SCOTTISH AMBULANCE SERVICE HEAT DELIVERY PLAN

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1 SCOTTISH AMBULANCE SERVICE HEAT DELIVERY PLAN Scottish Ambulance Service National Headquarters Gyle Square 1 South Gyle Crescent Edinburgh EH12 9EB 16 th March 2011

2 List of Contents Introduction Purpose of Plan Working Together for Better Patient Care SAS Strategic Framework The HEAT Targets and Standards - Summary Annex 1 -Supporting the quality ambitions and wider outcomes-based approach Annex 2 - Management Plans Delivery, workforce, finance, improvement and equalities related risks for each target / standard, where appropriate Other Activity in Support of NHS Board HEAT targets Monitoring Progress Core HEAT targets SAS Quality Scorecard Annex 3 - SAS trajectories for NHSS HEAT targets NHSS E1 financial target Annex 4 - Financial template Annex 5 - Summary of Main Workforce Issues Facing Board

3 Introduction Purpose of Plan This HEAT Delivery Plan sets out the planned service delivery objectives and performance for the Scottish Ambulance Service (SAS) in 2012/13, building on performance achievements in 2011/12. It is designed to: Set out the contribution that SAS will make to the Government s National Performance Framework outcomes Enable the Board to fulfil its corporate governance role within NHS Scotland Allow the Board to be specific about its implementation and performance plans for the forthcoming year Promote a robust planning process, including the involvement of stakeholders in the development of the Plan Promote accountability by enabling progress against the Plan to be measured. This document also meets our requirement, as for each NHS Board, to produce and publish an annual Local (HEAT) Delivery Plan in agreement with the Scottish Government. This document will be incorporated into the SAS Corporate Plan for 2012/13. Working Together for Better Patient Care SAS Strategic Framework This HEAT Delivery Plan is set firmly in the context of our wider Strategic Framework, Working Together for Better Patient Care , published in /13 will be year 3 of our five year strategy and the Service has made significant progress in developing its scheduled and unscheduled care, strengthening community resilience and in developing our organisation, staff and infrastructure over those first two years. Our strategy sets out clearly our aims to be Patient centred Clinically excellent Leading-edge This year will see the completion of the development of our Single Clinical Triage Tool (SCTT) in partnership with NHS 24 and colleagues in A&E and Out of Hours. This tool will ensure a more appropriate clinical assessment for patients and a consistent triage process whether they contact SAS or NHS 24. A key component of the development of the SCTT is clarity around care pathways and the Service will build on its success with frail and elderly and fallers in 2011/12, continuing to develop pathways in respect of alcohol and mental health, and explore the role of the Service in relation to dementia and road traffic collisions. Further extension of the professional to professional lines across NHS Boards, will offer additional decision support to crews and help reduce unnecessary attendances at A&E. Introduction - Page 1

4 We will also continue to improve our scheduled care service following detailed review and development of a business case and improvement plan in 2011/12. We will establish three regional centres based in our EMDCs to offer increased direct patient access to booking and registration and, following completion of the roll out of mobile data across our entire scheduled care fleet, increased efficiency and flexibility in the deployment, planning and day control of our resources. We will also continue to work with local and regional transport providers to ensure that those not requiring ambulance transport are, nevertheless, routed easily to an alternative transport provider as part of an integrated approach to meeting this challenge. We have further strengthened our partnership working in the last year and will continue to build upon that as we deliver this year s plans. We will work with our partners to increase the number and awareness of public access defibrillators across Scotland and continue to grow the base of Community First Responder schemes strengthening community resilience. We will continue to work with communities and with NHS Boards as we implement our Community Resilience Strategy published in 2011, developing appropriate integrated models of healthcare. We will complete the procurement of the next generation of air ambulance and establish a national specialist retrieval service for Scotland bringing together the various existing retrieval teams co-ordinated by SAS. We will continue to make best use of the latest technology to support service delivery, linking in with the national tele-health agenda through the Scottish Centre for Telehealth and Scottish Government e-health programmes. This will not only see the introduction of mobile technology into the PTS fleet, but further integration with NHS systems to transfer clinical information to hospitals on route, explore the potential to link patient booking systems for outpatient appointments, and investment in telephone and system technology as we take forward our EMDC quality improvement programme. Underpinning our service delivery will be the continuation of our learning & development, organisational development and e-health strategies. Following the establishment of the new Scottish Ambulance Academy at Glasgow Caledonia University in 2011 and the introduction of our Careers Framework, we will look to further develop new roles such as critical care paramedics. And we will continue to implement our organisational development and learning and development strategies, strengthening our leadership capability and embedding a culture of learning and quality improvement. This Local HEAT Delivery Plan is set firmly in the context of Working Together for Better Patient Care and the NHS Quality Healthcare Strategy and 2020 Vision for Scotland s NHS and we will continue to build upon our success in delivering our strategy and contributing to that wider strategic direction of NHS Scotland in 2012/13. Introduction - Page- 2

5 The HEAT Targets and Standards The delivery plan confirms what SAS is planning to deliver in terms of performance. It contains a manageable number of indicators, which are aligned to the three strategic goals of the organisation. These indicators have been specifically chosen to provide a balanced summary of the organisations activities and performance. It is these indicators that will be used to report performance externally. The performance objectives of the HEAT Delivery Plan are not the only indicators of performance of the Service. Although core key performance objectives and indicators have been identified to represent a summary of the Service performance externally, there are other aspects of performance that will continue to be measured and managed internally. The Executive Directors and the Board have reviewed the risks raised in the plan, as outlined in the risk narrative for each target (and where appropriate these will be managed through our standard risk management process). Note The SAS prefix below denotes a target specific to the Scottish Ambulance Service. The NHSS prefix denotes a target for all NHS Boards HEALTH SAS H1: Between 12-20% of eligible cardiac arrest patients with Return of Spontaneous Circulation (ROSC) on arrival at hospital. SAS H2: Reach 80% of cardiac arrest patients within 8 minutes (mainland). SAS H3: Reach 75% of Category A (life-threatening) emergency incidents within 8 minutes (mainland) SAS H4: Reach 95% of Category B (serious but not life-threatening) incidents within 19 minutes (mainland) SAS H5: Reach 56% of all emergency incidents within 8 minutes (Island NHS Board areas) EFFICIENCY NHSS E1: NHS Boards to operate within their agreed revenue resource limit; operate within their capital resource limit; meet their cash requirement SAS E2: Reduce energy consumption by 2.5% per annum SAS E3: Achieve sickness absence rate of less than 5% for full year continuing direction of progress towards the national HEAT Standard of 4% Introduction - Page- 3

6 ACCESS SAS A1: Reach 91% of 1 hour GP urgent calls within time agreed SAS A2: Ensure 72% of all PTS Patients arrive at hospital 30 minutes or less before appointment time SAS A3: Ensure 90% of all PTS Patients are picked up within 30 minutes of agreed time after appointment SAS A4: Ensure that no more than 0.5% of booked PTS journeys are cancelled by SAS SAS A5: Answer 90% of 999 telephone calls within 10 seconds TREATMENT SAS T1: Treat 15% of emergency incidents at scene. SAS T2: Convey 80% of hyper acute stroke patients to hospital within 60 minutes of receipt of call at SAS SAS QUALITY SCORECARD In 2011/12, the SAS introduced a quality scorecard setting out a balanced suite of performance indicators and the Service will continue to use this tool in 2012/13 to manage performance and delivery. The scorecard not only encompasses the targets and measures set out in this HEAT Delivery Plan, but additionally includes a wider range of KPIs under four headings: Access and referral; Clinical excellence; Engaging with Partners; Organisational development. In 2012/13, we propose to develop 2 new targets which reflect current service and clinical developments and will be monitored throughout the year as we implement these developments. These measures are; DEV1: Average time spent on vehicle for scheduled care patients This reflects the service improvements being implemented in 2012 to our scheduled care service to be more demand responsive and our ability to monitor performance through the introduction of mobile data across our PTS fleet. As we roll out mobile data we will begin to monitor performance; the current average is around 90 minutes and the Service will determine an appropriate target during the year as we gather and analyse more available data. Introduction - Page- 4

7 DEV2: Answer 80% of scheduled care calls within 30 seconds will see the SAS establish 3 regional centres for scheduled care, a key driver for which has been the intent to shift towards increased direct patient booking. As with our A&E service, we will introduce a developmental target in 2012/13 to monitor performance in respect of telephone answering as we establish these three centres during the year. Introduction - Page- 5

8 Annex 1 - Supporting the Quality Ambitions and wider outcomes-based approach An outcomes-based approach encourages us all to focus on the difference that we make to people using the service, their families, carers, staff and all who work with NHSScotland in delivering the vision of world-leading healthcare quality. It is about far more than just the inputs or processes over which we have control. Success is about impact and should be judged by tangible improvements in the things that matter to the people of Scotland. SAS has been working in partnership across NHSScotland, with Community Planning Partners and with the Scottish Government to embed an outcomes-based approach by identifying key priority areas. This has enabled SAS to: i. Align activity to explicitly contribute to the Government s over-arching purpose of sustainable economic growth through the National Performance framework. ii. Better integrate activities with local government, with other Public Bodies, and in partnership with the Third and private sectors to address the Government s Purpose Targets and National Outcomes through Single Outcome Agreements (SOAs). iii. Focus activity and spend on achieving real and lasting benefits for people and as such minimise the time and expense on associated tasks which do not support the national outcomes and purpose. iv. Create the conditions to release innovation and creativity in delivering better outcomes. In 2010, the Healthcare Quality Strategy for NHSScotland set out the overarching aim of achieving world-leading quality healthcare services across Scotland, underpinned by the 3 Healthcare Quality Ambitions; Healthcare Quality Ambitions Person-centred - Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making. Safe - There will be no avoidable injury or harm to people from healthcare they receive, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all times. Clinically Effective - The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated. Annex 1 - Page 6

9 Over the last four years NHSScotland has developed its outcome approach. National Purpose (targets) National CPPs National Outcomes Local Authority / Health / System-wide Outcomes Outcomes Public Reporting NHS/LAs/Vol Healthcare Quality Ambitions and Outcomes NHS HEAT/Support for Healthcare Quality Ambitions LAs Local objectives Service specific actions/outputs Performance Management Other Other public service/vol organisations objectives/targets The Quality Strategy sets out NHSScotland s vision to be a world leader in healthcare quality, described through 3 quality ambitions: effective, person centred and safe. These ambitions are articulated through the 6 Quality Outcomes that NHSScotland is striving towards: o o o o o o Everyone gets the best start in life, and is able to live a longer, healthier life People are able to live at home or in the community Healthcare is safe for every person, every time Everyone has a positive experience of healthcare Staff feel supported and engaged The best use is made of available resources Twelve direction of travel Quality Indicators help demonstrate progress towards the six outcomes (these are not targets). Every year a small number of HEAT targets are agreed with NHSScotland and partners. These set out the accelerated improvements that will be delivered across Scotland in support of progress towards the Healthcare Quality Ambitions and Outcomes. SAS is committed to working with our NHS partners and the wider social care system and voluntary community to develop services and solutions which meet the needs of Scotland and deliver clinical excellence in a modern, effective and efficient health service, which makes a genuine difference to the lives of people in Scotland. Annex 1 - Page 7

10 This HEAT Delivery Plan sets out how SAS will contribute towards those national outcomes and indicators with a strategy, Working Together for Better Patient Care which is clearly aligned to both the NHS Quality Strategy and the recently published 2020 Vision set out below: Our 2020 Vision Our vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting. We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self management. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission. We will continue to build on our success in treating more people at home and in the community, working in partnership with the rest of the NHS, social care, voluntary sector and communities to develop more appropriate care pathways, strengthen community resilience and develop appropriate, integrated healthcare models. We will continue to invest in staff and technology to offer the highest levels of clinical care and greatest opportunities to share information to improve treatment and response. Patient Focus Public Involvement SAS has a PFPI Strategy in place to 2014 and a clear Implementation Plan. The Service was assessed positively against the participation standard in 2011 and this process has helped to focus the PFPI Implementation Plan for 2012/13 around further strengthening the governance of the divisional Involving People Groups and continuing to create the capability and capacity across the Service to effectively engage and involve patients and public. SAS is also an early adopter of the Patient Opinion web-based system and will continue to develop more innovative means of involving patients and public in service development and delivery. SAS will continue to build on the strong involvement to date as we implement the developments and improvements to our scheduled care service and the next generation of the air ambulance service, as well as continuing to strengthen engagement at a local level, not least in remote and rural areas of Scotland as we work with partners and communities to develop resilience. Annex 1 - Page- 8

11 e-health SAS has developed its e-health strategy in the context of our own strategy Working Together for Better Patient Care and the National e-health Strategy for Scotland. Technology is recognised as a key enabler in taking forward the SAS and is now a well-established strategic programme within the Service. Our approach to e-health aligns with the strategic aims of the National e-health Strategy, to: maximise efficient working practices, minimise wasteful variation, bring about savings and value for money; support people to communicate with NHSS, manage their own health and wellbeing, and to become more active participants in the care and services they receive; contribute to care integration and to support people with long term conditions; improve the availability of appropriate clinical information for healthcare workers and the tools to use and communicate that information effectively to improve quality; and improve the safety of people taking medicines and their effective use. Our commitment to using technology more effectively to support and enable service delivery will be demonstrated through: delivery of a mobile-health agenda which recognises the potential of a mobile ambulance fleet in shifting the balance of care, taking care to the patient and maximising the use of telemedicine; continued sharing of data and linking of systems to transfer patient information between ambulance and hospital to improve pre-arrival information for emergencies, treatment by crews at scene with access to ECS, and booking of non-emergency appointments, for example; partnership working with NHS24 and OOH providers to develop a single clinical triage tool and improve triage and assessment of need and onward referral and ambulance dispatch; more efficient use of SAS ICT systems to minimise duplication and waste and offer improved flexibility for operational and back-office services; continued development of our data warehouse and management information systems to offer evidenced based service development, improve patient care and support better understanding across the NHS in Scotland and with our partners of the challenges and potential opportunities in respect of the national outcomes. Annex 1 - Page- 9

12 HEAT TARGETS CONTRIBUTING TOWARD SCOTTISH GOVERNMENT S NATIONAL OUTCOMES We have tackled the significant inequalities in Scottish society Our children have the best start in life and are ready to succeed AND We have improved the life chances for children, young people and We live longer, healthier lives Our public services are high quality, continually improving, efficient and responsive to local people s needs We reduce the local and global environmental impact of our consumption and production We have strong, resilient and supportive communities where people take responsibility for their own actions and how they SAS H1 Cardiac arrest ROSC rates families at risk affect others. SAS H2 Cat A cardiac arrest patients response times SAS H3 Category A response times SAS H4 Category B response times SAS H5 Island Board emergency response times NHSS E1 Financial Balance SAS E2 Carbon emissions and energy consumption SAS E3: Sickness Absence Rates SAS A1 GP urgent calls responses SAS A2 PTS punctuality for appointment SAS A3 PTS punctuality for pick up SAS A4 PTS journeys cancelled by SAS SAS A5 999 telephone answering times SAS T1 Reducing Hospital Admissions SAS T2 Conveyance of hyper-acute stroke patients to hospital clear line of sight in supporting short term indirect or longer term contribution Annex 1 - Page- 10

13 Healthcare Quality Ambitions Person-centred - Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making. Safe - There will be no avoidable injury or harm to people from healthcare they receive, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all times. Clinically Effective - The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated. HEAT TARGETS CONTRIBUTING TOWARD SCOTTISH GOVERNMENT S NHS QUALITY AMBITIONS SAS H1 Cardiac arrest ROSC rates SAS H2 Cat A cardiac arrest patients response times SAS H3 Category A response times SAS H4 Category B response times SAS H5 Island Board emergency response times NHSS E1 Financial Balance SAS E2 Carbon emissions and energy consumption SAS E3: Sickness Absence Rates SAS A1 GP urgent calls responses SAS A2 PTS punctuality for appointment SAS A3 PTS punctuality for pick up SASA4 PTS journeys cancelled by SAS SASA5 999 telephone answering times SAS T1 Reducing Hospital Admissions SAS T2 Conveyance of hyper-acute stroke patients to hospital People live longer healthier lives People supported to live at home / community with access to treatment Healthcare is safe People have a positive experience of healthcare Staff feel supported and engaged There is no inappropriate variation Annex 1 - Page- 10

14 Annex 2: Management Plans SAS H1: Between 12-20% of eligible cardiac arrest patients with Return of Spontaneous Circulation (ROSC) on arrival at hospital NHS BOARD LEAD: Medical Director Delivery There is a risk that we fail to achieve 12-20% ROSC in eligible patients. Continue to work with NHS Boards and partners to improve treatment of cardiac arrest patients. Work to increase levels of first responders and working in communities across Scotland in line with our Community Resilience Strategy. Continue to work with our voluntary sector partners to increase level public access defibrillators, mapping of all cpads through our EMDCs, and raise public awareness. Continued prioritisation of cardiac arrest patients by EMDC to improve response times. Workforce There is a risk that staff are not fully trained and developed to provide the appropriate care for cardiac arrest patients. ALS training as part of all mandatory training. Strengthen capacity of PTS staff as FPOS and availability of defibrillators in PTS fleet. Increase number of Community First Responder schemes and associated support from CRDOs. Finance There is a risk that funding for further joint working and roll out of defibrillators in communities is not available. Equalities There is a risk that communities are not aware of the public access defibrillators and the role they can play. Explore funding opportunities for research and improvement and opportunities with voluntary organisations to support roll out of community public access defibrillators. Ongoing engagement with communities to raise awareness and support establishment of CFR schemes. Annex 2 - Page-1

15 SAS H2: Reach 80% of cardiac arrest patients within 8 minutes (mainland) Background NHS BOARD LEAD: Medical Director Delivery 80% of cardiac arrest patients are not responded to within 8 minutes Clinical Decision Making processes identify and give priority to patient in or at risk of cardiac arrest and are well-embedded in development of Single Clinical Triage Tool. Work to increase levels of first responders and public access defibrillators available across Scotland. Workforce There is a risk that we do not necessarily have first responder schemes in the right places deemed appropriate to the SAS as opposed to areas communities want them to be set up Implementation of plans developed in response to SOF targeting vulnerable communities Targeted engagement with vulnerable communities through communications and engagement plans in place across Divisions Implement Community Resilience Strategy and strengthen role of CRDOs to support increased levels of CFR schemes. Finance As per SAS H1 Equalities There is a risk that communication links with 999 are not accessible for all communities and this is not addressed as SAS/NHS24 develop new triage tool. As per SAS H1 Communication support facilities are utilised where appropriate, e.g. SMS messaging, Type Talk and Language Line Service. Work with staff and communities to ensure we raise awareness regarding these facilities and continue to monitor their use in practice. Annex 2 - Page-2

16 SAS H3: Reach 75% of Category A (life-threatening) emergency incidents within 8 minutes (mainland) NHS BOARD LEAD: Director of Service Delivery Delivery There is a risk that the single clinical triage tool will continue to be risk adverse in assessing clinical need and, consequentially, finite A&E resources will be dispatched inappropriately. Ensure EMDC make full use of all available resources to respond to demand, including tactical deployment and further development of first responder schemes. Continue progress in specification and procurement of single common triage tool ensuring Cat A incidents are quickly identified and resourced appropriately. Workforce There is a risk that all resources are not fully utilised and not adequately matched to demand profile. There is a risk that any changes to staff deployment will take longer than required to deliver performance Finance There is a risk that existing resources are not sufficient to meet demand and additional funding may be required. Ensure that rosters match demand profile across all divisions and that staff are deployed appropriately geographically and to match demand. Establish a short-life working group to fully review deployment and implement across the Service involving partnership. Ensure effective deployment and utilisation of existing and new resources as part of deployment review across Service. Tight management of overtime, nonproductive hours and sickness absence rates. Opportunities through cash releasing efficiency savings to generate efficiencies for A&E resources. Equalities Ensuring equity of access. As per H2 Ensuring appropriate response to meet individual patient needs. Working with partners to explore opportunities to develop more integrated healthcare provision in line with SAS Community Resilience Strategy. As per H2. Annex 2 - Page-3

17 SAS H4: Reach 95% of Category B (serious but not life-threatening) incidents within 19 (mainland) NHS BOARD LEAD: Director of Service Delivery Background The Scottish Ambulance Service previously reported performance against three time standards for Category B calls dependent upon population density in a Health Board area, but this year has moved to a single 19 minute response target, ensuring every area of mainland Scotland receives the same standards of response and clinical care. Delivery As per SAS H3 Workforce As per SAS H3 Finance As per SAS H3 Equalities As per SAS H3 As per SAS H3 As per SAS H3 As per SAS H3 As per SAS H3 Annex 2 - Page-4

18 SAS H5: Reach 56% of all emergency incidents within 8 minutes (Island NHS Board areas) NHS BOARD LEAD: Director of Service Delivery Delivery As per SAS H3 applied to all emergency calls There are specific geographical challenges for the 3 Island Boards As per SAS H3 applied to all emergency calls Work with NHS partners to explore opportunities to maximise use of joint resources Further development of SOF models of service for remote & rural communities Workforce As per SAS H3 AS per SAS H3 Further development of SOF models of service for remote & rural communities Finance As per SAS H3 There is a risk that NHS Boards will be unwilling or unable to share resources in current financial climate As per SAS H3 Work with NHS partners to explore opportunities to maximise use of joint resources Further development of SOF models of service for remote & rural communities. Equalities As per SAS H3 As per SAS H3 Annex 2 - Page-5

19 NHSS E1: NHS Boards to operate within their agreed revenue resource limit; operate within their capital resource limit; meet their cash requirement NHS BOARD LEAD: Director of Finance and Logistics Background The Service recognises that this year will be particularly challenging financially. Specific areas of concern are: the volatility of the economy in respect of fuel and related costs, this also impacts on the air ambulance service, where demand and contract pricing are adding to the cost pressure. In respect of other non pay areas there are significant cost pressures from heat, light and power, supplies inflation and CNORIS contributions increases that are outwith the control of Ambulance Service. The service has in place a challenging CRES programme that will be required to enable financial balance to be met, however some of the programmes are high risk and the full benefit may not be achieved in year. The Service is acutely aware that redesign of services will require to be cost neutral as a minimum and wherever possible deliver cash efficiencies as part of the redesign process. Delivery There is a high risk that the increase in financial allocation will be insufficient to meet pay award for staff and non- pay inflation increases. There is a risk that the economic climate is producing volatility in fuel costs which is creating cost pressures and makes financial planning challenging. There is a risk that the continued volatile nature of fuel prices will increase pressure on revenue spending. There is risk that Service redesign programmes are not progressed as effectively and timeously to achieve the efficiency required. There is a risk that pay terms and conditions are not yet known with certainty beyond 2012/13. Therefore financial planning for future years is more challenging. There are still unresolved terms and conditions issues in relation to on-call. Robust Budget Setting, Achievement of the CRES programme that will be required to enable status quo. Fuel and energy projections used in budget setting. Management of Energy usage. Additional new fuel-efficient vehicles will be purchased to add to existing fuel-efficient fleet. Robust and appropriately resourced project management which ensure delivery within agreed timescales and generates planned efficiencies. Scenario planning relating to future pay awards. Dialogue with national terms and Conditions groups relating to unresolved issues and impact on SAS. There is a risk that the CNORIS contributions which have already exceeded budget figure will escalate beyond the projections provided. Continued dialogue with centre re methodology for contributions and ways in which Scotland wide the risks can be reduced. Annex 2 - Page-6

20 There is a risk that the air ambulance reprocurement produces a preferred option that is unaffordable within current SAS resources. Debate with Health Boards re methodology for Sharing in respect of Air Ambulance Services for additional activity and national agreement as to funding for enhanced specification aircraft. Workforce There is a risk that staff will not appreciate the impact of tightening financial resources and change in economic environment That the economic environment that results in tightening pay settlements and any impact on pensions will lead to IR issues that are not able to managed within the Service. Training and awareness raising session to be held at all levels throughout the organisation Open debate in partnership of the issues both locally and nationally to gain an understanding of staff expectations and intended actions. There is a risk that the proposed changes to NHS pensions have an adverse impact on both staff retention and potential industrial relations issues. Finance As Above Equalities Insufficient funds available to ensure we are able to sustain full SAS ambulance model in some communities. Insufficient funds to support planned engagement with communities across Scotland. As Above Work with NHS Boards and with communities and voluntary sector to enhance community resilience and develop appropriate integrated models. Work with local partners to share engagement opportunities. Annex 2 - Page-7

21 SAS E2: Reduce energy consumption by 2.5 % per annum NHS BOARD LEAD: Director of Finance and Logistics Background Although this is not a mandatory target for Special Boards during 2012/13 SAS is committed to contributing to the reduction in emissions. We will therefore aim to continue to put in place measures to reduce our dependence on fossil fuels and move towards renewable energy sources. In addition we aim to reduce our overall energy consumption by 2.5% year on year. We aim to ensure our fleet have as low as possible C02 emissions. We are also actively engaged in exploring alternative fuel sources. Delivery There is a risk that reductions in energy consumption may not be achieved due to winter. There is a risk that initial funding may not be available to change to renewable energy sources There is a risk that vehicle manufacturers may not be able to combine SAS specifications and reductions in Co2 emissions Workforce There is a risk that staff awareness of energy reduction measures may not be sufficient to achieve desired impact Aim for higher reductions in the lighter consumption months of the year Business case to identify benefits of renewable energy sources Partnership working with suppliers to identify requirements Training Education and feedback on progress Finance There is a risk that funding for development of renewable energy sources is restricted or unavailable Business case development as appropriate Equalities None Known Annex 2 - Page-8

22 SAS E3: Achieve sickness absence rate of less than 5% for full year continuing direction of progress towards the national HEAT Standard of 4% NHS BOARD LEAD: Director of Human Resources and Organisational Development Delivery There is a risk that we fail to reduce sickness absence below 5%. Continued focused management of sickness absence across all divisions and departments following revision of attendance management policy. Ensure continued use of employee counselling, occupational health and fasttrack physiotherapy services for staff. Implementation of high impact changes identified during Workforce Learn & Improve review. Improve information available to managers to manage sickness absence in a more timely manner. Workforce There is a risk that staff are not fully supported to return to work as timeously as possible. There is a risk that high absence levels have an effect on the management of relief staff and/or overtime usage As above Implementation of high impact changes identified during Workforce Learn & Improve review. Finance There is a risk that sickness absence impacts on overtime budgets and reduced benefits of efficiency savings. As above. Equalities There is a risk that reasonable adjustments are not made for individuals. Ensure absence management toolkit is used and that needs are based on individual requirements. Annex 2 - Page-9

23 SAS A1: Reach 91% of 1 hour GP urgent calls within time agreed NHS BOARD LEAD: Director of Service Delivery Background The Scottish Ambulance Service categorises incidents which require the skills of our A&E staff but not an emergency response under blue lights as an urgent call. These calls are primarily received from GPs, hospitals and other health care professionals and around 30% of all these calls are a request to transfer patients from one hospital location to another. At the time of the call, SAS agrees a time to arrive at the patient based on acuity of the patient s condition, which can be 1, 2 or 4 hours or longer if agreed with the requesting clinician. Previously SAS has reported against those urgent calls with a 1 hour response regardless of which clinician the request came from. Whilst we will continue to internally monitor our response against each of the time standards requested and each of the groups requesting transfer, this year we will report specifically on those requests from GPs within 1 hour, which result in an admission to hospital and our performance in meeting their expectations within time agreed. Delivery There is a risk that there are insufficient resources to meet all the demands placed upon the A&E fleet. There is a risk that where resources are diverted from urgent requests, calls will increasingly be upgraded to emergencies further impacting the problem, or target will not be met. There is a risk that the time expectations for urgent calls are not appropriately assessed by clinicians and agreed when the request is made based on clinical need of patients Ensure maximum availability and utilisation of dedicated mid-tier vehicles for urgent transfers and calls as part of planned review of deployment. Work with GPs to agree and monitor clinically appropriate response times for urgent requests. Ensure EMDCs liaise closely with clinicians requesting transfer to review timescales appropriately for clinical need and avoid unnecessary upgrading of calls to emergencies or unnecessary one hour urgent calls where a longer time period would be appropriate. Ensure Divisional Management Teams are liaising with NHS Boards around consistent appropriate urgent requests. Workforce There is a risk that dedicated urgent resources are not fully utilised putting additional pressure on emergency A&E resources. Ensure maximum availability and utilisation of dedicated mid-tier vehicles for urgent transfers and calls as part of planned review of deployment. Annex 2 - Page-10

24 Where appropriate, make use of scheduled care service ensuring robust clinical governance is in place. Finance There is a risk that existing resources are not sufficient to meet demand and additional funding may be required. Ensure effective deployment and utilisation of existing resources. Tight management of overtime, non-productive hours and sickness absence rates. Opportunities through cash releasing efficiency savings to generate efficiencies for urgent resources. Equalities None Known Annex 2 - Page-11

25 SAS A2: Ensure 72 % of all PTS patients arrive at hospital 30 minutes or less before appointment time NHS BOARD LEAD: Director of Service Delivery Background In 2011, the SAS Board approved the Scheduled Care business case and service improvement plan will see the implementation of that improvement plan, not least with the establishment of 3 regional centres for all booking, registration, day control and planning. Coupled with the roll out of mobile data across the scheduled care fleet, the service will be better placed than ever to manage and monitor performance and service delivery. Delivery There is a risk that developments flowing from the Service s Scheduled Care Programme do not deliver the service improvement identified. There is a risk that the projections of reduced demand do not materialise and the Service is unable to generate the predicted efficiency savings to reinvest in the service improvements identified. There is a risk that public and patient perceptions of the scheduled care service is negatively affected by perceived changes to service delivery resulting from consistent application of patient needs assessment. There is a risk that NHS Boards and transport partners do not engage fully with the planned improvements and there is no perceptible change in practice for accessing scheduled care as a result. Implementation across all NHS Board areas of agreed patient needs assessment for ambulance transport. Relocation of Area Service Office functions to 3 regional centres increasing direct patient access, more robust management of clinical need and standardisation of practice. Roll out of mobile data solution to PTS fleet to allow for real time management and deployment of resources and maximise efficiency. Working with NHS and other transport partners to develop integrated transport to healthcare models. Patient, partner and staff engagement mechanisms and approaches established during the review period and development of improvement plans will be maintained during implementation. A comprehensive programme of awareness raising and communication will be critical to success and has been factored into all plans. Workforce There is a risk that changes to the service delivery model will impact on staff roles and responsibilities and management structures. Fully engage with partnership nationally and locally and adhere to service management of change policies and procedures. Ensure staff continue to be involved at Annex 2 - Page-12

26 each stage in the design and development of the scheduled care service. Finance There is a risk that efficiencies identified do not generate sufficient resources to reinvest in service improvements Raise awareness and robustly manage the patient needs assessment process and increase level of direct patient booking will deliver a reduction in demand which in turn will generate efficiencies. Consistent communication will be key to success as will standardisation of approach which will be better managed through 3 regional centres. Effective management and monitoring of implementation across Service through analysis of data generated through mobile data solution, local delivery plans and programme board. Equalities There is a risk that rigid application of patient needs assessment could leave patients with social need for transport unable to attend for appointments for financial reasons. Work with local NHS Board Transport Coordinators, Regional Transport Partnerships and other transport providers to implement patient needs assessment and develop protocols for referral of nonmedical needs patients as appropriate in line with SAS strategy and NHS Scotland Healthcare Transport Framework. Explore ICT system links between SAS and transport information service providers. There is a risk that transport needs are not met in respect of need for advocacy or carers or, for example, wheelchair users. There is a risk that ineffective communication with patients results in confusion at the time of booking and/or collection for appointment. Ensure patient needs assessment is fully embedded and staff are all fully trained to ensure patients needs are established and met through regional booking centres. Ensure communication with patients is clear and unambiguous and where materials are provided they are in plain English. Annex 2 - Page-13

27 SAS A3: Ensure 90 % of all PTS patients are picked up within 30 minutes of agreed time after appointment NHS BOARD LEAD: Delivery As per SAS A2 Director of Service Delivery As per SAS A2 Workforce As per SAS A2 As per A2. Finance As per SAS A2 As per SAS A2 Equalities As per SAS A2 As per SAS A2 Annex 2 - Page-14

28 SAS A4: Ensure that no more than 0.5% of booked PTS journeys are cancelled by SAS NHS BOARD LEAD: Delivery As per SAS A2 Director of Service Delivery As per SAS A2 Workforce As per SAS A2 As per SAS A2 Finance As per SAS A2 As per SAS A2 Equalities As per SAS A2 As per SAS A2 Annex 2 - Page-15

29 SAS A5: Answer 90% of 999 calls within 10 seconds NHS BOARD LEAD: Director of Service Delivery Background In 2011, following a Learn and Improve review, the SAS established an EMDC Quality Improvement Project Board and identified a number of service improvements to be taken forward, including ensuring the highest levels of telephone answering service for patients and the public. Additionally, the Service has reviewed the suite of indicators now used in other UK ambulance services and as such, has introduced this measure for 2012/13 as part of its HEAT indicators, which has been internally monitored for a number of years. Delivery There is a risk that the Service fails to answer 90% of 999 calls within 10 seconds. Ensure staffing profile in EMDCs matches demand patterns, including the impact of GP urgent activity. Progress to call virtualisation across the 3 EMDCs to minimise delays in responding due to high levels of demand at any time. Implement EMDC quality improvement programme developing staff, systems and processes reducing variation in practice and improving service delivery. Upgrade existing telephone system including additional reporting capabilities to provide better analysis of call handling function. Workforce There is a risk that staff are not aware of the importance of achieving this measure and its contribution to patient safety. Staff fully engaged in the EMDC quality improvement programme which encompasses organisational development and coaching to support a performance management culture. Finance There is a risk that the finance is not available to take forward improvement identified in EMDC programme. Expectation that EMDC improvement programme will deliver efficiencies. Business case developed as appropriate. Equalities There is a risk that training / development will not be available to all staff. Clear staff development workstream in EMDC development programme. Annex 2 - Page-16

30 SAS T1: Treat 15% of emergency incidents at scene NHS BOARD LEAD: Medical Director Delivery There is a risk that we are unable to access or develop joint pathways to reduce hospital admissions and attendances. There is a risk that partners are not fully engaged in supporting a reduction in attendances and admissions. There is a risk that the existing scope of conditions where see and treat protocols apply will be insufficient to generate quantifiable performance gain. Working with partners to develop joint pathways to reduce hospital admissions Explore opportunities for appropriate development of clinical pathways to increase levels of see and treat. Development of single-common triage tool in partnership with NHS 24, A&E and OOHs services which delivers improved triage and clinical assessment, deployment of appropriately skilled resource to attend and referral to appropriate care. Continued roll out of professional to professional lines across NHS Boards to provide decision support to crews. Progress m-health strategy to strengthen use of telemedicine to support to support near patient testing and assessment of patients in the community. Workforce There is a risk that staff awareness and confidence is not sufficient to increase levels of see and treat. There is a risk that staff do not make full use of ECS/KIS systems and professional to professional advice to support delivery. Finance There is a risk that the efficiency gains for the NHS through reduced attendance at A&E are not fully realised. Equalities There is a risk that patients will not be effectively communicated with. Update training to commence as new guidelines are published and competencies identified. Continue to roll out professional to professional support for crews. Continue to monitor the use of ECS and prof to prof support and demonstrate its effectiveness to staff. Work with NHS Boards and partners to ensure appropriate referral pathways are available and appropriately applied. Ensure supportive material is clear and appropriate to leave with patients. Annex 2 - Page-17

31 SAS T2: Convey 80% of hyper acute stroke patients to hospital within 60 minutes of receipt of call by SAS NHS BOARD LEAD: Medical Director Delivery There is a risk that we fail to convey 80% of hyper acute stroke patients to hospital within 60 minutes of symptom onset Development and liaison with Managed Clinical Networks to ensure access to stoke services. Introduction and monitoring of no stand down procedure for hyper-acute stroke to ensure fast response and dispatch of ambulance to convey to hospital. Engage effectively with the development of tele-health decision support for effective management of hyper-acute stroke patients. Clinical decision-making to quickly assess patients and minimise delays in conveyance to hospital through dispatch of appropriate ambulance resource. Introduction of an additional measure around response times for hyper-acute stroke patients will minimise delays in responding and impact on overall pathway. Workforce There is a risk that staff awareness of stroke protocols is not sufficient. All staff trained in FAST assessment, including EMDC call taking and dispatch staff. Awareness for staff of local and regional stroke services and agreed pathways. Finance None Known Equalities None Known Annex 2 - Page-18

32 Other Activity in Support of NHS Board HEAT targets In addition, in order to support territorial boards meet their LDP targets, SAS will continue to support boards where appropriate. Examples of this activity include, but are not restricted to, the following: 2012/13 HEAT Target Reference Comment Reduce suicide rate between 2002 and SAS will continue to promote suicide 2013 by 20%. awareness and mental health first aid training amongst front line crews. Deliver 18 week referral to treatment from 31 December 2011 To improve stroke care, 90% of all patients admitted with diagnosis of stroke will be admitted to a stroke unit on the day of admission, or the day following presentation by March Reducing the need for emergency hospital care, NHS Boards will achieve agreed reductions in emergency inpatient bed day rates for people aged 75 and over by at least 12% between 2009/10 and 2014/15. To support shifting the balance of care, NHS Boards will achieve agreed reductions in the rates of attendance at A&E. SAS will work with NHS Boards to implement improvements to scheduled care service to reduce the number of aborted and cancelled journeys which impact on levels of did not attend. SAS achieved fewer than 1% cancellations in 2010/11 and aims to further reduce this below 0.5% in 2011/12. SAS will continue to monitor its performance in respect of initial response and subsequent routing of hyper-acute stroke patients directly to hospital with CT scanner in line with the agreed pathways to support delivery of this target and improve are for stroke patients. Following development of a national care pathway for frail and elderly fallers, SAS will work with NHS Boards to embed these locally and explore further pathway development opportunities for this patient group in partnership. SAS will continue to work towards increased treatment of patients at home through development of better triage and assessment, further roll out of the professional to professional lines, continuing to grow community paramedic capability, embracing the tele-health agenda and developing alternative care pathways in line with our strategic framework. In line with our Strategy, Working Together for Better Patient Care, the Scottish Ambulance Service is also committed to working with NHS Boards and other partners to develop joint action plans and more integrated healthcare provision. These include: Annex 2 - Page-19

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