Scottish Ambulance Service Annual Review 2016/17 · PDF file · 2017-09-08Scottish Government’s 2020 Vision as a frontline service providing emergency, ... for 2017/2018 and beyond

Scottish Ambulance Service, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB

Telephone: 0131 314 0000 www.scottishambulance.com

Scottish Ambulance Service Annual Review 2016/17 Self Assessment

Scottish Ambulance Service – Annual Review 2016/17 – Self Assessment

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SECTION 1: INTRODUCTION

The aim of this Annual Review Self-Assessment document is to provide information on the performance of Scottish Ambulance Service for the period 2016/17.

The Scottish Ambulance Service recognises that it has a significant contribution to make to the Scottish Government’s 2020 Vision as a frontline service providing emergency, unscheduled and scheduled care 24/7.

In 2015/16, we launched our five year strategy Towards 2020: Taking Care to the Patient. This 2020 strategy, underpinned by six key goals, is based on the principle that care should be appropriate to need – and care should be in an appropriate setting, which may not be in a hospital.

Our 2020 goals are to:

1. Ensure our patients, staff and the people who use our services have a voice and can contribute to future service design, with people at the heart of everything we do.

2. Expand our diagnostic capability and the use of technology to enhance local decision making to enable more care to be delivered at home in a safe and effective manner.

3. Continue to develop a workforce with the necessary enhanced and extended skills by 2020 to deliver the highest level of quality and improve patient outcomes.

4. Evidence a shift in the balance of care through access to alternative care pathways that are integrated with communities and with the wider health and social care service.

5. To reduce unnecessary variation in service and tackle inequalities, delivering some services ‘Once for Scotland’ where appropriate.

6. Develop a model that is financially sustainable and fit for purpose in 2020.

This strategy builds on a consistent set of ambitions which put the patient and the delivery of high quality clinical care at the centre of our performance agenda. This self-assessment document sets out the progress made during 2016/17, year two of our strategy implementation, and considers this in the context of the work remaining during the lifetime of this programme. Good progress is being made – we are saving more lives than ever before, treating more patients at home where they want to be cared for and improving staff experience, in the context of rising demand and tight public finances. We have more to do however. We cannot deliver our 2020 goal in isolation and need to work effectively in partnership with NHS Boards, Health and Social Care Partnerships, patients, communities and other public and voluntary agencies. Examples of this in 2016/17 include the further development of our Out of Hospital Cardiac Arrest strategy, establishment of Wildcat responders in the North, and co-responding pilots with Police Scotland and the Scottish Fire and


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Rescue Service in rural and remote areas. All of these achievements are against a backdrop of sound financial planning, management and performance, with all of our financial targets being achieved.


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SECTION 2: UPDATE ON 2015/16 ANNUAL REVIEW ACTIONS

2015/6 Annual Review Action Progress Update

ACTION 1) Pilot the new response model, and continue to work closely with the Chief Medical Officer, providing regular updates to the Scottish Government on evaluation throughout the year. Following discussions with Scottish Government officials these should include: a) the time all (GP, ILT and non ILT) arrive at the hospital in the same format as you have for GP referred patients so we can ensure there isn't a drift to later in the day arrival at hospital. b) data to ensure there hasn’t been a drift to later in the day discharges, although SAS discharges should be a relatively small % of overall discharges it would be good to set a benchmark.

a) A reporting format has been agreed with the Scottish Government and is provided weekly as part of the Scottish Ambulance Service return. b) A data report specific to this action was created following engagement with the Scottish Government. The report is available on an as required basis.

ACTION 2) Maintain focus on reducing absence levels across the organisation, working towards the NHS Heat Standard of 4%.

Our absence rate for performance year 2016/17 remained at 7.6%. April 2017 was 7.12%. Our short term sickness absence is comparable to other NHS boards, however our long term absence is higher and our action is focused in three areas: staff health and wellbeing, policy and process, and working practices. Most long term absence is caused by musculoskeletal. Staff have speedy access to physiotherapy services, where injuries can be treated and support/advice provided that enables an individual’s return to good health. More generally, we provide Occupational Health Services that give staff and managers advice and information on how to manage health conditions and promote better or more sustained attendance. We have been reviewing interventions to help with anxiety, stress and depression. Following a successful test, Mindfulness training will continue to be spread across the Service this year. Other action includes the promotion of the “See Me” campaign, providing mental health awareness and training to managers and a refresh of the national campaign on Healthy Working Lives. In terms of policy and support, we regularly provide awareness raising


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sessions for managers on the use of the Attendance Management policy and measure that staff are being managed in line with this. This policy highlights the provision of support channels for those absent from work, including fast track physiotherapy, employee counselling and occupational health advice and assessment.

ACTION 3) Develop a performance monitoring and reporting framework aligned to the pilot delivery model that can be implemented in the short, medium and longer term.

A Key Performance Indicator and Clinical Quality Indicators framework has been developed as part of the implementation of the New Clinical Response Model. These frameworks have been implemented. In the medium to longer term, with the introduction of data visualisation software (Tableau) and the Data Warehouse rebuild, all reporting frameworks in the Service will be reviewed. We are also working increasingly with health and social care partners to link Scottish Ambulance Service data to focus on outcome standards and aim to develop this further in 2017/18.

ACTION 4) Continue to achieve in-year and recurring financial balance, and keep the Health Directorates informed of progress in implementing your local efficiency savings programme.

The Service reported the revenue resource outturn to March 2017 as a £50,000 under spend against the core revenue resource limit target of break even. The capital resource limit outturn was break even, as forecast. The service delivered the full quantum of savings required in year at £9,897,000. However, a significant portion of these (45%) were delivered on a non-recurring basis. The non-recurring savings outturn was £1,200,000 more than anticipated at £4,500,000 for the full year, which adds to the savings challenge for 2017/2018 and beyond. Efficiency Savings Programme Board and support team was set up in order to closely monitor the delivery of the service efficiency and productivity programme for 2016/2017 and beyond. This group is working to move the balance of savings from non-recurring to recurring in future years. Service leads identified for the Service Delivery Directorate efficiency savings plan team and to work collaboratively with the Strategic Workforce Group to review and jointly plan the work required to ensure the delivery of the strategic finance, workforce, training and education plans as set out in the Local Delivery Plans for 2017/2018 and beyond.


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Regular monthly briefings were provided by the Service’s Finance Director to the Scottish Government, including updates of any financial plans and trajectories.

ACTION 5) Identify new ways of working with health and social colleagues, as well as other partners including NHS 24, to deliver a more joined-up approach to delivering healthcare to patients across Scotland. Particularly in relation to primary care transformation both in and out-of-hours.

The Scottish Ambulance Service is working across in and out of hours primary care as well as across the wider healthcare system through planning, testing and implementation of new models of care. These include:

testing new models of care in collaboration with GP Practices/Clusters across the country

working as part of multidisciplinary teams providing care closer to home

linking into the primary and urgent care resource hubs in coordination and face to face delivery of care

supporting the effective transfer to and from the Scottish Ambulance Service and NHS24

increasing the urgent care capacity through development of our Paramedic and Specialist Paramedic workforce

developing pathways of care that will support people to be cared for at home, in a homely setting or an alternative to the emergency department, such as those for people who fall or are frail, with Chronic Obstructive Pulmonary Disease or mental health illness both on the telephone and face to face.

ACTION 6) Continue to engage with the four regional trauma networks to test essential components, build on the current trauma desk provision to ensure a robust service is in place 24/7.

Links are in place with all four trauma regional networks and, as well as being represented on both the Scottish Trauma Network strategic and core groups, the Scottish Ambulance Service is taking the lead in pre-hospital and major incident planning. The Scottish Ambulance Service has recruited a Consultant Paramedic (Clinical Lead) for major trauma, and plans are now well developed for 24/7 cover for the trauma desk. The second round of tests of change for the trauma triage tool is underway in Tayside and aide memoires for both pre-alert and handover are about to be spread across the Service.


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Major Trauma packs are on all vehicles and e-learning is in place for all staff, including a Patient Group Directive for Tranexamic Acid. Extra training equipment is in place at Glasgow Caledonian University for students including advanced simulation mannequins and ventilators.

ACTION 7) Ensure mapping of Public Access Defibrillators onto the Service’s Computer Aided Dispatch (CAD) System is completed by April 2017.

Following the launch of the Registration to Resuscitation campaign on 10 March 2017, another 1017 Publicly Accessible Defibrillators have been registered with the Scottish Ambulance Service. This is now business as usual and the number continues to increase. Since April 2017 the new defibrillator module has allowed these defibrillators to be utilised (when available) to Out of Hospital Cardiac Arrest incidents which occur within 150m of the defibrillator location. The Scottish Ambulance Service has attempted resuscitation on 796 patients between 1 April 2017 and 27 June 2017. The Ambulance Control Centres have signposted / allocated callers to a Publicly Accessible Defibrillator on 29 occasions during this period.


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SECTION 3: CLINICAL SERVICES TRANSFORMATION During this year we received 1,412,830 calls and responded to 740,637 accident and emergency incidents, of which 560,359 were emergencies. We also conveyed 778,070 planned patient journeys across Scotland, mainly to their outpatient, dialysis and oncology treatment appointments. Clinical Performance for 2016/17 in relation to NHS Scotland objectives is summarised in the table below:

Measure Target 2015/16 Performance 2016/17 Performance

H1: Achieve a return of spontaneous circulation for VF/VT patients on arrival at hospital

>35% 39% 40.3%

H2: % of cardiac arrest patients responded to within 8 minutes

80% 71% 70.4%

H3A: % of Category A incidents responded to within 8 minutes (1 April to 20 November 2016)

75% 65.5% 66.6%

H3B: % of immediately life threatening incidents responded to within 8 minutes (23 November 2016 to 30 March 2017)

75% n/a 63.8%

H4: % of Category B incidents responded to within 19 minutes (1 April to 20 November 2016)

95% 81.7% 79.3%

T1: % of unscheduled cases managed by telephone or face to face assessment

28% 30.1% 31.2%

T2: % of hyper acute stroke patients who receive the pre hospital care bundle (from April 2017)

90% n/a n/a

T3: % of recorded use of peripheral vascular cannula (PVC) insertion care bundle

78% 79% 82.5%


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3.1 NEW CLINICAL RESPONSE MODEL

On 23 November 2016 we introduced the first phase of a New Clinical Response Model, with the key aims of saving more lives and improving patient outcomes. The model, which is a 12 month pilot, was developed following the most extensive clinically-evidenced review of its type ever undertaken in the United Kingdom, with nearly half a million calls examined.

Developed in partnership with our staff, the model is the first major change to the time-based targets system since 1974 and focuses on improving patient outcomes, rather than simply measuring the time it takes to respond.

This will enable us to respond faster to more patients with time-critical, immediately life-threatening conditions. In other situations, we will safely and more effectively identify and send the right resource first time for patients, resulting in better overall clinical outcomes. Similar changes in Wales and parts of England have led to faster response times for critically-ill patients. This new model replaces the categories ‘A’, ‘B’ and ‘C’, which are reported on up to 23 November 2016. The time-based performance target to reach 75% of patients with immediately life-threatening conditions within eight minutes has remained. A range of clinical outcome measures are being introduced to evaluate the quality, safety and timeliness of care delivered for all patients. The second phase of the new model will be introduced from June 2017 and will include moving to ‘dispatch on disposition’, whereby resources will be sent to patients based on their clinical condition. We will be able to demonstrate the impact of the new model on patient outcomes in Scotland through on-going monitoring and review in line with clinical governance arrangements. An independent evaluation will also be commissioned. This will inform any future improvements to the model. In 2016/17 we said we would:

Introduce a New Clinical Response Model to save more lives and improve patient care. In 2016/17 we:

Successfully introduced phase one in November 2016.

Improved our average time to respond to patients with immediately life-threatening conditions from 7 minutes 37 seconds in November 2016 to 7 minutes 31 seconds in April 2017.

Saw 95% of patients most likely to need to be taken to definitive care being sent a conveying resource first time.

3.2 OUT OF HOSPITAL CARDIAC ARREST In 2016/17 we said we would:

Develop our Out of Hospital Cardiac Arrest strategy to save more lives. In 2016/17 we:

Increased Return of Spontaneous Circulation (ROSC) by 10%.

Early lessons have been learnt from the first pilot sites the Co-responding project with Scottish Fire and Rescue Service. This has allowed both organisations to work together to further identify geographic areas and extend the pilot in semi-rural areas across the whole of Scotland.


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Following the encouraging early benefits of the semi-rural co-responding with Scottish Fire and Rescue Service, we have secured Health Foundation investment of £75,000 across 18 months for a co-responding test of change in remote and rural in Mull and Oban. This project has seen a total of 4 fire stations in this remote area trained and ready to respond to OHCA and this test went live in March 2017

Introduced Co-responding with Police Scotland in Grampian. Ten Automated External Defibrillators have been made available and are being used by the Road Policing Vehicles in and around Elgin, Inverurie, Mintlaw, Stonehaven and Aberdeen.

Started the Sandpiper Wildcat programme in North of Scotland. This collaborative project between the Sandpiper Trust Charity, BASICs Scotland, the Edinburgh Resuscitation Research Group and the Scottish Ambulance Service aims to train and equip up to 400 cardiac responders within rural Grampian over a 2 year period. The principles of the chain of survival are always the same; early recognition of cardiac arrest, starting CPR early, early defibrillation and early advanced life support, however the methods by which these can be delivered vary in rural communities where ambulance resources are often further away in terms of time taken to be able to respond to emergencies. By having a group of trained and equipped cardiac responders, available to attend cardiac arrests quickly within their own community provides these communities with the earliest possible access to high quality CPR and defibrillation prior to advanced life support being delivered to these casualties by the Scottish Ambulance Service, with the aim of helping saving more lives in rural communities.

Increased community first responder schemes to 138, with more than 1,500 volunteers retrained.

Promoted registration of Public Access Defibrillators on Scottish Ambulance Service website.

Extended our 3RU (Resuscitations Rapid Response Unit) to cardiac arrests in Glasgow. This is a project of audit, education, feedback and leadership, aimed at improving the quality of pre-hospital resuscitation in the urban environment. A dedicated paramedic response car in these urban areas is then preferentially tasked to OHCA, in addition to the usual resources. These paramedics have had further training in team leadership to enable a more co-ordinated response to cardiac arrest management in environments that are often challenging. As part of the implementation process all frontline staff are offered extra refresher training in OHCA management and the event data is downloaded from the defibrillators to assess the impact of the training and provide a feedback platform for staff following the resuscitation attempt. When implemented in Edinburgh this process of audit, education and feedback demonstrated increased survival rates and plans are in place to further extend the project during 2017 across urban Scotland.

Worked with key partners under the ‘Save a Life for Scotland’ campaign in order to help them achieve their aim of training 500,000 more people in how to perform CPR by 2020. This included supporting events in schools, emergency services fun days, local community events and events planned across the country during restart a heart day in October 2016.

3.3 HYPER ACUTE STROKE

In 2016/17 we said we would:

Develop our national and local pathways for hyper-acute stroke to improve patient outcomes.

In 2016/17 we:

Progressed the implementation of this indicator. The required changes have been made to the crew’s ePacer units to enable them to record when the stroke bundle has been applied, and work is ongoing to educate staff to ensure they are recording this information using the new method. It is planned to report this indicator from April 2017.


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3.4 MAJOR TRAUMA In 2016/17 we said we would:

Enhance our capability and capacity to respond to major trauma to save more lives.

In 2016/17 we:

Established a Trauma Desk as part of the Specialist Services Desk in our Ambulance Control Centre to enable effective trauma recognition, triage and tasking 24/7.

Procured new trauma kit and introduced for frontline staff.

Delivered training to staff and began trialling the use of a Major Trauma Triage Tool as part of the Tayside Trauma Network.

3.5 SAFE NON-CONVEYANCE

Safe non-conveyance for the Scottish Ambulance Service involves reducing the reliance on emergency ambulances taking patients to Hospital Emergency Departments through expanding our capacity and capability to safely treat patients via telephone advice (‘Hear and Treat’), or to deliver more care at the scene (‘See and Treat’).

Central to this aspiration is the development of alternative care pathways amongst the wider Health and Social Care community to enable patients to experience care appropriate to their needs at home or in community settings.

In 2016/17 we aimed to reduce hospital attendance by managing 31.2% of attendances by telephone or face-to-face assessment and this was achieved. The following sections describe our progress in this regard.

3.5.1 HEAR & TREAT


Work to improve the number of patients we Hear and Treat, to ensure patients receive the most appropriate care first time and reduce demand on operational ambulances.

Develop the Clinical Hub within our Ambulance Control Centre, to further strengthen clinical decision support.

Develop the role of GPs within our Ambulance Control Centre to strengthen professional-to-professional support.

In 2016/17 we:

Achieved 12.0% Hear and Treat as a proportion of eligible demand. This is an increase of 0.6% from the previous year.

Recruited additional clinical advisors and supervisors to establish our Clinical Hub.

Seconded a GP within our west Ambulance Control Centre to enable support and enhance triage and responses to GPs requesting ambulances to convey patients who need to be admitted to hospital within agreed timeframes.


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3.5.2 SEE & TREAT


Work to improve the number of patients we See and Treat, to ensure patients receive the most appropriate care first time and reduce demand on operational ambulances.

Work locally with our partners to develop and access appropriate care pathways to reduce avoidable attendances at A&E.

Work with our partners in NHS boards and Health and Social Care Partnerships to support the development of new integrated models of unscheduled care both in and out of hours.

In 2016/17 we:

Increased See and Treat from 18.7% to 19.2% as a proportion of eligible demand, resulting in more than 100,000 patients being cared for at home or in communities.

Evaluated the trial of Specialist Paramedics in Hawick medical practice leading to a further pilot in Inverclyde. The Service now has 29 Specialist Paramedics operating across the country in urgent and emergency care.

We were supported by the Active and Independent Living Programme in the creation of community based pathways for older people who fall.

Ensured all divisions were focussing on local work with partners to develop, establish and improve local pathways. Our priorities are falls, respiratory conditions and mental health, with most work centred on falls to date.

Developed local falls and frailty data collection methodologies to more effectively refer patients to pathways.

3.6 SCHEDULED CARE In 2016/17 we said we would:

Work with health boards to support the development of transport hubs across Scotland and model future provision of services.

Review arrangements for patients who do not currently go through our clinical assessment for transport process.

Realign the day to day work patterns for our scheduled care service to ensure it matches demand, utilising data and information from our auto-plan system.

In 2016/17 we:

Supported the development of integrated transport hubs, in conjunction with Strathclyde Partnership for Transport (SPT), across the West of Scotland.

Began testing, in conjunction with Royal Alexandra Hospital, supporting patients as scheduled outpatients following an unscheduled referral from GPs.

Continued to review our Patient Needs Assessment to make sure we accurately determine when patients require support.

Commenced shift reviews in all divisions to align resources to the needs of patients.


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3.7 AIR AMBULANCE & SCOTSTAR (Scottish Transport And Retrieval service)

Year on year demand for the Air Ambulance service has decreased by 8.6% in 2016/17. Improved coordination and tasking of aircraft from the Specialist Services Desk has been a contributory factor to this reduction in overall activity, and ensuring there are resources available to respond to the acute patient care requirements of ScotSTAR.

Air Ambulance 2015/16 2016/17

Total Activity 3,849 3543

Change on previous year +290 -306

% change on previous year +8.1% -8.6%

To cover all Scotland within 60 minutes (target 95%)

96.4% 95.1%

At the same time, there has been a slight increase in journeys undertaken by the ScotSTAR service, with a significant increase seen in adult retrieval journeys:

ScotSTAR Journeys Completed 2015/16 2016/17

Adults 720 850

Neonates 1,428 1,372

Paediatrics 323 281

TOTAL 2,471 2,503


Improve coordination and tasking of air and retrieval teams.

Consolidate and develop the workforce of multi disciplinary teams for the future needs of the patients.

Work to coordinate and align all data reporting systems from the retrieval teams.

Develop a strategy to provide the Perinatal Advisory Service to the whole of Scotland.

In 2016/17 we:

Adopted a new clinical governance structure within ScotSTAR to further integrate the three retrieval services – Adult, Neonatal, and Paediatric – and ensure closer working between ScotSTAR and the wider Scottish Ambulance Service.

Transferred 21 staff from territorial health boards to the Scottish Ambulance Service to consolidate the workforce of ScotSTAR. In addition, a Deputy General Manager and Associate Medical Director started in July and August 2016 respectively.

Developed a raft of Key Performance Indicators for ScotSTAR to continuously monitor performance and target improvements in delivery of care.

Refined and tested our processes to be in a position to move from a regional to national Perinatal Advisory Service in 2017.


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3.8 INFECTION CONTROL In 2016/17 we said we would:

Continue to strengthen infection control procedures, including robust audit and monitoring. In 2016/17 we:

Maintained strong performance against key indicators in respect of hand hygiene and National Cleaning Services Specification. Overall annual compliance with hand hygiene opportunity was 91% against a target of 90%. Compliance with National Cleaning Services Specification was 95% for both cleanliness and for estates, against a target of 90%.

Had an unannounced Healthcare Environment Inspectorate (HEI) inspection of the Service over four days in November 2016; the first inspection against the new Healthcare Associated Infection (HAI) standards. The inspection resulted in four requirements and one recommendation for improvement, but demonstrated an overall improvement in the management and profile of HAI by the Service. The main areas for improvement were around: o hand hygiene compliance, particularly after contact with patients and when leaving hospital

departments; o staff awareness of correct temperatures for laundering uniforms and mop heads in line with

Service policy; and o appropriate storage of clean blankets in stations.

Produced an Improvement Action Plan, and conducted a 16 week post-inspection update on progress to HEI.

Continued to proactively manage infection control through a regular programme of enhanced Standard Infection Control Precautions audits. These demonstrate further improvement, reporting overall compliance of 96%.

Now have over 1,500 staff that have successfully completed NHS Education for Scotland’s Cleanliness Champions infection control training programme. Now that this programme has been discontinued to be replaced by the Standard Infection Prevention and Control Education Pathway (SIPCEP), Technician students will continue to complete the latter as part of their first year study.


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SECTION 4: WORKFORCE DEVELOPMENT Performance for 2016/17 in relation to NHS Scotland Workforce objectives is summarised in the table below:

Measure Target 2015/16 Performance 2016/17 Performance

E2: Reduce sickness absence to a target of 5%

<5% 7.6% 7.6%

4.1 RECRUITMENT & TRAINING In 2016/17 we said we would:

Develop clinical roles to support delivery of our 2020 Strategy.

Target recruitment to increase the number of Paramedics and Specialist Paramedics.

In 2016/17 we:

Defined and agreed with our trade union colleagues, a Scope of Practice for all operational roles.

Introduced the Specialist Paramedic model in line with our Clinical Strategy.

Trained 193 paramedics.

Recruited 82 specialist paramedics, 51 of whom have completed training.

Recruited 254 technicians.

Recruited 51 staff to our Ambulance Control Centres. 4.2 STAFF EXPERIENCE In 2016/17 we said we would:

Transition to 20% of frontline manager time protected for management duties and Clinical leadership, to ensure staff have greater access to managers.

Develop the employee experience within the Service, to support a sustainable workforce.

In 2016/17 we:

Achieved a positive trajectory towards 20%, with work to consolidate protected time.

Carried out further tests of change being developed to support enhanced staff engagement.

Continued development programmes for frontline leaders.

Approved our Employee Wellbeing Strategy, with year one of the delivery plan underway.

Achieved iMatter organisational roll out, with the completion rate increasing from 68% in 2015/16 to 76% in 2016/17, and an employee engagement index of 68%.


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SECTION 5: ENABLING TECHNOLOGY 5.1 TELEHEALTH In 2016/17 we said we would:

Enhance the cab based technology hardware in the unscheduled care ambulance fleet, to support our strategic aims by ensuring our clinical staff are able to access, record and transfer relevant information, e.g. patient related information and up to date clinical guideline and pathway information.

In 2016/17 we:

Replaced the cab-based technology in more than 500 unscheduled care ambulances (Ambulance Telehealth Phase One).

Completed the specification and procurement for Ambulance Telehealth Phase Two developments. This includes the replacement of our electronic Patient Report (ePR) and provision of a paramedic information ‘app’.

5.2 e-HEALTH In 2016/17 we said we would

Enhance and promote our capability to electronically transfer the patient information our clinicians collect to our NHS Scotland partners, e.g. territorial health boards, to support and enable better clinical decision making, patient care and patient safety.

Progress the delivery of our eHealth Strategy. In 2016/17 we:

Developed and actively refined a technical solution for information sharing.

Implemented and / or piloted that solution in NHS Greater Glasgow and Clyde, NHS Ayrshire & Arran, NHS Tayside, NHS Grampian and NHS Highland.

Collaborated and engaged with various NHS Scotland partners to extend the reach of the solution, e.g. eHealth Leads, Clinical Change Leads and the Scottish Government eHealth team.

Completed migration to Scottish Wide Area Network and NHS Mail 2.

Completed provision of corporate Wi-Fi at all sites.

Replacement of our Ambulance Control Centre call recording solution.

Completed a Patient Transport System infrastructure hardware replacement programme.

Enhanced and extended our video conferencing capability.


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5.3 EMERGENCY SERVICES NETWORK In 2016/17 we said we would:

Ensure the Service has continued access to appropriate emergency service communications when the current Airwave system is ‘decommissioned’. This will be achieved through active participation in the GB-wide Emergency Service Mobile Communications Programme.

In 2016/17 we:

Established an internal Emergency Service Network Programme.

Actively participated in the Emergency Services Mobile Communications Programme.

Carried out proactive engagement and collaboration with the Scottish Government, Police Scotland, Scottish Fire and Rescue Service and other relevant partners.

Began preparation and planning for transition to the GB-wide Emergency Services Network in 2019/20.


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SECTION 6: PATIENT EXPERIENCE In 2016/17 we said we would:

Promote a Patient Focus Public Involvement (PFPI) framework, to encourage greater diversity in participation.

Improve patient experience through addressing themes of complaints and concerns received by the Service. In 2015/16, the biggest issues were attitude and behaviours, delayed response and cancelled Patient Transport Service journeys.

Improve the quality of responses to patient feedback, and our compliance with guidance to respond to complaints within 20 working days.

In 2016/17 we:

Conducted a comprehensive public awareness campaign to build awareness of our New Clinical Response Model, which was complimented by a series of sessions at local Patient Public Forums to speak to remote, rural, island and urban communities about how the new model works.

Continued to promote Care Opinion as a helpful feedback channel for patients and carers who want to share how they felt about a care experience anonymously. There were 105 posts about care from the Service in 2016/17, which were viewed 62,298 times. This is a 46% increase on the 72 posts in the previous year, which were viewed 50,254 times.

Received 1,276 complaints and concerns (422 complaints and 854 concerns). This is a 1.5% increase on the 1,256 complaints and concerns (470 complaints and 786 concerns) received in 2015/16.

Experienced an increase in complaints and concerns about attitude and behaviour in an accident and emergency setting, up 16% year on year. This remains a challenge for the Service.

Shared patient and carer stories about the importance of positive attitude and behaviour with our Human Resources and Organisational Development team, to promote culture change.

Involved staff in formulating and implementing iMatter action plans, which are designed to improve the work experience of our staff, and subsequently help reduce these types of complaints.

Experienced a simultaneous 33% reduction in the number of complaints and concerns about clinical assessment.

Received fewer complaints about attitude and behaviour in our Patient Transport Service, though delays and cancellations remains a common theme. These themes have been shared with our Scheduled Care Advisory Group, which has begun directing improvement activity on how the Patient Transport Service can better meet the needs of patients requiring support with clinical or mobility issues in getting to and from hospital appointments safely and punctually.

Introduced an action plan to improve our responsiveness to complaints in April 2016. Our 2016/17 complaints handling compliance, i.e. responding within 20 working days, was 77%, up from 51% last year. In addition, there were no Scottish Public Services Ombudsman (SPSO) Investigation Reports laid before Parliament in 2016/17 and there was a year on year reduction in SPSO Decision Reports in 2016/17 from eight to five.


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SECTION 7: FINANCIAL PERFORMANCE 7.1 FINANCIAL POSITON The Service again met its three financial targets in 2016/17 in terms of managing budgets and meeting its cash releasing efficiency target for the year. Achievement of this position was delivered as a result of continued delivery on agreed recovery actions and downward pressure on all discretionary expenditure.

Indicator 2014-15 2015-16 2016-17

Under spend against Core Revenue Resource Limit

£59K £54K £50k

Against Total Revenue Resource Limit

£61K £54K £50k

Against Capital Resource Limit

£1K £1K £1k

Cash Requirement £229m – under requirement by

£557K

£222.717 – met requirement £0

£244.495m – met requirement £0

Note: the reporting of cash balance changed in financial year 2015/16. 7.1 EFFICIENCY PROGRAMME The service delivered the full quantum of savings required for financial year 2016/17 at £9,897,000. However, a significant portion of these (45%) were delivered on a non-recurring basis. The non-recurring savings outturn was £1,200,000 more than anticipated, at £4,500,000 for the full year, which adds to the savings challenge for 2017/2018 and beyond.

Efficiency Savings 2016-17 Realised

£000s

Service Productivity £6,370

Procurement £3,100

Support Services (non-clinical) £159

Estates and Facilities £268

Total In-Year Savings £9,897

Documents

Scottish Ambulance Service Annual Review 2016/17 · PDF file · 2017-09-08Scottish Government’s 2020 Vision as a frontline service providing emergency, ... for 2017/2018 and beyond