A N a tio n a l S e rvic e M e e tin g L o c a l N e e d s...ÒThe staf f of the S co tis h A m b u la n e Service ar e key to delivering the high quality clinical car e ex pc td b

A National ServiceMeeting Local NeedsScottish Ambulance ServiceAnnual Report and Accounts 2009/2010

Annual Report and Accounts 09/10 01

Ann Clyde from EdinburghPTS patientOver the last five years, Ann

Clyde has been attending the

Western General Hospital in

the north of Edinburgh for her

cancer treatment. The Patient

Transport Service has been

making sure she gets to her

appointments on time and then

and back to her home. Living in

the south east area of the city,

the journey to and from hospital

can be arduous, and when Ann

has been feeling particularly

poorly, she finds the journey

wearing. She really appreciates

the care given to her by PTS

staff. “They really look after

me – from getting me and my

wheelchair into the vehicle and

making sure I’m safely strapped

in and secure, for example,

putting the collar of my coat

over the strap to make me more

at ease - to taking extra care

going over bumps in the road.

The staff always have a kind

word and a smile, and can

really lift my spirits with words

of encouragement. I can’t praise

the PTS Service and its staff

enough. The quality of care

I’ve received makes me think

the people who look after me

don’t see this as just a job,

for them it’s a vocation.”

We strive to deliver the best patient care

for people in Scotland, when they need us,

where they need us. In doing so we aim to

provide a patient-centred, clinically

effective and leading-edge, 24/7 service.

During the last 12 months, we have

concluded our most extensive consultation

ever about the future of the Service, by

gathering views from patients and their

carers, from staff, voluntary organisations

and charities across the country, and from

partners across the NHS Scotland and

other emergency services. We produced

our strategic framework: “Working

Together for Better Patient Care,” which

builds on the NHS Scotland Quality

Strategy, and sets out how we will deliver

our aims.

During the year we delivered these aims

in a number of key areas:

We improved our average response time to

life-threatening calls in mainland Scotland

from 7.2 minutes to 6.9 minutes, and

improved our response performance in

Island Boards areas, reaching 51.6% of all

emergencies within 8 minutes, against a

target of 50%. For patients suffering from

suspected cardiac arrest, where time of

response is critical to outcome, we

reached 78.5% of patients within 8

minutes, against a target of 75%.

We improved punctuality for appointment

for patients requiring our Patient Transport

Service and invested in new vehicles and

equipment. We have also worked closely

with our NHS partners to review

scheduling and in doing so increase

conveying rates through reducing

cancellations.

We have invested substantially in

developing the effectiveness of our clinical

services, and our Paramedic Director is

now in place, as are Clinical Governance

and Quality Leads in each Division.

Our Clinical Governance and Risk

Management assessment, by NHS Quality

Improvement Scotland, showed an overall

improvement against national governance

standards. The Service is playing an

increasingly important role in improved

outcomes for cardiac and stroke patients

through improved resuscitation procedures

and the introduction of optimal reperfusion

services. Additional improvements to

pre-hospital care of cardiac patients have

been delivered by working closely with

clinicians and senior academics on the

TOPCAT (Temperature Post Cardiac Arrest)

and ICECAP (Informed Continuous

Education on Cardiac Arrest for Ambulance

Personnel) research projects and through

the innovative use of telemetry.

We were delighted to sign off the Remote

and Rural Strategic Operating Framework

for emergency and urgent responses and

have developed action plans with each

NHS Board to deliver improvements in

those areas. These set out the standards

to be expected in remote and rural

locations and a range of solutions which

can be adapted to meet local needs.

In addition we now have over 121

Community First Responder Schemes and

60 BASICS GPs, training in local schools,

and are sup porting the introduction of

public access defibrillator programmes.

The Service is also implementing the roll

out of the Emergency Medical Retrieval

Service across Scotland to enable access

to highly specialised clinical skills for

remote communities.

We recognise that the goals set out in

“Working Together for Better Patient Care”

will only be achieved through skilled,

motivated and caring staff. Consequently,

we have increased support for the people

who work for the Service and in November

2009 we launched our learning strategy:

“Realising our Potential,” which is helping

enhance our culture of learning, this is

further developing our clinical expertise

and excellence in practice, and is helping

increase professionalism at all levels. All of

these are key to delivering an improved

patient experience. With input from over

1000 members of staff we also developed

“Doing The Right Thing”, our Human

Resources and Organisational

Development Strategy for the next five

years. This will play a key role in achieving

our vision, embedding a culture of doing

the right thing, by encouraging staff to live

the Service’s values, by enhancing

leadership and management capability,

capacity and competence and building

staff confidence, further empowering

them to anticipate and meet the needs of

our patients.

We continue to anticipate patient needs,

developing innovative care solutions to

continuously improve the services we

provide, although we do not underestimate

the significant challenges presented by the

ongoing economic downturn. By the same

token, we confidently expect that working

together with partners across the NHS and

other organisations, the staff of the

Scottish Ambulance Service will continue

to meet the challenges ahead and to find

more collaborative ways to deliver better

patient care.

Annual Report and Accounts 09/1002 Annual Report and Accounts 09/10 03

David Garbutt

Chairman

Pauline Howie

Chief Executive

“The staff of theScottish AmbulanceService are key todelivering the highquality clinical careexpected by patients.”

//Chairman and Chief

Executive statement for

2009/10 annual report

A National Service

Meeting Local Needs

GeorgeHutchesonfromInverness“Since 2004 I have had nine

or ten heart attacks.

Each time I’ve had an attack,

ambulance crews have come

out to me, providing medical

care and reassurance to me

and my family. I’ve had a

good life, and thanks to these

extraordinary people, I can

look forward to few more

years yet.”

“I truly believe I wouldn’t be here

today if it wasn’t for the Scottish

Ambulance Service.”

Annual Report and Accounts 09/10 05Annual Report and Accounts 09/1004


\\How we performed

This section of the report

covers how we performed

in 2009/10 against our

HEAT targets

Target H1:

Save more lives

Target H2:

Category A Cardiac Arrest

Patients

Performance Indicator

% of cardiac arrests with

successful return of

spontaneous circulation

% of cardiac arrests patients

responded to within 8 Minutes

Target for 2009/10

12% to 20% full year

75%

Performance in 2009/10

17.8%

78.5%

Performance achieved for the full year 2009-10 was 17.8%, with all divisions across Scotland achieving target. Performance

against this indicator improved in March to 22.8%, above target range. In addition 78.5% of all cardiac arrest patients were

responded to within 8 minutes, exceeding the target of 75% by 3.5%

Saving more lives

The Scottish Ambulance Service is committed to operating within our allocated budget. The Service has a track record of meeting

its financial targets in recent years and, accordingly, financial planning and monitoring is rigorous. Once again, the Service

operated within our revenue and capital resource limits for this financial year. Key risks are identified and assessed annually and

then on an ongoing basis, arrangements are put in place to mitigate or reduce these risks. In addition, contingency plans are put

in place to deal with them if they arise. The Service has achieved this financial balance in a challenging environment which has

included significant pressures from: rising fuel costs, inflationary costs of parts and equipment and additional overtime worked to

provide 24/7 cover in some areas. This is against a backdrop of the 0.8% increase in emergency response to incidents within

8 minutes in 2009/10, as well as a 16% increase in air ambulance demand in 2009/10 compared to the previous year.

The Service met and exceeded this target and was able to use the cash releasing savings to invest in Board-approved

developments. The additional savings are able to be carried over to the coming financial year.

Meeting financial targets

By March 2010, 1.8% of all staff have completed their Personal Development review and had it signed off by themselves and their

manager, while a further 1.2% have completed their review and are awaiting sign-off. In addition, 9% of staff have begun but not

completed their KSF review - therefore we have approximately 13% of staff with current PRD activity on e-KSF.

Sickness absence

Reduce energy consumption

Target E1:

Meet financial targets


Operate within revenue and

capital limits; meet the cash

requirement

Target for 2009/10

Meet target


£79,000

underspend

Target E6: Reduce emissions



Target for 2009/10

2%


2.3%

Target E2:

Meet cash efficiency


Cash releasing savings

achieved

Target for 2009/10

2% (£3,786,000)


2.18% (£4,125,000)

Target E4:

Sickness absence


Rate of sickness absence

Target for 2009/10

5%


5.4%

Target E3:

Implement knowledge and

skills framework


80% of AfC staff to have had

KSF PDP reviewed by March

2011

Target for 2009/10

80% by March 2011


Reported March 2011

Sickness absence rates remained stable at 5.4% for 2009/10. The Service continues in its commitment to reduce sickness

absence rates through its Employee Assistance Programme, including fast-track rehabilitation and employee counselling.

Target E5:

Universal use of CHI number:


% of PTS journeys where CHI

number is used

Target for 2009/10

75%


84.7%

This target reflects the percentage of Patient Transport journeys where the Community Healthcare Index number is recorded. The

Service exceeded target, improving performance from 79.4% in 2008/09 to 84.7%, an increase of 5.3%.

Meeting financial targets (continued)

How we performed

>10/11

Total non-current assets 74,302 73,165

Total current assets 10,538 7,376

Total assets 84,840 80,541

Total current liabilities (18,272) (16,029)

Non-current assets plus/less net current assets/liabilities 66,568 64,512

Total non-current liabilities (6,362) (6,592)

Assets less liabilities 60,206 57,920

Taxpayers' Equity

General fund 54,882 53,545

Revaluation reserve 5,324 4,375

Total taxpayers' equity 60,206 57,920

The 2008/09 Annual Accounts were prepared under the convention of UK GAAP however the 2009/10 Annual Accounts were prepared under IFRS. The change from UK GAAP accounting

to IFRS has caused the comparative figures for 2008/09 to alter.

//Balance sheet

For the year ended 31March 2010

2010£000

2009 IFRS£000

Net capital expenditure 14,143 13,192

Capital Resource Limit 14,151 13,202

Saving/(excess) against Capital Resource Limit 8 10

The 2008/09 Annual Accounts were prepared under the convention of UK GAAP however the 2009/10 Annual Accounts were prepared under IFRS. The change from UK GAAP accounting

to IFRS has caused the comparative figures for 2008/09 to alter.

2010£000

2009 IFRS£000Summary of Capital Resource Outturn


2010£000

2009 IFRS£000

\\Operating cost statement

For the year ended 31March 2010

Clinical services costs

Hospital and Community 205,169 204,577

Less: Hospital and Community Income (6,992) (6,0710)

198,177 198,506

Family Health 0 0

Less: Family Health Income 0 0

Total Clinical Services Costs 198,177 198,506

Administration Costs 2,725 2,592

Less: Administration Income 0 0

2,725 2,592

Other Non Clinical Services 2,810 2,902

Less: Other Operating Income (1,024) (582)

1,786 2,320

Net Operating Costs 202,688 203,418

Summary of revenue resource outturn

Net Operating Costs (per above) 203,418

Capital Grants (to)/from Other Bodies (30)

Profit/(Loss) on disposal of fixed assets (33)

Annually Managed Expenditure (Write Downs) (1,940)

FHS Non Discretionary Allocation 0

Other Allocations 0

Net Resource Outturn 201,415

Revenue Resource Limit 201,494

Saving/(excess) against Revenue Resource Limit 79

The 2008/09 Annual Accounts were prepared under the convention of UK GAAP however the 2009/10 Annual Accounts were prepared under IFRS. The change from UK GAAP

accounting to IFRS has caused the comparative figures for 2008/09 to alter.

GeorgeRedpathfrom Fife“During the snowy weather

in January, I started to feel

extremely unwell. I thought

to myself: ‘Trust you to be

having a heart attack in the

middle of the night in such

atrocious weather. How are

you going to get help now?’

My wife dialled 999. Within

minutes, I was attended by

three Community First

Responders, local people

trained by the Scottish

Ambulance Service in life-

saving skills, including CPR.

They monitored my

condition, and were able to

reassure me that the

ambulance crew were on

their way. I still can’t believe

how quickly the ambulance

paramedics got to my

house, despite the dreadful

weather conditions outside.

They hooked me up to a

machine and quickly

confirmed I was having a

heart attack. They gave me

oxygen and medication to

make me more comfortable,

then took me to hospital,

where I underwent

emergency angioplasty.”

“Sitting in my garden in

the summer weather,

I’ve often thought

about that frightening

night in the snow, and

how grateful my wife

and I were to see the

First Responders and

the two paramedics.”


Balance sheets

>18/19George Redpathfrom Fife

>22/23

Chairman and ChiefExecutive’s Statement

>02/03

George Hutcheson from Inverness

>04/05

Patients come into contact with the Scottish

Ambulance Service in a variety of ways.

They may be users of our Patient Transport

Service (PTS), requiring medical care on

their way to and from hospital

appointments. They may be treated by a

paramedic or an ambulance technician in

response to a 999 incident; or after they’ve

been seen by a doctor, who has requested -

an ambulance within a specific time period,

which is appropriate for the medical need

of the patient. Some patients will be cared

for by a community paramedic.

The community paramedic brings treatment

to the patient, and may refer them to

additional healthcare support, such as their

general practitioner (GP). The community

paramedic may even work within

communities to provide advice on how

to prevent healthcare problems, such as

cardiovascular disease.

Over the last two years, Ann Clyde has

been attending the Western General

Hospital in the north of Edinburgh. The

Patient Transport Service has been making

sure she gets the care and attention she

needs en route to her appointment and

during her journey back to her home. Living

in the south east area of the city, the journey

to and from hospital can be arduous, and

when Ann has been feeling particularly

poorly, she finds the journey wearing. She

really appreciates the care given to her by

PTS staff. “They really look after me – from

getting me and my wheelchair into the

vehicle and making sure I’m safely strapped

in and comfortable, to taking extra care

going over bumps in the road. The staff

always have a kind word and a smile, and

can really lift my spirits with words of

encouragement. I can’t praise the PTS

Service and its staff enough. The quality

of care I’ve received makes me think the

people who look after me don’t see this

as just a job, for them it’s a vocation.”

Chris Bennett from Orkney required an

emergency response from the Service

when he suffered a stroke. “The last thing

I expected was to be having a stroke at 24.

And you might think that living on an island

might make things more complicated.

But everyone swung into action.

My colleagues realised right away that

something was wrong and dialled 999.

The paramedics who came by road

ambulance got to me in minutes.

They diagnosed a stroke, and organised

an air ambulance to take me to Aberdeen

Royal Infirmary for a CT scan, after which

I was given new clot-busting treatment

which dissolved a clot in my brain.

I’ve now made a full recovery. I’m really

grateful to the whole team who played a

role in making sure I quickly got the

treatment I needed – and so is my family.”

During the snowy weather in January,

George Redpath from Fife started to feel

extremely unwell. I thought to myself:

‘Trust you to be having a heart attack in

the middle of the night in such atrocious

weather. How are you going to get help

now?’ My wife dialled 999. Within minutes,

I was attended by three Community First

Responders, local people trained by the

Scottish Ambulance Service in life-saving

skills, including CPR. They monitored my

condition, and were able to reassure me

that the ambulance crew were on their

way. I still can’t believe how quickly the

ambulance paramedics got to my house,

despite the dreadful weather conditions

outside. They hooked me up to a machine

and quickly confirmed I was having a heart

attack. They gave me oxygen and

medication to make me more comfortable,

then took me to hospital, where

I underwent emergency angioplasty.

Sitting in my garden in the summer

weather, I’ve often thought about that

frightening night in the snow, and how

grateful my wife and I were to see the First

Responders and the two paramedics.”

The Scottish Ambulance Service delivers

accident and emergency care to patients

the length and breadth of the country.

Accident and emergency care is delivered

by specially trained paramedics and

ambulance technicians who, last year,

responded to over 600,000 incidents

across Scotland.

999 calls are handled by one of three

Emergency Medical Dispatch Centres

(EMDCs) and ambulance crews are

dispatched from stations and deployment

points situated near to areas where the

fastest response can be provided which

could be in the form of a double crewed

ambulance, motorbikes, all-terrain

vehicles and even mountain bikes to

reach patients as quickly as possible.

Crews provide life saving emergency

medical care. Having assessed the

medical needs of the patient, they

may take patients to hospital, treat

them at the scene or refer them to

an appropriate clinic.


Last year, the Patient Transport

Service (PTS), undertook 1.6 million

journeys across Scotland.

PTS provision is prioritised according

to clinical need. The service is provided

by specially trained ambulance care

assistants who are increasingly providing

this service to patients with more complex

needs for example palliative care.

The service is provided by specially

trained ambulance care assistants.

The Patient Transport Service operates

601 vehicles.

Patient Transport

Service

The Service plays

a vital role in taking

patients with a clinical

need during transport

to and from their

hospital appointments.

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.

Air wing provides

an emergency

response and an

essential hospital

transfer service

for the islands

and remote and

rural areas.

//Overview of our year

Putting the Patient at the

Heart of Everything we do

//Our servicesThe 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.

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 requiring clinical care

during transport to hospital in time

for their appointment.

Accident and

emergency care

We respond to 999

calls from the public

and healthcare

partners such as

general practitioners,

(GPs) in addition to

requests for an urgent

response by clinicians.

The quality of clinical care provided in

the patient stories of this annual report

is borne out in the scores and feedback

in the annual Patient Survey, conducted

by MRUK at the end of 2009. Overall

patient satisfaction continues to be high

at 95%. While this is extremely heartening

for everyone who works for the Service,

we are continuing to strive for clinical

excellence and to keep improving the

quality of patient care to the people of

Scotland. This commitment is clearly

articulated in the Service’s five year

strategic framework: “Working Together

for Better Patient Care.” The vision for this

five year strategy is: to deliver the best

patient care for people in Scotland, when

they need us, where they need us.”

This annual report is testament to the

determination of Scottish Ambulance

Service staff to achieve this vision.

Overview of our year

>06/07

Clinical Governance

Committee

The Clinical Governance Committee

currently comprises four Non-Executive

Directors: Mrs Christine Humphries

(Chair); Mr Andrew Richmond; Ms

Suzanne Dawson; and Ms Theresa

Houston. Mr David Nelson is the

Public/Patient Representative. The

Committee meets approximately four

times per year to monitor standards of

care and measure the effectiveness of

pre-hospital treatment.

Audit Committee

The Audit Committee currently comprises

four Non-Executive Directors:

Mr Douglas Marr (Chair); Mr Andrew

Richmond; Ms Theresa Houston; and

Mrs Christine Humphries. Mrs Humphries

took up her position in September 2009,

replacing Mr David Alexander. The Audit

Committee 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 Service.

Staff Governance

The Staff Governance Committee

comprises three Non-Executive Directors:

Mr Matthew Bell, who took up post in July

2009 replacing Mr Alan Bickerstaff as

Employee Director and Chair; Mrs

Christine Humphries; Mr Douglas Marr;

and the Chairman, Mr David Garbutt, who

took up his position in July 2009, replacing

Mr William Brackenridge. The Committee

meets four times per year to ensure

effective monitoring of staff governance

within the organisation.

Remuneration Committee

The Remuneration Committee currently

comprises the Chairman and three

Non-Executive Directors: Mr Douglas Marr;

Ms Suzanne Dawson; and Mr David

Alexander. The Committee is chaired by

the Chairman, Mr David Garbutt. It meets

at least three times per year to consider

the evaluation of performance and pay

awards for Executive Directors.

The committee has an important role in

ensuring consistency of policy and equity

of treatment of staff across the local NHS

system, including remuneration issues,

where they are not already covered by

existing arrangements at national level.

Working with NHS

Boards to reduce

unnecessary

attendances at A&E

departments, the

Service has treated

over 60,000 patients

at scene – over 8,000

more than last year.

\\Our Committee and

Membership 2009/10

HEAT Target

H1 Save more lives 12%-20%

% of cardiac arrests with successful return of spontaneous circulation

H2 Category A cardiac arrest patients 80%

% of cardiac arrests patients responded to within 8 Minutes

H3 Response to Category A Incidents 75%

% of life threatening incidents within 8 minutes

H4 Response to Category B incidents 95%

Cash releasing savings achieved

H5 Response to emergencies on island boards 53%

% of island emergency incidents within 8 minutes

SAS E1 Sickness absence 5%


SAS E2 Reduce emissions 2.5%


SAS E3 Universal use of CHI number 80%

% of PTS journeys where CHI number is used

NHSS E5 Meet financial targets Meet target

Operate within revenue and capital limits; meet the cash requirement

NHSS E6 Meet cash efficiency target 2%

Cash releasing savings achieved

NHSS E10 Implement knowledge and skills framework 80%

80% of AfC staff to have had KSF PDP reviewed by March 2011

A1 Response to urgent incidents 91%

% of 1 hour urgent calls responded to within 1 hour

A2 Patient Transport Service: punctuality for appointment 72%

% P1 patients at hospital 30 mins prior to appointment

A3 Patient Transport Service: punctuality for pick up after appointment 90%

% P1 patients picked up 30 mins after appointment

A4 Patient Transport Service: journeys cancelled by SAS < 1%

% of PTS journeys cancelled by SAS

T1 Improve health outcomes for patients 10 or above

NHSQIS standards for patient safety and clinical governance

T2 Health acquired infection Meet target

Compliance with Red Amber Green HAI monitoring

T3 Reduce Hospital Admissions 12%

% of emergency calls treated at scene

T4 SEWS score 95 – 98%

% of patients with a SEWS score above 4 taken to hospital

T5 Hyper acute stroke 80%

% of hyper acute stroke patients taken to hospital within 55 minutes

HEAT Targets 2010/11

2010/11 full year targets

Note: Where performance is not reported monthly, relevant indicators will be shaded unless they are reported in line with

the timetable outlined in the comments section.

Annual Report and Accounts 09/1014 Annual Report and Accounts 09/10 15Annual Report and Accounts 08/0906 Annual Report and Accounts 08/09 07

LyndaDonaldsonfrom Kirkcudbright“Having suffered anaphylactic

shock, my husband called the

local health centre. A doctor

arrived within minutes to

attend to me. On assessing

my condition, she called for

an ambulance while she

worked to stabilise me.

Within minutes of the call,

a paramedic arrived and

worked with the doctor to

improve my condition, which

was rapidly deteriorating.

An ambulance crew then

arrived to take me to hospital,

where I was admitted for

observation. My husband and

I are very appreciative of their

assistance and tremendously

quick response.”

“I believe the teamwork of

the doctor and the paramedic

saved my life that day.”


Committee & Membership

>14/15SAS Activity

>08/09

//Audit and inspection Information governancereviews

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. One of the main reviews

was an assessment of our Freedom of

Information arrangements. This was a

generally positive review with a few actions

to take forward.

Further information is available from

www.isdscotland.org or

www.nhshealthquality.org and the

Freedom of Information report is accessed

via www.itspublicknowledge.co.uk

Staff Governance

The Service recognises that investment in its

staff is a direct investment in patient care. As

outlined in our staff governance annual

report 2009/10: “Treating People Well”, the

Service aims to be an exemplar employer,

by following best employment practice,

investing in staff training and development,

undertaking integrated workforce planning

and embedding partnership working. The

Service’s Learning Strategy: ‘Realising our

potential’, was published in November 2009,

following an extensive nationwide

consultation with our staff and key

stakeholders. It sets out our ambitions to

develop a learning culture, strengthen our

educational infrastructure, and embed

professionalism, at all levels in order to

provide an improved patient experience.

More recently, the Service has developed its

Human Resources and Organisational

Development Strategy: “Doing the Right

Thing.” By building on the Staff Governance

Standards and working in conjunction with

the Service’s Strategic Framework, “Working

Together for Better Patient Care”, it will

strengthen leadership capability, build more

two-way communications with staff and

continue to develop employee relations and

engagement through working in partnership.

Working closely with the National

Partnership Forum, the Service has

developed a comprehensive staff

governance plan and we are making good

progress towards implementing the national

strategy in achieving the Staff Governance

standards.

Equality and Diversity and Reducing HealthInequalities

The Scottish Ambulance Service has a

strong commitment to equality for all and

recognises that work in this area is a

continuing journey as we move towards

mainstreaming equality into all that we do.

Scotland is an increasingly diverse country.

Whilst this provides great opportunities, it

also presents significant challenges in

ensuring that we, as both a service provider

and employer, ensure that we do not

consciously or unconsciously discriminate

and instead provide equitable access to our

services and fair employment practice in the

workplace.

A review of the Disability Equality Scheme

was recently undertaken setting out what

has been achieved during the last three

years and developing our Action Plan for

2009 – 2012.

Our annual report on the Gender Equality

Scheme highlights some of the work we

have done and areas where development is

still underway. For example, we are

identifying more effective ways of engaging

with men and women regarding service

development and we are developing a policy

for managing gender based violence in the

workplace.

We continue to monitor the Service Anti-

bullying and Harassment campaign, the aim

of which is to raise awareness of unacceptable

behaviour and encourage staff to raise any

concerns and issues at the earliest

opportunity in order to resolve problems as

soon as possible.

The Equality and Diversity Steering Group

continues to meet bi-monthly to take some

of the key areas of work forward. Membership

includes representatives from across the

Operational Divisions.

Key developments for the future include

identifying ways to attract more recruits from

the disabled community, developing a

communication tool to support disabled

patients and reviewing the consent strategy

to take account of adults and children with

incapacity / use of welfare guardianship.

Work is soon to commence to review the

Gender Equality Scheme. This will be

revised and the new Scheme published in

June 2010.Standard & Cor

Financial Governance

The Scottish Ambulance Service again met

its three financial targets in 2009/10, both in

terms of managing budgets and in meeting

its cash releasing efficiency target for the

year. The Service ended the year 2009/10

with a £79,000 surplus and efficiency

savings above the 2% Scottish Government

target at 2.18%. Further productivity

efficiencies amounted to £2,234,000.

The Service ensures that both financial

processes and controls are in place and are

working effectively through a system of

internal audit reviews. The Corporate

Register is used as a basis for developing

the internal audit plan. The Scottish

Ambulance Service commissioned 16

Internal Audit Reports during the year to 31

March 2010. Actions plans have been

developed to ensure that all

recommendations will be implemented.

Patient Focus PublicInvolvement (PFPI)

The Scottish Ambulance Service is strongly

committed to involving the public, patients,

carers and other stakeholders in the

planning and delivery of services and the

development of a mutual NHS. Throughout

2009/2010 we have listened intently to the

views of our stakeholders. The Service is

moving towards developing a more inclusive

relationship with the people across

Scotland; a relationship where patients and

the public are affirmed as partners rather

than recipients of care.

Our annual PFPI self assessment has

recently been published on our website. In

partnership with members of the public and

our patients we reviewed our progress in

PFPI and the key developments in

2009/2010. The highlights of the report

include the growth of our Community First

Responder scheme across Scotland and the

development of a new Complaints process

for service users.

The Scottish Ambulance Service continues

to make good progress in developing,

promoting and delivering Patient Focus

Public Involvement in 2009/2010. Our areas

of development for the coming year will be

writing in partnership our new PFPI strategy

and the continued involvement of our

patients, carers and the public in the

development of our Strategic Framework

delivery.

Full details of the assessment by the

Scottish Health Council are available on

www.scottishambulance.com


Governance

The Scottish Ambulance Service recognises

that the momentum which is building behind

its five year Strategic Framework: “Working

Together for Better Patient Care” must be

underpinned with sound governance

arrangements. A Strategic Implementation

Programme Board has been established by

the Scottish Ambulance Service Board in

order to monitor and govern the delivery of

our Strategic Framework over the next five

years. This Board will ensure it measures the

governance, monitors the implementation

and reports strategic issues, through the

Executive Team, to the Scottish Ambulance

Service Board. In addition, the Service

continues to conduct regular audits, to

ensure it is consistently providing safe and

effective clinical care for our patients, fair

and effective management of our staff and

that robust financial controls are in place.

To that end, the Service commissioned

16 Internal Audit Reports during the year

to 31 March 2010. Action plans have been

developed to ensure that all recommendations

are implemented. For further information

contact: Director of Finance and Logistics

on 0131 446 7000.

Clinical Governance and Risk Management

The Service has completed the second

review by NHS QIS against the National

Standards for Clinical Governance and Risk

Management where it achieved its best ever

score. These standards are extensive and

cover much of the clinical processes and

guidelines that we use. The results provided

an important focus for the Service in seeking

assurance that requirements are being

implemented across the Service. Although

the Service achieved a very high standard,

some areas of improvement were identified

and an action plan against the review has

been developed.

The results of this are shown below

and provide a comparison to the

previous review.

Standard & Core Area ‘06 ‘09

10 11

Standard 1

Risk Management 4 4

Emergency and

Continuity Planning 2 4

Clinical Effectiveness

and Quality Improvement 3 3

Standard 2

Access, Referral, Treatment

and Discharge 4 4

Equality and Diversity 2 2

Internal Communication 3 4

Standard 3

Clinical Governance

and Quality Assurance 4 4

Fitness to Practice 4 4

External Communication 3 4

Performance Management 4 4

Hand Hygiene Compliance Monitoring:

Over the last year the work programme that

forms part of the National Hand Hygiene

Campaign to improve hand hygiene

awareness has continued across the

Service. One requirement of the campaign

is bi-monthly audits to monitor compliance

with opportunities for hand hygiene and

these continue to demonstrate good

practice and ongoing improvement.

The most recent audits resulted in an

average score of 96%. The results of these

bi-monthly audits are published in NHS

Scotland ‘National Hand Hygiene

Campaign Audit Reports’

Over and above the National hand hygiene

audit programme a programme of local

hand hygiene audits continues. These audits

observe both compliance with opportunities

for hand hygiene and that the appropriate

hand hygiene technique was applied. Again

results from these audits demonstrate good

hand hygiene awareness and practice

across staff groups.

NHS Scotland NationalCleaning ServicesSpecification:

The service is required to comply with NHS

Scotland National Cleaning Services

Specification (NCSS) and monitoring

framework. The appropriate cleaning

specification for ambulances and

ambulance stations was piloted and

applied in early implementer sites where

the cleaning service was delivered by the

local NHS board domestic service

departments. The monitoring results for

these early implementer sites have

consistently met the required standard

of above 90%.

The cleaning specification and monitoring

is now being rolled out across the Service

with the challenge that across Scotland the

cleaning service is delivered by a variety of

different methods. This will require intense

work to ensure the standard is met. Three

NCSS auditor posts have been appointed

to support and monitor this.

The results of the cleaning monitoring are

published quarterly within ‘NHS Scotland

National Cleaning Services Specification:

Quarterly Compliance Reports’.

Annual Patient Experience Survey

2009/10 was the seventh consecutive year

the Scottish Ambulance Service has

conducted research into qualitative and

quantitative patient experience, continuing

our determination to routinely seek the

views of our users and thereby improve

services to patients requiring emergency

and patient transport care. As before, this

research was carried out independently by

Market Research UK and the results were

very positive.

With regards Accident and Emergency

Patients overall satisfaction was 98% and

93%. PTS patients had an overall

satisfaction rate of 95%. For A&E patients,

‘care received from ambulance staff’ and

‘professionalism of ambulance staff’ were

both high at 93% and 94% respectively

rating it ‘very good’. For PTS patients,

92% rated the ‘professionalism of the

ambulance staff’ as very good. Of the 10

respondents who had used the translation

service, 9 described it as very good.

These results have been fed into action

plans across the Service to support the

delivery of our Strategic Framework,

“Working Together for Better Patient Care”.

Copies of the survey can be obtained by

writing to the Corporate Affairs Manager,

National Headquarters, Tipperlin Road,

Edinburgh.

Audit & inspections

>24/25

Capital investments

>26/27

The Scottish Ambulance Service receives

over 900 patient feedback

correspondences annually. This includes

complaints, concerns, comments and

compliments. In 2009/2010, our staff

delivered direct patient care to over 2.2

million patients across Scotland and

carried out 469 formal complaint

investigations in 2009/2010.

Feedback from patients is welcomed as it

provides valuable information on how we

are performing and the experience of

patients, carers and relatives using our

services and clinicians we work in

partnership with. This feedback ensures

that our services are as good as they can

be and provides the opportunity to

highlight areas where we can improve.

Examples of improvements made by

listening to our service users include:

• simplifying complaint data consent

forms to make them more user friendly

• monitoring the reasons why an

ambulance response time may be

out of performance

• changing our triage questioning following

the recommendations made by the

Scottish Public Service Ombudsman

• liaising with Health Boards to improve

partnership working and communication

issues

The Service takes a proactive approach to

improving its services and is in the process

of implementing recommendations from a

review of its complaints process. As part of

this review the views of staff and patients

were sought, with their feedback informing

improvements to the existing process. The

revised process will be further integrated

into existing risk management and clinical

governance structures, creating a robust

system to handle patient feedback,

encourage transparency and openness

and create an environment where learning

from complaints is encouraged.

The patient is at the centre of the care we

deliver and at the heart of everything we

do. By listening to our patients and their

carers we are able to understand their

needs better. In essence this means:

• Resolving complaints as comprehensively

as we can and offering local resolution.

Ensuring that complaints are seen as part

of the whole Quality Assurance Process

• Ensuring that complaints are handled

with more of a patient focused approach

• Considering training needs and helping

our staff develop the knowledge and

skills required to fulfill their roles

• Learning from complaints by sharing

information throughout the organisation

• Using complaints to facilitate service

improvements and improve patient

safety and care

The revised process will be fully

implemented across all operational areas

in the coming year and will ensure that the

Service continues to use patient feedback

to facilitate improvements to the services

we deliver.


The Service met its

three financial targets

and achieved

efficiency savings of

2.18%, as well as

further productivity

efficiencies

amounting to

£2,234,000.

\\Capital investments

//Patient feedback

Complaints, Comments,

Concerns and Compliments

Total expenditure on the acquisition of assets during

the year was £13.1 million. Of this £6 million was

required for the acquisition of vehicles, £4.1 million

was on property and £3 million was on IT equipment,

plant and furniture.

Major projects included:

The Scottish Ambulance Service has moved to a model

of co-location between our Emergency Medical Dispatch

Centres (EMDC) and NHS24 advice centres. The Service

delivered part two of the project in 2009/10 with the move

to Norseman House, South Queensferry for our East and

Central Scotland EMDC, this project was completed in

February 2010 at a cost of £1.6 million. The project was

delivered on time and has already delivered benefits to the

patient, through the joined up working between NHS24

and the Scottish Ambulance Service. A number of station

upgrades were also completed this year benefiting both

staff and patients alike.

The on-going replacement of frontline emergency and

patient transport vehicles was also undertaken.

ChrisBennettfromOrkney

Chris Bennett from Kirkwall

in Orkney required an

emergency response when

he suffered a stroke at the

local supermarket, where

he works as a security guard.

“The last thing I expected

was to be having a stroke at

24. And you might think that

living on an island might make

things more complicated. But

everyone swung into action.

My colleagues realised right

away that something was

wrong and dialled 999.

The paramedics who came

by road ambulance got to

me in minutes. They diagnosed

a stroke, and organised an air

ambulance to take me to

Aberdeen Royal Infirmary for

a CT scan, after which I was

given new clot-busting

treatment which dissolved

a clot in my brain. I’ve now

made a full recovery.”

“I’m really grateful to the

whole team who played a

role in making sure I quickly

got the treatment I needed –

and so is my family.”


Scottish Ambulance

Service Annual Review:

14 September 2010

1. This letter summarises the main areas

of discussion and the actions arising

from the Scottish Ambulance Service

(SAS) Annual Review and associated

meetings at Caledonia House on 14

September 2010. I would want to

thank everyone who was involved

in organising such a successful day.

2. I welcomed the chance to hear from

frontline staff about the achievements

and innovations of the service through

a demonstration of the patient journey.

It was particularly useful to see the

focus placed on improving access,

enhancements in equipment and the

quality of care provided to patients.

I would be grateful if you could pass

on my thanks to all those I met during

the session.

Meeting with

Clinical Advisors

3. Now that the Medical Directorate is

established, I was pleased to hear

about the bottom-up approach being

taken to support clinical excellence

and best practice across the

orginisation, as well as the structures

that ensure robust clinical leadership

and support. The service has aligned

its work with the Healthcare Quality

Strategy for NHS Scotland and this is

evidenced particularly through the

continuing development of clinical

performance measures for the service.

While there remains some distance to

travel before we can audit the

interventions at all stages of the patient

journey through to final outcomes

considerable progress has been made,

for example in the expanding use of

the CHI number, service collaboration

in research programmes, and the use

of patient record forms to support best

clinical practice. The commitment of

the group to working through the

obstacles to monitoring the whole

patient journey is to be commended,

and it was acknowledged that this is

fundamental to understanding and

improving morbidity.

4. We talked about a few initiatives the

service is involved in to improve the

quality of patient care. I was interested

to hear about the work the service is

doing to give advanced notification

before a patient reaches hospital thus

improving the speed and effectiveness

of the response on arrival. I also noted

the work being done to look at

supporting 'frequent' callers, patients

with diabetes in the first instance, who

would previously have been recorded

as individual contacts with the service.

This initiative sees case conferences

triggered with primary care

practitioners, allowing clinicians to look

at the underlying cause of the

individual episodes and support the

patient to reduce these, through a

medication review for example. We

also talked about the development of

Community Paramedics and the

increasing contribution they are

making. The service will be continuing

to consider carefully the models of care

that Community Paramedics can

deliver and what fits best with local

circumstances. Integration with

territorial NHS Boards and the

availability of care pathways and

clinical support are key to the success

of these models of care.

Deputy First Minister & Cabinet Secretary

for Health and Wellbeing

Nicola Sturgeon MSP

T: 0845 774 1741

E: [email protected]

David Garbutt, Chair

Scottish Ambulance Service,

National Headquarters,

Tipperlinn Road, Edinburgh

EH10 5UU

4 October 2010


\\Annual Review 2010

Key action points

The Scottish Ambulance Service should prioritise Quality on Board agendas,

continue the process of staff engagement, identify and share examples of good

practice in quality improvement and work in partnership with colleagues across

the NHS, Public Sector and Third Sector to pursue Quality Strategy ambitions.

One

The Scottish Ambulance Service Board (and its Clinical Governance Committee)

should continue to have evidence available to it in order to provide assurances with

regard to the robustness of clinical governance and risk management arrangements.

Two

The Scottish Ambulance Service should ensure momentum and progress on

improving the management and performance of the Scheduled Care Service (PTS),

alongside continuing to work with partners to support those patients who do not

have a medical need for this transport.

Three

The Scottish Ambulance Service should continue active participation in the Scottish

Patient Safety Programme.Four

The Scottish Ambulance Service should ensure that there is a robust strategy

for managing demand on the Air Ambulance Service, working closely with NHS

Boards to ensure the best use of available resources to meet clinical need.

Five

The Scottish Ambulance Service must continue to work with NHS 24 and other NHS

partners in developing a common integrated triage system and clinical pathways that

support continuous improvement to the patient experience of contacting unscheduled

care services. To provide a report on progress, including scope of engagement with

NHS partners, by the end of March 2011.

Six

The Scottish Ambulance Service should ensure that staff, and their representatives,

are fully engaged in the development and operation of the organisation.Seven

Chris Bennett from Orkney

>30/31Annual Review 2010

>32/33

//Contents

We strive to deliver the best patient carefor people in Scotland, when they need us,where they need us. In doing so we aim toprovide a patient-centred, clinicallyeffective and leading-edge, 24/7 service.During the last 12 months, we haveconcluded our most extensive consultationever about the future of the Service, bygathering views from patients and theircarers, from staff, voluntary organisationsand charities across the country, and frompartners across the NHS Scotland andother emergency services. We producedour strategic framework: “WorkingTogether for Better Patient Care,” whichbuilds on the NHS Scotland QualityStrategy, and sets out how we will deliverour aims.

During the year we delivered these aimsin a number of key areas:We improved our average response time tolife-threatening calls in mainland Scotlandfrom 7.2 minutes to 6.9 minutes, andimproved our response performance inIsland Boards areas, reaching 51.6% of allemergencies within 8 minutes, against atarget of 50%. For patients suffering fromsuspected cardiac arrest, where time ofresponse is critical to outcome, wereached 78.5% of patients within 8minutes, against a target of 75%.

We improved punctuality for appointmentfor patients requiring our Patient TransportService and invested in new vehicles andequipment. We have also worked closelywith our NHS partners to reviewscheduling and in doing so increaseconveying rates through reducingcancellations.

We have invested substantially indeveloping the effectiveness of our clinicalservices, and our Paramedic Director isnow in place, as are Clinical Governanceand Quality Leads in each Division.Our Clinical Governance and Risk

Management assessment, by NHS QualityImprovement Scotland, showed an overallimprovement against national governancestandards. The Service is playing anincreasingly important role in improvedoutcomes for cardiac and stroke patientsthrough improved resuscitation proceduresand the introduction of optimal reperfusionservices. Additional improvements topre-hospital care of cardiac patients havebeen delivered by working closely withclinicians and senior academics on theTOPCAT (Temperature Post Cardiac Arrest)and ICECAP (Informed ContinuousEducation on Cardiac Arrest for AmbulancePersonnel) research projects and throughthe innovative use of telemetry.

We were delighted to sign off the Remoteand Rural Strategic Operating Frameworkfor emergency and urgent responses andhave developed action plans with eachNHS Board to deliver improvements inthose areas. These set out the standardsto be expected in remote and rurallocations and a range of solutions whichcan be adapted to meet local needs.In addition we now have over 121Community First Responder Schemes and60 BASICS GPs, training in local schools,and are supporting the introduction ofpublic access defibrillator programmes.The Service is also implementing the rollout of the Emergency Medical RetrievalService across Scotland to enable accessto highly specialised clinical skills forremote communities.

We recognise that the goals set out in“Working Together for Better Patient Care”will only be achieved through skilled,motivated and caring staff. Consequently,we have increased support for the peoplewho work for the Service and in November2009 we launched our learning strategy:“Realising our Potential,” which is helpingenhance our culture of learning, this isfurther developing our clinical expertise

and excellence in practice, and is helpingincrease professionalism at all levels. All ofthese are key to delivering an improvedpatient experience. With input from over1000 members of staff we also developed“Doing The Right Thing”, our HumanResources and OrganisationalDevelopment Strategy for the next fiveyears. This will play a key role in achievingour vision, embedding a culture of doingthe right thing, by encouraging staff to livethe Service’s values, by enhancingleadership and management capability,capacity and competence and buildingstaff confidence, further empoweringthem to anticipate and meet the needs ofour patients.

We continue to anticipate patient needs,developing innovative care solutions tocontinuously improve the services weprovide, although we do not underestimatethe significant challenges presented by theongoing economic downturn. By the sametoken, we confidently expect that workingtogether with partners across the NHS andother organisations, the staff of theScottish Ambulance Service will continueto meet the challenges ahead and to findmore collaborative ways to deliver betterpatient care.


David GarbuttChairman

Pauline HowieChief Executive

“The staff of theScottish AmbulanceService are key todelivering the highquality clinical careexpected by patients.”

//Chairman and ChiefExecutive statement for2009/10 annual reportA National ServiceMeeting Local Needs

GeorgeHutchesonfromInverness“Since 2004 I have had nineor ten heart attacks.Each time I’ve had an attack,ambulance crews have comeout to me, providing medicalcare and reassurance to meand my family. I’ve had agood life, and thanks to theseextraordinary people, I canlook forward to few moreyears yet.”

“I truly believe I wouldn’t be heretoday if it wasn’t for the ScottishAmbulance Service.”


Patients come into contact with the ScottishAmbulance Service in a variety of ways.They may be users of our Patient TransportService (PTS), requiring medical care ontheir way to and from hospitalappointments. They may be treated by aparamedic or an ambulance technician inresponse to a 999 incident; or after they’vebeen seen by a doctor, who has requested -an ambulance within a specific time period,which is appropriate for the medical needof the patient. Some patients will be caredfor by a community paramedic.The community paramedic brings treatmentto the patient, and may refer them toadditional healthcare support, such as theirgeneral practitioner (GP). The communityparamedic may even work withincommunities to provide advice on howto prevent healthcare problems, such ascardiovascular disease.

Over the last five years, Ann Clyde has beenattending the Western General Hospital inthe north of Edinburgh. The PatientTransport Service has been making sureshe gets the care and attention she needsen route to her appointment and during herjourney back to her home. Living in thesouth east area of the city, the journey toand from hospital can be arduous, andwhen Ann has been feeling particularlypoorly, she finds the journey wearing. Shereally appreciates the care given to her byPTS staff. “They really look afterme – from getting me and my wheelchairinto the vehicle and making sure I’m safelystrapped in and secure, for example,putting the collar of my coat over the strapto make me more at ease - to taking extracare going over bumps in the road. The staffalways have a kind word and a smile, andcan really lift my spirits with words ofencouragement. I can’t praise the PTSService and its staff enough. The quality ofcare I’ve received makes me think thepeople who look after me don’t see this asjust a job, for them it’s a vocation.”

Chris Bennett from Orkney required anemergency response from the Servicewhen he suffered a stroke. “The last thingI expected was to be having a stroke at 24.And you might think that living on an islandmight make things more complicated.But everyone swung into action.My colleagues realised right away thatsomething was wrong and dialled 999.The paramedics who came by roadambulance got to me in minutes.They diagnosed a stroke, and organisedan air ambulance to take me to AberdeenRoyal Infirmary for a CT scan, after whichI was given new clot-busting treatmentwhich dissolved a clot in my brain.I’ve now made a full recovery. I’m reallygrateful to the whole team who played arole in making sure I quickly got thetreatment I needed – and so is my family.”

During the snowy weather in January,George Redpath from Fife started to feelextremely unwell. I thought to myself:‘Trust you to be having a heart attack inthe middle of the night in such atrociousweather. How are you going to get helpnow?’ My wife dialled 999. Within minutes,I was attended by three Community FirstResponders, local people trained by theScottish Ambulance Service in life-savingskills, including CPR. They monitored mycondition, and were able to reassure methat the ambulance crew were on theirway. I still can’t believe how quickly theambulance paramedics got to my house,despite the dreadful weather conditionsoutside. They hooked me up to a machineand quickly confirmed I was having a heartattack. They gave me oxygen andmedication to make me more comfortable,then took me to hospital, whereI underwent emergency angioplasty.Sitting in my garden in the summerweather, I’ve often thought about thatfrightening night in the snow, and howgrateful my wife and I were to see the First

The Scottish Ambulance Service deliversaccident and emergency care to patientsthe length and breadth of the country.

Accident and emergency care is deliveredby specially trained paramedics andambulance technicians who, last year,responded to over 600,000 incidentsacross Scotland.

999 calls are handled by one of threeEmergency Medical Dispatch Centres(EMDCs) and ambulance crews aredispatched from stations and deploymentpoints situated near to areas where the

fastest response can be provided whichcould be in the form of a double crewedambulance, motorbikes, all-terrainvehicles and even mountain bikes toreach patients as quickly as possible.

Crews provide life saving emergencymedical care. Having assessed themedical needs of the patient, theymay take patients to hospital, treatthem at the scene or refer them toan appropriate clinic.


Last year, the Patient TransportService (PTS), undertook 1.6 millionjourneys across Scotland.

PTS provision is prioritised accordingto clinical need. The service is providedby specially trained ambulance careassistants who are increasingly providingthis service to patients with more complexneeds for example palliative care.

The service is provided by speciallytrained ambulance care assistants.

The Patient Transport Service operates601 vehicles.

Patient TransportServiceThe Service playsa vital role in takingpatients with a clinicalneed during transportto and from theirhospital appointments.

The air ambulance service is deliveredby four purpose built aircraft, twohelicopters and two fixed wing aircraft.

The air ambulance service is the onlyintegrated, publicly funded air ambulanceservice in the UK.

Air wing providesan emergencyresponse and anessential hospitaltransfer servicefor the islandsand remote andrural areas.

//Overview of our yearPutting the Patient at theHeart of Everything we do

//Our servicesThe Scottish Ambulance Service isa Special Health Board. We operatefrom 178 locations across five Divisionscovering the whole of Scotland, thelargest geographic area of any ambulanceservice in the UK.

The Scottish Ambulance Servicecontinues to deliver for patients acrossScotland – saving lives by respondingto life threatening emergency calls,increasingly preventing unnecessaryhospital admissions by treating

or referring people at the scene and,by taking patients requiring clinical careduring transport to hospital in timefor their appointment.

Accident andemergency careWe respond to 999calls from the publicand healthcarepartners such asgeneral practitioners,(GPs) in addition torequests for an urgentresponse by clinicians.

Responders and the two paramedics.”The quality of clinical care provided inthe patient stories of this annual reportis borne out in the scores and feedbackin the annual Patient Survey, conductedby MRUK at the end of 2009. Overallpatient satisfaction continues to be highat 95%. While this is extremely hearteningfor everyone who works for the Service,we are continuing to strive for clinicalexcellence and to keep improving thequality of patient care to the people ofScotland. This commitment is clearlyarticulated in the Service’s five yearstrategic framework: “Working Togetherfor Better Patient Care.” The vision for thisfive year strategy is: to deliver the bestpatient care for people in Scotland, whenthey need us, where they need us.”This annual report is testament to thedetermination of Scottish AmbulanceService staff to achieve this vision.


LyndaDonaldsonfromKirkcudbright“Having suffered anaphylacticshock, my husband called thelocal health centre. A doctorarrived within minutes toattend to me. On assessingmy condition, she called foran ambulance while sheworked to stabilise me.Within minutes of the call,a paramedic arrived andworked with the doctor toimprove my condition, whichwas rapidly deteriorating.An ambulance crew thenarrived to take me to hospital,where I was admitted forobservation. My husband andI are very appreciative of theirassistance and tremendouslyquick response.”

“I believe the teamwork ofthe doctor and the paramedicsaved my life that day.”



\\How we performedThis section of the reportcovers how we performedin 2009/10 against ourHEAT targets

Target H1:Save more lives

Target H2:Category A Cardiac ArrestPatients


% of cardiac arrests withsuccessful return ofspontaneous circulation

% of cardiac arrests patientsresponded to within 8 Minutes

Target for 2009/10

12% to 20% full year

75%


17.8%

78.5%

Performance achieved for the full year 2009-10 was 17.8%, with all divisions across Scotland achieving target. Performanceagainst this indicator improved in March to 22.8%, above target range. In addition 78.5% of all cardiac arrest patients wereresponded to within 8 minutes, exceeding the target of 75% by 3.5%

Saving more lives

The Scottish Ambulance Service is committed to operating within our allocated budget. The Service has a track record of meetingits financial targets in recent years and, accordingly, financial planning and monitoring is rigorous. Once again, the Serviceoperated within our revenue and capital resource limits for this financial year. Key risks are identified and assessed annually andthen on an ongoing basis, arrangements are put in place to mitigate or reduce these risks. In addition, contingency plans are putin place to deal with them if they arise. The Service has achieved this financial balance in a challenging environment which hasincluded significant pressures from: rising fuel costs, inflationary costs of parts and equipment and additional overtime worked toprovide 24/7 cover in some areas. This is against a backdrop of the 0.8% increase in emergency response to incidents within8 minutes in 2009/10, as well as a 16% increase in air ambulance demand in 2009/10 compared to the previous year.

The Service met and exceeded this target and was able to use the cash releasing savings to invest in Board-approveddevelopments. The additional savings are able to be carried over to the coming financial year.

Meeting financial targets

By March 2010, 1.8% of all staff have completed their Personal Development review and had it signed off by themselves and theirmanager, while a further 1.2% have completed their review and are awaiting sign-off. In addition, 9% of staff have begun but notcompleted their KSF review - therefore we have approximately 13% of staff with current PRD activity on e-KSF.

Sickness absence


Target E1:Meet financial targets


Operate within revenue andcapital limits; meet the cashrequirement

Target for 2009/10

Meet target


£79,000underspend

Target E6: Reduce emissions



Target for 2009/10

2%


2.3%

Target E2:Meet cash efficiency


Cash releasing savingsachieved

Target for 2009/10

2% (£3,786,000)


2.18% (£4,125,000)

Target E4:Sickness absence



Target for 2009/10

5%


5.4%

Target E3:Implement knowledge andskills framework


80% of AfC staff to have hadKSF PDP reviewed by March2011

Target for 2009/10

80% by March 2011


Reported March 2011

Sickness absence rates remained stable at 5.4% for 2009/10. The Service continues in its commitment to reduce sicknessabsence rates through its Employee Assistance Programme, including fast-track rehabilitation and employee counselling.

Target E5:Universal use of CHI number:


% of PTS journeys where CHInumber is used

Target for 2009/10

75%


84.7%

This target reflects the percentage of Patient Transport journeys where the Community Healthcare Index number is recorded. TheService exceeded target, improving performance from 79.4% in 2008/09 to 84.7%, an increase of 5.3%.

Meeting financial targets (continued)


In scheduled care, the Service has been successful in improving the punctuality for Patient Transport Service (PTS) appointmentsand reducing the number of cancelled PTS journeys, patients at hospital 30 minutes or less before appointment and patientspicked up within 30 minutes of agreed time.

Improving punctuality

Target A4 PTS: punctuality forappointment

Target A5 PTS: punctuality forpick up after appointment


% P1 patients at hospital 30mins prior to appointment

% P1 patients picked up 30mins after appointment

Target for 2009/10

70%

87%


71%

85.3%

Target A2: Response toCategory B Incidents


% of Serious (not lifethreatening) Incidents within14, 19 or 21 minutes(depending on populationdensity)

Target for 2009/10

95%


93.7%


51.6%

Category B performance remained strong with full year performance in 2009-10 of 93.7% of calls reached within target time.

Target A3 Response toEmergencies on Island Boards


% of Island EmergencyIncidents within 8 minutes

Target for 2009/10

50%

The performance achieved over the course of the full year was 51.6%, up from 50.5%.

Target T4 SEWS score % of patients with a SEWSscore above 4 taken to hospital

95 – 98% 97.1%


66.8%

Full year performance for 2009/10 was 97.1%, within target range

Target T5 Hyper acute stroke


% of hyper acute strokepatients taken to hospitalwithin 55 minutes

Target for 2009/10

90%

2009/10 performance was 66.8%. Levels of stroke service provision vary across Scotland, therefore the target for 2010/11 hasbeen changed to 80% of hyper acute stroke patients taken to hospital within 60 minutes, which better reflects the location andavailability of computerised scanners (CT) and stroke services.

The Service has completed the second review by NHS QIS against the National Standards for Clinical Governance and RiskManagement, where it improved its rating from 10, achieved in 2006, to 11. These standards are extensive and cover much of theclinical processes and guidelines used by the Service. The results provide an important focus in seeking assurance thatrequirements are being implemented across the Service. A high standard was achieved and areas of improvement have beenidentified, action plans against the review have already been developed.

Reducing hospital admissions

Target T1 Improve healthoutcomes for patients


NHSQIS standards for patientsafety and clinical governance

Target for 2009/10

10 or above


11%

The fourteenth National Hand Hygiene audit was completed between 22 March and 2 April 2010, it showed a consistent result forhand hygiene compliance at 96%. The current reported NHS Scotland national average compliance is 94%.

Target T2 Health acquiredinfection


Compliance with Red AmberGreen HAI monitoring

Target for 2009/10

Meet targets


Targets met

The service continues to increase the number of patients treated at the scene or at home. In 2009/10 57,560 patients havebeen treated at scene under our “See and Treat” protocols. This represents an increase of 8,332 patients (16.9%) comparedwith 2008-09.

Target T3 Reduce hospitaladmissions


% of Emergency Calls Treatedat Scene

Target for 2009/10

11%


11.1%

Improving response times

Target A1: Response toCategory A Incidents


% of Life Threatening Incidentswithin 8 Minutes

Target for 2009/10

75%


72.3%

Performance achieved over the full year 2009/10 for those Category A calls responded to within 8 minutes improved from 70.7% to72.3%, a further increase of 1.6%, with performance achieved in March 2009 reaching 77.5%. Average response time to CategoryA calls was 6.9 minutes compared with 7.2 minutes for 2008/09.

Reduce Energy Consumption (continued)

The organisation has achieved its 2009/10 target for reducing energy consumption. The winter months were more challenging,especially around the fourth quarter as adverse weather conditions resulted in an increase in consumption of gas for heatingsystems. Despite this, the target was exceeded, reducing energy consumption by 2.23% for the full year. Good practice willcontinue to be followed during 2010/11 and with continued focus. The Service can achieve as much or even more in 2010/11;therefore, a more stretching target of a 2.5% reduction has been set for this financial year.

Clinical GovernanceCommitteeThe Clinical Governance Committeecurrently comprises four Non-ExecutiveDirectors: Mrs Christine Humphries(Chair); Mr Andrew Richmond; MsSuzanne Dawson; and Ms TheresaHouston. Mr David Nelson is thePublic/Patient Representative. TheCommittee meets approximately fourtimes per year to monitor standards ofcare and measure the effectiveness ofpre-hospital treatment.

Audit CommitteeThe Audit Committee currently comprisesfour Non-Executive Directors:Mr Douglas Marr (Chair); Mr AndrewRichmond; Ms Theresa Houston; andMrs Christine Humphries. Mrs Humphriestook up her position in September 2009,replacing Mr David Alexander. The AuditCommittee meets four times per year toconsider the various reports from bothinternal and external auditors to assessthe risks that may arise in the Service.

Staff GovernanceThe Staff Governance Committeecomprises three Non-Executive Directors:Mr Matthew Bell, who took up post in July2009 replacing Mr Alan Bickerstaff asEmployee Director and Chair; MrsChristine Humphries; Mr Douglas Marr;and the Chairman, Mr David Garbutt, whotook up his position in July 2009, replacingMr William Brackenridge. The Committeemeets four times per year to ensureeffective monitoring of staff governancewithin the organisation.

Remuneration CommitteeThe Remuneration Committee currentlycomprises the Chairman and threeNon-Executive Directors: Mr Douglas Marr;Ms Suzanne Dawson; and Mr DavidAlexander. The Committee is chaired bythe Chairman, Mr David Garbutt. It meetsat least three times per year to considerthe evaluation of performance and payawards for Executive Directors.The committee has an important role inensuring consistency of policy and equityof treatment of staff across the local NHSsystem, including remuneration issues,where they are not already covered byexisting arrangements at national level.

Working with NHSBoards to reduceunnecessaryattendances at A&Edepartments, theService has treatedover 60,000 patientsat scene – over 8,000more than last year.

\\Our Committee andMembership 2009/10

HEAT Target

H1 Save more lives 12%-20%% of cardiac arrests with successful return of spontaneous circulation

H2 Category A cardiac arrest patients 80%% of cardiac arrests patients responded to within 8 Minutes

H3 Response to Category A Incidents 75%% of life threatening incidents within 8 minutes

H4 Response to Category B incidents 95%Cash releasing savings achieved

H5 Response to emergencies on island boards 53%% of island emergency incidents within 8 minutes

SAS E1 Sickness absence 5%Rate of sickness absence

SAS E2 Reduce emissions 2.5%Reduce energy consumption

SAS E3 Universal use of CHI number 80%% of PTS journeys where CHI number is used

NHSS E5 Meet financial targets Meet targetOperate within revenue and capital limits; meet the cash requirement

NHSS E6 Meet cash efficiency target 2%Cash releasing savings achieved

NHSS E10 Implement knowledge and skills framework 80%80% of AfC staff to have had KSF PDP reviewed by March 2011

A1 Response to urgent incidents 91%% of 1 hour urgent calls responded to within 1 hour

A2 Patient Transport Service: punctuality for appointment 72%% P1 patients at hospital 30 mins prior to appointment

A3 Patient Transport Service: punctuality for pick up after appointment 90%% P1 patients picked up 30 mins after appointment

A4 Patient Transport Service: journeys cancelled by SAS < 1%% of PTS journeys cancelled by SAS

T1 Improve health outcomes for patients 10 or aboveNHSQIS standards for patient safety and clinical governance

T2 Health acquired infection Meet targetCompliance with Red Amber Green HAI monitoring

T3 Reduce Hospital Admissions 12%% of emergency calls treated at scene

T4 SEWS score 95 – 98%% of patients with a SEWS score above 4 taken to hospital

T5 Hyper acute stroke 80%% of hyper acute stroke patients taken to hospital within 55 minutes

HEAT Targets 2010/112010/11 full year targets

Note: Where performance is not reported monthly, relevant indicators will be shaded unless they are reported in line withthe timetable outlined in the comments section.


Jamie &DonaldWilsonfromUddingston“In January my son, Jamie, hadan accident while sledging inthe snow. He sustained aserious head injury and wasunconscious. I cleared Jamie’sairway and my wife called 999.A friend, who has years of FirstAid and mountain rescueexperience, helped me lookafter Jamie until a paramedic ina Rapid Response Unit arrived,followed shortly after by anambulance crew. During thistime a call handler at theScottish Ambulance ServiceEmergency Medical DispatchCentre stayed on the lineto give advice. It was a realteam effort by all the ScottishAmbulance Service staff.Jamie was then airlifted to theSouthern General Hospital inGlasgow, where he was treatedfor a bleed in the brain, and hasnow made a full recovery. I wasso impressed by the attitudeand professionalism of theambulance crew memberswho came to my son’s aid,that I made a career changeand am now training to be anambulance technician andultimately to be a paramedic.”

“My son’s injury was a traumatic eventfor my wife and for me. The responsefrom the Scottish Ambulance Servicewas phenomenal.”


//Our StaffNumber of staff as at 31 March 2010

\\Top 10 Category A incidentsReported in 2009/10

Average response(mins)

Sub-division PTS journeys A&E incidents Air ambulance Category A All emergencies

Argyll & Clyde 173,953 54,130 1,097 6.4 7.6

Ayrshire & Arran 136,910 46,283 116 6.8 8.0

Borders 51,629 12,494 25 8.6 9.7

Dumfries & Galloway 55,485 17,310 136 8.1 9.1

Fife 157,668 41,575 9 6.6 7.5

Forth Valley 106,047 29,348 42 7.0 8.5

Grampian 88,186 56,000 247 6.8 8.0

Greater Glasgow 254,490 116,915 177 6.8 8.9

Highland 60,666 28,068 827 8.2 9.3

Lanarkshire 159,176 70,778 21 7.0 8.2

Lothian 137,073 86,896 28 6.8 8.5

Orkney 1,748 1,767 374 n/a 11.5

Shetland 1,951 1,827 262 n/a 13.1

Tayside 126,589 41,630 60 6.8 7.8

Western Isles 3,574 3,812 552 n/a 9.8

Totals 1,515,145 608,833 4,004** 6.9 8.3*

* Includes Island Boards. Average is 8.2 mins excluding Island Boards.

** Total air missions excludes aborted and cancelled missions.

Top 10 emergency chief incidents Demand

Transfer/Interfacility/Palliative Care 109,401

Falls 55,024

Unconscious/Fainting (Near) 36,921

Breathing Problems 33,031

Chest Pain (Non Traumatic) 30,588

Overdose/Poisoning 21,655

Convulsions/Fitting 21,299

Assault/Sexual Assault 18,009

Traffic/Transportation Accident 14,392

Haemorrhage/Lacerations 11,670

Staff 2010

Paramedics 1355

Technicians 1075

Patient Transport Service, including Ambulance Care Assistants, Drivers and PTS Ambulance Assistants 1060

Emergency Medical Dispatch Centre (EMDC) staff 343

Administrative & Clerical 259

Professional and Managerial 186

Others 66

TToottaall nnuummbbeerr ooff ssttaaffff oovveerraallll 44334444

Top 10 Category A chief incidents Demand

Chest Pain (Non Traumatic) 30,114

Breathing Problems 26,116

Unconscious/Fainting (Near) 22,841

Convulsions/Fitting 13,693

Falls 12,831

Traffic/Transportation Accident 10,825

Haemorrhage/Lacerations 5,396

Cardiac or Respiratory Arrest/Death 5,111

Assault/Sexual Assault 3,746

Heart Problems/AICD 3,083


missions

Number of employees

\\SAS Activity 2009/10

Total non-current assets 74,302 73,165

Total current assets 10,538 7,376

Total assets 84,840 80,541

Total current liabilities (18,272) (16,029)

Non-current assets plus/less net current assets/liabilities 66,568 64,512

Total non-current liabilities (6,362) (6,592)

Assets less liabilities 60,206 57,920

Taxpayers' Equity

General fund 54,882 53,545

Revaluation reserve 5,324 4,375

Total taxpayers' equity 60,206 57,920

The 2008/09 Annual Accounts were prepared under the convention of UK GAAP however the 2009/10 Annual Accounts were prepared under IFRS. The change from UK GAAP accounting to IFRS has caused the comparative figures for 2008/09 to alter.

//Balance sheetFor the year ended 31March 2010

2010£000

2009 IFRS£000

Net capital expenditure 14,143 13,192

Capital Resource Limit 14,151 13,202

Saving/(excess) against Capital Resource Limit 8 10


2010£000

2009 IFRS£000Summary of Capital Resource Outturn


2010£000

2009 IFRS£000

\\Operating cost statementFor the year ended 31March 2010

Clinical services costsHospital and Community 205,169 204,577

Less: Hospital and Community Income (6,992) (6,0710)

198,177 198,506

Family Health 0 0

Less: Family Health Income 0 0

Total Clinical Services Costs 198,177 198,506

Administration Costs 2,725 2,592

Less: Administration Income 0 0

2,725 2,592

Other Non Clinical Services 2,810 2,902

Less: Other Operating Income (1,024) (582)

1,786 2,320

Net Operating Costs 202,688 203,418

Summary of revenue resource outturnNet Operating Costs (per above) 203,418

Capital Grants (to)/from Other Bodies (30)

Profit/(Loss) on disposal of fixed assets (33)

Annually Managed Expenditure (Write Downs) (1,940)

FHS Non Discretionary Allocation 0

Other Allocations 0

Net Resource Outturn 201,415

Revenue Resource Limit 201,494

Saving/(excess) against Revenue Resource Limit 79



The Service has further developed its First ResponderScheme with 129now in placesupported by 1000 volunteers.

\\Independent auditors’statement to the Membersof the Scottish AmbulanceService on the summaryfinancial statement

We have examined the summary financialstatement for the year ended 31 March2010 which comprises Operating CostStatement and Balance Sheet.

This report is made solely to the parties towhom it is addressed in accordance withthe Public Finance and Accountability(Scotland) Act 2000 and for no otherpurpose. In accordance with paragraph 123of the Code of Audit Practice approved bythe Auditor General for Scotland, we do notundertake to have responsibilities tomembers or officers, in their individualcapacities, or to third parties.

Respective responsibilitiesof the Board and the Auditor

The Board of the Scottish AmbulanceService is responsible for preparing the summary financial statement within the Annual Report in accordance withguidance issued by the ScottishGovernment Health Directorate.

Our responsibility is to report to you ouropinion on the consistency of the summaryfinancial statement with the full auditedfinancial statements of the Board.

We also read the other informationcontained in the Annual Report andconsider the implications for our report if we become aware of any apparentmisstatements or material inconsistencies

with the summary financial statement. The other information comprises only theChairman and Chief Executive Statementfor 2009/10 annual report.

Basis of Opinion

We conducted our work having regard to Bulletin 2008/3 ‘The auditors’ statement on the summary financial statement in theUnited Kingdom’ issued by the AuditingPractices Board. Our report on the board’sfull annual financial statements describesthe basis of our opinion on those financialstatements.

Opinion

In our opinion the summary financialstatement is consistent with the full auditedannual financial statements of the ScottishAmbulance Service for the year ended 31March 2010.

We have not considered the effects of anyevents between the date on which wesigned our report on the full financialstatements and the date of this statement.

PricewaterhouseCoopers LLPEdinburgh28th October 2010

GeorgeRedpathfrom Fife“During the snowy weatherin January, I started to feelextremely unwell. I thoughtto myself: ‘Trust you to behaving a heart attack in themiddle of the night in suchatrocious weather. How areyou going to get help now?’My wife dialled 999. Withinminutes, I was attended bythree Community FirstResponders, local peopletrained by the ScottishAmbulance Service in life-saving skills, including CPR.They monitored mycondition, and were able toreassure me that theambulance crew were ontheir way. I still can’t believehow quickly the ambulanceparamedics got to myhouse, despite the dreadfulweather conditions outside.They hooked me up to amachine and quicklyconfirmed I was having aheart attack. They gave meoxygen and medication tomake me more comfortable,then took me to hospital,where I underwentemergency angioplasty.”

“Sitting in my garden inthe summer weather,I’ve often thoughtabout that frighteningnight in the snow, andhow grateful my wifeand I were to see theFirst Responders andthe two paramedics.”


//Audit and inspection Information governancereviewsThe Service conducts quarterly selfassessments which are provided to NHSQIS through completion of an “onlinetoolkit” managed by the InformationServices Division of NHS National ServicesScotland.

In addition, the Service has been involvedin a number of internal and externalreviews and all have shown that currentinformation governance arrangements arefit for purpose. One of the main reviewswas an assessment of our Freedom ofInformation arrangements. This was agenerally positive review with a few actionsto take forward.

Further information is available fromwww.isdscotland.org orwww.nhshealthquality.org and theFreedom of Information report is accessedvia www.itspublicknowledge.co.uk

Staff GovernanceThe Service recognises that investment in itsstaff is a direct investment in patient care. Asoutlined in our staff governance annualreport 2009/10: “Treating People Well”, theService aims to be an exemplar employer,by following best employment practice,investing in staff training and development,undertaking integrated workforce planningand embedding partnership working. TheService’s Learning Strategy: ‘Realising ourpotential’, was published in November 2009,following an extensive nationwideconsultation with our staff and keystakeholders. It sets out our ambitions todevelop a learning culture, strengthen oureducational infrastructure, and embedprofessionalism, at all levels in order toprovide an improved patient experience.

More recently, the Service has developed itsHuman Resources and OrganisationalDevelopment Strategy: “Doing the RightThing.” By building on the Staff GovernanceStandards and working in conjunction withthe Service’s Strategic Framework, “WorkingTogether for Better Patient Care”, it willstrengthen leadership capability, build moretwo-way communications with staff andcontinue to develop employee relations andengagement through working in partnership.Working closely with the NationalPartnership Forum, the Service hasdeveloped a comprehensive staffgovernance plan and we are making goodprogress towards implementing the nationalstrategy in achieving the Staff Governancestandards.

Equality and Diversity and Reducing HealthInequalitiesThe Scottish Ambulance Service has astrong commitment to equality for all andrecognises that work in this area is acontinuing journey as we move towardsmainstreaming equality into all that we do.Scotland is an increasingly diverse country.Whilst this provides great opportunities, italso presents significant challenges inensuring that we, as both a service providerand employer, ensure that we do notconsciously or unconsciously discriminateand instead provide equitable access to ourservices and fair employment practice in theworkplace.

A review of the Disability Equality Schemewas recently undertaken setting out whathas been achieved during the last threeyears and developing our Action Plan for2009 – 2012.

Our annual report on the Gender EqualityScheme highlights some of the work wehave done and areas where development isstill underway. For example, we areidentifying more effective ways of engagingwith men and women regarding servicedevelopment and we are developing a policyfor managing gender based violence in theworkplace.

We continue to monitor the Service Anti-bullying and Harassment campaign, the aimof which is to raise awareness of unacceptablebehaviour and encourage staff to raise anyconcerns and issues at the earliestopportunity in order to resolve problems assoon as possible.

The Equality and Diversity Steering Groupcontinues to meet bi-monthly to take someof the key areas of work forward. Membershipincludes representatives from across theOperational Divisions.

Key developments for the future includeidentifying ways to attract more recruits fromthe disabled community, developing acommunication tool to support disabledpatients and reviewing the consent strategyto take account of adults and children withincapacity / use of welfare guardianship.Work is soon to commence to review theGender Equality Scheme. This will berevised and the new Scheme published inJune 2010.Standard & Cor

Financial GovernanceThe Scottish Ambulance Service again metits three financial targets in 2009/10, both interms of managing budgets and in meetingits cash releasing efficiency target for theyear. The Service ended the year 2009/10with a £79,000 surplus and efficiencysavings above the 2% Scottish Governmenttarget at 2.18%. Further productivityefficiencies amounted to £2,234,000.

The Service ensures that both financialprocesses and controls are in place and areworking effectively through a system ofinternal audit reviews. The CorporateRegister is used as a basis for developingthe internal audit plan. The ScottishAmbulance Service commissioned 16Internal Audit Reports during the year to 31March 2010. Actions plans have beendeveloped to ensure that allrecommendations will be implemented.

Patient Focus PublicInvolvement (PFPI)The Scottish Ambulance Service is stronglycommitted to involving the public, patients,carers and other stakeholders in theplanning and delivery of services and thedevelopment of a mutual NHS. Throughout2009/2010 we have listened intently to theviews of our stakeholders. The Service ismoving towards developing a more inclusiverelationship with the people acrossScotland; a relationship where patients andthe public are affirmed as partners ratherthan recipients of care.

Our annual PFPI self assessment hasrecently been published on our website. Inpartnership with members of the public andour patients we reviewed our progress inPFPI and the key developments in2009/2010. The highlights of the reportinclude the growth of our Community FirstResponder scheme across Scotland and thedevelopment of a new Complaints processfor service users.

The Scottish Ambulance Service continuesto make good progress in developing,promoting and delivering Patient FocusPublic Involvement in 2009/2010. Our areasof development for the coming year will bewriting in partnership our new PFPI strategyand the continued involvement of ourpatients, carers and the public in thedevelopment of our Strategic Frameworkdelivery.

Full details of the assessment by theScottish Health Council are available onwww.scottishambulance.com


GovernanceThe Scottish Ambulance Service recognisesthat the momentum which is building behindits five year Strategic Framework: “WorkingTogether for Better Patient Care” must beunderpinned with sound governancearrangements. A Strategic ImplementationProgramme Board has been established bythe Scottish Ambulance Service Board inorder to monitor and govern the delivery ofour Strategic Framework over the next fiveyears. This Board will ensure it measures thegovernance, monitors the implementationand reports strategic issues, through theExecutive Team, to the Scottish AmbulanceService Board. In addition, the Servicecontinues to conduct regular audits, toensure it is consistently providing safe andeffective clinical care for our patients, fairand effective management of our staff andthat robust financial controls are in place.

To that end, the Service commissioned 16 Internal Audit Reports during the year to 31 March 2010. Action plans have beendeveloped to ensure that all recommendationsare implemented. For further informationcontact: Director of Finance and Logisticson 0131 446 7000.

Clinical Governance and Risk ManagementThe Service has completed the secondreview by NHS QIS against the NationalStandards for Clinical Governance and RiskManagement where it achieved its best everscore. These standards are extensive andcover much of the clinical processes andguidelines that we use. The results providedan important focus for the Service in seekingassurance that requirements are beingimplemented across the Service. Althoughthe Service achieved a very high standard,some areas of improvement were identifiedand an action plan against the review hasbeen developed.

The results of this are shown below and provide a comparison to the previous review.

Standard & Core Area ‘06 ‘09

10 11Standard 1

Risk Management 4 4Emergency and Continuity Planning 2 4Clinical Effectiveness and Quality Improvement 3 3

Standard 2

Access, Referral, Treatment and Discharge 4 4Equality and Diversity 2 2Internal Communication 3 4

Standard 3

Clinical Governance and Quality Assurance 4 4Fitness to Practice 4 4External Communication 3 4Performance Management 4 4

Hand Hygiene Compliance Monitoring:Over the last year the work programme thatforms part of the National Hand HygieneCampaign to improve hand hygieneawareness has continued across theService. One requirement of the campaign is bi-monthly audits to monitor compliancewith opportunities for hand hygiene andthese continue to demonstrate goodpractice and ongoing improvement. The most recent audits resulted in anaverage score of 96%. The results of thesebi-monthly audits are published in NHSScotland ‘National Hand Hygiene Campaign Audit Reports’

Over and above the National hand hygieneaudit programme a programme of localhand hygiene audits continues. These auditsobserve both compliance with opportunitiesfor hand hygiene and that the appropriatehand hygiene technique was applied. Againresults from these audits demonstrate goodhand hygiene awareness and practiceacross staff groups.

NHS Scotland NationalCleaning ServicesSpecification:The service is required to comply with NHSScotland National Cleaning ServicesSpecification (NCSS) and monitoringframework. The appropriate cleaningspecification for ambulances andambulance stations was piloted andapplied in early implementer sites where

the cleaning service was delivered by thelocal NHS board domestic servicedepartments. The monitoring results forthese early implementer sites haveconsistently met the required standard of above 90%.

The cleaning specification and monitoringis now being rolled out across the Servicewith the challenge that across Scotland thecleaning service is delivered by a variety ofdifferent methods. This will require intensework to ensure the standard is met. ThreeNCSS auditor posts have been appointedto support and monitor this.

The results of the cleaning monitoring arepublished quarterly within ‘NHS ScotlandNational Cleaning Services Specification:Quarterly Compliance Reports’.

Annual Patient Experience Survey 2009/10 was the seventh consecutive yearthe Scottish Ambulance Service hasconducted research into qualitative andquantitative patient experience, continuingour determination to routinely seek theviews of our users and thereby improveservices to patients requiring emergencyand patient transport care. As before, thisresearch was carried out independently byMarket Research UK and the results werevery positive.

With regards Accident and EmergencyPatients overall satisfaction was 98% and93%. PTS patients had an overallsatisfaction rate of 95%. For A&E patients,‘care received from ambulance staff’ and‘professionalism of ambulance staff’ wereboth high at 93% and 94% respectivelyrating it ‘very good’. For PTS patients,92% rated the ‘professionalism of theambulance staff’ as very good. Of the 10respondents who had used the translationservice, 9 described it as very good.

These results have been fed into actionplans across the Service to support thedelivery of our Strategic Framework,“Working Together for Better Patient Care”.

Copies of the survey can be obtained bywriting to the Corporate Affairs Manager,National Headquarters, Tipperlin Road,Edinburgh.

The Scottish Ambulance Service receivesover 900 patient feedbackcorrespondences annually. This includescomplaints, concerns, comments andcompliments. In 2009/2010, our staffdelivered direct patient care to over 2.2million patients across Scotland andcarried out 469 formal complaintinvestigations in 2009/2010.

Feedback from patients is welcomed as itprovides valuable information on how weare performing and the experience ofpatients, carers and relatives using ourservices and clinicians we work inpartnership with. This feedback ensuresthat our services are as good as they canbe and provides the opportunity tohighlight areas where we can improve. Examples of improvements made bylistening to our service users include:

• simplifying complaint data consent forms to make them more user friendly

• monitoring the reasons why anambulance response time may be out of performance

• changing our triage questioning followingthe recommendations made by theScottish Public Service Ombudsman

• liaising with Health Boards to improvepartnership working and communicationissues

The Service takes a proactive approach toimproving its services and is in the processof implementing recommendations from areview of its complaints process. As part ofthis review the views of staff and patientswere sought, with their feedback informingimprovements to the existing process. Therevised process will be further integratedinto existing risk management and clinical

governance structures, creating a robustsystem to handle patient feedback,encourage transparency and opennessand create an environment where learningfrom complaints is encouraged.

The patient is at the centre of the care wedeliver and at the heart of everything wedo. By listening to our patients and theircarers we are able to understand theirneeds better. In essence this means:

• Resolving complaints as comprehensivelyas we can and offering local resolution.Ensuring that complaints are seen as partof the whole Quality Assurance Process

• Ensuring that complaints are handledwith more of a patient focused approach

• Considering training needs and helpingour staff develop the knowledge andskills required to fulfill their roles

• Learning from complaints by sharinginformation throughout the organisation

• Using complaints to facilitate serviceimprovements and improve patient safety and care

The revised process will be fullyimplemented across all operational areasin the coming year and will ensure that theService continues to use patient feedbackto facilitate improvements to the serviceswe deliver.


The Service met itsthree financial targetsand achievedefficiency savings of2.18%, as well asfurther productivityefficienciesamounting to£2,234,000.

\\Capital investments

//Patient feedbackComplaints, Comments, Concerns and Compliments

Total expenditure on the acquisition of assets duringthe year was £13.1 million. Of this £6 million wasrequired for the acquisition of vehicles, £4.1 millionwas on property and £3 million was on IT equipment,plant and furniture.

Major projects included:The Scottish Ambulance Service has moved to a model of co-location between our Emergency Medical DispatchCentres (EMDC) and NHS24 advice centres. The Servicedelivered part two of the project in 2009/10 with the moveto Norseman House, South Queensferry for our East andCentral Scotland EMDC, this project was completed inFebruary 2010 at a cost of £1.6 million. The project wasdelivered on time and has already delivered benefits to thepatient, through the joined up working between NHS24and the Scottish Ambulance Service. A number of stationupgrades were also completed this year benefiting bothstaff and patients alike.

The on-going replacement of frontline emergency andpatient transport vehicles was also undertaken.

Name Position Remuneration Related Undertakings

Contracts Houses, Land & Buildings

Shares & Securities

Non Financial Interests Voluntary/Charity Work

Relative (s) in Scottish Ambulance Service

David Garbutt Chairman Scottish Ambulance Service; Self Employed Consultant

None None None None Chartered Fellow of Chartered Institute of Personnel and Development; Fellow, Scottish Police College ; Visiting Fellow Australian Institute of Police Management

Chair, Peebleshire Committee of MacMillan Cancer Support; Member Tweed Valley Bike Patrol

None

Pauline Howie Chief Executive Scottish Ambulance Service None None None None None None None

Suzanne Dawson Non Executive Director Scottish Ambulance Service, Self Employed Marketing Consultant

None None None None Chair of the Borders College Board of Management; 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

None None

Christine Humphries Non Executive Director Scottish Social Services Council – Due Regard Member Registration and Conduct Committee – Allowance plus expenses; Scottish Ambulance Service

None None None None Member British Association of Social Workers Vice Chairman, Scottish Borders Valuation Appeal Committee

None

Douglas Marr Non Executive Director Scottish Ambulance Service None None None None None Chair Thriepmuir Investment Club Rotary Club Currie & Balerno

None

Andrew Richmond Non Executive Director Scottish Ambulance Service; Non-Executive Member of NHS Tayside; Director of Laverock Properties Ltd; Director of Rushyglen Ltd

None None None Share-holder of Rushyglen Ltd. Share-holder of Laverock Properties Ltd

Associate of Society of Investment Professionals (ASIP); Member of Angus Conservative & Unionist Association; Member of Carlton Club; Member of Church of Scotland; Trustee Tayside NHS Board Endowment Fund; Member of TAGRA

Treasurer of Airlie Primary School Parent Council

None

David Alexander Non Executive Director Scottish Ambulance Service; Falkirk Council Elected Member

None None None None Member and National Office Bearer Scottish National Party; Member C.N.D Scotland; Member Central Scotland Fire Board

None None

Theresa Houston Non Executive Director Scottish Ambulance Service; NHS Education for Scotland

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 Board of Management of Borders College

None None

Pete Ripley Director of Service Delivery Scottish Ambulance Service None None None None None None None

Pamela Mclauchlan Director of Finance and Logistics

Scottish Ambulance Service None None None None Executive Member CIPFA in Scotland Group Scout Leader, Church of Scotland Elder

None

Matt Bell Employee Director Scottish Ambulance Service None None None None None None None

George Crooks Medical Director Scottish Ambulance Service; Medical Director NHS 24

None None None None None None None


\\Board members and positions2009/10

ChrisBennettfromOrkneyChris Bennett from Kirkwall in Orkney required anemergency response when he suffered a stroke at the local supermarket, where he works as a security guard. “The last thing I expected was to be having a stroke at24. And you might think thatliving on an island might makethings more complicated. Buteveryone swung into action.My colleagues realised rightaway that something waswrong and dialled 999. The paramedics who came by road ambulance got to me in minutes. They diagnoseda stroke, and organised an airambulance to take me toAberdeen Royal Infirmary for a CT scan, after which I wasgiven new clot-bustingtreatment which dissolved a clot in my brain. I’ve nowmade a full recovery.”

“I’m really grateful to thewhole team who played a role in making sure I quicklygot the treatment I needed –and so is my family.”


Scottish Ambulance Service Annual Review: 14 September 20101. This letter summarises the main areas

of discussion and the actions arisingfrom the Scottish Ambulance Service(SAS) Annual Review and associatedmeetings at Caledonia House on 14September 2010. I would want tothank everyone who was involved in organising such a successful day.

2. I welcomed the chance to hear fromfrontline staff about the achievementsand innovations of the service througha demonstration of the patient journey.It was particularly useful to see thefocus placed on improving access,enhancements in equipment and thequality of care provided to patients. I would be grateful if you could pass on my thanks to all those I met duringthe session.

Meeting with Clinical Advisors3. Now that the Medical Directorate is

established, I was pleased to hearabout the bottom-up approach beingtaken to support clinical excellenceand best practice across theorginisation, as well as the structuresthat ensure robust clinical leadershipand support. The service has alignedits work with the Healthcare QualityStrategy for NHS Scotland and this isevidenced particularly through thecontinuing development of clinicalperformance measures for the service.While there remains some distance totravel before we can audit theinterventions at all stages of the patientjourney through to final outcomesconsiderable progress has been made,for example in the expanding use ofthe CHI number, service collaborationin research programmes, and the useof patient record forms to support bestclinical practice. The commitment ofthe group to working through theobstacles to monitoring the wholepatient journey is to be commended,and it was acknowledged that this isfundamental to understanding andimproving morbidity.

4. We talked about a few initiatives theservice is involved in to improve thequality of patient care. I was interestedto hear about the work the service isdoing to give advanced notificationbefore a patient reaches hospital thusimproving the speed and effectivenessof the response on arrival. I also notedthe work being done to look atsupporting 'frequent' callers, patientswith diabetes in the first instance, whowould previously have been recordedas individual contacts with the service.This initiative sees case conferencestriggered with primary carepractitioners, allowing clinicians to lookat the underlying cause of theindividual episodes and support thepatient to reduce these, through amedication review for example. Wealso talked about the development ofCommunity Paramedics and theincreasing contribution they aremaking. The service will be continuingto consider carefully the models of carethat Community Paramedics candeliver and what fits best with localcircumstances. Integration withterritorial NHS Boards and theavailability of care pathways andclinical support are key to the successof these models of care.

Deputy First Minister & Cabinet Secretaryfor Health and Wellbeing

Nicola Sturgeon MSP

T: 0845 774 1741E: [email protected]

David Garbutt, Chair Scottish Ambulance Service, National Headquarters,Tipperlinn Road, Edinburgh EH10 5UU

4 October 2010


\\Annual Review 2010Key action points

The Scottish Ambulance Service should prioritise Quality on Board agendas,continue the process of staff engagement, identify and share examples of goodpractice in quality improvement and work in partnership with colleagues across the NHS, Public Sector and Third Sector to pursue Quality Strategy ambitions.

One

The Scottish Ambulance Service Board (and its Clinical Governance Committee)should continue to have evidence available to it in order to provide assurances withregard to the robustness of clinical governance and risk management arrangements.

Two

The Scottish Ambulance Service should ensure momentum and progress onimproving the management and performance of the Scheduled Care Service (PTS),alongside continuing to work with partners to support those patients who do nothave a medical need for this transport.

Three

The Scottish Ambulance Service should continue active participation in the ScottishPatient Safety Programme.Four

The Scottish Ambulance Service should ensure that there is a robust strategy for managing demand on the Air Ambulance Service, working closely with NHSBoards to ensure the best use of available resources to meet clinical need.

Five

The Scottish Ambulance Service must continue to work with NHS 24 and other NHSpartners in developing a common integrated triage system and clinical pathways thatsupport continuous improvement to the patient experience of contacting unscheduledcare services. To provide a report on progress, including scope of engagement withNHS partners, by the end of March 2011.

Six

The Scottish Ambulance Service should ensure that staff, and their representatives,are fully engaged in the development and operation of the organisation.Seven

5. We also discussed the opportunitiesto fully consider the way services aredelivered, the opportunities aroundmore effective sharing of NHS andwider public sector resources,including information sharing, and theimportance of fully engaging with thepublic about the future shape of theirservices. We all recognised thatefficiency and quality can be deliveredtogether but only if servicedevelopments are evidence based and delivered in partnership.

6. I would be grateful if you could passon my thanks to all those who metwith me.

Meeting with Partnership Forum7. My meeting with the Partnership

Forum provided an opportunity todiscuss a range of important issues.We talked about the considerable staffengagement in the recently publishedHR and Organisational DevelopmentStrategy for 2010-15 'Doing the RightThing' and the focus on theachievement of quality within that. Theservice has continued to respond tothe challenges highlighted in the 2008staff survey, particularly in relation toensuring effective communication withstaff, where a considerable amount ofwork has been taken forward such as

putting in place varied communicationschannels, continuing the weekly ChiefExecutive bulletins which arewelcomed by staff, development of the intranet site, world cafeapproaches to discussing servicedevelopments and increased use ofdivisional forums to engage with staff.The service has also ensured focus onhealth and safety where considerableemphasis has been placed on localaudit and support across divisions.More widely, we discussed theintegration of the ambulance servicewith other parts of the NHS and publicservice, and the opportunities todevelop relationships that will benefitpatients and communities.

8. We discussed the workforce HEATtargets and standards, and thechallenges that remain around on-callworking and the implications ofworking time regulations for theambulance service, particularly inremote and rural areas. Sicknessabsence levels increased slightly in2009/10, up to 5.59% for the full year.However, I noted the impact of severeweather and pandemic flu on theselevels and was reassured to hear thatthe year to date position (to the end ofAugust) was 5.1%. I was advised that arobust absence management system isin place to support staff and managersand that employee assistanceprogrammes are demonstrating their

effectiveness. In relation to the March2011 target to complete and record80% of e-KSF reviews, you were sittingat 2.5% by the end of June which issome way below your trajectory of35%. However, I was told that theservice is putting in extra effort toensure that the target will be achieved.In relation to on-call working andworking time regulations, the ScottishGovernment Health Directorates arecommitted to supporting the service onthese complex matters and I invitedthe group to keep in close contact withHealth Workforce colleagues as thesediscussions progress

9. Finally, we talked about the tighterfinancial times ahead, and the criticalimportance of genuine and effectivepartnership working in achievingcontinued success. The delivery ofefficiencies must not reduce the qualityof care for patients, that is whyfrontline staff and their representativesneed to be involved.

10. I was pleased to hear the assessmentfrom the group that partnershipworking across the ambulance serviceis strong, that the structures andprocesses that support that are theright ones, and that staff are involvedat every stage in service development.My thanks go to everyone who tookthe time to meet with me.

Meeting with Patient Representatives11. The meeting I had with patient

representatives was a particularlyinteresting part of the day and it wasclear to me that the service values theviews of patients as they take forwardservice developments. Attendees werevery appreciative of the support offeredto them in carrying out their duties aspatient representatives for theambulance service.

12. There was considerable enthusiasm for Community First Responderschemes and they were described tome as a 'jewel in the crown' of theorganisation. Such schemes not onlydevelop stronger community resiliencebut are also encouraging people tobecome involved in learning about thework of the service, volunteering insome capacity or even joining theservice on a more permanent basis. It is important for the message to beclear and consistent that CommunityFirst Responder schemes are anaddition to ambulance services, not areplacement for them, but the benefitsbrought to the communities in whichthese schemes operate were clearlyarticulated.

13. A great deal of work has beenundertaken in the past year on thePatient Transport Service (PTS) which,for most people, is the only contactthat they have with the ambulanceservice. Some of this work hasfocussed on the eligibility criteria and itwas felt that better information andtransparency around the criteria wouldbe beneficial for both patients and forthose within the health service whobook PTS transport. We also talkedabout how the service can improveperformance for those patients whomeet the eligibility criteria, for exampleby working with NHS Boards toencourage out-patient managers toorganise clinic times for patientstravelling from the same localities toreduce distances for groups of patients

who travel together. These are thetypes of idea that I would expect theservice to be working closely withpartners to explore. As I said, I supportthe service in its efforts to ensure that itis providing the best possible care foreligible patients, but it remains equallyimportant to ensure that all patientscan get to their appointments and,where the barriers are around publictransport availability, car parking orother factors, all those with aresponsibility need to work together to achieve solutions.

14. We spoke about the need for membersof the public to have confidence in theability of the service to respond in anemergency situation and the particularimportance of this for patients forwhom English is not their firstlanguage. I was reassured to hear thatthe service has introduced amultilingual key phrase book that allstaff can use in order to quicklyunderstand a patient who may, in somecases, be in considerable distress.It was also useful to know that the 999system itself has a language translationservice available and that with moreeffective utilisation of their new datawarehouse system and the CHInumber, it may be possible to minimisethe requirement for the service to seekthe same information each time theservice has had contact with aparticular patient. The service alsoundertook to look into the use of thepersonal health information cards thatwere shown to me by one of therepresentatives on the day.

15. It was very evident that patientrepresentatives such as the ones I wasable to meet bring a lot of benefit tothe work of the Service and I would begrateful if you could pass on my thanksand best wishes to all those who madethe effort to meet with me.

Annual Review MeetingAction Points from 2009 Annual Review

16. Following my report back from thevarious morning meetings youprovided an update on the actionsfrom the 2009 review and an overviewof 2009/10. I was able to confirm thatall of the actions from the previousreview had been progressed, and thatwe would return to some of these aswe moved through the agenda. Foreach of the substantive agenda items,you also gave a brief presentation onthe achievements and performance ofthe service during the year.

Improving the Quality of Care and Treatment for Patients17. The theme for all of the 2010 NHS

Annual Reviews has been the recentlypublished Healthcare Quality Strategyfor NHS Scotland and I was pleased tobe assured of the importance theambulance service places on meetingits aspirations. Due to the timing of thedevelopment of your StrategicFramework document for 2010-2015'Working Together for Better PatientCare', which was supported byextensive staff, stakeholder and patient consultation, you were able to align that framework with theHealthcare Quality Strategy and local implementation is beingprogressed well.

18. You are continuing to make progress indeveloping as a clinical service, and,as I said last year, the ScottishAmbulance Service has progressed agreat deal from the one that operatedfive or ten years ago. Delivering themost appropriate clinical care remainsintegral to everything you do and oneimportant aspect of this is thecontinued development of 'see andtreat' protocols. In 2009/10 57,560patients (11.1%) were supported underthese protocols and therefore avoidedan unnecessary journey andattendance at hospital.


\\Annual Review 2010Continued

Alongside this, the service continues to work in partnership to understandpatient flows to unscheduled care andto develop the most appropriatepatient pathways, for example bytaking patients directly to specialistunits or admitting wards rather thanalways going to Accident & Emergency.We also touched on the potential forclinical audit and outcomemeasurement spanning the entirepatient journey and it is clear that suchdevelopments will support yourcontinued commitment to delivering aclinically excellent service. All of this is,of course, underpinned by researchmethodology that supports evidencedbased practice and must be robustlygoverned and audited. The serviceachieved a 'Return of SpontaneousCirculation (ROSC)' rate for cardiacpatients of 17.8%, against the targetrange of 12% – 20%.

19. The ambulance service has placed agreat deal of emphasis and resourceon hand hygiene levels andcleanliness, an area of challenge insuch a mobile and geographicallybroad service. Hand hygiene levelshave been consistently above 94%,you have utilised Scottish Governmentfunding to put in place regionalcleanliness auditors, and have includedthe cleanliness champions programmeas a core part of ambulance techniciantraining. You have also continued toensure attention on vehicle andequipment design so that these cansupport robust infection control. A keychallenge for your Infection ControlTeam (lCT) will be to ensure equitableand consistent cleanliness standardsacross the service and it will also beimportant that your ICT integrate withthe HAl elements of the ScottishPatient Safety Programme.

20. Against what is now a national HEATstandard of 75%, the service respondedto 72.3% of Category A calls within 8minutes across mainland Scotland(March 2010 figure was 77.5%), with an

average response time of 6.9 minutes.This compares well with the 70.7%achieved for 2008/09 and demonstratesthat the measures put in place by theservice are now delivering a sustainedlevel of performance. While overallCategory A demand fell by around1.5%, this still means that more patientswere reached within 8 minutes. As asubset of overall Category A response,78.5% of cardiac arrest patients werereached within 8 minutes. Category Bperformance was 93.7%, slightly belowthe target of 95% and down from 94.4%in 2008/09, and total emergencyperformance across the Island Boardswas 51.6%, up from the 50.5%achieved in each of the last two yearsand exceeding the target of 50%. Thisperformance should, of course, be setagainst the backdrop of the severeweather experienced last winter wherethe service performed extremely well tosupport patients despite the obviouschallenges. As we discussed, it will beimportant for the service to achieve andembed the Category A, B and Islandperformance levels in the current yearand for the future, response times willcontinue to remain an importantperformance measure for the servicealongside clinical measures andoutcomes.

21. I was pleased to be updated on thework being taken forward to improvethe operation of the Patient TransportService (PTS), for example thereduction in cancellation levels toaround 0.5% of booked journeys inJune and the slight improvement inpunctuality for priority 1 patients. Youare also continuing to engage andwork collaboratively with NHS partnersand others to support those patientswho do not have a clinical need forPTS. I look to the service to continuethese efforts to ensure that patientaccess continues to be supported, inline with the commitments in yourstrategic framework. We also talked about the operation of the AirAmbulance Service and the importance

of robust clinical triage and demandmanagement. Demand for the air wingcontinues to increase and it will beincreasingly important to ensure thesevaluable resources are used mosteffectively and efficiently. Work isprogressing on the re-procurement of the next generation of air ambulances and I would ask that you continue toengage closely with the ScottishGovernment on this.

22. We discussed the telephone difficultiesexperienced by the service on 21 July,and the ongoing and detailedinvestigation you are carrying out toensure that there is a full understandingof what happened on the day, the causeof the fault, the lessons and actions thatneed to be taken to prevent or minimisea recurrence and the clinical audit that isongoing in relation to any impact forpatients. I was pleased to be informedthat the clinical case mix and outcomesthat were achieved on 21 July reflectedthose that are experienced when theservice works as normal. You areworking closely with BT on a full reviewof system resilience; this has includedmany steps already taken such asimplementing system upgrades andinstalling analogue phones, for example.As I said, it is important for the serviceto ensure that due process is followed,including detailed consideration by theSAS Board and its Audit and ClinicalGovernance Committees. I look forwardto receiving a detailed report on all ofthis from the Scottish AmbulanceService by the end of November, as setout in the statement I have now given toParliament on this matter.

23. Finally under this item we talked aboutthe importance of ensuring the work of the ambulance service is fullyintegrated into the wider NHS. I wasadvised that this is achieved through arange of structures and forums and atall levels across the Service, includingBoard members having 'nominated'territorial Boards for which they areresponsible, as well as Executive Team

membership of various national andregional groups, including those convenedby the Scottish Government. All of this issupported by ongoing and dailyengagement between operating divisions,territorial boards and other local partners.

Improving Health andReducing Inequalities24. We talked about the range of ways the

service is contributing to shifting thebalance of care to local communities. 18 Community Paramedics, with afurther five in training, are working withinterritorial NHS Boards and accredited toan academic institution, and aresupported to deliver models of care thatsee them working as part of a multi-disciplinary healthcare team andutilising extended skills. These roles areclosely governed and audited to ensuresafe and clinically effective services for patients.

25. We had a very useful discussion aboutcommunity resilience and theconsiderable efforts of the ambulanceservice to support this. The service hasput in place a retained service inShetland, the first scheme of its kind,and I will be very interested to be keptupdated on this service and the robustevaluation that will be undertaken toinform any future roll-out of similarschemes. As discussed with thepatient group earlier in the day,Community First Responder (CFR)schemes continue to make a valuablecontribution to resilience, though it wasstressed that these schemes arealways in addition to the coreambulance service, never areplacement for it. The service remainscommitted to developing andincreasing the number of CFRschemes, but it is very important forthe schemes to be robustly governedwith volunteers properly trained,supported and equipped to enhancecommunity resilience in the areas they support.

26. Finally, I was pleased to hear theservice would fulfil its commitment toeliminate rostered single crewing;meaning that from October onwards,single crewing will only happen inexceptional circumstances, such asshort notice sickness absence whencover cannot be secured.

Finance and Efficiency 27. The Scottish Ambulance Service met

its financial and efficiency targets for2009/10 and I was pleased to hear thatyou are on track to do so in the currentyear. Efficiency savings have beenreinvested in patient care, for examplein new infection control measures,clinical developments and increased airambulance activity. The service isengaging with staff to identifyopportunities for future efficiencies, animportant step in ensuring thatefficiency and the quality of patientcare are interlinked.

28. The service is continuing to focus onworkforce planning, a new IT systemhas been implemented to support thisand resource levels, skills mix and staffdeployment are kept under review withworkforce and financial planning linkedat all levels.

Q&A29. In the question and answer session

that followed the review there wasdiscussion around the importance ofintegration and partnership in relationto transport services, particularly wherethere is no clinical requirement for SASsupport, the evaluation and roll-out ofthe Emergency Medical RetrievalService, and the importance of theambulance service, as with all parts of the public sector, living within thebudget set for them and consideringcarefully the costs and benefits ofservice developments. I also confirmedthat there are no plans to put in place asingle emergency service for Scotland,though there is of course considerablevalue and benefit in the ambulance

service working with Police and Fireand Rescue Services where appropriate,for example in relation to sharedpremises, or to support remote andrural communities. I am grateful tothose who asked questions and tothose who took the time to attend onthe day.

Conclusion30. As I said on the day, the nature of

emergency services means that therewill always be challenges andpressures. However, the ScottishAmbulance Service is clearlycommitted to high standards of patientcare and this commitment is supportedby dedicated and motivated staffacross the organisation. You, yourboard, and all of the staff of theScottish Ambulance Service should be proud of the achievements of the organisation over the last year. As we move into an increasinglychallenging financial climate, I believethat you are well placed to meet thechallenges ahead.

31. The attached annex sets out the mainaction points arising from the review.

Nicola Sturgeon MSPDeputy First Minister & Cabinet Secretary for Health and Wellbeing

\\Annual Review 2010Continued


Equal Opportunities PolicyThe Scottish Ambulance Service firmlybelieves that all employees should betreated equally and fairly. The Boardopposes all forms of discrimination on grounds of colour, race, nationality,ethnic origin, disability, marital status,sexual orientation, gender or age.

Information about the Service, the fullfinancial accounts for 2008/09 and details of the organisation and operation of the Service can be obtained from:Secretary to the Scottish AmbulanceBoard, National Headquarters, TipperlinnRoad, Edinburgh, EH10 5UU. Telephone:0131 446 7000 email [email protected] or visit ourwebsite www.scottishambulance.com A full Annual Report will also be availableon our website.

A summary is available in other languagesand formats on request. Please telephonethe Interpretation and Translation Serviceon 0131 242 8181 and quote referencenumber 08571.

Un résumé est disponible en d’autreslangues et autres formats sur demande.Veuillez téléphoner au Serviced’Interprétation et de Traduction au 0131 242 8181 et indiquez le numéro de référence 08751.

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Papra!ius santrauk> galima gauti kitomiskalbomis ir formatais. Skambinkite vertimotarnybai (Interpretation and TranslationService) telefonu 0131 242 8181,nurodykite kod> 08751.

Streszczenie dost?pne jest na @yczeniew innych j?zykach lub formatach. Prosz?skontaktowaA si? telefonicznie z BiuremT"umaczeB Ustnych i Pisemnych (ang.Interpretation and Translation Service)pod numerem telefonu: 0131 242 8181i podaA numer referencyjny: 08751.

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A N a tio n a l S e rvic e M e e tin g L o c a l N e e d s...ÒThe staf f of the S co tis h A m b u la n e Service ar e key to delivering the high quality clinical car e ex pc td b