from the asset. This is specific to the NHS trust and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over their estimated useful lives

At each reporting period end, the NHS trust checks whether there is any indication that any of its tangible or intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually.

A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit should be taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve.

Impairments are analysed between Departmental Expenditure Limits (DEL) and Annually Managed Expenditure (AME). This is necessary to comply with Treasury's budgeting guidance. DEL limits are set in the Spending Review and Departments may not exceed the limits that they have been set. AME budgets are set by the Treasury and may be reviewed with departments in the run-up to the Budget. Departments need to monitor AME closely and inform Treasury if they expect AME spending to rise above forecast. Whilst Treasury accepts that in some areas of AME inherent volatility may mean departments do not have the ability to manage the spending within budgets in that financial year, any expected increases in AME require Treasury approval.


1.11 Donated assets

Donated non-current assets are capitalised at their fair value on receipt, with a matching credit to Income. They are valued, depreciated and impaired as described above for purchased assets. Gains and losses on revaluations, impairments and sales are as described above for purchased assets. Deferred income is recognised only where conditions attached to the donation preclude immediate recognition of the gain.

1.12 Government grants

The value of assets received by means of a government grant is credited directly to income. Deferred income is recognised only where conditions attached to the grant preclude immediate recognition of the gain.

1.13 Non-current assets held for sale

Non-current assets are classified as held for sale if their carrying amount will be recovered principally through a sale transaction rather than through continuing use. This condition is regarded as met when the sale is highly probable, the asset is available for immediate sale in its present condition and management is committed to the sale, which is expected to qualify for recognition as a completed sale within one year from the date of classification. Non-current assets held for sale are measured at the lower of their previous carrying amount and fair value less costs to sell. Fair value is open market value including alternative uses.

The profit or loss arising on disposal of an asset is the difference between the sale proceeds and the carrying amount and is recognised in the Statement of Comprehensive Income. On disposal, the balance for the asset on the revaluation reserve is transferred to retained earnings.

Property, plant and equipment that are to be scrapped or demolished does not qualify for recognition as held for sale. Instead, it is retained as an operational asset and its economic life is adjusted. The asset is de-recognised when it is scrapped or demolished.

1.14 Leases

Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases.

The trust as lessee

Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the trust‟s surplus/deficit.

Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term.


Contingent rentals are recognised as an expense in the period in which they are incurred.

Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases.

The NHS trust as lessor

Amounts due from lessees under finance leases are recorded as receivables at the amount of the NHS trust‟s net investment in the leases. Finance lease income is allocated to accounting periods so as to reflect a constant periodic rate of return on the trust‟s net investment outstanding in respect of the leases.

Rental income from operating leases is recognised on a straight-line basis over the term of the lease. Initial direct costs incurred in negotiating and arranging an operating lease are added to the carrying amount of the leased asset and recognised on a straight-line basis over the lease term.

1.15 Inventories

Inventories are valued at the lower of cost and net realisable value using the first-in first-out cost formula. This is considered to be a reasonable approximation to fair value due to the high turnover of stocks.

1.16 Cash and cash equivalents

Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value.

In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the NHS trust‟s cash management.

1.17 Provisions

Provisions are recognised when the NHS trust has a present legal or constructive obligation as a result of a past event, it is probable that the NHS trust will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where a provision is measured using the cash flows estimated to settle the obligation, its carrying amount is the present value of those cash flows using HM Treasury‟s discount rate of 2.2% in real terms 1.3% for employee early departure obligations.


When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably.

A restructuring provision is recognised when the Trust has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The measurement of a restructuring provision includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with on-going activities of the entity.

1.18 Clinical negligence costs

The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the trust pays an annual contribution to the NHSLA which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the NHSLA is administratively responsible for all clinical negligence cases the legal liability remains with the NHS trust‟. The total value of clinical negligence provisions carried by the NHSLA on behalf of the trust is disclosed at note 22.

1.19 Non-clinical risk pooling

The NHS trust participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the NHS trust pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due.

1.20 Contingencies

A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the NHS trust, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote.

A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the NHS trust. A contingent asset is disclosed where an inflow of economic benefits is probable.

Where the time value of money is material, contingencies are disclosed at their present value.


1.21 Financial assets

Financial assets are recognised when the NHS trust becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred.

Financial assets are classified into the following categories: financial assets at fair value through profit and loss; held to maturity investments; available for sale financial assets, and loans and receivables. The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition.

Financial assets at fair value through profit and loss

Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial assets at fair value through profit and loss.

Loans and receivables

Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market.

1.22 Financial liabilities

Financial liabilities are recognised on the statement of financial position when the NHS trust becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired.

Loans from the Department of Health are recognised at historical cost. Otherwise, financial liabilities are initially recognised at fair value.

1.23 Value Added Tax

Most of the activities of the trust are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

1.24 Public Dividend Capital (PDC) and PDC dividend

Public dividend capital represents taxpayers‟ equity in the NHS trust. At any time the Secretary of State can issue new PDC to, and require repayments of PDC from, the trust. PDC is recorded at the value received. As PDC is issued under legislation rather than under contract, it is not treated as an equity financial instrument.


An annual charge, reflecting the cost of capital utilised by the trust, is payable to the Department of Health as public dividend capital dividend. The charge is calculated at the real rate set by HM Treasury (currently 3.5%) on the average carrying amount of all assets less liabilities (except for donated assets and cash balances with the Government Banking Service). The average carrying amount of assets is calculated as a simple average of opening and closing relevant net assets.

1.25 Losses and Special Payments

Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled.

Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had NHS Trusts not been bearing their own risks (with insurance premiums then being included as normal revenue expenditure).

1.26 Subsidiaries

Material entities over which the NHS trust has the power to exercise control are classified as subsidiaries and are consolidated. The NHS trust has control when it is exposed to or has rights to variable returns through its power over another entity. The income and expenses; gains and losses; assets, liabilities and reserves; and cash flows of the subsidiary are consolidated in full into the appropriate financial statement lines. Appropriate adjustments are made on consolidation where the subsidiary‟s accounting policies are not aligned with the NHS trust or where the subsidiary‟s accounting date is not co-terminus.

Subsidiaries that are classified as „held for sale‟ are measured at the lower of their carrying amount or „fair value less costs to sell‟.

The Trust does not consolidate the results of East of England Ambulance Service NHS Charitable Funds over which it considers it has the power to exercise control in accordance with IFRS10 requirements, due to it being considered immaterial.

1.27 Accounting Standards that have been issued but have not yet been adopted

The Treasury FReM does not require the following Standards and Interpretations to be applied in 2014-15. The application of the Standards as revised would not have a material impact on the accounts for 2014-15, were they applied in that year:

IFRS 9 Financial Instruments - subject to consultation - subject to consultation

IFRS 13 Fair Value Measurement - subject to consultation IFRS 15 Revenue from Contracts with Customers


2. Revenue from patient care activities 2014-15

2013-14

£000s

£000s

NHS Trusts 1,050

917 NHS England 558

369

Clinical Commissioning Groups 228,936

223,122 Foundation Trusts 3,449

5,739

Department of Health 62

498 NHS Other (including Public Health England and Prop Co) 4

362

Non-NHS:

Local Authorities 35

62 Injury costs recovery 794

840

Other 1,058

3,285

Total Revenue from patient care activities 235,946

235,194

3. Other operating revenue 2014-15

2013-14

£000s

£000s

Education, training and research 6,920

1,080

Income generation 1,046

1,088

Rental revenue from operating leases 445

363

Other revenue 1,625

0

Total Other Operating Revenue 10,036

2,531

Total operating revenue 245,982

237,725


4. Operating expenses 2014-15

2013-14

£000s

£000s

Purchase of healthcare from non-NHS bodies 0

22 Trust Chair and Non-executive Directors 75

59

Supplies and services - clinical 10,083

4,893

Supplies and services - general 2,974

2,967

Consultancy services 396

412 Establishment 6,698

6,842

Transport 40,331

41,523

Premises 5,009

5,134

Business rates 1,060

1,096

Insurance 2,616

2,325

Legal Fees 492

238

Impairments and Reversals of Receivables 620

(87)

Inventories write down 141

289

Depreciation 5,930

5,184

Amortisation 0

5

Impairments and reversals of property, plant and equipment 253

2,904

Audit fees 114

87

Clinical negligence 406

282

Education and Training 3,870

2,218

Change in Discount Rate 297

0

Other 1,727

2,703

Total Operating expenses (excluding employee benefits) 83,092

79,096

Included in Other expenses is charges for occupational health services totalling £708k, (2013/14 £470k), losses and special payments £235k, (2013/14 £645k), see note 27 for details and injury benefit costs of £568k, (2013/14 £688k).

Employee Benefits Employee benefits excluding Board members 160,017

159,026

Board members 574

1,187

Total Employee Benefits 160,591

160,213


5 Operating Leases Lease costs are incurred primarily on land and buildings and leased vehicles. Commitments are made on

non-cancellable operating leases.

2014-15

5.1 Trust as lessee Buildings

Other

Total

2013-14

£000s

£000s

£000s

£000s

Payments recognised as an expense Minimum lease payments

16,594

11,990

Total

16,594

11,990

Payable:

No later than one year 1,057

12,355

13,412

9,850

Between one and five years 3,497

28,744

32,241

14,954

After five years 19,685

0

19,685

19,560

Total 24,239

41,099

65,338

44,364

5.2 Trust as lessor

The Trust leases office space within some of the properties it occupies.

2014-15

2013-14

£000

£000s

Recognised as revenue

Rental revenue

445

363

Total

445

363

Receivable:

No later than one year

163

285

Between one and five years

87

250

Total

250

535


6 Employee benefits and staff numbers

6.1 Employee benefits

2014-15

Total

Permanently employed

Other

£000s

£000s

£000s

Employee Benefits - Gross Expenditure Salaries and wages

132,287

125,913

6,374

Social security costs

9,797

9,797

0

Employer Contributions to NHS BSA - Pensions Division

15,112

15,112

0

Other pension costs

5

5

0

Termination benefits

3,390

3,390

0

Total employee benefits

160,591

154,217

6,374

Employee costs capitalised

0

0

0

Gross Employee Benefits excluding capitalised costs

160,591

154,217

6,374

Employee Benefits - Gross Expenditure 2013-14

Total


Other

£000s

£000s

£000s

Salaries and wages

133,255

123,272

9,983

Social security costs

9,865

9,865

0

Employer Contributions to NHS BSA - Pensions Division

14,919

14,919

0

Other pension costs

3

3

0

Termination benefits

2,656

2,656

0

TOTAL - including capitalised costs

160,698

150,715

9,983

Employee costs capitalised

485

81

404

Gross Employee Benefits excluding capitalised costs

160,213

150,634

9,579

6.2 Staff Numbers

2014-15

2013-14

Total


Other

Total

Number

Number

Number

Number

Average Staff Numbers Medical and dental 29

0

29

35

Ambulance staff 1,683

1,683

0

1,628

Administration and estates 504

457

47

675

Healthcare assistants and other support staff 1,659

1,659

0

1,585

Nursing, midwifery and health visiting staff 33

26

7

48

Scientific, therapeutic and technical staff 1

1

0

1

Other 1

1

0

1

TOTAL 3,910

3,827

83

3,973

Of the above staff engaged on capital projects 0

0

0

9


6.3 Staff Sickness absence and ill health retirements

2014-15

2013-14

Number

Number

Total Days Lost

55,243

55,280

Total Staff Years

3,810

3,747

Average working Days Lost

14.50

14.75

2014-15

2013-14

Number

Number

Number of persons retired early on ill health grounds

15

22

£000s

£000s

Total additional pensions liabilities accrued in the year

1,014

2,171

6.4 Exit Packages agreed in 2014-15

2014-15

2013-14

Exit package cost band (including any special payment element)

Number of compulsory

redundancies

Number of other

departures agreed

Total number of

exit packages

by cost band

Number of compulsory

redundancies

Number of other

departures agreed

Total number of

exit packages by

cost band

Number

Number

Number

Number

Number

Number

Less than £10,000 9

2

11

2

0

2

£10,000-£25,000 3

8

11

1

4

5

£25,001-£50,000 7

6

13

0

2

2

£50,001-£100,000 9

7

16

0

6

6

£100,001 - £150,000 3

3

6

0

7

7

£150,001 - £200,000 1

0

1

0

3

3

>£200,000 2

1

3

0

2

2

Total number of exit packages by type (total cost 34

27

61

3

24

27

Total resource cost (£s) 1,948,430

1,494,665

3,443,095

20,957

2,621,803

2,642,760

Redundancy and other departure costs have been paid in accordance with the provisions of the NHS Scheme. Exit costs in this note are accounted for in full in the year of departure. Where the Trust has agreed early retirements, the additional costs are met by the Trust and not by the NHS pension‟s scheme. Ill-health retirement costs are met by the NHS pension‟s scheme and are not included in the table. Other departures includes costs associated with a national voluntary severance scheme designed to help NHS organisations manage workforce redesign and reductions.


This disclosure reports the number and value of exit packages agreed in the year. Note: The expense associated with these departures may have been recognised in part or in full in a previous period.

6.5 Exit packages - Other Departures analysis

2014-15

2013-14

Agreements

Total value of

agreements

Agreements

Total value of

agreements

Number

£000s

Number

£000s

Voluntary redundancies including early retirement contractual costs

27

1,495

23

2,470

Total

27

1,495

23

2,470

This disclosure reports the number and value of exit packages agreed in the year. Note: the expense associated with these departures may have been recognised in part or in full in a previous period

As a single exit packages can be made up of several components each of which will be counted separately in this Note, the total number above will not necessarily match the total numbers in Note 6.4 which will be the number of individuals.

No non-contractual payments were made to individuals where the payment value was more than 12 months‟ of their annual salary.

The Remuneration Report includes disclosure of exit payments payable to individuals named in that Report.


6.6 Pension costs

Past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. The scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS Body of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period. In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between formal valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows:

a) Accounting valuation A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data for the current reporting period, and are accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2015 is based on valuation data as 31 March 2014, updated to 31 March 2015 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used. The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Pension Accounts, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office.

b) Full actuarial (funding) valuation The purpose of this valuation is to assess the level of liability in respect of the benefits due under the scheme (taking into account its recent demographic experience), and to recommend the contribution rates. The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2012. The Scheme Regulations allow contribution rates to be set by the Secretary of State for Health, with the consent of HM Treasury, and consideration of the advice of the Scheme Actuary and appropriate employee and employer representatives as deemed appropriate.

c) Scheme provisions The NHS Pension Scheme provided defined benefits, which are summarised below. This list is an illustrative guide only, and is not intended to detail all the benefits provided by the Scheme or the specific conditions that must be met before these benefits can be obtained:


The Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service.

With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax free lump sum, up to a maximum amount permitted under HMRC rules. This new provision is known as “pension commutation”.

Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year. From 2011-12 the Consumer Price Index (CPI) has been used and replaced the Retail Prices Index (RPI).

Early payment of a pension, with enhancement, is available to members of the scheme who are permanently incapable of fulfilling their duties effectively through illness or infirmity. A death gratuity of twice final year‟s pensionable pay for death in service, and five times their annual pension for death after retirement is payable. For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to the employer. Members can purchase additional service in the NHS Scheme and contribute to money purchase AVC‟s run by the Scheme‟s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers.


7 Better Payment Practice Code

7.1 Measure of compliance 2014-15

2014-15

2013-14

2013-14

Number

£000s

Number

£000s

Non-NHS Payables Total Non-NHS Trade Invoices Paid in the Year 41,538

69,131

49,220

65,543

Total Non-NHS Trade Invoices Paid Within Target 37,527

53,767

43,736

41,268

Percentage of NHS Trade Invoices Paid Within Target 90.34%

77.78%

88.86%

62.96%

NHS Payables Total NHS Trade Invoices Paid in the Year 1,333

3,532

1,684

11,040

Total NHS Trade Invoices Paid Within Target 1,141

2,728

1,338

8,505

Percentage of NHS Trade Invoices Paid Within Target 85.60%

77.24%

79.45%

77.04%

The Better Payment Practice Code requires the NHS body to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later.

8 Investment Revenue

2014-15

2013-14

£000s

£000s

Interest revenue Bank interest

52

61

Total investment revenue

52

61

9 Other Gains and Losses

2014-15

2013-14

£000s

£000s

(Loss)/Gain on disposal of assets other than by sale (PPE)

(282)

25

Total

(282)

25

10 Finance Costs

2014-15

2013-14

£000s

£000s

Interest Interest on late payment of commercial debt

0

0

Total interest expense

0

0

Provisions - unwinding of discount

64

81

Total

64

81


11.1 Property, plant and equipment

Land Buildings excluding dwellings

Assets under construction &

payments on account

Plant & machinery

Transport equipment

Information technology

Furniture & fittings

Total

2014-15

£000's

£000's

£000's

£000's

£000's

£000's

£000's

£000's

Cost or valuation: At 1 April 2014 11,537

14,650

164

20,165

5,698

10,909

768

63,891

Additions of Assets Under Construction

1,117

1,117

Additions Purchased 0

922

4,296

17

52

3

5,290

Reclassifications 0

126

(126)

0

0

0

0

0

Disposals other than for sale 0

0

0

(452)

(525)

(1,801)

0

(2,778)

Impairments/negative indexation 0

(39)

0

0

0

0

0

(39)

At 31 March 2015 11,537

15,659

1,155

24,009

5,190

9,160

771

67,481

Depreciation At 1 April 2014 3

1,092

0

10,209

3,765

5,228

492

20,789

Disposals other than for sale 0

0

(452)

(521)

(1,494)

0

(2,467)

Impairments 0

253

0

0

0

0

0

253

Charged During the Year 1

1,108

1,876

1,007

1,885

53

5,930

4

2,453

0

11,633

4,251

5,619

545

24,505

Net Book Value at 31 March 2015 11,533

13,206 1,155

12,376

939

3,541

226

42,976

Asset financing: Owned 11,533

13,206

1,155

12,376

939

3,541

226

42,976


11.1 Property, plant and equipment (continued)

Revaluation Reserve Balance for Property, Plant & Equipment

Land Buildings

Assets under construction & payments on

account

Plant & machinery

Transport equipment



Total

£000's

£000's

£000's

£000's

£000's

£000's

£000's

£000's

At 1 April 2014 1,161

654

0

98

25

0

15

1,953

Movements 0

(39)

0

0

(22)

0

0

(61)

At 31 March 2015 1,161

615

0

98

3

0

15

1,892

Additions to Assets Under Construction in 2014-15

£000's

Land

0 Buildings excl Dwellings

83

Plant & Machinery

1,034 Balance as at YTD

1,117


11.2 Property, plant and equipment prior-year 2013-14 Land Buildings

excluding dwellings

Assets under construction &

payments on account

Plant & machinery

Transport equipment



Total

£000s

£000s

£000s

£000s

£000s

£000s

£000s

£000s

Cost or valuation: At 1 April 2013

12,000

23,795

851

15,375

6,147

9,352

748

68,268 Additions of Assets Under Construction

0

0

162

0

0

0

0

162

Additions Purchased

0

704

0

4,060

57

1,557

20

6,398

Reclassifications

0

101

(849)

748

0

0

0

0

Reclassification to Investment Property

(34)

(846)

0

0

0

0

0

(880)

Disposals other than for sale

0

0

0

(18)

(506)

0

0

(524)

Revaluation

54

(8,987)

0

0

0

0

0

(8,933)

Impairments/negative indexation charged to reserves

(483)

(117)

0

0

0

0

0

(600)

At 31 March 2014

11,537

14,650

164

20,165

5,698

10,909

768

63,891

Depreciation At 1 April 2013

918

6,407

0

8,657

3,283

3,567

441

23,273

Disposals other than for sale

0

0

0

(18)

(506)

0

0

(524)

Revaluation

(639)

(9,409)

0

0

0

0

0

(10,048)

Impairments/negative indexation charged to operating expenses

812

3,966

0

0

0

0

0

4,778

Reversal of Impairments charged to operating expenses

(1,088)

(786)

0

0

0

0

0

(1,874)

Charged During the Year

0

914

1,570

988

1,661

51

5,184

3

1,092

0

10,209

3,765

5,228

492

20,789

Net Book Value at 31 March 2014

11,534

13,558

164

9,956

1,933

5,681

276

43,102

Asset financing: Owned - Purchased

11,534

13,558

164

9,956

1,933

5,681

276

43,102


11.3 Property, plant and equipment (continued)

Land and Buildings were re-valued as at 31 March 2014 by Montagu Evans LLP an Independent Chartered Surveyor. The valuation has been prepared in accordance with the RICS Valuation Standards (6th edition) which states that valuations for Public Sector Accounts shall be undertaken in accordance with the Code of Practice on Local Authority Accounting in the UK 2010/11. It was determined that all assets held by the Trust were operational property and therefore valued at Fair Value which is interpreted as the amount that would be paid for the asset in its existing use.

Asset Lives

Tangible non-current assets are depreciated on a straight line basis to write off the costs or valuation, less any residual value, over their estimated useful lives. No depreciation is provided on freehold land and asset surplus to requirements. Buildings, installations and fittings are depreciated on their fair value over the estimated remaining life of the asset as advised by the Valuer. Leaseholds are depreciated over the primary lease term.

Equipment is depreciated on current cost evenly over the estimated life of the asset using the following lives:

Years

Medical equipment and engineering plant and equipment 5 to 10

Furniture 10

Mainframe information technology installations 8

Soft Furnishings 7

Office and information technology equipment 5

Set-up costs in new buildings 10

Ambulances and other vehicles 3 to 7

There were no changes to the Trust's assessment of asset lives or residual values during the year.

Economic lives of property, plant & equipment

The remaining lives of the Trusts property, plant and equipment are as follows;

Minimum Life

Maximum Life

years years

Buildings (includes set up costs in new buildings) 1 59

Plant and machinery (includes medical equipment) 2 20

Transport equipment (includes ambulances and other vehicles) 1 7 Information technology (includes mainframe information technology, office and information technology)

3 10

Furniture and fittings (includes furniture and soft furnishings) 3 40


12.1 Intangible non-current assets

2014-15

Software purchased

Cost or valuation:

£000's

At 1 April 2014

32

At 31 March 2015

32

Amortisation At 1 April 2014

32

Charged during the year

0

At 31 March 2015

32

Net Book Value at 31 March 2015

0

Asset Financing: Net book value at 31 March 2015 comprises: Purchased

0

12.2 Intangible non-current assets prior year

2013-14

Software purchased

£000s

Cost or valuation: At 1 April 2013

32

At 31 March 2014

32

Amortisation At 1 April 2013

27

Charged during the year

5

At 31 March 2014

32

Net book value at 31 March 2014

0

Net book value at 31 March 2014 comprises: Purchased

0


13.1 Analysis of impairments and reversals recognised in 2014-15

2014-15 2013-14

Total Total

£000s £000s

Property, Plant and Equipment impairments and reversals taken to SoCI Loss or damage resulting from normal operations 0

0

Over-specification of assets 0

0

Abandonment of assets in the course of construction 0

0

Total charged to Departmental Expenditure Limit 0

0

Changes in market price 253

2,904

Total charged to Annually Managed Expenditure 253

2,904

Property, Plant and Equipment impairments and reversals charged to the revaluation reserve

Changes in market price 39

600

Total impairments for PPE charged to reserves 39

600

Total Impairments of Property, Plant and Equipment 292

3,504

Total Impairments charged to SoCI - DEL 0

0

Total Impairments charged to SoCI - AME 253

2,904

Total Impairments charged to revaluation reserve 39

600

Overall Total Impairments 292

3,504

Land and Buildings were re-valued as at 31 March 2014 by Montagu Evans LLP an Independent Chartered Surveyor. The valuation has been prepared in accordance with the RICS Valuation Standards (6th edition) which states that valuations for Public Sector Accounts shall be undertaken in accordance with the Code of Practice on Local Authority Accounting in the UK 2010/11. It was determined that all assets held by the Trust were operational property and therefore valued at Fair Value which is interpreted as the amount that would be paid for the asset in its existing use.


14 Investment property

31 March

2015

31 March 2014

At fair value

£000s

£000s

Balance at 1 April 2014

880

0

Other Acquisitions

0

880

Balance at 31 March 2015

880

880

15 Commitments

Contracted capital commitments at 31 March not otherwise included in these financial statements:

31 March

2015

31 March 2014

£000s

£000s

Property, plant and equipment

508

73

Intangible assets

0

0

Total

508

73

16 Intra-Government and other balances

Current receiva

bles

Current

payables

£000s

£000s

Balances with Other Central Government Bodies

3

2,966

Balances with Local Authorities

21

32

Balances with NHS bodies inside the Departmental Group

6,861

607

Balances with Bodies External to Government

11,798

20,693

At 31 March 2015

18,683

24,298

Prior period:

Balances with Other Central Government Bodies

6,854

4,325 Balances with Local Authorities

10

1

Balances with NHS Trusts and FTs

795

366

Balances with Bodies External to Government

13,896

23,118

At 31 March 2014

21,555

27,810


17 Inventories Drugs

Consumables

Energy

Total

£000s

£000s

£000s

£000s

Balance at 1 April 2014 37

1,269

321

1,627

Additions 216

4,224

1,956

6,396

Recognised as an expense in the period (185)

(3,863)

(1,935)

(5,983)

Write-down of inventories (including losses) (7)

(134)

0

(141)

Balance at 31 March 2015 61

1,496

342

1,899

18.1 Trade and other receivables

Current

31 March 2015

31 March 2014

£000s

£000s

NHS receivables - revenue

6,843

7,198

NHS prepayments and accrued income

21

0

Non-NHS receivables - revenue

1,468

1,067

Non-NHS prepayments and accrued income

10,765

8,835

Provision for the impairment of receivables

(785)

(749)

VAT

33

433

Other receivables

338

4,771

Total

18,683

21,555

The great majority of trade is with Clinical Commissioning Groups, as commissioners for NHS patient care services. As Clinical Commissioning Groups are funded by Government to buy NHS patient care services, no credit scoring of them is considered necessary.

Other receivables includes £79,482 (2014: £4,493,937) relating to new vehicles originally purchased by the Trust which will be sold to a financing company for leaseback to the Trust.

18.2 Receivables past their due date but not impaired

31 March 2015

31 March 2014

£000s

£000s

By up to three months

5,369

1,886

By three to six months

167

899

By more than six months

30

123

Total

5,566

2,908

18.3 Provision for impairment of receivables

31 March 2015

31 March 2014

£000s

£000s

Balance at 1 April 2014

(749)

(875)

Amount written off during the year

19

39

Credit notes raised during the year

259

0

Amount recovered during the year

371

186

Increase in receivables impaired

(685)

(99)

Balance at 31 March 2015

(785)

(749)


Receivables that were 90 days old were reviewed and considered on an individual basis as to whether the amounts were recoverable.

19 Cash and Cash Equivalents 31 March

2015 31

March 2014

£000s £000s

Opening balance 18,048

21,185

Net change in year (1,040)

(3,137)

Closing balance 17,008

18,048

Made up of Cash with Government Banking Service 16,963

18,006

Commercial banks 44

41

Cash in hand 1

1

Cash and cash equivalents as in statement of financial position 17,008

18,048

Cash and cash equivalents as in statement of cash flows 17,008

18,048

20 Trade and other payables Current 31 March

2015

31 March 2014

£000s

£000s

NHS payables - revenue 454

2,089

NHS accruals and deferred income 153

133

Non-NHS payables - revenue 7,471

7,124

Non-NHS payables - capital 1,071

4,436

Non-NHS accruals and deferred income 11,292

10,493

Social security costs 2,966

2,805

Other 891

730

Total payables (current and non-current) 24,298

27,810

Included above: Outstanding Pension Contributions at the year end 87

1,964

21 Deferred revenue Current

31 March 2015

31 March 2014

£000s

£000s

Opening balance at 1 April 2014 0

81

Deferred revenue addition 34

0

Transfer of deferred revenue 0

(81)

Current deferred Income at 31 March 2015 34

0


22 Provisions

Total

Pensions Relating to Other Staff

Legal Claims

Other

Redundancy

£000s

£000s

£000s

£000s

£000s

Balance at 1 April 2014 8,450

4,968

211

726

2,545

Arising during the year 3,208

310

226

467

2,205

Utilised during the year (4,434)

(301)

(94)

(77)

(3,962)

Reversed unused (348)

(16)

(79)

(199)

(54)

Unwinding of discount 64

61

0

3

0

Change in discount rate 297

292

0

5

0

Balance at 31 March 2015 7,237

5,314

264

925

734

Expected Timing of Cash Flows: No Later than One Year 1,990

299

264

717

710

Later than One Year and not later than Five Years 1,330

1,157

0

149

24

Later than Five Years 3,917

3,858

0

59

0

Due After One Year 5,247

5,015

0

208

24

7,237

5,314

264

925

734

Amount Included in the Provisions of the NHS Litigation Authority in Respect of Clinical Negligence Liabilities:

As at 31 March 2015 5,929 As at 31 March 2014 5,907

Pensions relating to other staff:

These provisions relate to payments to the NHS Pension Agency for Early Retirements and Injury Benefit Awards and are based on amounts paid by the NHS Pensions Agency and average life expectancy for the individuals concerned. As these amounts are known with reasonable certainty there is no related balance in contingent liabilities.

Legal Claims:

The legal provision is for claims made against the Trust by employees and members of the public. Due to the nature of these provisions there is considerable uncertainty concerning when the provisions are likely to be realised. These claims also give rise to a contingent liability (see note 23).

Other Provisions:

Included within other provisions are Terms and Conditions of employment for Whitley Council ambulance staff changed in 1986 in respect of annual leave entitlement. The move from accrued to current leave entitlement resulted in the "freezing" of accrued leave to be paid at a future date on resignation/retirement from the Ambulance Service, at current rates of pay. A provision has been made for the estimated value of discharging this entitlement when staff leave the service.

Redundancy:

This includes departure costs which have been agreed in accordance with the provisions of the NHS Scheme.


23 Contingencies

31 March 2015

31 March 2014

£000s

£000s

Contingent liabilities

Other (213)

(137)

Net value of contingent liabilities (213)

(137)

The contingent liabilities relate to the provision for legal claims detailed in note 22. These claims are notified to the Trust by the NHS Litigation Authority.

Contingent assets Contingent assets 0

1,600

Net value of contingent assets 0

1,600

The contingent asset relates to an incentive proposed by one of the Trusts Lessors to vacate the site prior to the lease termination date.

24 Financial Instruments

24.1 Financial risk management

Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. Because of the continuing service provider relationship that the NHS Trust has with Commissioners and the way those Commissioners are financed, the NHS Organisation is not exposed to the degree of financial risk faced by business entities. Also financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The NHS Trust has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the NHS Trust in undertaking its activities.

The Trusts treasury management operations are carried out by the finance department, within parameters defined formally within the Trusts standing financial instructions and policies agreed by the board of directors. Trust treasury activity is subject to review by the Trusts internal auditors.

Currency risk

The Trust is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The Trust has no overseas operations. The Trust therefore has low exposure to currency rate fluctuations.

Interest rate risk

The Trust borrows from government for capital expenditure, subject to affordability as confirmed by the Trust Development Authority. The borrowings are for 1 – 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The Trust therefore has low exposure to interest rate fluctuations.

Credit risk

Because the majority of the Trusts revenue comes from contracts with other public sector bodies, the Trust has low exposure to credit risk. The maximum exposures as at 31 March 2015 are in receivables from customers, as disclosed in the trade and other receivables note.


Liquidity risk

The Trust‟s operating costs are incurred under contracts with Clinical Commissioning Groups, which are financed from resources voted annually by Parliament. The Trust funds its capital expenditure from funds obtained within its prudential borrowing limit. The Trust is not, therefore, exposed to significant liquidity risks.

24.2 Financial Assets At ‘fair value through profit

and loss’

Loans and receivables

Total

£000s £000s £000s

Receivables - NHS 0 6,316 6,316

Receivables - non-NHS 0 1,376 1,376

Cash at bank and in hand 0 17,008 17,008

Total at 31 March 2015 0 24,700 24,700

Receivables - NHS 0 6,566 6,566

Receivables - non-NHS 0 1,073 1,073

Cash at bank and in hand 0 18,048 18,048

Total at 31 March 2014 0

25,687

25,687

24.3 Financial Liabilities At ‘fair value through profit and loss’

Other Total

£000s £000s £000s

NHS payables 0 573 573

Non-NHS payables 0 18,527 18,527

Total at 31 March 2015 0 19,100 19,100

NHS payables 0 2,222 2,222

Non-NHS payables 0 20,730 20,730

Total at 31 March 2014 0 22,952 22,952


25 Related party transactions During the year none of the Department of Health Ministers, Trust board members or members of

the key management staff, or parties related to any of them, has undertaken any material transactions with the East of England Ambulance Service NHS Trust.

The Department of Health is regarded as a related party. During the year the East of England Ambulance Service NHS Trust has had a significant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department. These entities are:

Basildon & Brentwood Clinical Commissioning Group (CCG), Bedfordshire CCG, Cambridgeshire & Peterborough CCG, Castle Point & Rochford CCG, East & North Hertfordshire CCG, Great Yarmouth & Waveney CCG, Herts Valley CCG, Ipswich & East Suffolk CCG, Luton CCG, Mid Essex CCG, North East Essex CCG, North Norfolk CCG, Norwich CCG, Southend CCG, South Norfolk CCG, Thurrock CCG, West Essex CCG, West Norfolk CCG, West Suffolk CCG.

Cambridge University Hospitals NHS Foundation Trust

NHS Litigation Authority

NHS Business Services Authority

NHS Pensions

Health Education East of England

Dr Anthony Marsh, Interim Chief Executive costs were charged to the Trust by West Midlands Ambulance Service Foundation Trust. For further details see the remuneration note in the Annual Report page 55.

Mrs C Youell, Interim Director of HR and Organisational Development, invoiced fees and travel expenses of 2013/14 £19,871 to the Trust though People and Performance Limited, a company jointly owned with Mr R Youell.

The Trust provides administrative and management services to the Charitable Trust totalling £400. All members of the Trust Board act on behalf of the Trust in its capacity as the Trustee of the Charitable Trust. The draft total funds of the charity in 2014/15 were £721k (2013/14 were £716k).

In addition the Trust has had a number of material transactions with other government departments and other central and local government bodies.


26 Financial performance targets The figures given for periods prior to 2009-10 are on a UK GAAP basis as that

is the basis on which the targets were set for those years.

26.1 Breakeven performance 2005-06

2006-07

2007-08

2008-09

2009-10

2010-11

2011-12

2012-13

2013-14

2014-15

£000s

£000s

£000s

£000s

£000s

£000s

£000s

£000s

£000s

£000s

Turnover 0

189,026

192,842

213,814

228,076

222,389

226,874

235,499

237,725

245,982

Retained surplus/(deficit) for the year 0

1,157

104

283

(19,161)

(445)

3,121

1,706

(2,525)

998

Adjustment for:

Adjustments for impairments

201

19,918

2,809

0

2,469

2,904

253

Break-even in-year position 0

1,157

104

484

757

2,364

3,121

4,175

379

1,251

Break-even cumulative position 0

1,157

1,261

1,745

2,502

4,866

7,987

12,162

12,541

13,792

Due to the introduction of International Financial Reporting Standards (IFRS) accounting in 2009-10, NHS Trusts‟ financial performance measurement needs to be aligned with the guidance issued by HM Treasury measuring Departmental expenditure. Therefore, the incremental revenue expenditure resulting from the application of IFRS to IFRIC 12 schemes (which would include PFI schemes), which has no cash impact and is not chargeable for overall budgeting purposes, is excluded when measuring Breakeven performance. Other adjustments are made in respect of accounting policy changes (impairments and the removal of the donated asset and government grant reserves) to maintain comparability year to year.

2005-06

2006-07

2007-08

2008-09

2009-10

2010-11

2011-12

2012-13

2013-14

2014-15

%

%

%

%

%

%

%

%

%

%

Materiality test (I.e. is it equal to or less than 0.5%):

Break-even in-year position as a percentage of turnover 0.00

0.61

0.05

0.23

0.33

1.06

1.38

1.77

0.16

0.51

Break-even cumulative position as a percentage of turnover 0.00

0.61

0.65

0.82

1.10

2.19

3.52

5.16

5.28

5.61

The amounts in the above tables in respect of financial years 2005/06 to 2008/09 inclusive have not been restated to IFRS and remain on a UK GAAP basis.


26.2 Capital cost absorption rate The dividend payable on public dividend capital is based on the actual (rather than forecast) average

relevant net assets and therefore the actual capital cost absorption rate is automatically 3.5%.

26.3 External financing The Trust is given an external financing limit which it is permitted to undershoot.

2014-15

2013-14

£000s

£000s

External financing limit (EFL)

2,206

3,240

Cash flow financing

1,040

3,137

Unwinding of Discount Adjustment

0

81

External financing requirement

1,040

3,218

Under spend against EFL

1,166

22

26.4 Capital resource limit The Trust is given a capital resource limit which it is not permitted to exceed.

2014-15

2013-14

£000s

£000s

Gross capital expenditure

6,408

6,560

Less: book value of assets disposed of

(311)

0

Charge against the capital resource limit

6,097

6,560

Capital resource limit

7,000

7,000

Underspend against the capital resource limit

903

440

27 Losses and special payments

The total number of losses cases in 2014-15 and their total value was as follows:

Total Value Total Number

of Cases of Cases

£s £s

Losses 19,080 564

Special payments 216,201 45

Total losses and special payments 235,281 609

The total number of losses cases in 2013-14 and their total value was as follows:

Total Value Total Number

of Cases of Cases

£s

Losses 478,019 783

Special payments 167,319 27

Total losses and special payments 645,338 810

Included in losses are amounts in respect of prescription charges which total £5,214 (2014: £7,563) and 527 cases (2014: 774 cases).


28 Events after the end of the reporting period

In April 2015, the Trust was notified that it was unsuccessful in its bid to continue to provide the Norfolk Out of Hours/ 111 contract from the 1 September 2015. The full year effect of the loss of this contract is £8.6m.

east of england ambulance service nhs trust · 1. recruit 400 student paramedics in 2015/16 2. up...

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