The Scottish Ambulance Service Annual Report and Accounts 2007/08

Transcription

1 The Scottish Ambulance Service Annual Report and Accounts 2007/08

2 CONTENTS 02 CHAIRMAN S STATEMENT 04 CHIEF EXECUTIVE S STATEMENT 05 OUR SERVICES 06 KEY STATISTICS 08 OVERVIEW OF THE YEAR 12 HOW WE PERFORMED 16 KEY STATISTICS 18 OUR COMMITTEE MEMBERSHIPS 2007/08 19 VITAL STATISTICS 20 BOARD OPERATING COST STATEMENT 21 BALANCE SHEET 22 TOP 10 CATEGORY A INCIDENTS, OUR STAFF AND ACCIDENT AND EMERGENCY JOURNEY PERCENTAGES 23 AUDIT AND INSPECTION 24 KEY STATISTICS 26 CAPITAL INVESTMENTS 27 PATIENT FEEDBACK 28 REGISTER OF INTERESTS 2007/08 30 ANNUAL REVIEW EQUAL OPPORTUNITIES POLICY 36 CONTACT DETAILS 01

3 CHAIRMAN S STATEMENT FOR ANNUAL REPORT 2007/08 We will never be able to thank your crew enough for their efficiency and professionalism. They quite simply saved my life. You must be proud to have them as members of your team. This patient suffered a cardiac arrest whilst on holiday. After responding quickly the crew were able to restart his heart and he was able to return home. THE SCOTTISH AMBULANCE SERVICE CONTINUES TO DELIVER FOR PATIENTS ACROSS SCOTLAND SAVING LIVES BY RESPONDING TO LIFE THREATENING EMERGENCY CALLS, INCREASINGLY PREVENTING UNNECESSARY HOSPITAL ADMISSIONS BY TREATING OR REFERRING PEOPLE AT THE SCENE AND BY TAKING PATIENTS TO HOSPITAL IN TIME FOR THEIR APPOINTMENT. We recognise that change can be challenging but we have a long tradition of successful Partnership working with staff. We are committed to working in Partnership with our staff, recognising the essential contribution they make not only in delivering but also developing and improving our services. These vital services could not be delivered without the continued support, commitment and dedication of our staff, for which the Board is extremely appreciative. 2007/08 was a challenging but highly productive year for the Service, our continuing focus being the delivery of patient-centred, clinically excellent services. I am grateful for the professionalism and commitment of all staff to the Service over the past 12 months. The Scottish Ambulance Service makes a difference to the lives of thousands of people across Scotland every year and I, together with my colleagues on the Board, am tremendously proud of the difference we make. The sustained increase in emergency demand over recent years has, and continues to have, a major impact on our Accident and Emergency Service. Once again emergency demand continued to grow, this year by a further 4.8% increase. Yet, despite this continued uplift in demand, our continued focus on improvement resulted in ambulance crews treating an additional 25,679 emergency patients within 8 minutes. WILLIAM BRACKENRIDGE Chairman of the Scottish Ambulance Service Board Our air ambulance service, one of the most advanced in Europe, continues to deliver a high-quality service, delivering a life line to people in remote and rural communities. During the year, our Patient Transport Service continued to play a vital role in the delivery of healthcare services across Scotland undertaking over 1.6 million patient journeys, retaining high levels of punctuality and patient satisfaction. At a time when healthcare in Scotland is changing rapidly we are at the forefront of many of the changes that will lead to improved patient experience and provide enhanced roles for many of our staff. We are committed to developing new ways of clinical working in partnership with patients, our staff, our health colleagues and our local communities, building on public and stakeholder confidence in the Service. 02

4 CHIEF EXECUTIVE S STATEMENT FOR ANNUAL REPORT 2007/08 OUR SERVICES OUR COMMITTED AND HIGHLY SKILLED STAFF CONTINUED TO DELIVER CLINICALLY EFFECTIVE, PATIENT-CENTRED CARE. WE ARE DETERMINED TO BUILD ON OUR SUCCESSES TO MEET THE IMPORTANT CHALLENGES AHEAD. We will listen to our patients, the public, our staff and our colleagues across the healthcare sector as we continue to improve and develop services which meet the needs of patients wherever they are in Scotland. Increased training and improved skills are key to a modern ambulance service and in 2007/08 we successfully developed new care pathways, introduced paramedic advisors into our Emergency Medical Dispatch Centres and not least, provided 700 paramedics with extended skills training. The year saw a consistent improvement in the percentage of patients treated at scene and kept from unnecessary hospital attendances. Importantly, our patients continue to be satisfied with the services we provide. Throughout the year we maintained a sharp focus on the target for responding to life-threatening calls: investing in our Emergency Medical Dispatch Centres to increase dispatcher and call taker numbers; in our staff and vehicles to ensure the most effective and appropriate response to each incident; and in new technology to improve travel times to scene. Not only are we reaching more patients, more quickly than ever before, we have created a sound platform for continued improvement. The delivery of the state-of-the art CAB based technology is a key achievement and one which will support ongoing clinical development and improvement over the coming years. Our Patient Transport Service performance over the past five years has made a steady and continual improvement. Increasingly we are being asked to care for patients with more dependent needs. Looking forward, to ensure flexibility and efficiency in meeting the health transport needs of patients, a key objective over the next year will be the review of the Patient Transport Strategy. Our financial performance was strong despite a range of major pressures, including increasing demand and fuel costs. We continue to ensure that scarce resources are used effectively to the maximum benefit of the patient. A huge effort also went into workforce issues. We welcome the approach taken in the Better Health Better Care Action Plan and have taken steps to fully integrate this into our strategic plans for 2008/09. The successes of 2007/08, together with the commitment and dedication of our staff, provide a firm foundation towards achieving our goals as the demands on the Service continue to grow. ACCIDENT AND EMERGENCY CARE WE RESPOND TO 999 CALLS AND REQUESTS FOR URGENT RESPONSE BY CLINICIANS. The Scottish Ambulance Service delivers accident and emergency care to patients across Scotland. Accident and emergency care is delivered by specially trained paramedics and ambulance technicians who, last year, responded to over 580,000 calls across Scotland. 999 calls are handled by one of our three Emergency Medical Dispatch Centres and crews are dispatched from stations and deployment points situated near to areas where the fastest response can be provided. The Accident and Emergency Service operates 522 specially equipped vehicles including ambulances, cars and motorbikes. Our crews provide life saving emergency medical care. They can take patients to hospital, treat patients at the scene or refer them to an appropriate clinic. PATIENT TRANSPORT SERVICES WE PROVIDE AN ESSENTIAL ROLE IN TAKING PATIENTS TO AND FROM THEIR HOSPITAL APPOINTMENTS. Last year, our Patient Transport Service, undertook 1.6 million journeys across Scotland. The Service is prioritised according to those with greatest need and provides a service to an increasing number of patients with greater dependencies. The service is provided by specially trained ambulance care assistants. The Patient Transport Service operates 601 vehicles. AIR WING WE PROVIDE AN EMERGENCY RESPONSE AND INVALUABLE HOSPITAL TRANSFER FOR REMOTE AND RURAL AREAS. The air ambulance service is delivered by four purpose built aircraft, two helicopters and two fixed wing aircraft. The air ambulance service is the only integrated, publicly funded air ambulance service in the UK, last year flying over 3,200 missions. The Scottish Ambulance Service is a Special Health Board. We operate from 178 locations across five Divisions covering the whole of Scotland, the largest geographic area of any ambulance service in the UK. PAULINE HOWIE Acting Chief Executive 05

5 Mark Tynan Paramedic, Edinburgh City Station Photographer: Joel Symonds, Ambulance Technician, Edinburgh City Station 06 07

6 OVERVIEW OF THE YEAR THIS SECTION OF THE REPORT PROVIDES AN OVERVIEW OF HOW WE PERFORMED IN 2007/08. SOUND GOVERNANCE The Scottish Ambulance Service is underpinned by sound clinical, staff and financial governance arrangements which ensure safe and effective clinical care for our patients, fair and effective management and development of all staff, and sound financial management. STAFF GOVERNANCE The Scottish Ambulance Service takes pride in the way that it continues to manage staff fairly and effectively and make improvements in line with the Staff Governance Standard. Last year this included the introduction of fast track physio for all staff who require it and the introduction of an employee counselling service. Absence management procedures have been strengthened and absence management training has been delivered locally. The Service has a good record of informing and involving staff in partnership. The Service achieved a favourable report from the Scottish Government based on our assessment by the National Partnership Forum. PATIENT SAFETY AND CLINICAL GOVERNANCE Clinical Governance is the corporate responsibility for safe and effective clinical care. This covers a wide range of areas such as the provision of patient centred care, clinical performance, training and development, clinical policies and procedures, clinical audit and the management of clinical risk. A national hand hygiene co-ordinator was appointed in August 2007 and alcohol gel dispensers have been provided to all front line members of staff including first responders. As part of a continuing programme to increase the number of patients that can be treated at scene, 700 paramedics were given extended skills training. FINANCIAL GOVERNANCE Once again the Scottish Ambulance Service delivered a balanced budget for the year ending March The Scottish Ambulance Service ensures that both financial processes and controls are in place and working effectively though a system of internal audit reviews. The corporate risk register is used as a basis for developing the audit plan. The Scottish Ambulance Service commissioned 21 Internal Audit Reports during the year to 31 March Of these 16 were completed during 2007/08. Action plans have been developed to ensure that all recommendations are implemented. In addition, Audit Scotland request overview reports across Scotland in relation to specific topics. Where these impact on the Scottish Ambulance Service we contribute fully. Audit Scotland also commissions the external audit of our annual accounts on an annual basis. All of these matters are discussed four times a year at Audit Committee. The Scottish Ambulance Service s assessment by Quality Improvement Scotland was once again excellent. The scores for risk management, clinical governance and patient safety were the highest in Scotland. National audits were conducted covering a wide range of topics including asthma, acute coronary syndromes, pain management and air wing activity. Thank you all so much for showing us all the fabulous things on the ambulance. We really enjoyed seeing and hearing about the equipment you use each day to help people. Our teacher loved it too. Thank you for taking the time with us; you are people of our community who help us. Thanks for all you do to keep us safe. Our crews take the time to meet and engage with local communities. Overall, in 2007/08, there has been an improvement in clinical performance and effectiveness. This has been supported by the installation of CAB based technology and training which provides decision support for crews and enables electronic, real time capture of all clinical data which can be analysed and used to better understand and continue to improve our clinical performance

7 PATIENT EXPERIENCE The fourth annual patient experience survey undertaken by Market Research UK demonstrated continuing high levels of patient satisfaction. 98% of the accident and emergency patients surveyed were satisfied with the service they received, an improvement of 2% on The satisfaction rate for patient transport service patients was also high at 97%, again an improvement of 2% on Detailed interviews were carried out with carers, renal patients and patients treated by community paramedics, all of which indicated high levels of satisfaction with all aspects of service delivery. The results of this survey have been shared widely across the Scottish Ambulance Service and will be used to improve on the patient experience for the coming year. I was attended to at home by a young lady and gentleman from your Service. I must thank them for their efficiency, cheerfulness and thoroughness and for the reassurance they gave to my wife. This patient was attended to at home and as a result did not need to go to hospital. INVOLVING PATIENTS AND THE PUBLIC Improvements have been identified in Patient Focus Public Involvement (PFPI) activity over the past 12 months. The Scottish Health Council assessment of PFPI performance notes improvements in areas including: the support of community resilience schemes and First Responder Schemes; the annual programme of surveys and research to capture patient experience; and work ongoing with the British Health Foundation (BHF) Scotland to educate the public in emergency life support. A PFPI Steering Group has been established chaired by the Director of Human Resources and Clinical Development which is taking forward an action plan to further develop and support PFPI activity across the Service. This group includes representatives from all Divisions as well as patient representatives and service redesign managers. We will continue to work closely with the patients and public and the Scottish Health Council to improve our PFPI activity. REDUCING HEALTH INEQUALITIES The Scottish Ambulance Service continues to support work to reduce health inequalities. New treatments and care pathways for hard to reach and at risk groups have been developed over the last 12 months. The Reducing Health Inequalities Board has overseen important initiatives including: the development of a Carer s Strategy which has been endorsed by Carer s Scotland; guidance for working with social inclusion partners; and a health mapping exercise of Scotland. We continue to generate solutions to the challenges of meeting the requirements of remote and rural communities through: the use of technology such as digital mapping technology and automated vehicle location systems; the development of the air ambulance service in support of a more integrated response; and through enhanced skills and extended roles for staff. The Rural Health Solutions Project Board has also developed and extended a number of initiatives and models including First Responder schemes. EQUALITY AND DIVERSITY The Scottish Ambulance Service, as both an employer and service provider, ensures that it does not consciously or unconsciously discriminate. We provide equitable access to our services and fair employment practice in the workplace. Alongside our Race and Disability Equality Schemes the Scottish Ambulance Service published its first Gender Equality Scheme in June This together with the Equal Pay Statement and Action Plan will assist in addressing any issues relating to gender equality. We are fully committed to an agenda of continuous improvement and as such closely monitor the progress we are making in the area of equality and diversity. The first Disability Equality Scheme report was published in December The paramedics came within minutes and treated my dad. If it wasn t for the paramedics that night being fully experienced and reading all the signs my dad wouldn t be here today. Thank you for saving my dad s life and doing a fantastic job. In order to have a greater understanding of the impact our Service has on all aspects of equality we are developing a programme to ensure all our policies, functions and practices are Equality and Diversity Impact Assessed. Further training will be provided during the coming year to support this programme. RISK AND RESILIENCE The Service continues to provide a specialised response to major incidents as well as serious road traffic accidents, fire calls and explosions. Special Operation Response Team skills have been demonstrated effectively at emergencies such as the Glasgow Airport attack and the Stockline Plastics explosion. Risk and resilience crews also attended 5,073 emergency calls which included: hazardous materials incidents; firearms; airport; public order incidents; sieges; large fires, including high rise and ship based fires; and major road crashes. SUSTAINABLE DEVELOPMENT The Scottish Ambulance Service is committed to continuing to improve its environmental performance in the provision of resources and training of staff. In 2006/07, it established the Environmental Strategy Development Group which has continued to meet throughout 2007/08 to progress the Scottish Ambulance Service s Environmental Strategy. Progress has been made on issues such as green travel planning, bike to work schemes and promoting the use of video conferencing facilities to reduce travelling. The Environmental Strategy will be renewed in 2008/09. Paramedics attended a patient who was having difficulty breathing and took him to hospital where he received more care

8 HOW WE PERFORMED THIS SECTION OF THE REPORT COVERS HOW WE PERFORMED IN 2007/08 AGAINST OUR HEAT TARGETS. My family and I would like to express my thanks and gratitude to the crews who looked after my husband. Their determination enabled him to die in his own home with his family and we will never forget that. The admiration we have as a family for your service and dedication is enormous. Thank you all most sincerely. This terminally ill patient was taken home by our Patient Transport Service. SAVING MORE LIVES PERFORMANCE INDICATOR TARGET FOR 2007/08 PERFORMANCE IN 2007/08 TARGET FOR 2008/09 Target H1: Maintain rates of survival 17% to 21% full year 20.2% 17% to 21% full year Save more lives of cardiac arrest on arrival at hospital within band of reasonableness Results show an improvement from 16.5% in 2006/07 to 20.2% in 2007/08. The improvement in performance was supported by the continued development of First Responder Schemes, the implementation of new drug regimes for cardiac arrest and new UK Resuscitation Council Guidelines as well as enhancing clinical advice through the introduction of paramedic advisors within our Emergency Medical Dispatch Centres. Data on pre-hospital cardiac arrest showed continued improvement in the early part of 2008/09. MEETING FINANCIAL TARGETS PERFORMANCE INDICATOR TARGET FOR 2007/08 PERFORMANCE IN 2007/08 TARGET FOR 2008/09 Target E1: Operate within the revenue Meet targets 38k revenue underspend Meet targets Meet financial targets and capital resource limits; 11k capital underspend meet the cash requirement Met the cash requirement The Scottish Ambulance Service is committed to operating within our allocated budget. Once again we operated within our revenue and capital resource limits and met the cash requirement. In addition, the Service achieved a small underspend of 38k (0.02%) on the Revenue Resource Limit. REDUCING SICKNESS ABSENCE PERFORMANCE INDICATOR TARGET FOR 2007/08 PERFORMANCE IN 2007/08 TARGET FOR 2008/09 Target E2: Reduce the % of hours lost 5% full year 5.8% 5% full year Reduce sickness absence to 5% in 2009/10 Sickness absence has a high profile within the Service and is monitored alongside performance targets on a weekly basis. Significant improvements have been made in regard to the management of absence and the application of policies and procedures. Sickness absence has been successfully controlled for some five years at a rate between 5.5% and 6% which compares favourably with sickness absence rates in other ambulance services. IMPROVING RESPONSE TIMES PERFORMANCE INDICATOR TARGET FOR 2007/08 PERFORMANCE IN 2007/08 TARGET FOR 2008/09 Target A1: Improve response times to 61.3% 62% 75% by March 2009 Improve response time to life Category A (life threatening threatening calls emergency incidents) (mainland) to 75% within 8 minutes by March 2009 Target A2: Improve response times to 91% 91.4% 95% Improve response time to serious Category B (serious but not but not life threatening calls life threatening) (mainland) to 95% within target time in 2009/10 Target A3: Improve response times to 49.0% 50.5% 50% Improve response time in all emergency incidents (Island Island Board NHS Board) to 50% within 8 minutes in 2009/10 Despite a continued uplift in demand, notably Category A demand which increased by almost 30,000 incidents, the Service has maintained its focus on performance over the year. 2007/08 saw an improvement in performance for both life-threatening Category A calls and serious, but not immediately life-threatening, Category B Calls. A 6.3% improvement in Category A performance to 62% for the year, resulted in 25,679 more patients responded to within the 8 minute target. Category B performance also improved from 88.2% in 2006/07 to 91.4% in 2007/08, exceeding the target for the year

9 We have introduced a number of measures to bring about improvement including investment in our Emergency Medical Dispatch Centres to increase dispatcher and call taker numbers, investment in staff and vehicles to ensure the most effective and appropriate response to each incident, investment in CAB based satellite navigation technology to improve travel times to scene and more effective use of tactical deployment points being in the right place at the right time to respond. Performance across the three Island Boards of Orkney, Shetland and Western Isles also improved from 46.5% in 2006/07 to 50.5% in 2007/08, again exceeding target. The Service has worked to develop better performance via collaboration with public and voluntary sectors for example by extending the use of First Responder Schemes and supporting the building of community resilience. I owe my life to your skills and patience. Thank you very much for your expert care and attention for when I was unwell and for not giving up on my collapsed veins and for your efforts to stabilise me enough to get to hospital. I can t thank you enough for everything you did. Our highly skilled crew responded quickly to this incident and provided the patient with the best possible clinical care. IMPROVING PUNCTUALITY PERFORMANCE INDICATOR TARGET FOR 2007/08 PERFORMANCE IN 2007/08 TARGET FOR 2008/09 Target A4: Patient Transport Service: 71% full year 69.4% 71% full year Improve punctuality for appointments Improve punctuality for for priority 1 patients appointments for priority 1 patients to 73% in 2009/10 Target A5: Patient Transport Service: 89% full year 83.7% 89% full year Improve punctuality for pick up Improve punctuality for for priority 1 patients pick up for priority 1 patients to 91% in 2009/10 Last year the Patient Transport Service made around 1.6 million patient journeys across the country. The key performance indicators are punctuality for appointment and punctuality for pick-up for priority patients and in recent years the Service has made substantial improvements in performance and patient satisfaction levels have been high. REDUCING HOSPITAL ADMISSIONS PERFORMANCE INDICATOR TARGET FOR 2007/08 PERFORMANCE IN 2007/08 TARGET FOR 2008/09 Target A6: Increase % of emergency calls 10% 9.2% 10% to 15% Reduce Hospital Admissions treated at scene to 10 20% Preventing unnecessary emergency transport to hospital releases ambulances for front line response to life-threatening incidents and helps prevent unnecessary admissions to hospital A&E departments. As such, this target supports NHS Boards in the achievement of their HEAT target on reductions in the rates of attendance at accident and emergency and the accident and emergency four-hour wait target. The Service s strategy has been built on widening the role of paramedics and enhancing their training appropriately and the Service continues to invest in training pathfinder paramedics. It is the longer-term aim of the Service that extended skills for paramedics continue to be developed and utilised effectively in the community. As we are increasingly being asked to care for patients with more dependent needs the proportion of vehicles designed to convey patients with impaired mobility has changed. The Service continues to work together with NHS Boards, local authorities and voluntary agencies to make the best use of health and social care resources and, last year, the Service began the process of revising the Patient Transport Strategy

10 Derrick O Hagan Ambulance Care Assistant, SORT Photographer: Joel Symonds, Ambulance Technician, Edinburgh City Station 16 17

11 OUR COMMITTEE MEMBERSHIPS 2007/08 VITAL STATISTICS AUDIT COMMITTEE The Audit Committee comprises three Non-Executive Directors, Mr Iain McMillan, CBE (Chair until December 2007), Mr Alan Lawton and Mr Doug Marr (Chair from December 2007). Mr Andrew Richmond joined the Committee in It meets four times per year to consider the various reports from both internal and external auditors to assess the risks that may arise in the Scottish Ambulance Service. STAFF GOVERNANCE AND REMUNERATION COMMITTEE The Staff Governance and Remuneration Committee comprises three Non-Executive Directors, Mr Alan Bickerstaff (Chair), Mrs Christine Humphries, Mr Doug Marr and the Chairman, Mr William Brackenridge. The Committee meets four times per year to ensure effective monitoring of the machinery for effective staff governance. REMUNERATION COMMITTEE The Remuneration Committee comprises the Chairman and three Non-Executive Directors, Mr Iain McMillan, CBE (until December 2007), Mr Doug Marr, and Mrs Suzanne Dawson. The Committee is chaired by the Chairman, Mr William Brackenridge. It meets at least three times per year to consider the evaluation of senior posts and pay awards for Executives. CLINICAL GOVERNANCE COMMITTEE The Clinical Governance Committee of the Health Board has two key roles: Systems assurance to ensure that clinical governance mechanisms are in place and effective throughout the Scottish Ambulance Service System; and Public health governance to ensure that the principles and standards of clinical governance are applied to the health improvement activities of the Scottish Ambulance Service. The Clinical Governance Committee comprises four Non-Executive Directors, Mrs Christine Humphries (Chair), Mr Andrew Richmond and Mrs Suzanne Dawson plus one vacant post. Mr David Nelson is the Public/Patient Representative. The Committee meets approximately four times per year to monitor standards of care, patient safety and measure the effectiveness of pre-hospital treatment. AVERAGE RESPONSE AVERAGE RESPONSE CAT A (ALL EMERGENCIES) Argyll and Clyde Ayrshire and Arran Borders Dumfries and Galloway Fife Forth Valley Grampian Greater Glasgow Highland Lanarkshire Lothian Orkney Shetland Tayside Western Isles Scotland Average A&E INCIDENTS PTS JOURNEYS AIR MISSIONS Argyll and Clyde 49, , Ayrshire and Arran 44, , Borders 12,342 54, Dumfries and Galloway 16,429 54, Fife 40, ,765 4 Forth Valley 27, , Grampian 53,490 96, Greater Glasgow 113, , Highland 26,816 67, Lanarkshire 65, , Lothian 88, , Orkney 1,758 2, Shetland 1,684 3, Tayside 40, , Western Isles 3,076 4, Outside Scotland 19 Total Scotland 584,108 1,691,971 3,274 % increase since 06/07 2.6% 0.22% 4.4% 18 19

12 BOARD OPERATING COST STATEMENT FOR THE YEAR ENDED 31 MARCH 2008 BALANCE SHEET AS AT 31 MARCH / / CLINICAL SERVICES Hospital and community 169, ,094 Less: Hospital and community income (3,847) (4,549) Total Clinical Services Costs 165, ,545 ADMINISTRATION Administration costs 1,823 2,176 Less: Administration income (216) (241) Total Administration Costs 1,607 1,935 OTHER NON CLINICAL SERVICES Other non clinical services 3,189 1,443 Less: other operating income (1,399) (1,350) Total Non Clinical Services 1, NET OPERATING COSTS 169, ,573 SUMMARY OF REVENUE RESOURCE OUTTURN Net resource outturn 169, ,628 Revenue resource limit 169, ,666 Saving/(Excess) Against Revenue Resource Limit / / FIXED ASSETS Intangible fixed assets 1,518 1,356 Tangible fixed assets 83,089 84,644 Total Fixed Assets 84,607 86,000 Debtors falling due after more than one year 3,511 CURRENT ASSETS Stocks Debtors 9,675 9,570 Investments Cash at bank and in hand CURRENT LIABILITIES Creditors due within one year (16,239) (17,353) Net current assets/(liabilities) (6,504) (7,723) Total assets less current liabilities 78,103 81,788 Creditors due after more than one year (4,269) (1,713) Provisions for liabilities and charges (5,802) (4,955) TOTAL 68,032 75,120 FINANCED BY: General Fund 54,857 61,519 Revaluation Reserve 13,150 13,597 Donated Asset Reserve ,032 75,120 Adopted by the Board on 25 June PAMELA M C LAUCHLAN Interim Director of Finance PAULINE MOORE Acting Chief Executive 20 21

13 TOP 10 CATEGORY A INCIDENTS REPORTED IN 2007/08 INCIDENTS Chest Pain 27,319 Unconscious/Fainting (Near) 26,675 Breathing Problems 23,511 Traffic/Transportation Accidents 15,378 Convulsions/Fitting 14,780 Falls 10,832 Haemorrhage/Lacerations 6,201 Cardiac/Resp Arrest 5,989 Assault/Sexual Assault 3,903 Overdose/Poisoning (Ingestion) 3,412 OUR STAFF NUMBER OF STAFF AS AT 31 MARCH 2008 Paramedics 1,256 Technicians 968 PTS (ACAs, Drivers, PTS Amb Assts) 1,032 Admin and Clerical 176 Managers 167 Emergency Medical Dispatch Centre 260 Ambulance Auxiliaries 24 Ancillary and Maintenance 67 Total 3,950 ACCIDENT AND EMERGENCY JOURNEY PERCENTAGES REPORTED IN 2007/08 INCIDENTS Emergency 416, % from 06/07 Urgent 156, % from 06/07 Routine 11, % from 06/07 AUDIT AND INSPECTION INTERNAL AUDIT The Scottish Ambulance Service commissioned 21 Internal Audit Reports during the year to 31 March Of these 16 were completed during 2007/08. Action plans have been developed to ensure that all recommendations are implemented. For further information contact: Director of Finance on NATIONAL HEALTH SERVICE QUALITY IMPROVEMENT SCOTLAND (NHS QIS) REVIEW The National Standards for Clinical Governance and Risk Management: Achieving Safe, Effective, Patient-Focused Care and Services were published in October These standards are being used to assess the quality of services provided by NHSScotland nationwide. The Scottish Ambulance Service was subject to review on 15 June 2006 and the assessment was once again excellent. Comparison across Scotland shows that the Scottish Ambulance Service was the highest scoring Health Board across the range of standards. Full details of their findings, including membership of the review team, can be found on the NHS QIS website at INFORMATION GOVERNANCE REVIEWS The Service conducts quarterly self assessments which are provided to NHS QIS through completion of an online toolkit managed by the Information Services Division of NHS National Services Scotland. In addition, the Service has been involved in a number of internal and external reviews and all have shown that current information governance arrangements are fit for purpose. Further information is available from or PATIENT FOCUS PUBLIC INVOLVEMENT (PFPI) The Scottish Ambulance Service is formally assessed on its PFPI activity by the Scottish Health Council on a quarterly basis. These submissions include evidence relating to actions identified as important to patients in the previous year. These actions are progressed via the PFPI steering group and a full annual self assessment which is approved and commented on by the Scottish Health Council is available on the Scottish Ambulance Service website. Areas of praise in our self assessment included First Responder Schemes, the establishment of a steering group to govern the PFPI strategy and implementation and the good work that had been taken forwards with regards acting on complainants feedback. Areas for improvement included ensuring that carers were actively involved in patient surveys for the future as well as remote and rural patients and ensuring that issues from the patient survey such as reducing length of journeys for PTS patients were taken forward in the coming 12 months. Full details of the assessment by the Health Council are available on HER MAJESTY S INSPECTORATE OF EDUCATION (HMIE) CHILD PROTECTION REVIEW(S) HMIe were commissioned to undertake child protection reviews across all public and health services in Scotland. The Service has fully cooperated in HMIe s work programme across Scotland and have received positive and favourable comments on our arrangements. The reports are published by Council area and can be found at

14 Rob Dalziel Paramedic, Air Ambulance Photographer: Joel Symonds, Ambulance Technician, Edinburgh City Station 24 25

15 CAPITAL INVESTMENTS PATIENT FEEDBACK The Scottish Ambulance Service completed a number of capital projects last year. Our capital funding is composed of direct capital from the Scottish Government plus income from sale of Scottish Ambulance Service assets. The total expenditure on acquisition of capital assets in 2007/08 was 12.2million. Of this, 9.2million was used to acquire vehicles and 2.8million invested in property. The remainder was used for plant, IT equipment and furniture and fittings. The Service operates within the parameters of the Capital Strategy which is agreed at Board Level each year. Individual projects which exceed 1million or 500k for ICT are individually approved by the Board. MAJOR PROJECTS INCLUDED: THE EDINBURGH CITY STATION A new purpose built ambulance station and workshops situated close to the Royal Infirmary of Edinburgh was completed, providing modern, well equipped facilities for staff who were previously based in two separate stations in the north and south of the city. The total cost of the project was 3.5million and it was delivered on time and within budget. CAB BASED TERMINALS A key success in 2007/08 was the completion of a 5million investment and successful implementation of state-of-the art CAB based technology and training programme. This provides crews with much improved facilities for recording the Service s part of the patient s journey through NHS treatment and care, as well as online decision support. This has placed the Service at the forefront of the e-health revolution, which allows sharing of appropriate data, rigorously secured under information governance arrangements with other agencies and professionals, to improve patient treatment and care. NEW VEHICLES Fleet capital expenditure during 2007/08 totalled 9.2million. 5million of this was spent on 63 front-line ambulances which included 26 of the newly designed mid tier vehicles. 3.2million was used to replace 70 ageing patient transport vehicles and 47 patient transport cars. The remaining 1million was used to purchase 35 rapid response vehicles, 25 support vans, two motorbikes and two specialist training units. The Scottish Ambulance Service welcomes feedback and comments from patients and the public. The table below shows the number of complaints that we received last year and the number that were actually upheld. Also illustrated are the number of written compliments and commendations that we have been sent by patients and families. Learning lessons from any mistakes made is an essential part of the complaints process and examples of improvements made as a result of complaints last year are given below. NUMBER COMPARISON CATEGORY IN 2007/08 WITH 2006/07 Complaints made % Complaints upheld % Commendation % The table shows a slight reduction in the number of complaints made to the Service and a reduction in the number of complaints that were upheld. When a complaint is upheld this means that, after an investigation, it has been found that the complainant was correct and that there were issues that required to be resolved and taken forward. EXAMPLES OF LESSONS LEARNED 1. EMDC CLINICAL ADVISORS The Service received a call in our Emergency Medical Dispatch Centre requesting an emergency ambulance to attend the caller s mother, who had collapsed at her home with abdominal pain. As per protocol, the caller was taken through a series of questions and this resulted in the caller being asked to contact their GP. The caller was not happy with this and felt that the call-taker did not help enough with the patient s condition. Action taken: The Scottish Ambulance Service call-taker did not record the full information taken from the call on our records and did not have the opportunity to refer the call for further guidance from someone with a clinical background. The Service have now introduced Clinical Advisors within our Emergency Medical Dispatch Centres who offer further clinical guidance and support for complex or sensitive cases, including protection of vulnerable people. 2. E-PRF An accident and emergency ambulance crew attended a patient who had injured his ankle. The patient s partner was unhappy as she felt the crew did not complete a full assessment of the injury and that the patient should have been taken to hospital. The crew did offer to take the patient to hospital but the patient refused. The crew omitted to record their full clinical findings and that the patient refused transport to hospital. Actions taken: The Service have now introduced an electronic patient recording form (e-prf) that is completed by the crew when attending an incident. This e-prf includes a consent section that must be completed for every patient irrespective of any decision to refuse treatment or transport. The introduction of this new technology helps reduce the risk of a patient not being fully treated and is a great opportunity for us to develop our services and the information it provides helps the Service develop our clinical care

16 REGISTER OF INTERESTS 2007/08 RELATIVE(S) IN SCOTTISH RELATED HOUSES, LAND SHARES NON FINANCIAL VOLUNTARY/ AMBULANCE NAME POSITION REMUNERATION UNDERTAKINGS CONTRACTS AND BUILDINGS AND SECURITIES INTERESTS CHARITY WORK SERVICE William Brackenridge Chairman Scottish Ambulance Service; None None None None Chairman None None CiPFA occasional sub-contractor; The Helensburgh Partnership Non-Executive Director NHS Highland; Chairman, Argyll and Bute, CHP Suzanne Dawson Non-Executive Director Scottish Ambulance Service None None None None Chair of the Borders College None None Self-employed marketing Board of Management; consultant Member of the Board of the Association of Scotland s Colleges; Chair of BC Consultants (wholly owned subsidiary of Borders College); Fellow of Chartered Institute of Marketing Christine Humphries Non-Executive Director Scottish Social Services Council None None None None Member British Association Member of Scottish None Due Regard Member Registration of Social Workers Borders Valuation and Conduct Committee Appeal Committee Allowance plus expenses; Scottish Ambulance Service Alan Lawton Non-Executive Director Scottish Ambulance Service None None None None None None None Iain McMillan, CBE Non-Executive Director Scottish Ambulance Service; None None None None None Board member None Confederation of British Industry Scottish North American business representative organisation Business Council; Trustee Industrial Mission Trust Trustee The Teaching Awards Douglas Marr Non-Executive Director Scottish Ambulance Service None None None None None Chair Fundraising Committee None Rotary Club Currie and Balerno (to July 2006) Chair Thriepmuir Investment Club Rotary Club Currie and Balerno Andrew Richmond Non-Executive Director Scottish Ambulance Service; None None None Shareholder of Rushglen Ltd Associate of Society of Investment None None Non-Executive Member of NHS Tayside; Shareholder of Laverock Professionals (ASIP); Member of Director of Laverock Properties Ltd; Properties Ltd Angus Conservative and Unionist Director of Cottages Express Ltd Association; Member of Carlton Club; Member of National Childbirth Trust (NCT); Member of Church of Scotland; Member of Congregational Board of the Isla Parishes (Church of Scotland); Trustee Tayside NHS Board Endowment Fund Alan Bickerstaff Employee Director/ Scottish Ambulance Service None None None None None None None State Registered Paramedic Adrian Lucas (to 8/10/07) Chief Executive Scottish Ambulance Service None None None None None None None Kevin Doran (from 5/11/07) Chief Executive Scottish Ambulance Service None None None None Member of Management Committee None None of Reid Kerr College Andrew Marsden Consultant Medical Director Scottish Ambulance Service Officer of Faculty of Prehospital None None None None None None Care of Royal College of Surgeons; Member of Panel of Examiners in Diploma of Immediate Care RCSEd Pauline Moore Director of Finance Scottish Ambulance Service None None None None None None None Shirley Rogers Director of Human Resources Scottish Ambulance Service None None None None Non-Executive Member of the None None Board of Management of Borders College Grace Kennedy (from 10/12/07) Director of Operations Scottish Ambulance Service None None None None None None None 28 29

17 Deputy First Minister & Cabinet Secretary for Health and Wellbeing NICOLA STURGEON MSP T: E: ANNUAL REVIEW 2008 KEY ACTION POINTS William Brackenridge Chair Scottish Ambulance Service National Headquarters Tipperlinn Road Edinburgh EH10 5UU 9 October 2008 FOR SAS TO SHARE RESULTS OF AUDIT OF ADULT CRITICALLY ILL PATIENT TRANSFERS WITH THE SCOTTISH GOVERNMENT AND TO BEGIN DIALOGUE WITH NHS PARTNERS BY END NOVEMBER ENSURE ROBUST ARRANGEMENTS ARE IN PLACE TO ENSURE THE LOCAL DELIVERY PLAN IDENTIFIES KEY ACTIONS AND HOW ANY RISKS TO DELIVERY WILL BE MITIGATED IN ORDER TO DEMONSTRATE REQUIRED LEVELS OF PROGRESS AGAINST THE NHS QIS CLINICAL GOVERNANCE AND RISK MANAGEMENT STANDARDS WILL BE ACHIEVED. ENSURE THE BOARD (AND ITS CLINICAL GOVERNANCE COMMITTEE) CONTINUES TO HAVE EVIDENCE AVAILABLE TO IT IN ORDER TO PROVIDE ASSURANCES WITH REGARD TO THE ROBUSTNESS OF CLINICAL GOVERNANCE AND RISK MANAGEMENT ARRANGEMENTS. ENSURE THAT ALL RECOMMENDATIONS FROM THE QIS RAPID REVIEW OF THE FRONT LOADED MODEL AND THE AUDIT OF SAS PERFORMANCE INFORMATION ARE FULLY IMPLEMENTED. SAS SHOULD ENSURE ITS ACTIVE PARTICIPATION IN THE SCOTTISH PATIENT SAFETY PROGRAMME FOR THOSE INTERVENTIONS WHICH ARE APPLICABLE. THE AMBULANCE SERVICE SHOULD CONTINUE TO ENCOURAGE COMPLETION RATES OF THE E-PACER INCLUDING THE QUALITY OF INFORMATION RECORDED, AND PROVIDE AN UPDATE ON THIS AT NEXT YEAR S ANNUAL REVIEW. MAINTAIN DOWNWARD PRESSURE ON THE LEVEL OF SICKNESS ABSENCE. SCOTTISH AMBULANCE SERVICE ANNUAL REVIEW: 24 SEPTEMBER This letter summarises the main points discussed and actions agreed at the Annual Review and associated meetings on 24 September. I would like to thank you, Pauline Howie and everyone else involved for all the hard work that went in to organising the programme. 2. It was extremely interesting to see the demonstration from the Special Operations Response Team and to see their specialist equipment. I also welcomed the chance to be shown the mid-tier vehicle. It is clear that these ambulances play an important part in the fleet mix and it was good to see first hand the new CAB based terminals. 3. I would be grateful if you could pass on my thanks to all those ambulance service staff I had the opportunity to meet. MEETING WITH CLINICAL ADVISERS 4. I found the discussions with the clinical advisers very useful, and in particular appreciated the opportunity to hear more detail about the New Ways of Clinical Working project. It was noted that this work is about focussing on ensuring the service gets to patients quickly, combined with providing the most appropriate care and referral. Staff need to have the skills, equipment and confidence to deliver for patients and it is clear that progress is being made in full partnership. I was pleased to hear that all the various aspects of the work really put patients at the heart of how the service is developing and I look forward to hearing more in the future about how you are ensuring evaluation of this approach. 5. We discussed the new CAB based terminals, and how these would provide a range of robust data about clinical outcomes. These will be a valuable tool as the service moves forward. 6. In discussion around ambulance cleanliness, we talked through the infection control procedures and protocol that are used across the service. We agreed that this was an important area and one that would continue to require focus and attention. The process for ensuring that the Ambulance National Cleaning Standards Specification was implemented was also discussed. Service agreements with NHS Boards were being established for the busier stations, with local arrangements being put in place for the others. 7. Finally, we discussed the current crewing arrangements for the air ambulance helicopters at night. I was assured that every mission is evaluated to ensure no adverse effects and that this scrutiny will continue as a matter of course, an important commitment as the air ambulance service develops in the future. Please can you convey my thanks to all those who took the time to meet with me

18 ANNUAL REVIEW 2008 MEETING WITH PARTNERSHIP FORUM 8. There is no doubt that the Scottish Ambulance Service has undergone a period of change and challenge, particularly in relation to partnership working. The partnership forum was clear that partnership was largely back on track and this was due to a great deal of effort on both sides. New Ways of Clinical Working has partnership input to all workstreams and, more widely, involves every member of staff in various ways, including meetings across the country. We agreed that the pace of change must be right, and staff involvement is key in ensuring this. 9. We talked about the implementation of the Knowledge and Skills Framework (KSF) and it is certainly the case that the service has some way to go. However, I was reassured to hear that processes are in place to ensure that the nine posts that cover around 75% of staff are approved and assigned to staff in the next couple of months. We also discussed the continued efforts in reaching the sickness absence target of 5% and, while there are clearly challenges specific to the service, I was encouraged to hear about the success of the fast-track physiotherapy service and the employee counselling service. Appreciating the local factors at play, I would still encourage best practice to be adopted by those areas with the higher levels of sickness absence. The service had reached 6.09% as at 31 March 2008 and Shirley Rogers advised that local figures report recent performance at 5.2%. This is encouraging. 10. Specific aspects of Agenda for Change, including unsocial hours, meal breaks and on-call working remain under consideration and I was sympathetic to the proposal that Scottish solutions continue to be explored. This must not, of course, have an unintended adverse impact on other parts of NHSScotland and Scottish Government officials will be happy to continue to work with the service on this. I would be grateful if my thanks could be passed on to everyone who came along to the meeting. MEETING WITH PATIENT REPRESENTATIVES 11. I had an interesting and useful meeting with patient representatives who noted that they were impressed with the high levels of patient satisfaction recorded by users of the Ambulance Service. They expressed appreciation for the efforts of staff across Scotland and noted the importance of staff morale levels being high. The Patient Transport Service was an area where it was suggested that there is a need for service improvement for patients and I know that this will be an important focus for the service in the coming period. 12. I agreed with the views expressed that it is crucial to articulate to the public what the service does, what patients can expect and when changes are under consideration that will impact on patients. I would appreciate it if you could thank the patient representatives who took the time to take part in the meeting. ANNUAL REVIEW MEETING ACTION POINTS FROM ANNUAL REVIEW Following my report of the various meetings I had attended, you gave a brief presentation on progress in 2007/08. I was content that the actions from last year had been progressed and that most would be picked up in the course of the agenda. In relation to inter-hospital transfers, I asked that the result of the audit funded by the Scottish Government be shared by the end of November At that time, I would also expect dialogue to have commenced with NHS partners and, as I said, the Scottish Government stands ready to help facilitate this. PERFORMANCE CLINICAL PERFORMANCE 14. In our discussions on clinical performance, we touched on many of the aspects discussed at the session with Clinical Advisers, and recorded earlier in this letter. Robust Clinical Governance must underpin New Ways of Clinical Working and decisions about the way the service is organised and managed must be based on the best possible clinical evidence. The way the service is delivered must, of course, be sensitive to the needs of different communities and individual patients. In that regard, it is important to strike the right balance between a nation vision, purpose and direction, and delivery at a local level. Public confidence is key and the Ambulance Service should continue to engage with patients to properly inform these considerations. 15. The significant investment of some 5million in CAB based terminals will allow new and richer data to be used more effectively for clinical performance monitoring and improvement. As the NHS works hard to measure and evaluate the entire patient journey, this technology provides a significant step forward in how the ambulance service contributes to this aim. A specific example given of how this might be applied was in relation to patients who suffer a Myocardial Infarction. 16. Further to this, I was pleased to congratulate the service on the continuing improvement to the Return to Spontaneous Circulation (ROSC) rate, now at 23.4% across 2007/08 ACCIDENT & EMERGENCY PERFORMANCE 17. We talked in some detail about the performance of the accident and emergency service. Category A performance for 2007/08 was recorded at 62% of calls reached within 8 minutes, an improvement of 6.3% over the previous year. It is impressive that this has not been achieved at the expense of Category B performance, where the service improved from 88.2% in 2006/07 to 91.4% in 2007/08. Performance has also improved in the three island Boards, up to 50.5% in 2007/08. The service is to be commended on the hard work that has gone in to this performance and, as discussed, the recent data audit review identified the service developments that underpinned these improvements. Looking forward, Dr Woods and I were reassured by your clear commitment that the 75% target for Category A performance will be reached by March Most recent figures show Cat A performance at around 73%. There is no doubt this will be challenging, particularly given the requirement to manage the risks associated with the winter period, but I expect the Board to accommodate these risks in the usual way as it plans for the coming months. 18. In discussion around how 75% will be reached and, equally importantly, sustained in the coming years, I noted the various ways the service seeks to achieve this, such as recruiting new staff, enhanced performance management, seeking innovative rural solutions to improve performance in these communities and the better management of peak demand times

19 ANNUAL REVIEW 2008 PATIENT TRANSPORT SERVICE 19. The Patient Transport Service (PTS) undertakes some 1.6 million journeys a year and, for many patients, is the only engagement they have with the Ambulance Service. Performance in relation to targets records that in 2007/08: 69.4% of patients arrived at hospital 30 minutes or less before their appointment time, up from 69.2% in 2006/ % of patients were picked up within 30 minutes of the agreed pick up time, down from 86.1% in 2006/ Appreciating that the patient survey records that satisfaction in the service remains high, I think that the review of the PTS Strategy is an important opportunity to ensure that the service continues to improve, develop and meet the needs of the many patients who rely on it. It is also vital for the Scottish Ambulance Service to work with partner NHS Boards, Regional Transport Partnerships, Local Authorities and others to seek solutions for patient across the country. AIR AMBULANCE SERVICE 21. While demand on the air Ambulance Service increased by 4.4% in 2007/08, the service met all targets for performance. The service remains committed to working closely with clinicians to ensure that the needs of those communities who make most use of the air ambulance continue to be met. In considering the future role of the air ambulance service, particularly in its contribution to achieving the Category A target, it will be important to ensure full evaluation of the clinical and cost factors that impact on such decisions. FINANCE, EFFICIENCY AND WORKFORCE ISSUES 22. I welcomed the confirmation that the Scottish Ambulance Service had met its financial targets for 2007/08 and is on track to do so in the current year. My congratulations for this performance. You noted that, while challenging, the service would deliver against the 2% efficient government targets and you were able to confirm that savings achieved already had been reinvested in the accident and emergency service. 23. You also confirmed that the service continues to strive to meet the sickness absence target of 5% and the KSF target. STRATEGIC DIRECTION 24. It was useful to discuss the way the Ambulance Service works with partners to deliver unscheduled care services. I think that the co-location of the Glasgow EMDC with NHS24, and the future plans to do the same in Edinburgh, are evidence of real progress in this area. Staff from both organisations will be able to work closely together and support each other in delivering for patients, and it was promising to hear that already this is happening. In the future, the Boards of NHS24 and the Scottish Ambulance Service will be working together on a programme of joint objectives. 25. We discussed the valuable contribution made by Community First Responder Schemes, particularly in the more remote and rural areas of Scotland. There are now around 52 directly managed schemes, supported by some 500 volunteers and it is the aim of the service looking to the future to double the number of volunteers. The mapping exercise described to me will allow SAS support in terms of training, vehicles and equipment to be best targeted and I look forward to hearing about progress in this area at next year s review. I noted that progress is being made in developing proposals for a retained Ambulance Service to support some of the more rural communities and, as this planning moves forward, it will be important to ensure sensitive engagement with both staff and the public and to be clear about the purpose and role of such a resource. Q&A 26. The development of the Q&A section of the programme allowed an opportunity to explore issues around how the skills and qualifications of paramedics are recognised and rewarded, the valuable contribution made by volunteer drivers, the unacceptable abuse sometimes faced by staff and what the service and government can do to protect and support staff as well as appropriately punish offenders, the use and costs of the air Ambulance Service, and the welcome allocation of additional funds by the government to eliminate rostered single crewing of traditional ambulances. CONCLUSION 27. In summing up our discussion, I noted that the review had been a constructive exchange about the challenges that have been, and continue to be, faced by the Scottish Ambulance Service. I want to place on record my sincere thanks to all the staff of the Scottish Ambulance Service for their hard work, dedication and commitment. 28. For 2008/09, I stressed that meeting the HEAT target to reach 75% of Category A calls within 8 minutes, as well as other aspects of your Local Delivery Plan, must remain a priority. As I said earlier in this letter, I welcomed your confirmation that the Cat A target would be met by March I have set out the main actions points from the review in the attached annex and I look forward to continued close working between the Scottish Government and the Scottish Ambulance Service to deliver for patients across Scotland. NICOLA STURGEON MSP Deputy First Minister & Cabinet Secretary for Health and Wellbeing 34 35

20 Designed and Produced by Hookson EQUAL OPPORTUNITIES POLICY The Scottish Ambulance Service firmly believes that all employees should be treated equally and fairly. The Board opposes all forms of discrimination on grounds of colour, race, nationality, ethnic origin, disability, marital status, sexual orientation, gender or age. CONTACT DETAILS ICE IN YOUR MOBILE If you have a mobile phone, please enter a contact number in case of emergency. This can assist the emergency services to help you. INFORMATION ABOUT THE SCOTTISH AMBULANCE SERVICE Information about the Service, the full financial accounts for 2007/08 and details of the organisation and operation of the Service can be obtained from: Secretary to the Scottish Ambulance Service Board, National Headquarters, Tipperlinn Road, Edinburgh EH10 5UU. Telephone: boardsec@scotamb.co.uk Website: A summary is available in other languages and formats on request. Please telephone the Interpretation and Translation Service on and quote reference number Un résumé est disponible en d'autres langues et autres formats sur demande. Veuillez téléphoner au Service d'interprétation et de Traduction au et indiquez le numéro de référence Краткое содержание на других языках и в других форматах предоставляется по просьбе. Пожалуйста, звоните в Службу устных и письменных переводов (ITS) по тел и указывайте исходящий номер: Paprašius santrauką galima gauti kitomis kalbomis ir formatais. Skambinkite vertimo tarnybai (Interpretation and Translation Service) telefonu , nurodykite kodą Streszczenie dostępne jest na yczenie w innych językach lub formatach. Proszę skontaktować się telefonicznie z Biurem Tłumaczeń Ustnych i Pisemnych (ang. Interpretation and Translation Service) pod numerem telefonu: i podać numer referencyjny: