Scottish Ambulance Service Annual Review 2013/14 Self-Assessment

Transcription

1 Scottish Ambulance Service Self-Assessment

2 Section 1- Introduction The aim of this Annual Review Self Assessment Document is to provide information on the performance of Scottish Ambulance Service for the period 2013/14. The strategic aims of Scottish Ambulance Service for 2013/14 remained consistent with those set out in our 5 year strategic framework Working Together for Better Patient Care, , which was published in January The strategy set out an ambitious programme of development and quality improvement over a period of five years from 2010 until Our Strategic Framework remains consistent with the Government s 2020 Vision. Our quality aspirations and strategic aims continue to be focussed on delivering the commitments made in Working Together for Better Patient Care to deliver a person-centred, leading edge, clinically effective and safe service 24/7 for the people of Scotland. 2013/14 represented year four in the implementation phase of our strategic framework. This self assessment document sets out the progress made during 2013/14. Our success in achieving progress has been enhanced by the valuable contribution made by our stakeholders, partners and more importantly informed through the extensive patient engagement throughout the design and delivery of the changes. Throughout 2013/14, the Service has also reviewed its strategy Working Together for Better Patient Care in response to the Scottish Government s 2020 Vision. We have engaged widely with our stakeholders internally and externally to develop our clinical and workforce models to support the transition required by the 2020 vision and ensure we have the right skills and response in place requires SAS to work collaboratively and innovatively and, throughout the year we have developed a new strategic framework Towards 2020; Taking Healthcare to the Patient which describes the role the Scottish Ambulance Service can play within an integrated health and social care system focussed on delivering high quality, person-centred clinical care. We are currently engaging with our key stakeholders on the development of our strategic framework, and aim to publish it later in

3 Section 2- Overview 2.1 Overview of /14 was a year of continued improvement for the Scottish Ambulance Service. The Service has demonstrated an improvement in response times for life threatening emergencies and against a number of other key quality indicators. Key achievements in the year included; Maintained average response time to Cat A immediately life-threatening incidents at 6.5 minutes and, despite a 9.7% increase in Cat A demand, reached 73.9% of calls within 8 minutes across all of Scotland; Significant improvement in punctuality for appointment for Patient Transport Service, up from 52.1% in 2012/13 to 71.4% in 2013/14; Punctuality for picking patients up after appointment also improved in 2013/14, to 78% compared to 73% in 2012/13; The % of hyper-acute stroke patients taken to hospital within 60 minutes has improved from 78.6% to 78.8%; Following significant investment in our Ambulance Control Centres, we answered 88.1% of 999 calls within 10 seconds compared to 66.6% in 2012/13; Further improvement in the percentage of cardiac arrest patients successfully resuscitated, notably patients in ventricular fibrillation or ventricular tachycardia, where successful ROSC rate of 32.5% was achieved; Continued improvement in responding to 1 hour requests from GPs for hospital admissions and transfers, up to 88.4%; Achieved all 3 financial targets and achieved in excess of the 3% efficiency target (3.4%); Improved sickness absence from 6.5% in 2012/13 down to 6.1% in 2013/14; Significant investment in Ambulance Control Centres (ACCs) to develop a single CAD system and virtual call handling capability with demonstrable improvements in telephone answering for 999 calls, 24/7 operational management and more effective operational management of crossboundary incidents; Launched ScotSTAR specialist retrieval service for Scotland bringing together specialist neonatal, paediatric, trauma and Emergency Medical Retrieval Services (EMRS) teams co-ordinated by SAS; Progressed development of integrated transport models, working with NHS Boards such as Lothian to support development of a discharge and transfer hub, and with regional transport partnerships, local authorities and - 2 -

4 community transport providers with two pilot sites now operating in the West of Scotland and Lochaber to route patients who do not require an ambulance to an appropriate alternative provider; Realigned A&E rosters and completed the transition to a 37.5 hour week, including investment in additional urgent tier capacity; In partnership with NHS Boards, progressed implementation of national framework and care pathways for elderly patients who have fallen in partnership across 23 CHCP areas; Completed short life working group review of professional-to-professional decision support with a number of principles and recommendations to be progressed through Local Unscheduled Care Actions Plans with NHS Boards; Continued to strengthen and support our community first responder schemes across Scotland building community resilience, developing a national framework for training, and supported the extended availability and awareness of community based public access defibrillators; Established our Developing Future Leaders and Managers (DFLM) programme to build capacity and strengthen clinical leadership across the organisation; Continued to develop a cohort of managers across the Service through the Scottish Ambulance Service National Quality Improvement Collaborative building capacity and capability within the Service for continuous quality improvement and driving forward service innovation, improvement and patient safety; Undertaken extensive planning and preparation for the Commonwealth Games in Glasgow in 2014; Continued improvement in the management of major incidents as demonstrated at the tragic event at Clutha Bar in Glasgow

5 2.2 Update on 2013 Annual Review Actions Following the 2012/13 Annual Review, the Cabinet Secretary for Health, Wellbeing and Cities Strategy agreed the following actions with the Scottish Ambulance Service: 2013 Annual Review Action Update and Progress Continue to deliver on key responsibilities in terms of clinical governance, risk management, quality of care and patient safety. Since implementing the Policy on the 1 st July 2013, we have commissioned 17 Significant Adverse Event Reviews. All completed reviews are presented to the Board, the Clinical Governance Committee and the Senior Management Team. We are developing methods to spread the learning throughout the organisation and to the Scottish Ambulance Academy. We are using the Being Open methodology with relatives of affected patients to enable them to contribute to the review and understand the outcomes 3 Quality Hub and Collaborative events held to build capacity for quality improvement, review progress against local PDSAs, flying lessons cultural work and leadership development across the Service Service will address the challenge of providing high quality clinical decision making at every point of the patient journey by: o Audit the Manchester Triage Tool s suitability to provide additional decision support for clinical advisors in the ACC due for implementation in 2014 o Review our see and treat algorithms to ensure that clinical decisions by paramedics in communities are supported by effective decision support and subject to review and evaluation through a revised suite of clinical quality indicators Programme of patient safety walk rounds Revised patient safety programme developed for 2014/15 based on work in 2013/14, including roll out of the 3RU (rapid resuscitation response) model

6 Retain a focus on the delivery of your Local Delivery Plan targets, while continuing to work with Scottish Government in the development of clinically focussed and outcome based targets that support a more holistic assessment of quality and performance. Continue to review, update and maintain robust arrangements for controlling Healthcare Associated Infection. Continued focus on real-time management of performance through the ACC Continuing to progress implementation of revised skills mix and shifts to better match demand to deployment and appropriate skills mix across the service Improvements to planning process for PTS to automate the process, reconfigure the planning desks to better use existing resources and explore the potential for dynamic planning all of which will support improved PTS pick up and drop off performance HAI improvement action plan was implemented to address the requirements and recommendations from the unannounced HEI inspection in June Work around ensuring the provision of compliant laundry facilities on stations for uniforms is ongoing with advice requested from HPS and HFS to help inform final decisions. Fob watches have been introduced to replace wrist watches and the uniform dress code policy updated to reflect this. In line with other Boards, the revised version of the 1st chapter of the national prevention and control of infection manual covering Standard Infection Control Precautions (SICPs) was implemented in January to replace the service existing SICPs policies. Hand hygiene audit programme continues to be completed across all divisions with compliance of 91% achieved for the year. Cleaning compliance monitoring against National Cleaning Services Specifications for ambulance stations and vehicles continues across all divisions with full year compliance at 95.5% for vehicles and 94.3% for estates. The number of Cleanliness Champions across the Service continues to increase month on month. This programme is mandatory for Team Leaders. The annual Infection Prevention and Control programme includes developing and implementing action plans to address requirements and recommendations from - 5 -

7 Maintain and enhance effective partnership structures and cultures across the Service, at both a local and national level. HEI inspections and HAI progress is reviewed at every Board meeting. New partnership arrangements agreed and in place Workforce Steering Group in place to address a number of key issues notably the ongoing monitoring of rest periods, single crewing, implementation of skills mix, on call and relief Developing our Future Workforce Group to lead and support the transition to a new workforce model to support SAS and Scottish Government s 2020 vision Maintain progress towards the national HEAT sickness absences standard of 4%, in partnership with staff and their representatives. An Attendance Management Taskforce has been set up as a case management group reviewing those staff with the highest levels of short term persistent absence across the organisation and staff with long term absence of over 4 months to assess the support they are receiving and review interventions undertaken to date. The aim of this is to ensure that absence cases are being appropriately managed and that we, as a Service, are taking a consistent approach in managing attendance. The case management group will identify cases where management interventions are failing and provide feedback on the management of the case and recommendations for next steps. The panel needs to ensure that appropriate support is put in place for staff to stay at work, and if this is not possible, promote discussions with staff and take actions that are in line with the Attendance Management policy. Entered into a new occupational health contract with NSS. Phase one of the contract will be live across Scotland at the start of June Phase two will be in place by the end of 2014/15 year. Phase one of the contract provides occupational health services through a single point of contact supported by an attendance management process provided by SALUS. Improved sickness absence for 2013/14 to 6.1% compared to 6.5% in 2012/

8 Continue to work with NHS Boards and other partners on the planning and delivery of services in support of a healthcare system that is integrated and mutually supportive. Continue to achieve financial in-year and recurring financial balance, and keep the Health Directorates informed of progress in implementing the local efficiency programme. LUCAPs developed with NHS Boards with specific paramedic practitioner model developments in NHS Lanarkshire, NHS Shetland and NHS Borders, working alongside the local out of hours service initiated Practitioner model in NHS Lanarkshire supporting the development of the ASSET team providing integrated out of hospital care for elderly patients Working with NHS Boards to embed the national framework for frail and elderly patients who have fallen Work across a number of Boards to improve discharge and planning processes Continued work to develop enhanced triage with NHS 24 and increased % of calls transferred to NHS 24 Lead review and development of professional-to-professional decision support through national Task & Finish Group Met our financial targets for the year Exceeded CRES target for year achieving 3.4% - 7 -

9 Section 3 - Everyone has the best start in life and is able to live longer, healthier lives 3.1 Clinical Strategy Key successes in implementing our Clinical Strategy in 2013/14 include: Significant engagement around emerging new clinical model, and supporting workforce and education models, to deliver the Service s strategy towards 2020 and ensure that high quality clinical decisions are made in partnership with patients and their families/carers. This means that, where appropriate, we take care to the patient and reduce avoidable attendances at hospital; Developed plans for extension of 3RU (Rapid Response Resuscitation) approach to community based cardiac arrests and enhanced real time feedback with Q-CPR meter technology in place across 80% of A&E fleet, saving more lives. The Service recently received a BMJ recognition award for this work and in 2013/14, 509 lives were saved following cardiac arrest as a result; Continued work to develop SAS triage protocols and care pathways, including adoption of the Manchester Triage Tool for clinical advisors offering enhanced decision support for time critical and lower acuity calls appropriate for hear and treat, which will be reviewed in 2014; Lead a national review of professional-to-professional decision support systems, establishing some core principles to be taken forward in partnership with NHS Boards through Local Unscheduled Care Action Plans; Implemented new care pathways for COPD across Edinburgh City with positive evaluation to date; Continued to build and strengthen community resilience, increasing awareness and use of public access defibrillators with our partners and developing a national framework for supporting and developing community first responder schemes more effectively; Participation in the national review of major trauma service across Scotland and positive evaluation of a dedicated trauma desk within Ambulance Control Centre to better target specialist resources; Participation in the GEOS (Geographical Evaluation of Systems of Trauma Care for Scotland) to fully determine the spread and severity of trauma across Scotland using SAS data, to assist with the development of major trauma units as part of the national review; Development of paediatric early warning score (PEWS) to be launched nationally early in 2014/15; - 8 -

10 Improvement across most of our clinical performance targets i.e., VF/VT ROSC, Hyper-acute stroke, PVC Bundle; Participation in the Unscheduled Care Data Mart (NASA) Data Linkage project led by ISD and STAG Trauma Audit to improve data sharing and better understanding of outcomes to improve treatment and manage access and demand to emergency and unscheduled care more; Ongoing collaborative work in research and development with Stirling University Nursing and Allied Health Professions Research Unit particular focus on long term conditions and pathways for diabetes and COPD; Emerging engagement with the Innovation Leads Group to ensure that the Service is identified as a leader in NHS Scotland s innovation work. Ongoing work with the Digital Health Institute to promote the effective evidence-based use of near-patient testing technology supporting quality decision making for patients. Another work stream with DHI is preparatory work for our Ambulance Telehealth project, which brings together clinical quality, technology and innovation. 3.2 Improved Response Demand for SAS continued to increase in 2013/14, up 2.8% to 523,726 emergencies compared to 2012/13. We saw regional variance in terms of this increase with the North of Scotland experiencing a 5.1% increase in emergencies compared to a 0.5% decrease across Glasgow and Lanarkshire. There was also a significant increase in the number of Category A life-threatening emergencies responded to in 2013/14, up 9.7% on the previous year. In 2013/14, the 3 Island Boards covering Orkney, Shetland and Western Isles also came in line with the rest of Scotland in respect of categorisation and response to emergencies. Despite this continued increase in demand, the Service maintained average response to Category A incidents at 6.5 minutes. Additionally, although performance fell to 73.9% for Cat A, the number of patients reached within 8 minutes for an immediately life-threatening emergency increased to 105,200 in 2013/14, 8,285 more than in 2012/13. During the year, SAS has invested significantly in the 3 Ambulance Control Centres (ACC) with a significant improvement programme successfully delivered. Key achievements in this programme include; A single virtual CAD system which allows ACC staff to dispatch ambulances and manage incidents anywhere in Scotland ensuring a faster response and access to the right clinical resource; A virtual call handling capability across the 3 ACCs allowing calls to be answered and managed as one virtual ACC, which has resulted in a - 9 -

11 significant improvement in telephone answering standards for 999 calls up from 66.6% in 2012/13 to 88.1% in 2013/14; An enhanced management structure, including real time analytical capacity and performance management focus. The Service also completed the transition to a 37.5 hour working week in the first quarter of 2013/14 and, throughout the year, has made significant progress in reviewing shifts and skills mix to ensure we have the right response at the right time in the right place to meet demand and deliver performance. As well as realigning A&E resources, we have increased the level of dedicated urgent tier resources, which has helped improve performance for 1 hour GP requests. A summary of our performance against key HEAT LDP response targets is set out below. Measure Target Number of incidents 2013/ /13 performance 2013/14* performance Respond to life-threatening emergencies in 8 minutes (Cat A) 75% 142,340 (9.7%) 74.7% 73.9% Respond to serious but not immediately lifethreatening emergencies in 19 (Cat B) 95% 295,299 (-2.7%) 91.8% 91.3% Respond to GP 1 hour urgent calls within 1 hour 91% 48,158 (0.8%) 87.6% 88.4% % of 999 calls answered within 10 seconds 90% 418,311 (0.8%) 66.6% 88.1% *In 2013/14, the Service applied the same response time standards to the 3 Island Board areas of Orkney, Shetland and Western Isles. Previously these had been reported against a target of 56% of all emergencies responded to within 8 minutes, whereas now the 75% target for responding to all Category A immediately life-threatening emergencies within 8 minutes and 95% of Category B serious but not immediately lifethreatening incidents within 19 minutes applies equally to these Board areas

12 Section 4 Healthcare is safe for every person, every time 4.1 Clinical Governance The Service continued to strengthen its Clinical Governance arrangements in 2013/14 in line with our Clinical Strategy. Key areas of work progressed to strengthen clinical governance in SAS in 2013/14 includes: Successful pilot with NHS Greater Glasgow and Clyde to test real time sharing of electronic patient care form with elected GP practices where SAS has attended and successfully treated a patient at home. This allows the GP to see the full nature of the events surrounding their patients episodes of care and ensures continuity of care. This is the first project of its kind in the UK and has been well received, as a result of which, it was extended to all GP practices across NHS GG&C and we will look to extend this across other NHS Boards in 2014/15; Further development of SEPSIS 6 protocols testing diagnostic capability and real time sharing of information with NHS Forth Valley, NHS Borders and on Arran; Review and implementation of new clinical practice guidelines (JRCALC/AACE) together with appropriate training module across the Service; Strengthened our systems and processes for review of significant adverse events and, following internal audit, enhanced the level of openness and sharing across the Service following review of these events; During 2013/14, the Learning in Practice programme provided staff with a 4 hour clinical teaching session. This included advanced life support and essential skills updates, including the use of the new pelvic splint, intraosseous access, traction splinting and advanced airway management. Nationally 86% of staff completed this programme. Learning in Practice was further supported by the introduction of a workbook that contained not only statutory and mandatory updates for infection control and moving and handling, but also core content on person centred care, communication, dementia, sociology and psychology. Furthermore the role of the practice placement educator was expanded to provide clinical supervision for qualified staff, with 25% of staff having an observed clinical shift and reflective debrief; Continued comprehensive programme of clinical audit throughout the year, focussing on frail and elderly patients who have fallen, airway care, witnessed cardiac arrest, medicine management and on-scene times in line with core clinical developments and care pathway development;

13 The Service also appointed a full-time Medical Director in January 2014, Dr James Ward, and we are currently reviewing and strengthening our core Medical Directorate structure and associate governance arrangements. 4.2 Patient Safety Significant Adverse Events During 2013/14 the Service implemented a new framework for the management of significant adverse events (SAE). The framework called Management and Review of Significant Adverse Events also includes a policy for Being Open with Patients. In August 2013, Healthcare Improvement Scotland (HIS) reviewed the way in which the Service manages adverse events and an action plan for improvement was developed and is currently being implemented. The framework includes templates for each stage of the review to ensure the Service adopts a consistent approach to such events and learning is implemented where appropriate. The Significant Adverse Event (SAE) Group continues to meet monthly to ensure lessons learned from incidents, claims, concerns and complaints continue to be shared internally and with external stakeholders in a consistent and open manner. The group is the focal point for all SAE activity, including seeking assurance on the completion of reviews and actions. To underpin this work and promote a learning and improvement culture within the Service, root cause analysis and being open, training events have been organised for managers at all levels across the Service to ensure they are trained appropriately to implement the new framework. These courses took place over April and May 2013 and further courses are planned for Sharing the learning from these events has also improved in 2013/14 with a review of ongoing incidents through Clinical Governance Committee and Senior Management Team. Use is also made intranet and Response magazine to raise awareness amongst staff of the learning from these events and support a more open culture across the Service. Person-Centred Care In 2013/14, the Service reviewed its approach to the development of personcentred care and developed a Person-Centred Health and Care programme and associated action plan. The programme focuses on patient experience, staff experience and co-production as the three key pillars of person-centred care and there are four priority areas being progressed:

14 Mission and Values We have a process in place to ensure that the whole team (SAS) understand the behaviours that demonstrate our person-centeredness values Listening We can demonstrate how the voice of people who use our service clearly informs strategic / operational aims / goals. Environment and Design Our environment supports family presence and participation at the level they choose (formal care settings) as well as interdisciplinary collaboration. Information and Education People and families who have experienced our service contribute, as faculty, in training and development for existing staff. Working closely with the Person-centred Health and Care Collaborative, and with staff input gathered from the Service s annual programme of Patient Safety Walk Rounds, the Service has been testing opportunities to improve patient care. This includes greater involvement of patients in the curriculum at the Scottish Ambulance Academy and the development of a Person-centred health and care session to be delivered as part of the Service s Delivering Future Leaders and Managers Programme. Quality Improvement Collaborative In 2013/14, the Service continued to build capacity and capability for quality improvement bringing together a cohort of around 60 frontline managers through our Quality Improvement Collaborative and Hub. Three sessions were held in 2013/14 focussing on developing skills, tools and techniques for quality improvement, effective leadership and sharing learning. This collaborative approach was aligned to the delivery of our strategic programme and helped progress the development of specific care pathways locally giving those responsible in divisions an opportunity to present and discuss progress throughout the year. The success of this approach is demonstrated by the increase from 4 to 23 in the number of partnerships locally, 19 of which have been focussed on embedding the national framework for frail and elderly patients who have fallen with a marked reduction in the percentage of these patients being treated at home and accessing a range of health and social care support

15 Additionally, two senior members of the Clinical Directorate successfully completed the IHI sponsored Scottish Patient Safety Clinical Fellowship Programme, with a third senior clinician successfully gaining a place on the programme. Care Bundles The Service continued to see improvement in the appropriate adherence and implementation of the Peripheral Vascular Catheterisation (PVC) bundle being recorded by staff, improving from 69.6% in 2012/13 to 72.5% (24,950 patients) in 2013/14. This is an increase of 2,568 patients for the year. 4.3 Clinical Performance 2013/14 saw continued improvement across our clinical key performance indicators as set out in the table below: Measure Target Number of patients 2013/ /13 performance 2013/14 performance Return of spontaneous circulation (ROSC) Return of spontaneous circulation VF/VT (ROSC) Hyper-acute stroke patients to hospital within 60 minutes of call Cat A cardiac arrest patients responded to within 8 minutes 12-20% 2,938 (-1.4%) >20% 796 (2.7%) 80% 2,756 (-10.1%) 80% 4,520 (-5.7%) 17.5% 17.3% 30.3% 32.5% 78.6% 78.8% 79.1% 77.1% Recorded used of PVC bundle 67% 24,950 (11.5%) 69.6% 72.5% Community based cardiac arrest The Service continues to deliver successful Resuscitation of Spontaneous Circulation (ROSC) for patients in cardiac arrest with 509 lives saved in 2013/14. The success of the approach developed in partnership with NHS Lothian was recognised with a British Medical Journal award in 2014 and the 3RU model is being rolled out, where a dual response is standard to allow focussed

16 concentration on CPR and enhanced clinical support throughout with Q-CPR meters now in place across 80% of the Service s A&E fleet to give crews realtime feedback on the quality of CPR. 4.4 Infection Control Performance The Service continued to maintain high level performance against key performance indicators in respect of hand hygiene and national cleaning services specification (NCCS). Compliance with hand hygiene opportunity was 91% and against a target of 90% for the full year. Compliance with NCCS was 95.5% and NCCS for estates was 94.3% against a target of 90%. From January 2014 we rolled out a programme of Standard Infection Control Precautions (SICPs) auditing for staff compliance with all elements of SICPs in the clinical environment. These audits are completed at hospital receiving units; as ambulance crew drop off patients. It can be seen from the results that SICPs compliance is improving as the audit programme raises staff awareness. The Service appointed an HAI Quality Improvement Facilitator on a 2 year secondment until January 2016 with funding provided by Scottish Government. The post holder is currently developing their knowledge around patient safety and Quality improvement methodology. We will be looking at areas for improvement that will impact on the HAI elements of the patient safety programme. Initially this will be around SICPs compliance and possibly some work around peripheral vascular cannula (PVC) insertion. The Service also now has a National SICPs Co-ordinator in post which has evolved from the previous Hand Hygiene Coordinator post. This post has implemented and rolled out the SICPs audit programme and reporting across the Service

17 Section 5: Everyone has a positive experience of healthcare 5.1 Scheduled Care Improvement Programme In 2013/14, the Service carried out 1,135,343 patient journeys, down 3% on 2012/13. During 2013/14, the Service continued to progress Phase 2 of the Scheduled Care Improvement Programme, following successful completion of Phase 1 in 2012/13. Phase 1 focussed on establishing our direct patient booking line, relocation of area service offices and investment in mobile technology across the PTS fleet. Phase 2 has continued to build on this platform in 2013/14 with a number of key developments and improvements being taken forward, including; With NHS Lothian, supported the development of the Lothian Hub model, which uses SAS patient needs assessment process to manage requests for discharges and transfers from the three principal NHS Lothian hospital sites, ensuring appropriate use of SAS patient transport resources and access to appropriate alternatives where an ambulance is not required; Working with NHS Boards to improve discharge and transfer planning to support more effective flow of patients across the system; Improved telephone answering standards within 60 seconds to 68.5% across all 3 centres from 60.2% in 2012/13, with plans to introduce call virtualisation early in 2014/15. Only 5.8% of calls were abandoned after the 60 seconds in 2013/14, compared to 55% of calls at the start of the improvement programme; Continued to deliver improved performance in service for patients in respect of pick up and drop off for appointments and maintained levels of cancellations due to SAS below 0.5%; Reviewed the patient needs assessment process to ensure consistent application and enhanced our ICT system to make use of the system easier for staff; Instigated a performance management and staff development programme across the 3 ACCs to ensure consistency in approach, the development of a set of core competencies and ongoing coaching and support for staff and supervisors; Reviewed our systems and processes for journey planning to ensure patients reach their appointment in time and the Service makes better use of existing PTS resources. This has resulted in significant reconfiguration of systems and we are currently piloting Auto plan in tandem with our normal planning processes whereby the Cleric system is able to plan up to 80% of all patient journeys automatically, leaving planners able to focus on

18 complex requests and work with NHS Boards to minimise and more effectively manage on the day requests. We anticipate full roll out of Auto plan by August 2014; Worked with NHS Boards and Regional Transport Partnerships following publication of the outcomes of the Scottish Government Short-life Working Group review of Healthcare Transport, to explore more integrated models. We have continued to support the THINC model in Moray and, following receipt of funding from Scottish Government, will work in partnership with Strathclyde Transport Partnership and NHS Highland to progress two further pilots to develop integrated transport across the West of Scotland and in Lochaber. Scheduled Care Performance In 2013/14, following the introduction of mobile data across the PTS fleet, the Service moved from quality week auditing of performance for four weeks throughout the year to full year reporting of performance for the first time. We have seen consistent improvement across all indicators for scheduled care as a result of the focus of the improvement programme and performance against our HEAT LDP targets in respect of scheduled care is set out in the table below; Measure Target Number of patients 2013/ /13 performance 2013/14 performance Punctuality for appointment 75% 566,176 (-3.3%) 52.1% 71.4% Punctuality for pick up after appointment 90% 573,872 (-1.8%) 73.0% 78.0% Cancellations by SAS <0.5% 7,002 (-5.4%) 0.5% 0.5% PTS calls answered within 60 seconds 80% 677,661 n/a 68.5% 5.2 Ambulance Control Centres The Service has invested significantly in its improvement programme across the three Ambulance Control Centres in 2013/14, with some key improvements and developments progressed, including:

19 Scottish Ambulance Service Introduction of virtual call handling and auto-distribution of calls across the 3 sites which has seen a marked improvement in telephone answering standards and the ability for staff to answer calls in any centre; Move to a single C3 system allowing staff in any of the 3 ACCs to dispatch resources and manage incidents anywhere in Scotland, ensuring the nearest appropriate response is visible and available; Move to a dedicated Community of Interest Network (COIN) providing a robust telephony and data platform linked to N3; Revised management structure to focus on real time performance management and analysis, strengthen clinical governance and professional standards, and ensure 24/7 senior operational management across the 3 sites; Ongoing work to review and improve triage protocols and pathways, focussing on the role of the clinical advisors in managing lower acuity calls and ensuring effective triage and assessment of life-threatening Category A calls to improve response and performance; Review of standard operating procedures to ensure consistency in working practices across the 3 ACCs; Development of special operations desk to accommodate new air ambulance staff, dedicated trauma desk, and ScotSTAR retrieval service; Procurement of GRS workforce system, which will link directly to C3 CAD, and allow for more effective planning and management of staff resources; Progress towards implementation of Optima Live decision support software to improve deployment and dispatch of resources. 5.3 Patient Focus Public Involvement (PFPI) The Service continued to progress implementation of its PFPI strategy in 2013/14, establishing Involving People groups in each division to take work forward locally reporting into a national PFPI steering group. In 2013/14, we specifically worked with these groups to develop our national equality outcomes and engage with patients on the development of our strategic framework Towards 2020; Taking Care to the Patient. We have continued to engage with patients through social media and patient portals, including Patient Opinion and yourscottishambulance.com. We received around 10% of all our compliments through social media channels in 2013/14 for example. 5.4 Complaints & Commendations The Service s bespoke feedback system, Viewpoint, continued to support 20-day compliance and improve understanding of feedback trends. The compliance rate

20 for the year 2013/14 is 64.3% against a national NHS target of 70% responded to within 20 working days, although this figure still requires to be validated by ISD. The total number of complaints has increased from 412 to 475, which represents a 15% increase. The Corporate Affairs and Engagement team continues to work with Operations colleagues to provide meaningful response to complaints within 20 days of contact by complainants, which has impacted on the 20 day target. Progress has been made in both embedding a more consistent person-centred corporate tone in responding to complainants, as well as ensuring complaints are reviewed in a way which is proportionate to the seriousness of the complaint. As a consequence, the Service has seen fewer investigations with the Ombudsman down to 5 in 2013/14 compared to 8 in 2012/13. The Service continues to encourage all types of patient and carer feedback via a range of channels, including Patient Opinion. Poor care experiences from Patient Opinion, and from other social media channels are logged as a concern. For posts on Patient Opinion, where the care described suggests that more detailed investigation is necessary, the Service responds by inviting the person who posted the information anonymously, to get in touch, to help make sure the Service has understood where the patient s care has been sub-standard, thereby ensuring all appropriate actions are taken to prevent the same experience happening again to the patient, or a similar experience for other patients. The Service has recently secured funding from the Scottish Government to support promotional activity to drive more feedback through Patient Opinion. The promotional activity will target seldom heard groups, to highlight the importance of giving feedback to patient and community groups who have not traditionally shared their care experiences with the Service. This, in turn, should enable the Service to further improve patient care for all service users. Compliments The Service also monitors compliments received and, in 2013/14, we received 513, an increase of 56% compared to the 329 received in 2012/13. This reflects the Service s commitment to listening to patients and opening up as many channels as possible to gather feedback. Around 40% of the compliments specifically highlighted appreciation of positive behaviour: e.g. compassionate care. Just over 10% specifically highlighted appreciation of high quality clinical care. These examples below received through Patient Opinion portal highlight the positive impact that SAS staff can have and the Service ensures this message is fed back to staff: I woke up at 2am with chest pains and called the emergency services. From the moment my wife dialled 999 I could not have had speedier treatment from the help from the man on the phone with his clear and concise instructions to my wife to the fast response by the paramedics who attended me at home

21 .. I had various ambulance drivers, each of whom was enormously cheery, helpful and caring. It was in the detail of fastening the seatbelts and ensuring that I was comfortable that impressed me......the next thing I remember is being in shock, feeling frightened and very sore. Then I heard the ambulance and then the paramedics were talking to me. All of a sudden, I knew I was going to be OK. The paramedics chatted to me, joked with me and I felt like they really cared about me

22 Section 6: Staff feel supported and engaged Scottish Ambulance Service A key programme of work during 2013/14 was ongoing implementation of Doing the Right Thing our organisational development strategy; this is a key enabler for delivering Working Together for Better Patient Care. The programme has taken forward a number of key areas of development and improvement in 2013/ Developing our Future Workforce In 2013/14, the Service established in partnership a Developing our Future Workforce Group, to explore new and existing roles required to deliver our 2020 strategy. This group, working with Skills for Health, progressed the development of our strategic workforce plan, currently out for consultation, to support our new clinical service model and will continue to oversee development of our education model going forward. This is a significant piece of work recognising that the shape of our future workforce will be critical in delivering our strategy Towards 2020; Taking Care to the Patient. 6.2 Developing Future Leaders and Managers The Service is committed to developing future leaders and managers to be more effective, creating capacity and time for clinically focussed supervision and management. This programme moved to implementation phase in 2013/14, with a dedicated programme manager appointed to support the divisions in developing transition plans. A programme of learning and development has also been put in place to support managers in team leader and area service manager roles with the skills to lead effectively and the ultimate aim of this programme over the next two to three years is to create 40% capacity across the week for this cohort of managers to proactively manage staff to deliver clinical and service improvement. 6.3 Right Mix of Skills Early in 2013/14, the Service completed the transition to a 37.5 hour week largely completed by the end of 2012/13 and began the process of reviewing deployment of resources to match demand. Extensive modelling using Optima Predict was completed for every station across Scotland to determine the right level and mix of resources required. In 2013/14 a Workforce Steering Group was set up, including partnership representatives to oversee implementation of this review and significant progress has been made, not least in terms of increased urgent tier capacity which has impacted on performance in response to requests from GPs and hospitals

23 This group also assumed responsibility for monitoring of rest period management in line with the protocols agreed and a dedicated rest break manager is now in place in the ACC, which has resulted in a significant improvement in terms of application of protocols and consistency in management of rest periods. The group has also taken forward agreement around a number of working practices including relief, annual leave, monitoring of single crewing and skills mix to ensure the Service is able to respond with the right level and mix of skills to meet clinical needs. 6.4 Performance Sickness absence improved in 2013/14 to 6.1%, compared to 6.5% in 2012/13. An attendance task force was established in 2013/14 and has been working with each of the divisions and Ambulance Control Centres to focus on effective attendance management with positive results. The new occupational health contract with NSS will support the attendance management process by ensuring consistent support to staff and managers. Phase one of the contract will be live across Scotland at the start of June Phase two will be in place by the end of the 2014/15 year. Phase one of the contract provides national occupational health services through a single point of contact supported by an attendance management process provided by SALUS. Phase 2 of the contract will bring the employee assistance programme and the fast track physiotherapy programmes into the same contract enabling the delivery of a more focussed service and the provision of national reporting across all services. The Service also reviewed 63% of e-ksf personal development plans in 2013/14, compared to a NHS average of 58% and work was ongoing throughout the year to support managers to more effectively embed review. 6.5 Team Talk Our team briefing mechanism Team Talk, initially piloted in the North Division was rolled out in 2013/14 and managers have received training with positive feedback to date. 6.6 Partnership Working We reviewed our Partnership arrangements in 2013/14 and introduced a new partnership model which reflects practice in other NHS Boards. With the help of external facilitation, we undertook a series of partnership development sessions. The Service has a National Partnership Forum which meets on a bi-monthly basis. This is co-chaired by the Chief Executive and Employee Director, with senior management representation from each directorate and staff side

24 representation from the Employee Director (Unison) and national representatives from Unison, Unite and GMB. All major issues affecting staff are discussed at National Partnership, however, in addition, there are local partnership forums held in each division/department. Messages from the National Partnership Forum are cascaded down to these local forums and, equally, the local forums will raise issues at a national level which cannot be dealt with locally. 6.7 Staff Survey The Service has reviewed the results of the staff survey and, in discussion with staff, has agreed 4 key areas for further action: Improving organisational culture to address perceptions about bullying and harassment; Measures required to protect staff from abuse; Effective engagement and communication with staff; Treating staff fairly and consistently An action plan has been developed to progress these 4 key issues and progress and feedback to staff will be managed through our staff governance arrangements

25 Section 7: People are able to live well at home or in the community 7.1 Care Pathways The Service has continued to work in partnership with NHS Boards through CHCPs in 2013/14 to further embed the national framework for frail and elderly patients who have fallen, with around 23 partnerships now actively taking this work forward and a managers toolkit and DVD developed to support implementation. Overall, the percentage of patients over 65 taken to hospital as a result of a non-injured fall has dropped from 79.9% in April 2012 to 66.1% in April 2014, with notable success in Argyll, Edinburgh City and Lanarkshire where SAS staff have worked alongside community based teams to support management of these patients at home and identify and refer to appropriate services to put solutions in place to prevent future falls. A measure of the success of this work is the minimal number of patients re-presenting to SAS following application of the care pathway. The Service is continuing to develop its capability to more effectively and safely offer care to patients who suffer from dementia. SAS staff have undertaken Alzheimer Scotland s dementia champions training programme and the Service s approach was recognised at the Alzheimer Scotland National Award Ceremony in September. Additionally, in 2013/14, we piloted a new pathway for patients with COPD across Edinburgh City with initial positive outcomes; 7.2 Integrated services The Service has engaged with NHS Boards to extend the use of the specialist paramedic practitioner role in 2013/14 and supported Boards to develop integrated models of care. There have been a number of developments in 2013/14 which demonstrate the role SAS can play in supporting the transition to an integrated health and social care model and the effective delivery of unscheduled care, including; Working as part of the Grampian decision hub to determine the most appropriate response, be that a paramedic practitioner or alternative practitioner, GP our of hours, NHS 24 etc. and now linked in with social care teams; NHS Lanarkshire ASSET (Age Specialist Service Emergency Team) model, which offers a hospital at home service for acutely ill patients. SAS paramedic practitioners are able to refer to this team and work

26 alongside NHS colleagues to undertake assessment and treatment at home; With NHS Borders exploring the paramedic practitioner role in maintaining out of hours capacity out with Borders General and exploring how SAS can support redesign of unscheduled care service delivery across the area. The Service has been engaging with NHS Boards throughout the year as we refresh our strategy and this work has informed that process and demonstrated the effectiveness of this integrated model in delivering the 2020 outcomes and we will continue to develop our future workforce to support this approach. 7.3 Strengthened Community Resilience The Service has continued to strengthen community resilience and build its network of volunteers and schemes, with a number of developments progressed in 2013/14; Successful ROSC of 20.8% for cardiac arrest patients where a community based first responder is in attendance; Development of the Staying at Home (Shine) model whereby volunteers will be activated to provide support for patients treated at home. The British Red Cross (BRC) now hold a list of current volunteers who have noted interest in the role and the training modules they will require to undertake have been identified. Work is ongoing to adapt the falls screening tool which volunteers will use to capture information about the patient's fall history; Work to identify an evidence-based trigger tool that will be used by the role to ensure that any deterioration in the patient's condition is recognised and escalated accordingly, is progressing with indications that the National Early Warning Score (NEWS) can be adapted for this purpose with the added benefit that this will be continuous with the referring Paramedic's assessment; Further work to increase levels of community based public access defibrillators and enhance C3 to map these and raise awareness for call handlers to alert members of the public to the location of a defibrillator; Review of the training and support for first responders and develop a national standard strengthening governance arrangements